Stories Of public health through Local Art-based Community Engagement (SOLACE)

菲律宾是一个拥有1亿人口的中低收入国家。该国地理上有许多与世隔绝的农村地区，贫困程度(25%生活在贫困线以下)和薄弱的基础设施使人们平等地获得医疗保健成为一个巨大的挑战。菲律宾的临床医生通常不想在农村地区担任初级保健医生。该国只有10%的临床医生在这些地区工作，这些地区居住着超过一半的人口。这些地区的初级保健医生短缺是菲律宾公共卫生面临的最紧迫的挑战之一。其他小岛屿发展中国家以及全球北部国家也是如此。同样，在英国，许多农村地区面临着卫生专业人员短缺的问题。健康格局的另一个变化是，世界各地的人们寿命延长，疾病负担越来越多地由残疾主导，而不是过早死亡。死亡和残疾的主要原因已从儿童的传染病转变为成人的非传染性疾病(例如，精神健康、肌肉骨骼疾病、中风、糖尿病)。为了以成本和临床有效的方式解决这些问题，强大的以证据为基础的初级保健系统对于确定医疗保健需求并制定和实施满足这些需求的战略至关重要。伙伴关系将恰恰围绕这些领域发挥作用：卫生工作者的平等分配和为患有非传染性疾病的人提供有效的初级保健。Solace汇集了来自不同学科(医学、艺术和人文)的研究人员，他们热衷于与通常不会合作的同事合作。合作活动将使这些来自基尔大学(英国)和阿特内奥·德·马尼拉大学(菲律宾)的研究人员学习新的研究方法，并使用原创方法将结果带给几个利益相关者：学者、政府和社区组织，最重要的是，生活在农村和偏远地区的人们。我们将在菲律宾农村省份萨马省北部建立两个安慰健康中心。大约60名参与者(患者、医生、社区工作者和当地政客)将在这些中心聚集在一起，参加一个文化动画工作坊。在为期10个月的时间里，所有参与者都将创建艺术性的个人健康日记。他们还将每月聚在一起参加一个讨论小组，并定期会见一名安慰研究人员，该研究人员将在参与者的家庭和工作环境中进行实地考察。Keele和Ateneo团队将分析健康日记(以多种格式：文本、歌曲、图纸、电影、图片)、讨论小组和实地调查数据。Keele团队将访问北部萨马尔进行实地考察旅行，Ateneo团队将前往Keele进行研究和能力建设周。此外，还将与来自医学、艺术和人文学科的Keele和Ateneo学生对进行两次文化交流访问。Solace网站将开设博客，并定期上传播客、图片报告文学、视听纪录片和在线教育资源。将在基尔和马尼拉举行两次公开展览，展示参与者自己策划的实地考察照片和艺术健康日记。我们还将在萨马北部举办两个慰藉卫生节，将结果带回当地社区，并展示为什么积极的患者和公众参与在卫生研究中是重要的。我们的雄心是为全球公共卫生的“慰藉传统”奠定基础，这一传统可以扩展到其他LMIC。按照这一传统开展的跨学科研究的特点将是与当地社区持续和真诚地接触，消除知识层次，共同产生创新的公共卫生倡议和临床干预措施。

The Philippines is a Lower Middle Income Country (LMIC) with a population of 100 million. The country's geography with many isolated rural areas, the poverty levels (25% live below the poverty line) and the weak infrastructure make equitable access to health care for the population a big challenge. Clinicians in the Philippines usually do not want to work as primary care doctors in rural areas. Only 10% of the country's clinicians work in these areas where more than half of the population lives. The shortage of primary care doctors in such regions is one of the most urgent challenges for public health in the Philippines. This is also the case in other LMICs as well as countries in the global north. Likewise in the UK there are many rural areas faced with a shortage of health professionals. Another change in the health landscape is that people around the world are living longer and the disease burden is being increasingly dominated by disability instead of people dying early. The main causes of death and disability have changed from communicable diseases in children to non-communicable diseases in adults (for instance, mental health, musculoskeletal diseases, strokes, diabetes). To address these problems in a cost and clinically effective way, strong evidence-based systems of primary care are essential to identify healthcare needs and to develop and implement strategies for addressing those needs.It is precisely around those areas the partnership will work: equal distribution of health workers and efficient primary care for people with non-communicable diseases. SOLACE brings together researchers from different disciplines (medicine, arts and humanities) who are keen to work with colleagues who they would not normally work with. The partnership activities will allow these researchers from Keele University (UK) and Ateneo de Manila University (Philippines) to learn new research methods and to use original ways to bring the results to several stake holders: academics, governmental and community organisations and, most importantly, the people living in rural and remote areas.We will establish two SOLACE health hubs in Northern Samar, a rural province in the Philippines. About 60 participants (patients, doctors, community workers and local politicians) will come together for a Cultural Animation workshop in these hubs. Over a period of 10 months all participants will create artistic, personal health diaries. They will also get together every month for a discussion group and will meet a SOLACE researcher on a regular basis who will carry out fieldwork in the participants' home and work environments. The health diaries (in many formats: texts, songs, drawings, films, pictures), the discussion group and fieldwork data will be analysed by the Keele and Ateneo teams. The Keele team will visit Northern Samar for a fieldwork trip and the Ateneo team will travel to Keele for a research and capacity building week. Also two cultural exchange visits with Keele and Ateneo student pairs from medicine, arts and humanities will take place. The SOLACE website will host a blog and podcasts, photo reportages, audiovisual documentaries and online educational resources will be regularly uploaded. There will be two public exhibitions, in Keele and Manila, showcasing fieldwork photos and artistic health diaries curated by the participants themselves. We will also hold two SOLACE health festivals in Northern Samar, bringing the results back to the local communities and demonstrating why active patient and public engagement is important in health research.Our ambition is to lay the foundations for a 'SOLACE tradition' in global public health which can be expanded to other LMICs. Interdisciplinary research carried out in this tradition will be characterised by sustained and genuine engagement with local communities, dissolving knowledge hierarchies, and co-producing innovative public health initiatives and clinical interventions.