Presentation by Professor Jo Sharp of the University of Glasgow at the One Health for the Real World: zoonoses, ecosystems and wellbeing symposium, London 17-18 March 2016

1. A critical social analysis of
poverty and zoonotic disease risk
Jo Sharp
@ProfJoSharp

2. “The inequalities of [health] outcome
I describe are, by and large,
biological reflections of social fault
lines.
Exaggeration of patient agency is
particularly marked in the
biomedical literature, in part
because of medicine’s celebrated
focus on individual patients, which
inevitably desocializes.
The sickness [of the poor] is a result
of structural violence: neither culture
nor pure individual will is at fault;
rather, historically given (and often
economically driven) processes and
forces conspire to constrain
individual agency.”
Rethinking poverty

3. “I have a fear of the payment, and not of the sickness. Treatment exists,
good treatment that will cure quickly, but you worry you will not be able to find
the money in time because a fever does not wait for you. You worry if you will
be able to find the money to get treatment before the patient dies”
Focus group, Dar es Salaam, Laurie 2014.
“While ‘user fees’, ‘poverty’ or ‘inequality’ will not appear on death
certificates, a social autopsy of such deaths would inevitably reveal these
conspiring factors in such fatalities. Such deaths are born out of
bureaucratic decisions made in distant conference rooms, unaccountable
to any one individual.”
Laurie, 2014, The embodied politics of health in Dar es Salaam.
To take action, an individual needs to have a sense that s/he has the
ability / power to make change
Women’s access to healthcare

4. Poverty & gender “Bedouin women do not farm”

5. Coping strategies can lead to new risks:
“To be honest, if I have 4 goats, 3 cow and 6 pigs, I will vaccinate only cows and leave the
others because I don’t have the money to vaccinate all animals at once.”
“When our pigs died, we called the livestock doctor and he said we could not eat the meat
but he still wanted to be paid. … So, the way I see it, when the animal is sick, instead of
looking for medicine to treat, it is better to slaughter.”
“So, you get sick and stay at home for the whole week without going to the hospital, just
taking anti-pain while you don’t know you which disease you are suffering from, and
deciding what you can sell so that you can go to hospital.”
Focus group discussions, northern Tanzania
“The difference between going to the hospital and going direct to pharmacy is once you go
for prescription you have to wait in a queue all day and pay for registration, then pay for the
doctor, the doctor asks what you used before, writes a prescription and directs you to the
pharmacy. So why go through those stages, pay the extra money, wait all day to end up in
the same place? It makes no sense.”
Focus group, Dar es Salaam, Laurie 2014.
Consequences for disease risk

6. Livestock are key to livelihoods in social, cultural and economic terms
“I don’t think any of us keep animals for the purpose of become rich but
animals are our insurance because they help us to solve problem when
raised for instance if someone is sick at home or school fees is needed then
you can sell the animal and solve the problem you face.”
Focus group discussion, northern Tanzania
 Further emphasises the “social fault lines” that create an uneven
distribution of vulnerability to disease.
Thinking critically

7. Egypt: The Wadi Allaqi Project.
Tanzania: The impact and social ecology of bacterial zoonoses in northern
Tanzania (BacZoo); Social, Economic and Environmental Drivers of Zoonoses
in Tanzania (SEEDZ); Hazards Associated with Zoonotic enteric pathogens in
Emerging Livestock meat pathways (HAZEL).
Thanks to who have contributed to: