Shock tactics: urban health futures in the wake of Ebola

这项研究将解决日益城市化和易受传染病侵袭的相互关联的挑战。从急性流行病到抗生素耐药性等起病较慢的问题，世界正面临传染病挑战的死灰复燃。这些疾病不仅不是过去的事情，而且有可能在人口稠密的城市环境中广泛传播并“走向全球”。埃博拉病毒(2014-15年)和寨卡病毒(2015-16年)等危机带来的一个主要影响是，公共卫生标准中的严重不平等和严重忽视让我们所有人都变得脆弱。尽管它们的负担主要落在穷人身上，但它们也增加了发生无法控制的危机的可能性，并对人口结构产生更广泛的影响。尤其令人关切的是，迅速发展的城市住区加剧了最近的流行病，卫生条件对世界许多城市的健康和发展构成了日益棘手的挑战。世界上大多数人口已经生活在城市环境中，预计人数还将大幅增加。这些城市居民中有很大一部分住在类似贫民窟的非正式居民点，而且比例还在不断上升。我们对卫生系统在这些快速变化的背景下是如何组织的知之甚少，只知道它们是高度非正式的，旧的规则和方法不适用。埃博拉疫情尤其暴露了证据和对这些环境和人口的了解方面的明显差距，造成了致命的后果。事实上，它揭示了政策界普遍存在的误解和失实陈述，这使得流行病控制和基本公共卫生干预工作变得困难。然而，埃博拉也创造了一扇机会之窗，既可以更好地了解非正式住区的健康挑战，也可以作为采取不同做法的动力。这项研究将重点关注塞拉利昂弗里敦非正式住区在埃博拉疫情后的健康状况。它将探索这样一种重大流行病是否以及如何改变着游戏规则，以及可以从其他背景下吸取什么教训。为了能够了解这一点，我们需要更深入地了解围绕城市卫生系统的社会、政治和经济关系，这些关系将决定变革的机会。尽管城市健康的政治和社会决定因素的各个方面都有广泛的特点，但从当地社区成员的角度和经验--例如城市居民自己对传播的理解或社会根深蒂固的卫生做法--对非正式住区的健康的逻辑和做法知之甚少。同样不清楚的是，这些地方规范和做法如何与对这些背景的政策理解相联系，以及产生什么效果。因此，这一研究项目的目标是：1.阐明不同行为者所代表和经历的非正式城市住区卫生系统和疾病控制的社会和政治进程和做法，使用人种学和参与性方法，以了解和纳入居民自己的观点和做法；2.确定塞拉利昂在埃博拉后出现的有可能改善或恶化非正式城市住区健康状况的体制安排；3.综合医学人类学、城市研究和公共卫生的观点，为加强卫生系统和城市地区的流行病防控作出贡献。该项目将由一位在塞拉利昂有7年以上经验的英国人类学家与弗里敦的一个新的城市研究中心合作。国内经验和当地伙伴关系的结合提供了一个独特的平台，通过对城市和全球卫生政治和实践的深入了解，发展关于城市卫生的前沿观点。

This research will address the interconnected challenges of rising urbanisation and vulnerability to infectious disease. From acute epidemics to slower onset issues such as antibiotic resistance, the world is facing a resurgence of infectious disease challenges. Far from being a thing of the past, these diseases have the potential to spread extensively in densely populated urban settings and to 'go global'. A major implication emerging from crises like Ebola (2014-15) and Zika (2015-16) is that dramatic inequities and pockets of severe neglect in public health standards leave us all vulnerable. Though their burdens fall most acutely on the poor, they also increase the potential for unmanageable crises with broader demographic impacts. Of particular concern are rapidly growing urban settlements which have played a role in exacerbating recent epidemics and where sanitary conditions pose an increasingly intractable challenge to health and development in many cities across the world.The majority of the world's population already live in urban environments and numbers are predicted to rise dramatically. A large and growing proportion of these urban residents live in informal slum-like settlements. We know very little about how health systems are organised in these rapidly changing contexts, except that they are highly informal and old rules and approaches do not apply. The Ebola epidemic in particular revealed glaring gaps in evidence and understanding of these environments and populations, with fatal consequences. Indeed, it revealed there were pervasive misunderstandings and misrepresentations in policy circles which make interventions for both epidemic control and for basic public health difficult. Yet Ebola has also created a window of opportunity, both to understand the health challenges in informal settlements better and as the impetus to do things differently. This research will focus on health in informal settlements in Freetown, Sierra Leone, in the aftermath of Ebola. It will explore if and how such a major epidemic is changing the game and what lessons can be drawn for other contexts. To be able to know this we need a much deeper understanding of the social, political and economic relationships which surround urban health systems and which will determine the opportunities for change. Although aspects of the political and social determinants of urban health have been broadly characterized, less is known about the logics and practices of health in informal settlements from the perspectives and experiences of local community members - for example urban residents' own understandings of transmission, or socially embedded hygiene practices. It is equally unclear how such local norms and practices do or do not connect to policy understandings of these contexts, and to what effect. As such, the objectives of this research project are: 1. To elucidate the social and political processes and practices of health systems and disease control in informal urban settlements, as represented and experienced by different actors, using ethnographic and participatory methods to understand and incorporate residents' own perspectives and practices; 2. To identify institutional arrangements emerging in Sierra Leone post-Ebola which have the potential for improving or worsening health in informal urban settlements;3. To contribute to health systems strengthening and to epidemic preparedness and control in urban areas by integrating perspectives from medical anthropology, urban studies, and public health.The project will be a collaboration between a UK anthropologist with over 7 years' experience in Sierra Leone and a new urban research centre based in Freetown. The combination of in-country experience and local partnerships provides a unique platform to develop cutting edge perspectives on urban health, informed by a deep understanding of the city and of global health politics and practice.