Thursday, 4 December 2008

EPIDEMICS: UNDERSTANDING DISEASE DYNAMICS

By JULIA DAY, STEPS Centre member

Uncontrolled outbreaks of disease have always had the power to terrify. In recent years, such fears have grown to include the spectre of pandemic influenza, multi-drug resistant tuberculosis and virulent hemorrhagic fevers. Globally, changes in land use, migration, food production, and human/animal interaction are contributing to a startling rise in emerging infectious diseases. At the same time, diseases such as HIV/AIDS and obesity are entering endemic phases in many settings. Photo credit: Sean Warren, iStockphoto

The STEPS Centre Epidemics Project seeks to analyze the nature and meaning of epidemic disease in broad terms, including both infectious and non-infectious diseases, newly emerging and long-standing, or even endemic, diseases, and diseases of the past as well as those of the future.

Through a series of disease-specific case studies on HIV/AIDS, Ebola, obesity, avian influenza, SARS, and multi-drug resistant tuberculosis, the project seeks in particular to understand better the interplay between social, technological and environmental factors that help produce epidemics.

The complex dynamics of infectious diseases means that there is often deep uncertainty surrounding likely outcomes and their consequences. Nonetheless, much policy remains predicated on notions of risk management and assessment that presume linear and predictable disease models. The implicit narratives, or framings, inherent in such policies privilege certain types of knowledge while others narratives remain invisible or ignored.

The full range of multiple, and often competing, narratives represents a wide variety of perspectives on the relative importance of social, technological and environmental dynamics in both the threat of epidemics and appropriate interventions. Such diverse perspectives on the importance of short-term shocks versus long-term stresses, for example, or relatively narrow geographical factors versus global-scale changes, may provide for valuable resilience in the face of potentially devastating new epidemics as well as epidemics with an already established burden.

STEPS case studies demonstrate, in particular disease examples, how certain narratives, and the framing assumptions they embody, can become dominant in a particular setting, setting parameters by which risks and benefits come to be understood and interventions are conceived and implemented.

Three new STEPS Working Papers have just been published as part of this project - Epdemics, Ebola and Avian flu - and are available to download for free. And the case studies on HIV/AIDS, obesity, SARS, and multi-drug resistant tuberculosis will be available shortly.

The STEPS Centre is convening an Epidemics project workshop on December 8-9 to provide an opportunity for lively discussion of the current STEPS Epidemics case studies. The workshop is intended to be a forum for developing a comparative framework for the case studies as well as identifying ideas, strategies and collaborations for future interdisciplinary research and publication.

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