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Power Relations in Optimisation of Therapies and Equity in Access to Antibiotics (PROTEA) Study: investigating the intersection of socio-economic and cultural drivers on antimicrobial resistance (AMR) and its influence on healthcare access and health-providing behaviours in India and South Africa.优化治疗中的权力关系与抗生素获取公平性(PROTEA)研究:调查社会经济和文化驱动因素在印度和南非对抗菌素耐药性(AMR)的交叉影响及其对医疗服务获取和医疗行为的影响
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Using intersectionality to study gender and antimicrobial resistance in low- and middle-income countries.运用交叉性理论研究低收入和中等收入国家的性别与抗微生物药物耐药性问题。
Health Policy Plan. 2023 Oct 11;38(9):1017-1032. doi: 10.1093/heapol/czad054.

PMID:39656899
Abstract

The policy community, international and national, recognizes the significant health and economic impacts of antimicrobial resistance (AMR) on individuals, households, health systems and society. It is seeking sustainable solutions but often neglects the socioeconomic and sociocultural drivers of AMR. , shaping its health and economic impacts, and influencing the effectiveness of innovations that seek to tackle it. . but understanding them can inform better interventions. The emergence and spread of AMR relate to a mix of factors including gender, living situations, educational level, healthcare access, (poor) governance, human mobility, conflict, climate change, agriculture and pollution. Policy that understands these and the way they interact with one another will be more likely to achieve its aims. People-centredness fosters an equity-orientation and encourages policies that are responsive to individuals’ needs and challenges. Multisectorality recognizes AMR policy as a cross-cutting issue and brings on board various government departments and stakeholders reflecting the socioeconomic context. Effective governance and leadership that are mindful of the drivers of AMR are central to coordinating multisectoral action to address AMR’s wider determinants. Evidence-based policy helps ensure that policy formulation looks beyond the biomedical model and involves interdisciplinary research and surveillance to understand and tackle the socioeconomic drivers of AMR. Prevention, including infection prevention and control (IPC) in healthcare; biosecurity measures in agricultural settings; and equitable, global access to clean water, sanitation and hygiene (WASH) infrastructure. Access involves promoting equitable access to diagnostics and treatments for infection. This requires reducing barriers to accessing essential healthcare services, and strengthening procurement and the supply-chain. Innovation, which requires investment in new technologies and incentives for research and development but which must also respond to global needs and contexts, including in low and middle-income countries (LMICs), and address access and affordability. Stewardship policies are also needed to conserve pre-existing and emerging antimicrobials and to promote responsible use in ways that acknowledge the constraints and realities of different global contexts and avoid inadvertent discrimination against particular populations.

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