Abstract
The term 'neglected tropical diseases' (NTDs) points to the need for a biosocial perspective. Although 'diseases' are widely understood as biological phenomena, 'neglect' is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy - a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD 'brand' identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated. Developing such an approach is an iterative process, requiring on-going engagement with both biological and social insights as they emerge. Considerable theoretical, methodological and political challenges lie ahead, but it is essential they are overcome, if the sustainable control of NTDs is to become a reality.
Highlights
The term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective
Emphasis is placed on preventive chemotherapy, an approach which relies heavily on the mass distribution of drugs, at regular intervals and free of charge, to populations living in endemic areas
It is helpful to ask: what constitutes a biosocial approach to the control of NTDs? Can it be achieved? Ideally, a biosocial approach involves drawing upon insights emerging from zoology, parasitology, ecology, epidemiology, clinical medicine and pharmacology; whilst simultaneously taking seriously, and giving equal weight to, insights emerging from anthropology, history, demography, economics and political science
Summary
Social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. These dimensions of neglect are, themselves, neglected. This article reflects on the processes which have enabled an NTD ‘brand’ identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated. Developing such an approach is an iterative process, requiring on-going engagement with both biological and social insights as they emerge. Considerable theoretical, methodological and political challenges lie ahead, but it is essential they are overcome, if the sustainable control of NTDs is to become a reality
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