The Tuberculosis Behavioral and Social Science Research Forum Proceedings
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Section II. Presentations and Panel Discussions
Keynote Session: When Sacred Cows Become the Tiger’s Breakfast: Defining A Role for the Social Sciences in Tuberculosis Control
Jessica Ogden, Ph.D.
Technical Specialist, International Center for Research on Women
Day 1, Morning Session
Dr. Ogden presented a critical perspective on public health and TB control paradigms. Her presentation described a multidisciplinary approach to TB control that combines the strengths of the medical sciences with those of the behavioral and social sciences. Her proposed approach was informed by lessons learned from directly observed therapy short-course (DOTS) programs for TB treatment in India.
Dr. Ogden proposed a shift away from some of the “sacred cows” of classical public health thinking that emphasize disease control and elimination toward a social science paradigm focusing on the interactions among disease control personnel, individual patients, and the cultural and social contexts in which they live. At the level of the patient, such a paradigm emphasizes care, with particular attention to developing trust and fostering patient-provider partnerships. Outcomes in TB treatment and control are also strongly influenced by social and cultural contexts, including social structures within households, communities, and the policy-making environment. For example, social and cultural influences may determine who can adopt the sick role (and when), the range of treatment options available, and the extent to which a person can access and adhere to treatment.
A multidisciplinary, multilevel approach that takes into account the respective influences and roles of patients, communities, and households, as well as programs, providers, and policies can help to answer the following questions related to TB:
- Why don’t patients come for treatment?
- Why do they only come when it’s too late?
- Why don’t they complete their therapy?
- How can we make our programs accessible and acceptable?
- How can we meet the health needs of the community?
- How can we involve communities as participants in their own health?
Answering such questions in ways that address the multiple levels of influence is a critical step in improving TB control programs and the outcomes that they are able to achieve.