Economic, Social and Political Sciences
Disciplinary Heads: Elisa Vecchione / Henry Lishi Li
The disciplines within this pillar seek to address the issues and impacts projected by the molecular phenomenon of antimicrobial resistance (AMR) on societies, the individuals within, and the interrelationships among them. Economic, social and political sciences study how people come to know, interpret and organise themselves, their resources and other aspects of the world around them. At LSHTM, researchers apply Health Economics, Anthropology, Sociology, Health Policy Analysis and Political Sciences to address AMR. Our teams share a commitment to both academic rigour and direct engagement with strengthening policy formulation and implementation.
Health Economics concerns the valuation of resources, assessment of efficiency, equity and analysis of behaviours and health systems. A “macro” lens to explore the cost and impact of AMR at a supra-national cross-sectoral level is exemplified by the seminal research by Prof Richard Smith, which has provided an influential framework to examine the optimisation between the costs of resistance versus health outcomes, and analyse the distribution of equity and welfare. Applied health economics in AMR analyses supply and demand in the dynamic markets for antimicrobials and diagnostic tests, and evaluates the cost and consequences of interventions aimed at reducing AMR such as strategies to improve targeting of and adherence to antimicrobial treatments. The team includes world leading experts in these topics for TB and malaria.
Anthropology and Sociology explore the relationships between humans and antimicrobials, the roles these medicines play from the micro to the macro and the values and cultures that affect how AMR is conceptualised and addressed. On the one hand, human behaviour on a local level is widely recognised as contributing to AMR. Research into the multi-faceted reasons for our reliance on antimicrobials and therefore ways to reduce this is crucial. Our world-renowned research in understanding malaria, TB and HIV medicine use is exemplified by the body of work led by Dr Clare Chandler. On the other hand, AMR can be understood to operate on a global stage, co-constructed between the pharmaceutical industry, the scientific community and political-economic dynamics. To find alternative avenues for responding to AMR, it is necessary to unpick and reframe our scientific, political and public perceptions of the problem.
Health Policy Analysis and Political Sciences examine ideas, activities and behaviours pertinent to various forms of politics, government and policy. Health Policy Analysis focuses on understanding how factors such as the process, content and participating actors shape development, decision-making and implementation in health policy. The School’s leading research in multi-method complex policy evaluations is represented by the work of The Policy Innovation Research Unit, led by Prof Nicholas Mays. The team is currently evaluating implementation of the UK AMR Strategy, 2013-2018. Political Sciences commonly use the concept of ‘governance’ to consider the societal responses to the challenges of AMR, which concern the use of regulations, laws and incentives to help redirect stakeholders’ behaviours, and the establishment of due procedures and processes through which policy goals are achieved.
At LSHTM, these disciplines converge to tackle challenges associated with AMR that confront our health systems, addressing research questions pertinent to the micro levels (e.g. interface between species and spaces) through to the individual level (e.g. behaviours of actors), organisational and system levels (e.g. guidelines and resource allocation) and macro level (e.g. overarching policy arrangements and worldviews). The School’s breadth of research projects across these disciplines is well illustrated in the case of antimicrobial use and prescribing – a phenomenon that is closely linked to AMR development. These projects, which address each level of analysis from each disciplinary perspective, are shown in the matrix that follows: