The Epistemic Politics of Snakebite Envenomation: a social science study of the digitally-mediated governance of a One Health challenge

该项目研究了“一个健康”公共卫生治理范式如何在实践中实现其目标。该范式设想动物、人类和环境形成一个相互依存的系统，其健康应该以跨学科的方式进行治理。它通过蛇咬中毒（SBE）的案例研究来做到这一点；这种疾病每年造成约10万人死亡，其中大多数是全球南方的贫困人口。蛇咬伤对多种物种的健康造成影响，其驱动因素也多种多样，包括社会因素（如劳动条件）和环境因素（如气候变化），因此蛇咬伤越来越多地被纳入“同一个健康”范畴。这种“同一个健康”框架促使世卫组织采取SBE治理干预措施，将来自不同领域（如生态学、医学和药学）的专家知识与体验该疾病影响的非专业人员的知识结合起来。世卫组织最近发布的蛇咬伤信息数据平台（SIDP）试图通过综合来自专家和生活在SBE风险中的社区的蛇咬伤数据来推荐治疗方案，从而实现这一愿景。然而，尚不清楚这种“同一健康”方法是否公正地代表了不同的观点，并为人类、蛇和环境带来了公平的健康结果。因此，本项目将调查：1)不同群体如何“知道”蛇咬伤；2)这些知识实践如何为疾病管理提供信息；3)这些治理规划对多物种健康的影响。为此，我将采用一种混合方法，包括：文献分析（询问有关蛇咬伤全球治理的学术和灰色文献）；专家访谈（调查公共卫生行为者管理SBE的更为制度化的手段）；和参与性观察（分析外行和专家社区了解、使用和管理SBE的现有知识和实践）。这将包括在哥斯达黎加的Clodomiro Picado研究所（一个领先的蛇咬伤研究中心）和世卫组织的SIDP小组进行实地调查，以探索不同的认知社区——包括生态学家、卫生政策制定者、蛇咬伤临床医生和具有谈判蛇咬伤风险经验的非专业人士——对蛇咬伤是什么、由什么引起、影响是什么有不同的理解。以及这些知识如何为SBE管理策略提供信息，并对蛇和与蛇一起生活的社区产生不同的影响。作为对蛇咬伤的认知政治的第一次实质性研究，该项目代表了一个重要的测试案例，即数字化的全球卫生干预措施是否促进或限制了认知多元化，产生了产生可用流行病学数据和响应网络的关系，并确保了更公平的多物种健康结果。这个项目将包括在危地马拉进行语文培训和在南美洲进行实地工作培训。

This project investigates how the 'One Health' public health governance paradigm - which imagines that animals, humans, and the environment form an interdependent system whose health should be governed in an interdisciplinary manner - realises its aims in practice. It does so through the case study of snakebite envenomation (SBE); a disease causing ~100,000 deaths annually, mostly in poor populations in the Global South. Snakebite has become increasing framed in One Health terms due to its multispecies health impacts and diverse drivers including social factors (such as labour conditions) and environmental factors (such as climate change). This One Health framing has led the WHO to pursue SBE governance interventions that integrate expert knowledge from diverse fields (such as ecology, medicine, and pharmacy) alongside knowledge from laypeople who experience the disease's effects. The WHO's recently released Snakebite Information Data Platform (SIDP) attempts to realise this vision by synthesising snakebite data from experts and communities living at risk of SBE to recommend treatment protocols. However, it is unclear whether this One Health approach has led to just representation of diverse perspectives and equitable health outcomes for humans, snakes, and the environment. Thus, this project will investigate: 1) how different groups 'know' snakebite; 2) how these knowledge practices inform the disease's management; and 3) the implications of these governance programmes for multispecies health. To do this, I will employ a mixed-methods approach comprising: document analysis (interrogating academic and grey literature concerning snakebite's global governance); expert interviews (enquiring into the more institutionalised means through which public health actors govern SBE); and participant observation (analysing the situated knowledges and practices through which lay and expert communities know, live with, and manage SBE). This will involve fieldwork at the Instituto Clodomiro Picado in Costa Rica (a leading snakebite research hub) and the WHO's SIDP team to probe how diverse epistemic communities - including ecologists, health policymakers, snakebite clinicians, and laypeople with experience negotiating the risks of snakebite - have different understandings of what snakebite is, what it is caused by, what its effects are, and how these knowledges inform SBE management strategies with varying consequences for snakes and the communities who live with them. As the first substantial study of snakebite's epistemic politics, this project represents a major test case for whether digitised global health interventions facilitate or constrain epistemic pluralism, generate relationships that produce usable epidemiological data and responsive networks, and secure more equitable multispecies health outcomes. This project will involve language training in Guatemala and fieldwork training in south America.