School of Public Health, University of Sao Paulo - Brazil, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil.
Soc Sci Med. 2024 Nov;361:117349. doi: 10.1016/j.socscimed.2024.117349. Epub 2024 Sep 25.
As social science scholarship has historically documented, social structure and clinical practice are more commonly as contradictory or incoherent as they are often framed. The increasing emphasis on the rise of antimicrobial resistance (AMR) has drawn attention to how social realms of resistance are entrenched and interconnected through varied structural, political, clinical, biological, and ecological relations. In this study, set in São Paulo, Brazil, I sought to unpack relational consubstantialities of AMR within the healthcare labor process and their enfolded (bio)materialities and pathogenicity by drawing on a series of interviews with primary care-based health professionals, health services managers, and policymakers, completed between late 2021 and early 2023. Participants' accounts reveal how the reproduction of the labor process in primary care foregrounds (bio)material relations in which antimicrobial resistance finds timely and proper coextensive social conditions of reproduction. In their turn, the study results highlight how work intensification relates to economies of scarcity, teamwork coerciveness, AMR virulence and pathogenicity, destabilizing ecological (bio)materialities amid structural and clinical practice interrelations. Building on renewed materialisms of the political economy of health, I propose an approach to complexify understandings of relational interconnectedness of resistance by instilling relational tension lines of objects against their pragmatic reification in health interventions and theory.
正如社会科学学术文献历来所记录的那样，社会结构和临床实践通常是相互矛盾或不协调的，而不是通常所设想的那样一致。人们越来越关注抗菌药物耐药性（AMR）的上升，这引起了人们的注意，即社会领域的抵抗是如何通过各种结构、政治、临床、生物和生态关系根深蒂固和相互关联的。在这项在巴西圣保罗进行的研究中，我试图通过对 2021 年底至 2023 年初期间完成的一系列与初级保健为基础的医疗保健专业人员、医疗服务管理人员和政策制定者进行的访谈，来剖析 AMR 在医疗保健劳动力过程中的关系同构性及其所包含的（生物）物质性和致病性。参与者的叙述揭示了初级保健劳动力过程的再生产如何突出了（生物）物质关系，在这些关系中，抗菌药物耐药性找到了及时和适当的共同繁殖的社会条件。反过来，研究结果强调了工作强度如何与稀缺经济、团队合作强制性、AMR 毒力和致病性以及结构和临床实践相互关系中的不稳定生态（生物）物质性相关。在健康政治经济学的新唯物主义基础上，我提出了一种方法，通过在卫生干预措施和理论中对对象的关系紧张线进行对抗它们的实用具体化，来复杂化对抵抗的关系相互关联性的理解。
