London School of Hygiene and Tropical Medicine, London, UK.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Health Policy Plan. 2019 Apr 1;34(3):178-187. doi: 10.1093/heapol/czz022.
Antimicrobial resistance (AMR) has recently emerged as a salient global issue, and policy formulation to address AMR has become a contested space, with various actors sharing competing-and sometimes contradictory-explanations of the problem and the range of possible solutions. To facilitate national policy setting and implementation around AMR, more needs to be done to effectively engage policymakers in low- and middle-income countries (LMICs). However, there is a dearth of research on differences in issue framing by external agencies and LMIC's national policymakers on the problem of AMR; such analyses are imperative to identify areas of conflict and/or potential convergence. We compared representations of AMR across nine policy documents produced by multilateral agencies, donor countries and an LMIC at the forefront of the global response to AMR-Pakistan. We analysed the texts in relation to five narratives that have been commonly used to frame health issues as requiring action: economic impact, stunting of human development, consequences for health equity, health security threats and relationship with food production. We found that AMR was most frequently framed as a threat to human health security and economic progress, with several US, UK and international documents depicting LMICs as 'hotspots' for AMR. Human development and equity dimensions of the problem were less frequently discussed as reasons to address the growing burden of AMR. It is clear that no single coherent narrative on AMR has emerged, with notable differences in framing in Pakistani and external agency led documents, as well as across stakeholders primarily working on human vs animal health. While framing AMR as a threat to economic growth and human security has achieved high-level political attention and catalysed action from governments in high-income countries, our analysis suggests that conflicting narratives relevant to policymakers in Pakistan may affect policy-making and impede the development and implementation of integrated initiatives needed to tackle AMR.
抗菌药物耐药性（AMR）最近成为一个突出的全球问题，制定应对 AMR 的政策已成为一个有争议的领域，不同的行为体对该问题和可能的解决方案范围有着相互竞争的——有时甚至是相互矛盾的——解释。为了促进围绕 AMR 的国家政策制定和实施，需要做更多的工作来有效地让中低收入国家（LMICs）的政策制定者参与进来。然而，关于外部机构和 LMIC 的国家政策制定者对 AMR 问题的框架差异的研究还很缺乏；此类分析对于确定冲突和/或潜在趋同的领域至关重要。我们比较了多边机构、捐助国和在全球应对 AMR 方面处于领先地位的 LMIC（巴基斯坦）所制定的九份政策文件中对 AMR 的表述。我们分析了这些文本与五个叙事的关系，这些叙事通常被用来为需要采取行动的卫生问题提供框架：经济影响、人类发展受阻、对健康公平的影响、健康安全威胁和与粮食生产的关系。我们发现，AMR 最常被描述为对人类健康安全和经济进步的威胁，有几份来自美国、英国和国际组织的文件将 LMIC 描绘为 AMR 的“热点”。解决 AMR 日益加重的负担的问题，很少从人类发展和公平的角度来讨论。显然，关于 AMR 没有出现单一的连贯叙事，巴基斯坦和外部机构主导的文件之间以及主要关注人类和动物健康的利益相关者之间的框架存在显著差异。虽然将 AMR 描述为对经济增长和人类安全的威胁已经引起了高层政治关注，并促使高收入国家的政府采取行动，但我们的分析表明，与巴基斯坦政策制定者相关的相互冲突的叙事可能会影响政策制定，并阻碍制定和实施应对 AMR 所需的综合举措。
