Feinstein International Center, Tufts University, Boston, USA.
Prev Vet Med. 2020 Jul;180:105026. doi: 10.1016/j.prevetmed.2020.105026. Epub 2020 May 11.
This paper reviews experiences with participatory epidemiology (PE) and focuses in pastoralist areas of Africa where much of the early development and institutionalization of PE occurred. The paper discusses the importance of context when designing PE activities and framing study questions, and uses the example of changing livelihoods in pastoralist areas, and marked wealth and gender differences within communities. By reference to a recently proposed definition of PE that includes community empowerment, the paper describes the marked socio-economic and gender differentiation in pastoralist communities. In these contexts, questions of "disease control for who?" and "empowerment for who?" arise, as does the need to move beyond the concept of communities as homogenous social and economic units. By reference to the persistent complex emergencies and other humanitarian crises, the paper discusses community participation and how functional participation in programmes and PE can contribute to successful livestock disease control. In contrast, empowering forms of participation are difficult to achieve in humanitarian contexts and might not be needed to achieve effective livestock disease control. In non-humanitarian contexts, and secure countries with stable governments, national control programmes for important transboundary or zoonotic diseases usually require control strategies that can be applied consistently across areas, and with disease policy, funding, coordination and implementation controlled centrally. In contrast, empowerment in PE implies local, community-level decision-making and control of resources. The paper also discusses importance of designing PE studies that focus on action, and participatory evaluation of new or adapted disease control methods with communities.
本文回顾了参与式流行病学（PE）的经验，并重点关注了非洲牧民地区，早期的 PE 发展和制度化主要发生在这些地区。本文讨论了在设计 PE 活动和制定研究问题时考虑背景的重要性，并以牧民地区生计变化以及社区内明显的财富和性别差异为例进行了说明。通过参考最近提出的包括社区赋权在内的 PE 定义，本文描述了牧民社区中明显的社会经济和性别分化。在这些背景下，出现了“为谁控制疾病？”和“为谁赋权？”的问题，以及超越社区作为同质社会和经济单位的概念的必要性。本文通过参考持续存在的复杂紧急情况和其他人道主义危机，讨论了社区参与以及在计划和 PE 中进行功能性参与如何有助于成功控制牲畜疾病。相比之下，在人道主义背景下，赋予权力的参与形式很难实现，而且可能不需要实现有效的牲畜疾病控制。在非人道主义背景下和有稳定政府的安全国家，通常需要针对重要的跨境或人畜共患病的国家控制计划，这些计划可以在各个地区一致应用，并由中央控制疾病政策、资金、协调和实施。相比之下，PE 中的赋权意味着地方、社区层面的决策和资源控制。本文还讨论了设计专注于行动的 PE 研究以及与社区共同参与评估新的或适应的疾病控制方法的重要性。
