The Anthropological Approaches to Global Health group (AAGH) brings together a team of medical anthropologists conducting innovative research into a variety of topical challenges in global health. We work in settings across the world, with a particular commitment to addressing health challenges that disproportionately affect people living in low and middle-income countries.
The Anthropological Approaches to Global Health group (AAGH) brings together a team of medical anthropologists conducting innovative research into a variety of topical challenges in global health. We work in settings across the world, with a particular commitment to addressing health challenges that disproportionately affect people living in low and middle-income countries. The topics we address include:
- Antimicrobial resistance
- Epidemic preparedness and response
- Gender-based violence
- Humanitarian crises
- Medical research and bioethics
- Universal health coverage
- Pharmaceutical supply chains
- Roles of the private and informal retail sectors
We draw on theories from medical anthropology, critical global health, science and technology studies, history and other disciplines to offer fresh insights. In designing our studies, we work closely with partners and stakeholders to identity pressing research needs and to ensure responsive and impactful anthropological research. We analyse how health issues are framed and prioritised in the global policy arena, and how setting shapes implementation and vice versa. Many of our projects are grounded in ethnographic method and involve immersive, longitudinal fieldwork in particular settings to understand local realities and concerns. To design and deploy innovative mixed methods approaches, our interdisciplinary collaborations involve clinicians, epidemiologists, economists, lab scientists, pharmacists and veterinarians.
World-leading scholars present and discuss their research in our regular monthly medical anthropology seminar series.
The AAGH team is connected to a number of other groups, hubs and centres, including:
Senior Lecturer in Global Health
Research Fellow in Medical Anthropology
Research Fellow in Anthropology
Research Fellow in the Anthropology of Microbes
Professor of Medical Anthropology
- Anthropology of Microbial Resistance
Anthropology of Antimicrobial Resistance
The Anthropology of Antimicrobial Resistance (AMR) Research Group applies ethnographic approaches and social theories such as pharmaceuticalisation, care, global health assemblages and multi-species perspectives to the study of AMR. We currently have seven ongoing projects with collaborators in a number of low and middle-income countries, including Uganda, Zimbabwe, Malawi, Thailand and Myanmar. Our work addresses numerous topics, including pharmaceutical supply chains, prescribing practice in clinics and hospitals, clinical guidelines and algorithms, antibiotic use in residential and farm settings, and the roles of the private and informal providers.
Our approach is grounded in a commitment to slow thinking and exploring alternative ways of thinking about the 'problem' of AMR to those offered in prevailing discourses. In particular we seek to move beyond approaches which centre the individual and their behaviour and to instead foreground the complex interactions between epidemiology, economics, infrastructure, politics and culture that lead people use and depend on antimicrobials. To this, we use both discourse analysis to examine the framing of AMR in the global policy arena, as well as in-depth ethnographic research to examine antimicrobial use in context and the effects of AMR interventions in local worlds.
Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) – a fever aetiology study with social science work on antimicrobial use in Zimbabwe, Malawi and Myanmar.
Drivers of Resistance in Uganda and Malawi (DRUM) – research in Malawi and Uganda into how antimicrobial use in humans, animals and wider environment contribute to AMR.
Capacity Sharing for AntiMicrobial Stewardship (CaSAMS) – a collaboration between UK and Ugandan institutions to establish an antimicrobial stewardship committee at a referral hospital in Uganda.
- Clare Chandler
- Laurie Denyer-Willis
- Coll Hutchison
- Justin Dixon
- Eleanor MacPherson
- Nicolas Fortane
- Chris Pinto
- Jenny Westad
Resources and Publications
Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse
Laurie Denyer-Willis and Clare Chandler
BMJ Global Health
Knowing antmicrobial resistance in practice: a multi-country qualitative study with human and animal healthcare professionals
Maddy Pearson & Clare Chandler
Global Health Action
The ‘Drug Bag’ method: lessons from anthropological studies of antibiotic use in Africa and South-East Asia
Justin Dixon, Eleanor MacPherson, Salome Manyau, Susan Nayiga, Yuzana Khine Zaw, Miriam Kayendeke, Christine Nabirye, Laurie Denyer Willis, Coll de Lima Hutchison and Clare I. R. Chandler
Global Health Action
Antibiotic prescribing and resistance: Views from low- and middle-income prescribing and dispensing professionals
Doble A, Glogowski R, Ibezim S, Lazenby T, Heilie Redai A, Shaikh N, Treharne A, Yardakul S, Yemanaberhan R, Reynolds L, Chandler C
Anthropology’s contribution to AMR control
Laurie Denyer-Willis and Clare Chandler
The modern era must end: antibiotic resistance helps us rethink medicine and farming
Coll de Lima Hutchison, Gwen Knight, Richard Stabler, Clare Chandler
Addressing Antimicrobial Resistance Through Social Theory: An Anthropologically Oriented Report
Clare Chandler, Eleanor Hutchinson, Coll Hutchison, C 2016
Technical Report. London School of Hygiene & Tropical Medicine
Antimicrobial Resistance and Anthropology: Research Brief
Chandler, C.I.R., and Hutchinson, C.
ESRC AMR Research Champion/University of Bristol
- Consolidating practice in social science research for Ebola, DRC
Consolidating practice in social science research for Ebola, DRC
This project a collaboration between the University of Oxford in collaboration with UNICEF and LSHTM. The project aims to support the response to the Ebola epidemic in North Kivu and Ituri provinces, Democratic Republic of Congo which has been described as one of the most complex that national and international communities have had to face. Given the complexity of this protracted epidemic, social science research has become a critically important part of the response in order to help contextualise strategies, investigate social determinants of infection, and inform understanding and reception of interventions employed for outbreak control. To routinely generate this intelligence, an innovative solution has emerged in the form of the Cellule d’Analyse en Sciences Sociales. UNICEF-funded, this group is made up predominantly of local and national social scientists. Other ad hoc social science research is also being conducted in the field.
Through this project we aim to consolidate learning and articulate what is needed to replicate similar initiatives in future outbreaks. We will provide remote technical support, conduct structured critical appraisal of the field experience, capture lessons learned, and develop guidance and tools for the current and for future outbreaks. Our vision is to contribute to better outbreak prevention and response through excellence in social and behavioural science research, integrated into current and future responses to infectious disease.
- Preparedness for future epidemic outbreaks
Preparedness for future epidemic outbreaks
As part of a wider consortium called EBOVAC 3 the work package we lead on aims to explore how Sierra Leone, Guinea and DRC are prepared for future disease outbreaks.
In Sierra Leone the LSHTM team are leading on innovative research exploring and disrupting notions household structure and care-giving during peace-time to inform preparedness for epidemic outbreaks. Our work is also looking at Ebola clinical trial legacies. In Guinea, Frederic Le Marcis, professor of social anthropology at the Département des Sciences Sociales, Ecole normale supérieure de Lyon is conducting a study on Thinking Preparedness in the light of history. Unmasking virological longue durée in Guinea and Rubis Le Coq is conducting doctoral research on Seeking care in times of fear
Anthropological and survey methods
- Shelley Lees (PI)
- Shona Lee
- Frederic LeMarcis
- Rubis LeCoq
- Anthropological exploration of facilitators and barriers to vaccine deployment and administration during disease outbreaks (AViD)
Anthropological exploration of facilitators and barriers to vaccine deployment and administration during disease outbreaks (AViD)
Recent outbreaks have made clear that inadequate consideration of social, cultural, political, and religious factors in humanitarian responses has consequences for the effectiveness and community acceptability of response activities. A growing number of studies have focused on the historical, social, cultural and political determinants of vaccine acceptance, and have highlighted the specificities of these dynamics during emergencies. While these theories are useful to help understand potential issues for vaccine deployment and administration during an outbreak, there are gaps in the evidence, particularly relating to acquiring evidence in real-time.
Given the wider range of disease and contexts, there is a need to understand different of perspectives about vaccines and outbreaks, including the political and economic factors that determine whether vaccines can be deployed effectively in an emergency situation, health system perspectives, which are closely tied to cultural, policy, and historical developments in how provision is organised as well as local systems of to identify community perceptions surrounding vaccine use. Finally, given that many diseases are zoonotic, understandings of community experiences of vaccination in both human and animal health are needed.
This study sets out to address these gaps through qualitative, comparative research across four different countries to explore the facilitators and barriers to vaccine deployment during outbreaks. Rather than focusing on one disease/vaccine or one context, this study will explore an “ecosystem” of vaccine deployment, drawing on different perspectives in low-income contexts and for the poorest in middle-income contexts.
Using a multiple-case study approach and a mix of qualitative and ethnographic methods including key stakeholder interviews, document analysis and participant observation, the project will ensure insights into the complex web of factors that determine countries’ ability to deploy vaccines during an outbreak. Each case study aims to shed light on different factors that determine preparedness for emergency vaccine deployment.
The African coaLition for Epidemic Research, Response and Training (ALERRT) aims reduce the public health and socio-economic impact of REPID in SSA. This will be achieved by building a sustainable clinical and laboratory research preparedness and response network, with the operational readiness to rapidly implement clinical and laboratory research in support of REPID control efforts at local, regional and international level. Our role is the lead Work Package 5, which aims to understand effective community engagement through anthropological research.
Using systematic reviews, workshops and drawing anthropological research and political theory we aim to interrogate community engagement in response and research for emergent diseases
- Jimmy Whitworth (overall PI)
- Shelley Lees (work package lead)
- Mark Marchant
- The effects of cash transfers on intrahousehold dynamics and intimate partner violence in Mali: proposal for additional mixed method work (IFPRI)
The effects of cash transfers on intrahousehold dynamics and intimate partner violence in Mali: proposal for additional mixed method work (IFPRI)
In 2014 the Government of Mali began implementing the “Filets Sociaux (Jigisémèjiri)” program that aims at reducing inter-generational poverty and improving human capital accumulation through targeted cash transfers to predominantly male heads of household, accompanying measures (trainings), and preventive nutrition packages. Research has revealed significant impacts of the program on experiences of physical violence amongst women in polygamous relationships.
This study aimed to provide an in-depth qualitative exploration of the effects of the program on intimate partner relationships in Mali. Findings of the study revealed that positive aspects around intimate partner relationships were communication and shared values; however, much of the discussion around decision-making narrated male authority and limited power for women to influence decisions. The cash transfer reduced household poverty and improved personal wellbeing, especially for men. Whilst there were few discussions around the effects of the program on intimate partner violence, there were clear narratives on the reduction of tensions and disputes that lead to physical violence. This may have been greater in polygamous households, where there were more tensions and disputes over responsibilities across a husband and his wives and across co-wives.
Qualitative interviews with women and men in Malian households
- Shelley Lees
- Nambusi Kyeombe
Lees, S, Kyegombe, N, Diatta, A. D, Zongrone, A, Roy, S, Hidrobo, M (In Press) Intimate partner relationships and gender norms in Mali: The scope of cash transfers targeted to men to reduce intimate partner violence. Violence Against Women
- Contested legitimacy for anthropologists involved in medical humanitarian action: Experiences from the 2014-2016 West Africa Ebola epidemic
Contested legitimacy for anthropologists involved in medical humanitarian action: Experiences from the 2014-2016 West Africa Ebola epidemic
The study involved exploring lessons learnt of anthropologists and other social scientists, and key informants from humanitarian organisations involved in infectious disease responses, collating and assessing rapid ethnographic assessment tools and methodologies for use by social scientists in infectious disease outbreaks.
In-depth interviews with anthropologists and humanitarian workers. Round table discussion at a Wellcome Trust event led by Shelley Lees, Karl Blancher, Jennifer Palmer and Fanny Procureur
- Shelley Lees co PI
- Karl Blanchet co PI
- Jennifer Palmer
- Fanny Procureur
Lees S, Palmer J, Procureur F and Blanchet K (In Press) Contested legitimacy for anthropologists involved in medical humanitarian action: Experiences from the 2014-2016 West Africa Ebola epidemic. Anthropology and Medicine
- Anthropological study to explore the sociocultural context of sexual violence against children in Zanzibar
Anthropological study to explore the sociocultural context of sexual violence against children in Zanzibar
Anthropological study to understand the sociocultural context of sexual violence against children in Zanzibar.
Anthropological research including ethnography and in dept interviews with key informants, parents and adolescents in Zanzibar
- Shelley Lees
- Karen Devries
Lees, S and Devries, K (2018). Local narratives of sexual and other violence against children and young people in Zanzibar. Culture, Health and Sexuality. 20(1):99-112
- Social science research of the EBOVAC1 and PREVAC vaccine trials in Sierra Leone
Social science research of the EBOVAC1 and PREVAC vaccine trials in Sierra Leone
These multifaceted studies are exploring understand vaccine and trial acceptability by conducting in depth social science research (anthropology). This research has examined understandings and experiences of Ebola and vaccines, perspectives of the vaccine and the trial as well as rumours, and concerns.
Traditional social science methods, including in-depth interviews, focus groups discussions and ethnography, will employed to ensure an in-depth exploration is conducted and wider lessons can be learned for the current Ebola outbreak and any future outbreaks of this and other new infectious diseases. Further to this, rapid approaches will be employed to ensure that findings are quickly fed back to the trial investigators and trial processes and communication around the trial can be adapted to ensure that participants and communities accept the trial and that adherence and acceptability are high.
- Shelley Lees
- Luisa Enria
- Shona Lee
Enria L & Lees S (2018) Citizens, Dependents, Sons of the Soil: Defining Political Subjectivities through Encounters with Biomedicine during the Ebola epidemic in Sierra Leone Medical Anthropology Theory
Tengbeh A, Enria L, Smout E, Mooney T, Callaghan M, Ishola D, Leigh B, Watson-Jones D, Greenwood B, Larson H, Lees S (2018) “We are the heroes because we are ready to die for this country”: Participants’ Decision-making and “Grounded Ethics” in an Ebola vaccine clinical trial. Social Science & Medicine. 203: 35-42.
Enria, L., Lees, S., Smout, E., Mooney, T., Tengbeh, A. F., Leigh, B., ... & Larson, H. (2016). Power, fairness and trust: understanding and engaging with vaccine trial participants and communities in the setting up the EBOVAC-Salone vaccine trial in Sierra Leone. BMC Public Health, 16(1), 1140.
- Social Science research within the MAISHA study, Tanzania
Social Science research within the MAISHA study, Tanzania
The MAISHA Study is a cluster randomised trial to assess the impact of a combined micro-finance and gender training intervention for women, and the impact of a participatory gender training programme for women and their partners. The social science research focuses on women’s experiences of intimate partner violence and of the intervention. Understanding that violence against women is situated within structures that are instigated by political economics that create marginalisation and vulnerability to violence, including distribution and use of resources in the home, the community, and at the political level. In order to understand violence, a political economy approach is thus required and should incorporate broader links between poverty, identity, and power as well as reveal historical contingencies
Longitudinal qualitative study with trial participants
- Shelley Lees
- Sheila Harvey
- Saidi Kapiga
- Charlotte Watts