National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Waterhouse Building (2nd Floor, Block F), 1-5 Brownlow Street, Liverpool, L69 3GL, United Kingdom; Department of Public Health, Policy and Systems, The University of Liverpool, Whelan Building, Liverpool, L68 3GB, United Kingdom.
Division of Health Services Research and Management, School of Health Sciences, City, University of London, Myddelton Street Building, London, EC1R 1UW, United Kingdom.
Soc Sci Med. 2021 Aug;282:114131. doi: 10.1016/j.socscimed.2021.114131. Epub 2021 Jun 13.
Gastrointestinal infections are an important global public health issue. In the UK, one in four people experience a gastrointestinal infection each year and epidemiological research highlights inequalities in the burden of disease. Specifically, poorer children are at greater risk of infection and the consequences of illness, such as symptom severity and time off work/school, are greater for less privileged groups of all ages. Gastrointestinal infections are, however, largely 'hidden' within the home and little is known about the lived experience and practices surrounding these illnesses, how they vary across contrasting socioeconomic contexts, or how inequalities in the disease burden across socioeconomic groups might come about. This paper presents data from an ethnographic study which illuminate how socioeconomic inequalities in the physical and material management and consequences of gastrointestinal infections are generated in families with young children. The study shows how the 'work' needed to manage gastrointestinal infections is more laborious for people living in more 'disadvantaged' conditions, exacerbated by: more overcrowded homes with fewer washing and toilet facilities; inflexible employment; low household incomes; and higher likelihood of co-morbidities which can be made worse by having a gastrointestinal infection. Our findings call into question the current approach to prevention of gastrointestinal infections which tend to focus almost exclusively on individual behaviours, which are not adapted to reflect differences in socioeconomic context. Public health agencies should also consider how wider social, economic and policy contexts shape inequalities in the management and consequences of illness. Our findings are also pertinent to the COVID-19 pandemic response in the UK. They highlight how research and policy approaches to acute infectious diseases need to take into consideration the differing lived experiences of contrasting households if they wish to address (and avoid exacerbating) inequalities in the future.
胃肠道感染是一个重要的全球公共卫生问题。在英国，每四个人中就有一人每年会经历一次胃肠道感染，流行病学研究强调了疾病负担的不平等。具体来说，贫困儿童感染和患病的后果（如症状严重程度和旷工/辍学时间）的风险更高，所有年龄段的弱势群体的情况更糟。然而，胃肠道感染在很大程度上是“隐藏”在家里的，对于这些疾病的实际体验和实践、它们在不同社会经济背景下的差异以及社会经济群体中疾病负担不平等的产生方式知之甚少。本文介绍了一项民族志研究的数据，该研究阐明了在有年幼子女的家庭中，社会经济不平等是如何在胃肠道感染的身体和物质管理以及后果方面产生的。研究表明，对于生活在“劣势”条件下的人来说，管理胃肠道感染所需的“工作”更加费力，这加剧了以下情况：居住空间更加拥挤，洗涤和厕所设施更少；就业缺乏灵活性；家庭收入较低；以及共病的可能性更高，而胃肠道感染可能会使共病的情况恶化。我们的研究结果对胃肠道感染预防的当前方法提出了质疑，这种方法往往几乎完全侧重于个体行为，而没有适应社会经济背景的差异。公共卫生机构还应考虑社会、经济和政策环境如何塑造疾病管理和后果方面的不平等。我们的研究结果也与英国的 COVID-19 大流行应对措施有关。它们强调了如果要解决（并避免加剧）未来的不平等，急性传染病的研究和政策方法需要考虑到不同家庭的不同生活体验。
