GHS 201 FAU Critical Thinking Power & Socioeconomic Inequalities Essay

For the reflection papers, you are to write a critical reflection paper for the two-assigned reading. As noted in the course,critical thinking involves defining the meaning and importance of what is examined or expressed, or, about a given inference or argument, and establishing whether there is satisfactory reasoning to accept the conclusion as true. “It is the questioning with an open mind, of any belief, and coming to an unbiased conclusion supported by evidence and scrutinized assumptions.”

(Read 1st article)

https://onlinelibrary.wiley.com/doi/full/10.1002/ajhb.2348

Global Public Health
An International Journal for Research, Policy and Practice
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/rgph20
Sociocultural, behavioural and political factors
shaping the COVID-19 pandemic: the need for a
biocultural approach to understanding pandemics
and (re)emerging pathogens
Anna Friedler
To cite this article: Anna Friedler (2021) Sociocultural, behavioural and political factors
shaping the COVID-19 pandemic: the need for a biocultural approach to understanding
pandemics and (re)emerging pathogens, Global Public Health, 16:1, 17-35, DOI:
10.1080/17441692.2020.1828982
To link to this article: https://doi.org/10.1080/17441692.2020.1828982
Published online: 06 Oct 2020.
Submit your article to this journal
Article views: 4983
View related articles
View Crossmark data
Citing articles: 12 View citing articles
Full Terms & Conditions of access and use can be found at
https://www.tandfonline.com/action/journalInformation?journalCode=rgph20
GLOBAL PUBLIC HEALTH
2021, VOL. 16, NO. 1, 17–35
https://doi.org/10.1080/17441692.2020.1828982
Sociocultural, behavioural and political factors shaping the
COVID-19 pandemic: the need for a biocultural approach to
understanding pandemics and (re)emerging pathogens
Anna Friedler
a,b
a
Département des sciences humaines et sociales, École des Hautes Études en Santé Publique – Campus de Paris,
Saint-Denis, France; bl’Unité des Virus Emergents, Aix-Marseille Université, Marseille, France
ABSTRACT
ARTICLE HISTORY
Although there has been increasing focus in recent years on
interdisciplinary approaches to health and disease, and in particular the
dimension of social inequalities in epidemics, infectious diseases have
been much less focused on. This is especially true in the area of cultural
dynamics and their eﬀects on pathogen behaviours, although there is
evidence to suggest that this relationship is central to shaping our
interactions with infectious disease agents on a variety of levels. This
paper makes a case for a biocultural approach to pandemics such as
COVID-19. It then uses this biocultural framework to examine the
anthropogenic dynamics that inﬂuenced and continue to shape the
COVID-19 pandemic, both during its initial phase and during critical
intersections of the pandemic. Through this understanding of
biocultural interactions between people, animals and pathogens, a
broader societal and political dimension is drawn as a function of
population level and international cultures, to reﬂect on the culturally
mediated diﬀerential burden of the pandemic. Ultimately, it is argued
that a biocultural perspective on infectious disease pandemics will allow
for critical reﬂection on how culture shapes our behaviours at all levels,
and how the eﬀects of these behaviours are ultimately foundational to
pathogen ecology and evolution.
Received 3 April 2020
Accepted 4 September 2020
KEYWORDS
Biocultural; cultural
epidemiology; infectious
disease; COVID-19;
biopolitics
Introduction: the case for a biocultural framework for studying pandemics
COVID-19 and a biocultural approach
Attention has been drawn to the COVID-19 pandemic due to its unprecedented scale and potential
to completely overwhelm public health systems internationally. In the midst of co-contagions of
misinformation and fear (Depoux et al., 2020; Törnberg, 2018), questions have arisen as to how
and why such a pandemic could have emerged. Approaches from which to approach this topic
are diverse within the context of research on infectious disease pandemics. But whilst ecological
and climatic factors have been the focus of numerous investigations, sociocultural factors have
been slower to be incorporated into this mix. This may in large part be due to traditional subject
boundaries between the social and natural sciences. The role of ‘biocultural’ dynamics in
human–pathogen interactions therefore deserves further exploration, both as an interdisciplinary
CONTACT Anna Friedler
anna.friedler@etu.univ-amu.fr
This article was originally published with errors, which have now been corrected in the online version. Please see Correction
(http://dx.doi.org/10.1080/17441692.2020.1828982)
© 2020 Informa UK Limited, trading as Taylor & Francis Group
18
A. FRIEDLER
approach and speciﬁcally in providing an overview of emerging patterns in the COVID-19
pandemic.
Approaches to situating the sociocultural within pandemics
Current approaches to examining the interaction of sociocultural factors with disease more generally are numerous. From a social science perspective they include health sociology, medical psychology, medical anthropology, urban studies and health geography, to name a few. Within the natural
sciences, social epidemiology, evolutionary epidemiology and network modelling approaches are
prominent, whilst One Health and Ecosocial approaches are notable in attempting to bridge the
social-natural sciences divide. One Health, the study of epi/pandemics through linking multiple disciplines, has become particularly prominent and is closely aligned to biocultural approaches
(Ahmad & Hui, 2020; Conrad et al., 2013). However work in this area tends to be heavily focused
on ecology or eco-social dynamics, with comparatively less focus on the biological outcomes of
sociocultural variables themselves.
Social epidemiology has also emerged out of a similar interest in understanding how social
environments impact diﬀerential disease burdens. Work in this ﬁeld has particularly highlighted
how structural violence and inequalities in the form of socioeconomic and racial categories produce
diﬀerentially poorer health outcomes (Bauch & Galvani, 2013). However, studies within social epidemiology often have a heavy focus towards non-communicable disease, with the exception of
HIV/AIDS. They also favour an epidemiological, quantitative approach to speciﬁc (bio)social variables that can be diﬃcult to apply to complex multispecies and cultural interactions. Another
approach that has been suggested to bridge this gap is that of cultural epidemiology (Bhui, 2009;
DiGiacomo, 1999) as an idea to unite epidemiology and anthropology (Barbosa, 1998). However,
this has largely failed to gain popularity in comparison with social epidemiology, possibly due to
fears of disciplinary ‘reductionism’ (C. Benson, 1982). Meanwhile, health psychology tends to
focus on population-level psychosocial variables rather than locally constructed phenomena. Health
sociology on the other hand often employs quantitative approaches that capture in detail speciﬁc
behaviours but not always the broader cultural context in which such behaviours are constructed.
Mathematical modelling studies form a baseline for theorising how human behavioural patterns
inﬂuence predicated epidemic spread. However, in doing so they may make assumptions on human
behavioural dynamics that are necessarily simplistic and not always well-defended from a social
science or anthropology perspective. This is not to say at all that advances in modelling behavioural
factors in infectious disease epidemiology have not made immense strides in the last few decades.
Several studies have examined the eﬀects of network dynamics as a broad proxy for social dynamics
and their eﬀects on epidemics (Barrett et al., 2008; Cauchemez et al., 2011; Christley et al., 2005;
Eubank et al., 2004; Stattner & Vidot, 2011). Within evolutionary epidemiology, genuinely insightful use has been made of ‘big data’, to combine behavioural data such as ﬂight connections with
phylogeographic data on pathogen behaviour (Grubaugh et al., 2017; Salami et al., 2020; Tian
et al., 2017). Such work has also demonstrated how host shifts in network dynamics have the potential to create fundamental selective (Buckee et al., 2004; Leventhal et al., 2015) and epidemiological
pressures (Pellis et al., 2015) on pathogens, being largely constrained within such networks.
Biocultural approaches in the context of infectious disease
Biocultural approaches have already been cited across disciplinarily diverse studies, but what constitutes culture and the biological within this approach has been ambiguous (Wiley & Cullin, 2016).
Dressler (2016) has argued that culture can be situated within the biocultural though the concept of
cultural consonance: how well an individual is able to mirror beliefs and behaviours within their
social environment. Low cultural consonance has been shown to result in poorer health outcomes,
through mechanisms such as stress (Copeland, 2018). Whilst this model can be applied directly to
GLOBAL PUBLIC HEALTH
19
infectious disease, via the immunosuppressant eﬀects of stress and likely higher infection, this is a
host-centred perspective. This article proposes an approach that extends work on biocultural
approaches to include a more pathogen-centred perspective. This has traditionally been an exclusively biological and medical science focus, examining selective ecological and evolutionary pressures on the pathogen. However, recent work in medical anthropology has begun to shift this
dynamic by producing multi-species ethnographies that move away from privileging only the
human perspective. Celia Lowe for example, in her work on avian inﬂuenza (H5N1) discusses
the idea of viral and multispecies ‘clouds’ (Lowe, 2010), whilst Alex Nading explores how pathogen,
mosquito and human ecologies are ‘entangled’ (Nading, 2012). This work represents a clear move
towards a biocultural approach, with consideration not merely of how human social landscapes are
impacted by epidemics, but how vector and pathogen socioecological realities are impacted by
human behaviours. Additionally, researchers within areas such as urban studies and health geography have begun to incorporate more ‘epidemiological thinking’ into their analysis of how human
landscapes impact disease. One example of this is Ali and Keil’s (2006) work on SARS, illustrating
how global city networks, through their historical-cultural and economic linkages, produce physical
‘disease spaces’ via the movement of ‘microbial traﬃc’.
Broader examples of the impact of sociocultural phenomena on pathogen dynamics relevant to
the COVID-19 pandemic include spheres such as consumption and mobility patterns. The role of
consumption patterns more generally in structuring viral pandemics has already been amply
demonstrated from work on Ebola and H5N1. Research on Ebola for example indicates that bushmeat, a potential source of such zoonotic pathogens, is often considered healthier or of better quality than commercial alternatives (Chausson et al., 2019). Within a more general context bushmeat is
linked to cultural heritages in speciﬁc ecosystems such as rainforests as well as to consumer preference over intensively farmed species (van Vliet, 2018). Socioeconomic and ecological factors also
impinge on this relationship, as whilst consumer preference for bushmeat amongst the wealthy
households remained more stable during Ebola outbreaks, poorer households may rely on hunting
wild animals for income (Ordaz-Németh et al., 2017). This coupled with intensiﬁcation of land
exploitation such as logging intensiﬁes wildlife-human transmission networks through consumption patterns (Wolfe et al., 2005). Avian inﬂuenza is another example, where relations between
poultry and humans have been highlighted by Natalie Porter’s work as key in navigating the
H5N1 outbreak in Vietnam (Porter, 2013). Porter describes how the close relations between villagers and chickens were maintained by a constructed system of disease risk that viewed locally produced chickens as healthy, and industrially produced chickens as an unhealthy ‘other’. This was
linked to conﬂict between public health actors and small-scale poultry producers in complying
with culls and vaccinations. This can itself be contrasted to One Health approaches which have
indeed linked intensive animal raising practices in developed countries to zoonotic disease outbreaks such as Q fever (van der Hoek et al., 2012) and Nipah virus (Jones et al., 2013), as well as
to the potential for the spread of antibiotic resistance in the environment (Manyi-Loh et al., 2018).
It has also long been recognised that mobility patterns play a key role in pandemic emergence.
Historical examples linking sociocultural practices, mobility and pandemics include plague outbreaks in Europe such as the ‘Black Death’, where navigable rivers on trade routes have been statistically correlated with outbreak patterning (Yue et al., 2017). Similar examples of large scale
migratory movements linked to outbreaks are the introduction of diseases such as smallpox to
the Americas during European colonialisation (Ramenofsky, 2003) and the 1918 inﬂuenza pandemic (the ‘Spanish Flu’) linked to the mass movements of soldiers and poor trench conditions
during the First World War (Wever & van Bergen, 2014). More recent studies have begun to
turn attention not only to airborne infections but also vector-borne diseases such as dengue.
Work on this area has increasingly found that human, rather than mosquito, spatial networks
are a key factor in structuring dengue infection risk (Reiner et al., 2014; Wen et al., 2012). In the
case of zoonotic diseases, work on SARS from a health geography and urban studies perspective
20
A. FRIEDLER
has also suggested that connections both within and between cities are important predictors of pandemic outbreak dynamics (Ali & Keil, 2006).
Drawing on such work, this paper echoes Dressler’s call to ‘operationalize’ culture in a way that
can be used to directly examine its eﬀects on measurable biological outcomes. This also echoes calls
for a ‘cultural epidemiology’, but which hinged on the same issue: that many of these perspectives
are operationalised for non-communicable diseases. Understandings of multi-species entanglements continue to provide excellent insights into ‘cloudy’ biosocial realities but they do not provide
measurable outcomes from the perspective of the pathogen. That is to say, how do the cultural and
behavioural phenomena described in such ethnographies precisely shape the epidemiology and
evolution of such pathogens? It is suggested that to understand this two shifts be made when applying a biocultural framework to infectious disease.
Firstly, that ‘biocultural’ be extended, as proposed by Leatherman and Goodman (2019), over a
broad level: to examine for example, how political and socioeconomic dynamics may have cultural
underpinnings and biological consequences. This would allow for diverse factors that may shape
host transmission networks and dynamics to be examined: visualisation of such networks as pathogen ‘habitats’ would allow for operationalisation of multispecies entanglements. In this sense culture is viewed through an ethnological lens, as speciﬁc systems of behaviours that are socially
constructed and locally transmitted within a group. But that it is also, linking to the concept of cultural consonance, the medium through which a group understands norms of interaction and constructs categories and relations with the physical environment. Work by Celia Lowe (2010) has
already encapsulated this general idea into more integrative approaches by analysing how international inequalities around biosecurity compound diﬀerences in infection risk between developed
and developing nations. Beisel’s (2015) work on malaria in Ghana also demonstrates how socioeconomic factors such as commercialisation of mosquito nets and neocolonial power structures can
impact mosquito biology. This is also touched on in work by Kelly and Lezaun (2014), where urban
dynamics in Tanzania are described as both a sociohistorical narrative of inequality and the fabric
for mosquito reproduction, shaping the connection between both species.
Secondly, that infectious disease epidemiology be the source of the ‘measured biological outcome
(s)’ proposed by Dressler. This distinguishes such an approach from some medical sociology and
psychology studies, which tend to examine psychosocial responses to pandemics. By contrast a biocultural approach to pandemics would focus on how existing sociocultural structures may select for
eco-epidemiological outcomes at the pathogen level. This extends Margret Lock’s conception of
‘local biologies’ from human embodiment of diﬀerential eco-social landscapes (Lock, 2017) to a
conception of humans themselves as a shifting eco-social landscape of pathogen embodiment.
This requires drawing on both multispecies entanglements in anthropology and evolutionary epidemiological understandings of pathogen as the ‘unstable bodies’ described by Palsson (2016).
Human bodies themselves are therefore the vehicle for pathogen embodiment of cultural dynamics.
Emerging biocultural narratives in the COVID-19 pandemic
Whilst the COVID-19 epidemic, traced to crossover between bats and intermediate hosts via live
animal markets (Ji et al., 2020; Zhu et al., 2020), appeared in some ways to ‘come out of nowhere’,
it is perhaps not so surprising in the wake of the H1N1 and H5N1 outbreaks. As has often been
repeated, around 75% of emerging diseases are zoonotic pathogens (Woolhouse, 2002), representing crossover from animals to humans. On top of this, although antibiotic resistance represents one
of the most pressing public health concerns in the ﬁeld of infectious diseases globally (Roca et al.,
2015; Zhang et al., 2006), viruses are arguably a far more pressing threat in the context of emerging
infectious diseases. This is especially true of RNA viruses, of which COVID-19 is one, due to their
high mutation rate and thus fast evolutionary ‘pace’ of adaptation (Peck & Lauring, 2018) and high
taxonomic ﬂexibility (host range) (Johnson et al., 2015). This may contribute to their potential for
GLOBAL PUBLIC HEALTH
21
pathogenic changes such as ‘host jumping’ or changes in virulence patterns (Woolhouse et al.,
2005).
Biocultural hubs such as markets represent heightened risk for novel pathogen behaviours and
host crossovers due to their capacity to link sociocultural and eco-biological networks. Similar to
the idea of ‘superspreaders’ (Stein, 2011) they represent ‘superconnected axes’ linking potentially
diverse habitats. For example, in countries with high diversities of ecosystems, such as in and
around the Amazon, markets can form a direct link between habitats such as tropical forest and
mountainous regions (Uhart et al., 2012). There are also clear links between biodiversity and potential for transference events from one host species to another (K. E. Jones et al., 2008; World Health
Organization & Convention on Biological Diversity, 2018). Additionally, human disruptions to ecosystems have the potential to form ‘triggering events’ for host jumping, whilst psychological stress
in captive animals has been linked to immunosuppression (de Passillé & Rushen, 2005). Zoonotic
host-jumping events in hotspots of socioecological interchange have already been observed during
the Ebola (Alexander et al., 2015; Meseko et al., 2015) and Nipah virus (Daszak et al., 2013) outbreaks, and with other coronaviruses such as SARS (Sims & Peiris, 2013) and MERS-CoV
(Zumla et al., 2016).
Focus has been put on the role of bats in zoonotic diseases, due to the high diversity of viruses
found in bat populations (Hayman, 2016; Moratelli et al., 2015). The long evolutionary history, high
species and ecological diversity of bats has been suggested to account in part for this (Brook & Dobson, 2015; Wang et al., 2011). In particular through their greater co-evolutionary history with many
viruses, particularly coronaviruses (Cui et al., 2019), emerging work suggests that they have developed high tolerance of viral infection, resulting in little to no disease outcomes such as inﬂammation (Ahn et al., 2019; Hayman, 2019). There is even evidence that such viruses may even
confer some symbiotic beneﬁts such as strengthening bat immune systems against other pathogens
(Wang et al., 2011). However, this balance may become disturbed under conditions of stress (Chua,
2003; Chua et al., 2002), which is of particular importance in biocultural context. This is because
human changes in local habitats, or trade in animals such as bats, may induce stress-related
immunological changes that favour increased virus shedding. But it is unhelpful in a wider public
and One Health sense for two reasons. Firstly, it draws attention away from the likely principle causative reasons for the emergence of the pathogens in sustained human transmission networks at
speciﬁc intervals, which is human sociocultural dynamics and not simply bat biology. Secondly,
it ﬁlters into the public perception in a way that could be very damaging to fragile ecosystems
that depend on bats for several ecosystem services (Williams-Guillén et al., 2016). Consequent ‘reprisal ‘ killing of species such as bats – as occurred with pigs during the H1N1 pandemic (Leach &
Tadros, 2014, p. 1) – could ironically could trigger further host-jumping events either indirectly
through ecosystem disruption, or directly through contact with bat faeces or tissues.
Barriers to banning live animal markets however, despite previous coronavirus outbreaks from
these sources (Woo et al., 2006), also have a cultural source. Traditional medicine, including medicines from a variety of wild animal products (Still, 2003), has a central role in Chinese society that is
deeply historically and culturally routed and therefore arguably reaches far beyond Western
alternative medicine equivalents (Cheung, 2011; Hsu, 2008; Kim & Han, 2012). This is reﬂected
economically, in the value of traditional medicine and the trade of animal products used in traditional medicine estimated in the billions of dollars (Xu & Xia, 2019). It can also be seen though
research investment into the pharmacological activity of a range of traditional Chinese medicine
products (Li et al., 2012; Ma et al., 2013; Qiu, 2007; Wang et al., 2006) and the widespread couse of both traditional and modern medicines (Park et al., 2012; Xu & Yang, 2009). A further aspect
concerns diﬀerences in perceptions of pollution and safety. Whilst in in some cultural contexts the
killing of live animals would be unacceptable, equally in a Chinese context the idea of buying meat
of uncertain provenance might equally be viewed as suspect or even dangerous, since the origin,
quality and freshness might be unclear (Keck, 2012; Liu, 2008; Lynteris, 2016; Webster, 2004).
These factors can be seen to magnify on a national level, where the wildlife trade is worth billions
22
A. FRIEDLER
of dollars (Engler, 2008). Wet markets also act as important nexuses for local farmers and producers, even if such markets are themselves in the hands of state-owned or private companies (Si et al.,
2016). Beyond their socioeconomic value, research has highlighted how supermarkets do not
replace wet markets: rather, markets have an important cultural value that is enacted through
the experience of visiting itself, such as interacting with vendors (Si et al., 2019). Additionally,
although intense focus in the wake of the pandemic has been put on wet markets as a purely Chinese
phenomenon, wet markets can in fact be found all over the world – albeit within diﬀerential sociocultural contexts that may impinge on pathogen emergence. This is especially the case in areas with
high biodiversity (Uhart et al., 2012), despite research tending to centre around those in Asian contexts (Nhung et al., 2018; Rahman et al., 2018; Ribas et al., 2016). This goes a little way to understanding the biocultural placement of the outbreak, both within its local context and the wider
context of markets as biocultural nexuses of pathogen emergence and divergence. Additionally,
although China has now banned wild animal markets (Li et al., 2020), the possible impact of continued black market trade will be a question for future analysis.
The timing of the COVID-19 outbreak also appears to have intimate cultural links: coinciding
with Spring Festival, millions of people working in Wuhan dispersed across China to be with their
families before quarantine measures where imposed. This is signiﬁcant, not merely as a biocultural
superspreading event that may have been fundamental in the diﬃculty containing the COVID-19
pandemic (Zhong et al., 2020), but also because of the speciﬁc sociocultural networks involved. That
is to say, predominantly younger (working age) people, potentially carrying the virus asymptomatically to older relatives (those most at risk of severe infection outcomes) for weeks of cohabitation.
This ‘perfect storm’ of factors was also able to reach a critical stage in part due to the initial governmental suppression of information indicating that a new infectious agent linked to a wet market in
Wuhan could be causing a surge in pneumonia-related deaths. It has been suggested that early
restrictions on epidemiological data were themselves in part created by the lack of autonomy
between epidemiologists and the government (Gu & Li, 2020).
Some debate in journalistic literature has also focused on possible cultural reasons for the high
case numbers and diﬃculty in containing the epidemic in the case of Italy (‘Why is Italy’s coronavirus fatality rate so high?,’ n.d.). One example is the issue raised of high vaccine scepticism in the
context of seasonal ﬂu, which along with a co-epidemic of COVID-19 has the potential to overwhelm health systems as well as the potential for coinfection (Stefanska et al., 2013; Wu et al.,
2020). This is perhaps mirrored in the academic literature by discussion of the complex state–
society dynamics inﬂuencing vaccine conﬁdence (Kieslich, 2018). These include suggested correlative links between rises in populism and vaccine scepticism (Kennedy, 2019), as well as the role of
the H1N1 pandemic in bolstering the vaccine scepticism movement due to concerns that the vaccine had not been adequately tested (Verger et al., 2018). However, it is important to distinguish
between vaccine scepticism and actual vaccination rates in vulnerable groups, i.e. those in older
age groups and those with chronic health conditions. Whilst uptake of seasonal inﬂuenza vaccine
has been shown to be alarmingly low for older people in Italy (Manzoli et al., 2018; Marano et al.,
2020), vaccination coverage remains low in several European countries, including countries that
have drastically lower uptake rates than Italy (ECDC, 2018; Jorgensen et al., 2018). The role of seasonal inﬂuenza vaccination uptake in contributing to mortality during the COVID-19 epidemic
should therefore be weighed in the context of other factors, such as ﬂight connectivity, movement
patterns, and health system capacity. However, it is worth considering this as a risk factor for
capacity of health systems to cope with possible mortality in countries with very low seasonal
inﬂuenza uptake. It has also been suggested that the demographic structure (high elderly population) coupled with the sociocultural network dynamics – with more frequent interactions between
the young and old within families – increased the potential for spread between densely populated
areas with younger asymptomatic carriers travelling to surrounding zones (‘Why is Italy’s coronavirus fatality rate so high?,’ n.d.). Whilst this is not supported by data on cohabitation patterns for
older adults in the wider European context (Eurostat, 2015), there is research to suggest increased
GLOBAL PUBLIC HEALTH
23
social contact networks between older parents and children in Italy speciﬁcally (Albertini & Kohli,
2013; Floridi, 2018; Kalmijn & Saraceno, 2008). Emerging demographic research suggests that the
age structure of populations could play a large causative role in COVID-19 mortality patterns by
country (Dowd et al., 2020), whilst large-scale social network studies as illustrated by the BBC Pandemic Project (Klepac et al., 2020) could be useful in further illustrating the social network
dynamics within such structures.
The impact of school closures potentially bringing younger and older individuals into closer
contact through childminding roles has also been highlighted (Dowd et al., 2020). A further
topic for analysis in this area will also be intergenerational network shifts in light of quarantine
and containment measures. For example, whether younger populations may decide to move
back to family homes within or between countries during quarantine measures or the eﬀects of
assisting older individuals, (such as younger individuals delivering shopping). These issues may
be further exacerbated by the recovering nature of health systems in Southern Europe, having
been amongst the countries whose health systems and economics were more severely aﬀected by
the 2008 ﬁnancial crisis (OECD, 2011; Serapioni, 2017).
Eﬀects of biocultural inequalities on diﬀerential pandemic burden
Intersections of vulnerability in times of coronavirus
Within the context of the current COVID-19 pandemic, despite gaps in the social epidemiology
literature, we can reasonably expect diﬀerential eﬀects of such sociocultural inequalities on infection risk as well as burden and outcomes. Although data speciﬁcally on COVID-19 is just beginning
to emerge, work on intersectional vulnerabilities in epidemics can help us to gain an idea of those
who may be more aﬀected. The idea of intersectionalities of vulnerabilities in health is relatively
recent and can be seen as an important advance on the general concept of social epidemiology
(Bauer, 2014). However, as with the majority of social epidemiological work, and with the prominent exception of HIV (Rodríguez & Velázquez, 2017), most research attention has been focused on
non-communicable diseases. This has often been within fairly narrow categories of socioeconomic
class and sometimes self-identiﬁed ethnicity reﬂecting a highly quantitative epistemological framework, sometimes reducing such categories to naturalistic ﬁxed values rather than constructed cultural relations within a socially produced context. This obscures more complex interplays of
biocultural inequalities during epidemics, since how cultural constructions such as gender and ethnicity interact with variables like socioeconomic opportunity. Such interactions may produce compounding inequalities that are often complex and multi-faceted, making them diﬃcult to capture
using only qualitative techniques; partly due to the potentially ‘unexpected’ nature of some of
these eﬀects.
The role of ethnicity is somewhat better researched within social and infectious disease epidemiology literature, largely due to the diﬀusion of literature on HIV vulnerabilities in African-American and Hispanic communities in the USA (Bowden et al., 2006; Jarama et al., 2007). Again, much
of the causative mechanisms involved focus around the complex biosocial dynamics of structural
violence in the context of ethnicity, such as higher social vulnerability, poor socioeconomic conditions in predominantly African-American or Hispanic neighbourhoods, and lower education
and access to medical care (Bauch & Galvani, 2013; Marmot & Bell, 2016; Miller et al., 2007; Poundstone et al., 2004; Shedlin et al., 2005). In the context of racism and increased social epidemiological
risk, consideration within COVID-19 should also be given to the increased incidences of racism
recorded against Asian communities in places such as the United States and Europe (Wen et al.,
2020). Similarly, China itself reported similar discrimination on a national level against those
from Wuhan, the epicentre of the outbreak (Ren et al., 2020). Work on indigenous communities
has also linked ethnicity and associated structural violence issues to health inequalities, with
research pointing to higher rates of infection for diseases such as HIV (Negin et al., 2015),
24
A. FRIEDLER
tuberculosis (Romero-Sandoval et al., 2007; Tuite et al., 2017), malaria (Donnelly et al., 2016) and
streptococcal Infections (Bocking et al., 2017). For communities that not only suﬀer stigma, but also
live in poor socioeconomic conditions, or in remote communities (the protective eﬀect of which
will likely depend on long-distance social connections), access to medical aid and information in
the context of COVID-19 may be problematic. Intersecting at an overarching level will also be
the role of socioeconomic status and stability:: whilst there has been concern voiced over the economic eﬀects of quarantine on job stability, issues of more severe poverty raise pressing questions. A
prominent example of this is the potential impact on the homeless and their higher vulnerability at
times of crisis, including obvious issues such as the inability to self-quarantine, (Tsai & Wilson,
2020).
The role of gender: men as superspreaders, women as invisible caregivers?
Within the context of the current outbreak gender merits further discussion, but gaps within the
context of epidemics and gender have been highlighted on several occasions. Speciﬁcally, the
lack of awareness in crisis and humanitarian settings of the need to fundamentally integrate diﬀerential gender vulnerabilities, and the lack of gender analysis in health and epidemic policy documents (Smith, 2019). When gender is included, it can tend towards something of a ‘token
gesture’, focusing largely on a narrow and stereotyped view of largely non-white, non-occidental
women (Syed & Ali, 2011) in their role as mothers, or mothers-to-be. Within the context of infectious disease epidemics, the literature is scarcer still, despite lessons from the Ebola and Zika epidemics, both from the perspective of under-researched diﬀerential infection risk, and diﬀerential
burden of suﬀering during the crises (Davies & Bennett, 2016). This further impinged on the conditions of severe socioeconomic deprivation in which women most impacted by the crises lived
(Vélez & Diniz, 2016). Indeed early epidemiological results linking greater zika prevalence to higher
socioeconomic brackets have been shown to reﬂect the diﬀerential ability of women to pay for
screenings, with adjusted rates demonstrating a clear link between poverty and zika seroprevalence
(Lee et al., 2017).
The issue of gender gaps however, is separate (though related) to diﬀerential gender burden
highlighted from gender analyses in epidemic or crisis policy, since it is rooted ﬁrmly in the biocultural and not merely the cultural. This in practice means that an epidemiological diﬀerence
observed between males and females, in the absence of a purely biological causative explanation
(which would be a sex, and not a gender, gap), is primarily caused by diﬀerential patterns in risk
behaviours. These are transmission-related behaviours which though enacted on a physical, social
level, are themselves constructed though gendered culture. It is important to recognise this is not
the same, and in fact COVID-19 illustrates this very well: a male-predominated gender gap has been
observed (Zhao et al., 2020), which suggests that behavioural patterns associated with ‘male’ gender
predispose men to higher infection risk. Even given this, however, it has still been suggested in the
literature that women are at higher diﬀerential risk of adverse eﬀects. This may be due not only to
their socioculturally more vulnerable positions, again largely as caregivers (Wenham et al., 2020),
but also given the potential for gender violence and abuse during epidemics and their aftermath, as
seen during the co-epidemic of sexual and gender violence during the 2013–2015 Ebola outbreak
(Menéndez et al., 2015; Minor, 2017; Onyango et al., 2019).
One caveat should be noted in the study of gender in epidemics: that is that epidemiological
reporting statistics do not necessarily reﬂect a ‘true’ epidemiological reality at the population
level, and that is because they are largely a reﬂection of the number of hospital register cases.
This means that people who are asymptomatic, or do not report to hospitals (for example because
they cannot aﬀord time oﬀ work in the case of mild to moderate symptoms, or do not rate them as
important), will not be registered in such statistics. These measures therefore reﬂect rather a combination of both the likely true distribution of cases and the behaviour of people reporting to medical services. However, most research has strongly argued that this eﬀect is more strongly seen in
GLOBAL PUBLIC HEALTH
25
women, that is to say, that women are characterised in health psychology studies as more risk-averse
and generally more risk-aware (Harrant & Vaillant, 2008), thus they report to hospital more. This
has been argued to be the core reason for some gender gaps, such as in arboviruses, in the past
(Casapulla et al., 2018), although a link between risk aversion and diﬀerences in hospital treatment
seeking behaviours is not always well-supported (Hunt et al., 2011). However, this same ‘universal’
(i.e. psychological not cultural) argument is hard to employ in the case of COVID-19, since the gender gap shows that men, rather than women, register more cases, despite evidence from Chinese
surveys that men employ more risk-avoidance behaviours in the case of COVID-19 (Zhan et al.,
2020). This echoes to some extent tuberculosis gender gaps, where both seroepidemiological and
epidemiological studies have shown higher proportions of males, largely argued to result from
diﬀerential patterns in smoking (Watkins & Plant, 2006), another biocultural activity. In the context
of the COVID-19 outbreak therefore, this may be a factor, although if it is we might expect to see the
same inter-country diﬀerences in the COVID-19 gender gap as for tuberculosis. An initial study in
this area found a weak but not signiﬁcant correlation between smoking and infection severity
(Zhang et al., 2020), but it should be noted that the small sample size was likely a constraining factor. An additional possibility may be diﬀerences in gender-based transmission networks; for
example, higher superspreading due to diﬀerent working conditions for men than women. It
remains to be seen from potential seroepidemiological studies of COVID-19 therefore, how well
these reporting distributions may reﬂect population level distributions of infection.
International inequalities as a biocultural framework for structural risk in context
of pandemics
One of the themes well-illustrated by the COVID-19 outbreak is equally true for many other pandemics: the issue of inequality on an international level and its relation with the diﬀerential impact
of such pandemics. This diﬀerential impact is reﬂected not only in potential economic costs, – as it
can reasonably be assumed that this this will be much greater in weakened economic areas such as
Latin America than in Western European nations and the United States – but also bioculturally. In
countries with higher burdens of corruption, the potential COVID-19 burden may be particularly
great in poorer communities with less capacity to access healthcare and given social security during
such outbreaks is likely to be especially weak. Such eﬀects may be medicated through existing
implementation failures of infrastructure budgets (Gillanders, 2014), resulting in communities
exposed to higher diﬀerential infection risk, even if direct public health spending has a complex
relationship with corruption measures (Factor & Kang, 2015; Swaleheen et al., 2019).
This means that during quarantine measures social support, if advanced at all, may not reach the
most vulnerable communities and individuals. The link between socioeconomic inequality and disease burden has already been well established in social epidemiology (Marmot & Bell, 2016). In
recent years, reviews have also tentatively advanced the same link between infectious diseases epidemics and socioeconomic status (Houweling et al., 2016), albeit without necessarily expanding
greatly on social–biological linkages that might provide causative mechanisms. However, in slum
communities we can reasonably draw some broad hypotheses, such as the lack of treated water,
lack of consistent water supply, lack of reliable infrastructure for solid waste disposal, lack of drainage systems, poor housing quality and high population density (Butala et al., 2010; Turley et al.,
2013). In the context of the current outbreak, this also has implications in terms of being able to
contain the spread of the epidemic, since it is unlikely that the inhabitants of such areas will be
able to aﬀord personal protective equipment, highlighting a primary socioeconomic inequality in
risk.
Secondly, poor sanitation and water supplies in these areas will complicate the need for frequent
hand washing and cleaning of shared surfaces, potentially increasing the role of indirect transmission networks, which has already in higher income settings been shown to be signiﬁcant (Cai
et al., 2020). Issues with sanitation are also relevant in the context of uncertainties regarding
26
A. FRIEDLER
oral–faecal transmission (Gu et al., 2020), which in low-resource and slum settings has the potential
to further spread the virus, even with quarantine measures in place. Since many people in these
areas need to work on a daily basis to support themselves and their families, implementing quarantine will be especially challenging.
Such measures will therefore take a disproportionate social, economic and health toll on the
poorest communities and this will be further underlined in countries that may not have the budgets
to invest in systems of emergency social support. The World Health Organisation COVID-19 Solidarity Response Fund that has been established to tackle shortcomings and gaps in managing the
pandemic is therefore important in this regard, but its distribution and careful follow-up of funds to
ensure they are reaching communities most in need will be critical in minimising human suﬀering
during the outbreak. In the context of more extreme measures such as quarantine, ensuring that
most vulnerable groups such as women and girls in the poorest communities receive adequate support will be important. This will help avoid a repeat of abuses that occurred during Ebola quarantine
measures, such as sexual violence, inability to access basic maternity care and reports of women
trading sex for basic necessities during quarantine (Davies & Bennett, 2016; Eba, 2014; Korkoyah
& Wreh, 2015; Minor, 2017; Onyango et al., 2019).
It is worth mentioning that the distribution of cases and deaths has so far at the time of writing
shown great variation. Several explanations have already been put forward to explain this, such as
ﬂight connectivity (especially with reference to China) and reporting bias (Niehus et al., 2020) –
that is to say, the stronger economies will be more likely to have adequate public health reporting
systems. In countries with high political instability, there is also the potential for this data to be
actively supressed by governmental sources, as has been suggested to be the case currently in Syria
(Gharibah & Mehchy, 2020). A less extreme version of this can however, be seen in highly developed countries such as the United States, where early reports of COVID-19 were rebuﬀed by the
president as politically motivated conspiracies (Dyer, 2020). The interaction of political and
medical factors therefore may be critical in determining the early course of the pandemic on a
country level.
What should also be noted is that there has been a marked lack in the literature so far of collaborations between those analysing capacity and health system inequalities in developing countries’
abilities to cope with COVID-19 (Gilbert et al., 2020), and those working in climatic modelling
(Araujo & Naimi, 2020). This leaves gaps in the ability to identify zones that have intersecting socioeconomic, cultural and climatic vulnerabilities and further highlights the need for interdisciplinary
work in the context of pandemics.
Other key areas of diﬀerential biocultural risk within societies include conﬂict zones, fragile
states with weakened health systems, refugee camps and areas experiencing mass exoduses of people
– the latter of which is ongoing from Venezuela and has already been linked to increases in infectious disease incidence (Rodriguez-Morales et al., 2020). The impact of infectious diseases in
relation to these other factors is complex and has been less explored, although there is some evidence that the poor conditions and lack of medical supplies in conﬂict zones and refugee camps
are associated with increased epidemic outbreaks. For example, the re-emergence of leishmaniasis
in the Middle East in the wake of the war in Syria (Alawieh et al., 2014) and increases in tuberculosis
and cholera in refugee camps (Cookson et al., 2015; Phares & Ortega, 2014). In the context of the
COVID-19 outbreak, both of these examples are relevant, due to established droplet transmission
and also for possible oral–faecal transmission if sanitation is not adequate – both of which may
ampliﬁed in conditions of overcrowding.
Pandemic politics as biocultural dynamics writ large
Wider biocultural dimensions impinge on the biopolitics of pandemics: international governmental
cultures and their interactions may ultimately produce changes in pathogen dynamics through policy decisions. For example, one important issue to draw on from previous pandemics is
GLOBAL PUBLIC HEALTH
27
government-level ‘hoarding’ of supplies such as personal protective equipment, even in the context
of severe shortages in other countries. This was illustrated during the H5N1 epidemic, when
Material Transfer Agreements between the World Health Organization (WHO) and pharmaceutical companies were made without the involvement of the most impacted countries that had
provided viral samples such as Indonesia. Such moves allowed wealthier nations to hoard vaccine
capacity through pre-production agreements, despite their proportionally lower risk (KamradtScott & Lee, 2011). This raises important questions for the distribution of potential antiviral
drugs in the context of narratives concerning global health inequalities at a political level in pandemic policies. This is underlined by questions of international cooperation between non-allied
countries, such as the United States and Iran, where the impact of sanctions has been blamed for
severe shortages of medical and laboratory supplies and consequently for the severity of the
COVID-19 epidemic in Iran (Takian et al., 2020).
Further topics to explore in the context of potential diﬀerential burdens of COVID-19 internationally include the politics of vaccine and drug development, which currently rest largely in
the hands of pharmaceutical companies (Chakravarthy et al., 2016). The research priorities of
such companies are naturally shaped by expected ﬁnancial returns on investment, to the detriment of diseases that do not impact the richest nations, regardless of estimates of need or mortality (Trouiller et al., 2002). This further adds to global biopolitical inequalities in the context of
pandemics, where the richest populations will also be prioritised in terms of research and development, rather than those most at risk. Additionally, in the context of a public health crisis, it has
the potential to slow responses if the ﬁnancial return is uncertain due to the lack of investment
into potential drug and vaccine solutions. This further highlights the importance of emerging
models of broad public–private collaborations such as Coalition for Epidemic Preparedness Innovations (CEPI), one of the sources of research and funding for COVID-19 vaccine candidates
(Brende et al., 2017; Cohen, 2020). Ensuring that all countries have fair and economically adjusted
access to antiviral drugs and potential vaccines against COVID-19 – as well as reviewing such
research relationships in the context of future preparedness responses – will therefore be vital
areas of policy focus.
Conclusion
The biocultural spans those dynamics of human behaviour that are socially constructed in nature,
and how such factors fundamentally shape and direct the co-evolution of pathogen behaviours.
This is necessarily very broad in scope, uniting as it does many constructed identities, realities and
inequalities, from a highly local to international level, from the individual to the international
relations sphere of nations and organisations. In this way, academia and global health policy –
still western-dominated institutions – can simultaneously examine the cultural and geopolitical
assumptions in which they are themselves constructed whilst pursuing an understanding of biosocial relationships and inequalities in individual communities. Now that we must apply such
understandings to a pandemic like COVID-19 and not merely an epidemic, such an inclusive
view will be especially important. Ultimately, a biocultural view emphasises what the COVID19 pandemic has reinforced in our current understandings of pathogen–human dynamics: that
our behaviours, our cultures and societies, are fundamental drivers of pathogen emergence.
We are in many ways therefore, the architects of our own pandemics: understanding how and
why may help us to tackle not only the COVID-19 pandemic but better anticipate the sources
and dynamics of future pandemics.
Disclosure statement
No potential conﬂict of interest was reported by the author(s).
28
A. FRIEDLER
Funding
This work was supported by H2020 Marie Skłodowska-Curie Actions [grant number 665850].
ORCID
Anna Friedler
http://orcid.org/0000-0002-3008-743X
References
Ahmad, T., & Hui, J. (2020). One health approach and coronavirus disease 2019. Human Vaccines &
Immunotherapeutics, 1–2. https://doi.org/10.1080/21645515.2020.1732168
Ahn, M., Anderson, D. E., Zhang, Q., Tan, C. W., Lim, B. L., Luko, K., Wen, M., Chia, W. N., Mani, S., Wang, L. C.,
Ng, J. H. J., Sobota, R. M., Dutertre, C.-A., Ginhoux, F., Shi, Z.-L., Irving, A. T., & Wang, L.-F. (2019). Dampened
NLRP3-mediated inﬂammation in bats and implications for a special viral reservoir host. Nat Microbiol, 4, 789–
799. https://doi.org/10.1038/s41564-019-0371-3
Alawieh, A., Musharraﬁeh, U., Jaber, A., Berry, A., Ghosn, N., & Bizri, A. R. (2014). Revisiting leishmaniasis in the
time of war: The Syrian conﬂict and the Lebanese outbreak. International Journal of Infectious Diseases, 29, 115–
119. https://doi.org/10.1016/j.ijid.2014.04.023
Albertini, M., & Kohli, M. (2013). The generational contract in the family: An analysis of transfer regimes in Europe.
European Sociological Review, 29, 828–840. https://doi.org/10.1093/esr/jcs061
Alexander, K. A., Sanderson, C. E., Marathe, M., Lewis, B. L., Rivers, C. M., Shaman, J., Drake, J. M., Lofgren, E.,
Dato, V. M., Eisenberg, M. C., & Eubank, S. (2015). What factors might have Led to the emergence of Ebola in
West Africa? PLOS Neglected Tropical Diseases, 9, e0003652. https://doi.org/10.1371/journal.pntd.0003652
Ali, S. H., & Keil, R. (2006). Global cities and the spread of infectious disease: The case of severe acute respiratory
syndrome (SARS) in Toronto, Canada. Urban Studies (edinburgh, Scotland), 43, 491–509. https://doi.org/10.
1080/00420980500452458
Araujo, M. B., & Naimi, B. (2020). Spread of SARS-CoV-2 coronavirus likely to be constrained by climate. medRxiv.
https://doi.org/10.1101/2020.03.12.20034728
Barbosa, C. S. (1998). Epidemiology and anthropology: An integrated approach dealing with bio-socio-cultural
aspects as strategy for the control of endemic diseases. Memórias do Instituto Oswaldo Cruz, 93, 59–62. https://
doi.org/10.1590/S0074-02761998000700008
Barrett, C. L., Bisset, K. R., Eubank, S. G., Xizhou, F., & Marathe, M. V. (2008). EpiSimdemics: An eﬃcient algorithm
for simulating the spread of infectious disease over large realistic social networks, in: SC ‘08: Proceedings of the
2008 ACM/IEEE Conference on Supercomputing. Presented at the SC ‘08: Proceedings of the 2008 ACM/IEEE
Conference on Supercomputing, pp. 1–12. https://doi.org/10.1109/SC.2008.5214892.
Bauch, C. T., & Galvani, A. P. (2013). Social factors in epidemiology. Science, 342, 47–49. https://doi.org/10.1126/
science.1244492
Bauer, G. R. (2014). Incorporating intersectionality theory into population health research methodology: Challenges
and the potential to advance health equity. Social Science & Medicine, 110, 10–17. https://doi.org/10.1016/j.
socscimed.2014.03.022
Beisel, U. (2015). Markets and Mutations: Mosquito nets and the politics of disentanglement in global health.
Geoforum; Journal of Physical, Human, and Regional Geosciences, 66, 146–155. https://doi.org/10.1016/j.
geoforum.2015.06.013
Benson, T. C. (1982). Five arguments against interdisciplinary studies. Issues in Integrative Studies 1.
Bhui, K. (2009). The new science of cultural epidemiology to tackle ethnic health inequalities. J Public Health (Oxf),
31, 322–323. https://doi.org/10.1093/pubmed/fdp071
Bocking, N., Matsumoto, C., Loewen, K., Teatero, S., Marchand-Austin, A., Gordon, J., Fittipaldi, N., & McGeer, A.
(2017). High incidence of Invasive group A streptococcal infections in remote indigenous communities in
Northwestern Ontario, Canada. Open Forum infectious Diseases, 4. https://doi.org/10.1093/oﬁd/ofw243
Bowden, W. P., Rhodes, S. D., Wilkin, A. M., & Jolly, C. P. (2006). Sociocultural determinants of HIV/AIDS risk and
service use among immigrant Latinos in North Carolina. Hispanic Journal of Behavioral Sciences, 28, 546–562.
https://doi.org/10.1177/0739986306292295
Brende, B., Farrar, J., Gashumba, D., Moedas, C., Mundel, T., Shiozaki, Y., Vardhan, H., Wanka, J., & Røttingen, J.-A.
(2017). CEPI—a new global R&D organisation for epidemic preparedness and response. The Lancet, 389, 233–235.
https://doi.org/10.1016/S0140-6736(17)30131-9
Brook, C. E., & Dobson, A. P. (2015). Bats as ‘special’ reservoirs for emerging zoonotic pathogens. Trends in
Microbiology, 23, 172–180. https://doi.org/10.1016/j.tim.2014.12.004
Buckee, C. O., Koelle, K., Mustard, M. J., & Gupta, S. (2004). The eﬀects of host contact network structure on pathogen diversity and strain structure. PNAS, 101, 10839–10844. https://doi.org/10.1073/pnas.0402000101
GLOBAL PUBLIC HEALTH
29
Butala, N. M., VanRooyen, M. J., & Patel, R. B. (2010). Improved health outcomes in urban slums through infrastructure upgrading. Social Science & Medicine, 71, 935–940. https://doi.org/10.1016/j.socscimed.2010.05.037
Cai, J., Sun, W., Huang, J., Gamber, M., Wu, J., & He, G. (2020). Indirect virus transmission in cluster of COVID-19
cases, Wenzhou, China, 2020. Emerging Infect. Dis., 26. https://doi.org/10.3201/eid2606.200412
Casapulla, S. L., Aidoo-Frimpong, G., Basta, T. B., & Grijalva, M. J. (2018). Zika virus knowledge and attitudes in
Ecuador. aimsph, 5, 49–63. https://doi.org/10.3934/publichealth.2018.1.49
Cauchemez, S., Bhattarai, A., Marchbanks, T. L., Fagan, R. P., Ostroﬀ, S., Ferguson, N. M., Swerdlow, D., & the
Pennsylvania H1N1 working group. (2011). Role of social networks in shaping disease transmission during a community outbreak of 2009 H1N1 pandemic inﬂuenza. PNAS 108, 2825–2830. https://doi.org/10.1073/pnas.
1008895108
Chakravarthy, R., Cotter, K., DiMasi, J., Milne, C.-P., & Wendel, N. (2016). Public- and private-sector contributions
to the research and development of the most transformational drugs in the past 25 years: From theory to therapy.
Drug Information Journal, 50, 759–768. https://doi.org/10.1177/2168479016648730
Chausson, A. M., Rowcliﬀe, J. M., Escouﬂaire, L., Wieland, M., & Wright, J. H. (2019). Understanding the sociocultural drivers of urban bushmeat consumption for behavior change interventions in Pointe Noire, Republic of
Congo. Human Ecology, 47, 179–191. https://doi.org/10.1007/s10745-019-0061-z
Cheung, F. (2011). TCM: Made in China. Nature, 480, S82–S83. https://doi.org/10.1038/480S82a
Christley, R. M., Pinchbeck, G. L., Bowers, R. G., Clancy, D., French, N. P., Bennett, R., & Turner, J. (2005). Infection
in social networks: Using network analysis to identify high-risk individuals. Am. J. Epidemiol, 162, 1024–1031.
https://doi.org/10.1093/aje/kwi308
Chua, K. B. (2003). Nipah virus outbreak in Malaysia. Journal of Clinical Virology, 26, 265–275. https://doi.org/10.
1016/S1386-6532(02)00268-8
Chua, K. B., Chua, B. H., & Wang, C. W. (2002). Anthropogenic deforestation, El Niño and the emergence of Nipah
virus in Malaysia. The Malaysian Journal of Pathology, 24, 15–21.
Cohen, J. (2020). New coronavirus threat galvanizes scientists. Science, 367, 492–493. https://doi.org/10.1126/science.
367.6477.492
Conrad, P.A., Meek, L.A., Dumit, J., 2013. Operationalizing a one health approach to global health challenges.
Comparative Immunology, Microbiology and Infectious Diseases, Special issue: One Health 36, 211–216. https://
doi.org/10.1016/j.cimid.2013.03.006
Cookson, S. T., Abaza, H., Clarke, K. R., Burton, A., Sabrah, N. A., Rumman, K. A., Odeh, N., & Naoum, M. (2015).
Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian
tuberculosis prevalence: Case study of a tuberculosis public health strategy. Conﬂict and Health, 9, 18. https://
doi.org/10.1186/s13031-015-0044-7
Copeland, T. (2018). To keep this disease from killing you: Cultural Competence, consonance, and health among
HIV-positive women in Kenya. Medical Anthropology Quarterly, 32, 272–292. https://doi.org/10.1111/maq.12402
Cui, J., Li, F., & Shi, Z.-L. (2019). Origin and evolution of pathogenic coronaviruses. Nature Reviews Microbiology, 17,
181–192. https://doi.org/10.1038/s41579-018-0118-9
Daszak, P., Zambrana-Torrelio, C., Bogich, T. L., Fernandez, M., Epstein, J. H., Murray, K. A., & Hamilton, H. (2013).
Interdisciplinary approaches to understanding disease emergence: The past, present, and future drivers of Nipah
virus emergence. PNAS, 110, 3681–3688. https://doi.org/10.1073/pnas.1201243109
Davies, S. E., & Bennett, B. (2016). A gendered human rights analysis of Ebola and zika: Locating gender in global
health emergencies. International Aﬀairs, 92, 1041–1060. https://doi.org/10.1111/1468-2346.12704
de Passillé, A. M., & Rushen, J. (2005). Food safety and environmental issues in animal welfare. Rev. – Oﬀ. Int. Epizoot,
24, 757–766.
Depoux, A., Martin, S., Karaﬁllakis, E., Preet, R., Wilder-Smith, A., & Larson, H. (2020). The pandemic of social
media panic travels faster than the COVID-19 outbreak. J Travel Med., https://doi.org/10.1093/jtm/taaa031
DiGiacomo, S. M. (1999). Can there be a “cultural epidemiology”? Medical Anthropology Quarterly, 13, 436–457.
https://doi.org/10.1525/maq.1999.13.4.436
Donnelly, B., Berrang-Ford, L., Labbé, J., Twesigomwe, S., Lwasa, S., Namanya, D. B., Harper, S. L., Kulkarni, M.,
Ross, N. A., Michel, P., & Research Team, I. H. A. C. C. (2016). Plasmodium falciparum malaria parasitaemia
among indigenous Batwa and non-indigenous communities of Kanungu district, Uganda. Malaria Journal, 15,
254. https://doi.org/10.1186/s12936-016-1299-1
Dowd, J. B., Rotondi, V., Adriano, L., Brazel, D. M., Block, P., Ding, X., Liu, Y., & Mills, M. C. (2020). Demographic
science aids in understanding the spread and fatality rates of COVID-19. medRxiv, https://doi.org/10.1101/2020.
03.15.20036293
Dressler, W. (2016). “What’s cultural about biocultural research?” – Revisited. Annual Meeting of the American
Anthropological Association, Minneapolis, MN.
Dyer, O. (2020). Trump claims public health warnings on COVID-19 are a conspiracy against him. BMJ, 368. https://
doi.org/10.1136/bmj.m941
Eba, P. M. (2014). Ebola and human rights in West Africa. The Lancet, 384, 2091–2093. https://doi.org/10.1016/
S0140-6736(14)61412-4
30
A. FRIEDLER
ECDC. 2018. Seasonal inﬂuenza vaccination and antiviral use in EU/EEA Member States. ISBN: 978-92-9498-296-4.
https://doi.org/10.2900/721517.
Engler, M. (2008). The value of international wildlife trade. TRAFFIC Bull, 22, 4–5.
Eubank, S., Guclu, H., Kumar, V. S. A., Marathe, M. V., Srinivasan, A., Toroczkai, Z., & Wang, N. (2004). Modelling
disease outbreaks in realistic urban social networks. Nature, 429, 180–184. https://doi.org/10.1038/nature02541
Eurostat. 2015. People in the EU – who are we and how do we live? ISBN: 978-92-79-50328-3. https://doi.org/10.2785/
40646.
Factor, R., & Kang, M. (2015). Corruption and population health outcomes: An analysis of data from 133 countries
using structural equation modeling. International Journal of Public Health, 60, 633–641. https://doi.org/10.1007/
s00038-015-0687-6
Floridi, G. (2018). Social policies and intergenerational support in Italy and South Korea. Contemporary Social
Science, 1–16. https://doi.org/10.1080/21582041.2018.1448942
Gharibah, M., & Mehchy, Z. (2020). COVID-19 pandemic: Syria’s response and healthcare capacity [WWW
Document]. URL Retrieved January 4, 2020, from http://www.lse.ac.uk/international-development/conﬂictand-civil-society/conﬂict-research-programme/publications.
Gilbert, M., Pullano, G., Pinotti, F., Valdano, E., Poletto, C., Boëlle, P.-Y., D’Ortenzio, E., Yazdanpanah, Y., Eholie, S.
P., Altmann, M., Gutierrez, B., Kraemer, M. U. G., & Colizza, V. (2020). Preparedness and vulnerability of African
countries against importations of COVID-19: A modelling study. The Lancet, 395, 871–877. https://doi.org/10.
1016/S0140-6736(20)30411-6
Gillanders, R. (2014). Corruption and infrastructure at the country and regional level. The Journal of Development
Studies, 50, 803–819. https://doi.org/10.1080/00220388.2013.858126
Grubaugh, N. D., Ladner, J. T., Kraemer, M. U. G., Dudas, G., Tan, A. L., Gangavarapu, K., Wiley, M. R., White, S.,
Thézé, J., Magnani, D. M., Prieto, K., Reyes, D., Bingham, A. M., Paul, L. M., Robles-Sikisaka, R., Oliveira, G.,
Pronty, D., Barcellona, C. M., Metsky, H. C., … Andersen, K. G. (2017). Genomic epidemiology reveals multiple
introductions of zika virus into the United States. Nature, 546, 401–405. https://doi.org/10.1038/nature22400
Gu, J., Han, B., & Wang, J. (2020). COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission.
Gastroenterology, https://doi.org/10.1053/j.gastro.2020.02.054
Gu, E., & Li, L. (2020). Crippled community governance and suppressed scientiﬁc/professional communities: A critical assessment of failed early warning for the COVID-19 outbreak in China. Journal of Chinese Governance, 1–18.
https://doi.org/10.1080/23812346.2020.1740468
Harrant, V., & Vaillant, N. G. (2008). Are women less risk averse than men? The eﬀect of impending death on risktaking behavior. Evolution and Human Behavior, 29, 396–401. https://doi.org/10.1016/j.evolhumbehav.2008.05.
003
Hayman, D. T. S. (2016). Bats as viral reservoirs. Annu. Rev. Virol, 3, 77–99. https://doi.org/10.1146/annurevvirology-110615-042203
Hayman, D. T. S. (2019). Bat tolerance to viral infections. Nat Microbiol, 4, 728–729. https://doi.org/10.1038/s41564019-0430-9
Houweling, T. A. J., Karim-Kos, H. E., Kulik, M. C., Stolk, W. A., Haagsma, J. A., Lenk, E. J., Richardus, J. H., & de
Vlas, S. J. (2016). Socioeconomic inequalities in neglected tropical diseases: A systematic review. PLOS Neglected
Tropical Diseases, 10, e0004546. https://doi.org/10.1371/journal.pntd.0004546
Hsu, E. (2008). The history of Chinese medicine in the people’s Republic of China and its globalization. East Asian
Science, Technology and Society, 2, 465–484. https://doi.org/10.1215/s12280-009-9072-y
Hunt, K., Adamson, J., Hewitt, C., & Nazareth, I. (2011). Do women consult more than men? A review of gender and
consultation for back pain and headache. Journal of Health Services Research & Policy, 16, 108–117. https://doi.
org/10.1258/jhsrp.2010.009131
Jarama, S. L., Belgrave, F. Z., Bradford, J., Young, M., & Honnold, J. A. (2007). Family, cultural and gender role
aspects in the context of HIV risk among African American women of unidentiﬁed HIV status: An exploratory
qualitative study. AIDS Care, 19, 307–317. https://doi.org/10.1080/09540120600790285
Ji, W., Wang, W., Zhao, X., Zai, J., & Li, X. (2020). Cross-species transmission of the newly identiﬁed coronavirus
2019-nCoV. Journal of Medical Virology, 92, 433–440. https://doi.org/10.1002/jmv.25682
Johnson, C. K., Hitchens, P. L., Evans, T. S., Goldstein, T., Thomas, K., Clements, A., Joly, D. O., Wolfe, N. D.,
Daszak, P., Karesh, W. B., & Mazet, J. K. (2015). Spillover and pandemic properties of zoonotic viruses with
high host plasticity. Scientiﬁc Reports, 5, 1–8. https://doi.org/10.1038/srep14830
Jones, B. A., Grace, D., Kock, R., Alonso, S., Rushton, J., Said, M. Y., McKeever, D., Mutua, F., Young, J., McDermott,
J., & Pfeiﬀer, D. U. (2013). Zoonosis emergence linked to agricultural intensiﬁcation and environmental change.
PNAS, 110, 8399–8404. https://doi.org/10.1073/pnas.1208059110
Jones, K. E., Patel, N. G., Levy, M. A., Storeygard, A., Balk, D., Gittleman, J. L., & Daszak, P. (2008). Global trends in
emerging infectious diseases. Nature, 451, 990–993. https://doi.org/10.1038/nature06536
Jorgensen, P., Mereckiene, J., Cotter, S., Johansen, K., Tsolova, S., & Brown, C. (2018). How close are countries of the
WHO European Region to achieving the goal of vaccinating 75% of key risk groups against inﬂuenza? Results
GLOBAL PUBLIC HEALTH
31
from national surveys on seasonal inﬂuenza vaccination programmes, 2008/2009 to 2014/2015. Vaccine, 36, 442–
452. https://doi.org/10.1016/j.vaccine.2017.12.019
Kalmijn, M., & Saraceno, C. (2008). A comparative perspective on intergenerational support: Responsiveness to parental needs in individualistic and familialistic countries. International Journal of Cooperative Information Systems IJCIS, 10, 479–508. https://doi.org/10.1080/14616690701744364
Kamradt-Scott, A., & Lee, K. (2011). The 2011 pandemic inﬂuenza preparedness framework: Global health Secured
or a Missed opportunity? Political Studies, 59, 831–847. https://doi.org/10.1111/j.1467-9248.2011.00926.x
Keck, F. (2012). Live poultry markets and avian Flu in Hong Kong. In L. Coleman (Ed.), Food: Ethnographic encounters (pp. 49–58). Berg Publishers.
Kelly, A. H., & Lezaun, J. (2014). Urban mosquitoes, situational publics, and the pursuit of interspecies separation in
Dar es Salaam. American Ethnologist, 41, 368–383. https://doi.org/10.1111/amet.12081
Kennedy, J. (2019). Populist politics and vaccine hesitancy in Western Europe: An analysis of national-level data.
European Journal of Public Health, 29, 512–516. https://doi.org/10.1093/eurpub/ckz004
Kieslich, K. (2018). Addressing vaccination hesitancy in Europe: A case study in state–society relations. Eur J Public
H`Ealth, 28, 30–33. https://doi.org/10.1093/eurpub/cky155
Kim, T., & Han, C. (2012). Medicine within society, society within medicine : An anthropological exploration of
Korean medicine in South Korea and traditional Chinese medicine in China. The Journal of Internal Korean
Medicine, 33, 111–125.
Klepac, P., Kucharski, A. J., Conlan, A. J., Kissler, S., Tang, M., Fry, H., & Gog, J. R. (2020). Contacts in context: Largescale setting-speciﬁc social mixing matrices from the BBC pandemic project. medRxiv, https://doi.org/10.1101/
2020.02.16.20023754
Korkoyah, D.T., & Wreh, F.F.. (2015). Ebola Impact Revealed: An assessment of the diﬀering impact of the outbreak
on the women and men in Liberia. Oxfam. http://policy-practice.oxfam.org.uk/publications/ebola-impactrevealed-an-assessment-of-the-diﬀering-impact-of-the-outbreak-on-581371
Leach, M., & Tadros, M. (2014). Epidemics and the politics of knowledge: Contested narratives in Egypt’s H1N1
Response. Medical Anthropology, 33, 240–254. https://doi.org/10.1080/01459740.2013.842565
Leatherman, T., & Goodman, A. (2019). Building on the biocultural syntheses: 20 years and still expanding. American
Journal of Human Biology, e23360. https://doi.org/10.1002/ajhb.23360
Lee, C. T., Greene, S. K., Baumgartner, J., & Fine, A. (2017). Disparities in zika virus testing and incidence among
women of reproductive age-New York city, 2016. Journal of Public Health Management and Practice, https://
doi.org/10.1097/PHH.0000000000000684
Leventhal, G. E., Hill, A. L., Nowak, M. A., & Bonhoeﬀer, S. (2015). Evolution and emergence of infectious diseases in
theoretical and real-world networks. Nature Communications, 6, 6101. https://doi.org/10.1038/ncomms7101
Li, J., Li, J., Xie, X., Cai, X., Huang, J., Tian, X., & Zhu, H. (2020). Game consumption and the 2019 novel coronavirus.
The Lancet Infectious Diseases, 20, 275–276. https://doi.org/10.1016/S1473-3099(20)30063-3
Li, X., Xu, X., Wang, J., Yu, H., Wang, X., Yang, H., Xu, H., Tang, S., Li, Y., Yang, L., Huang, L., Wang, Y., & Yang, S.
(2012). A system-level Investigation into the mechanisms of Chinese traditional medicine: Compound Danshen
formula for cardiovascular disease treatment. PLoS ONE, 7. https://doi.org/10.1371/journal.pone.0043918
Liu, T. (2008). Custom, taste and science: Raising chickens in the Pearl River Delta Region, South China.
Anthropology & Medicine, 15, 7–18. https://doi.org/10.1080/13648470801918992
Lock, M. (2017). Recovering the body. Annual Review of Anthropology, 46, 1–14. https://doi.org/10.1146/annurevanthro-102116-041253
Lowe, C. (2010). VIRAL CLOUDS: Becoming H5N1 in Indonesia. Cultural Anthropology, 25, 625–649. https://doi.
org/10.1111/j.1548-1360.2010.01072.x
Lynteris, C. (2016). The prophetic faculty of epidemic photography: Chinese wet markets and the Imagination of the
Next pandemic. Visual Anthropology, 29, 118–132. https://doi.org/10.1080/08949468.2016.1131484
Ma, H.-D., Deng, Y.-R., Tian, Z., & Lian, Z.-X. (2013). Traditional Chinese medicine and immune regulation. Clinic
Rev Allerg Immunol, 44, 229–241. https://doi.org/10.1007/s12016-012-8332-0
Manyi-Loh, C., Mamphweli, S., Meyer, E., & Okoh, A. (2018). Antibiotic use in agriculture and its consequential
resistance in environmental sources: Potential public health implications. Molecules, 23. https://doi.org/10.
3390/molecules23040795
Manzoli, L., Gabutti, G., Siliquini, R., Flacco, M. E., Villari, P., & Ricciardi, W. (2018). Association between vaccination coverage decline and inﬂuenza incidence rise among Italian elderly. European Journal of Public Health,
28, 740–742. https://doi.org/10.1093/eurpub/cky053
Marano, G., Pariani, E., Luconi, E., Pellegrinelli, L., Galli, C., Magoni, M., Piro, A., Scarcella, C., Biganzoli, E. M.,
Boracchi, P., & Castaldi, S. (2020). Elderly people: Propensity to be vaccinated for seasonal inﬂuenza in Italy.
Human Vaccines & Immunotherapeutics, 1–10. https://doi.org/10.1080/21645515.2019.1706931
Marmot, M., & Bell, R. (2016). Social inequalities in health: A proper concern of epidemiology. Annals of
Epidemiology, 26, 238–240. https://doi.org/10.1016/j.annepidem.2016.02.003
Menéndez, C., Lucas, A., Munguambe, K., & Langer, A. (2015). Ebola crisis: The unequal impact on women and children’s health. The Lancet Global Health, 3, e130. https://doi.org/10.1016/S2214-109X(15)70009-4
32
A. FRIEDLER
Meseko, C. A., Egbetade, A. O., & Fagbo, S. (2015). Ebola virus disease control in West Africa: An ecological, one
health approach. Pan African Medical Journal, 21. https://doi.org/10.4314/pamj.v21i1
Miller, M., Korves, C. T., & Fernandez, T. (2007). The social epidemiology of HIV transmission among African
American women who use drugs and their social network members. AIDS Care, 19, 858–865. https://doi.org/
10.1080/09540120701191540
Minor, O. M. (2017). Ebola and Accusation: Gender dimensions of stigma in Sierra Leone’s Ebola Response.
Anthropology in Action, 24, 25–35. https://doi.org/10.3167/aia.2017.240204
Moratelli, R., Calisher, C. H., Moratelli, R., & Calisher, C. H. (2015). Bats and zoonotic viruses: Can we conﬁdently
link bats with emerging deadly viruses? Memórias do Instituto Oswaldo Cruz, 110, 1–22. https://doi.org/10.1590/
0074-02760150048
Nading, A. M. (2012). Dengue mosquitoes are single mothers: Biopolitics meets ecological aesthetics in Nicaraguan
community health work. Cultural Anthropology, 27, 572–596. https://doi.org/10.1111/j.1548-1360.2012.01162.x
Negin, J., Aspin, C., Gadsden, T., & Reading, C. (2015). HIV among indigenous peoples: A review of the literature on
HIV-related behaviour since the beginning of the epidemic. AIDS and Behavior, 19, 1720–1734. https://doi.org/10.
1007/s10461-015-1023-0
Nhung, N. T., Van, N. T. B., Cuong, N. V., Duong, T. T. Q., Nhat, T. T., Hang, T. T. T., Nhi, N. T. H., Kiet, B. T., Hien,
V. B., Ngoc, P. T., Campbell, J., Thwaites, G., & Carrique-Mas, J. (2018). Antimicrobial residues and resistance
against critically important antimicrobials in non-typhoidal Salmonella from meat sold at wet markets and supermarkets in Vietnam. International Journal of Food Microbiology, 266, 301–309. https://doi.org/10.1016/j.
ijfoodmicro.2017.12.015
Niehus, R., Salazar, P. M. D., Taylor, A., & Lipsitch, M. (2020). Quantifying bias of COVID-19 prevalence and severity estimates in Wuhan, China that depend on reported cases in international travelers. medRxiv, https://doi.org/
10.1101/2020.02.13.20022707
OECD. 2011. Divided we stand: Why inequality keeps rising. OECD Publishing. https://doi.org/10.1787/
9789264119536-en
Onyango, M. A., Resnick, K., Davis, A., & Shah, R. R. (2019). Gender-Based violence Among Adolescent girls and
young women: A Neglected Consequence of the West African Ebola outbreak. In D. A. Schwartz, J. N. Anoko,
& S. A. Abramowitz (Eds.), Pregnant in the time of Ebola: Women and their children in the 2013-2015 West
African epidemic, global maternal and child health (pp. 121–132). Springer International Publishing. https://
doi.org/10.1007/978-3-319-97637-2_8
Ordaz-Németh, I., Arandjelovic, M., Boesch, L., Gatiso, T., Grimes, T., Kuehl, H. S., Lormie, M., Stephens, C., Tweh,
C., & Junker, J. (2017). The socio-economic drivers of bushmeat consumption during the West African Ebola crisis. PLOS Neglected Tropical Diseases, 11, e0005450. https://doi.org/10.1371/journal.pntd.0005450
Palsson, G. (2016). Unstable bodies: Biosocial perspectives on human variation. The Sociological Review Monographs,
64, 100–116. https://doi.org/10.1002/2059-7932.12015
Park, H.-L., Lee, H.-S., Shin, B.-C., Liu, J.-P., Shang, Q., Yamashita, H., & Lim, B. (2012). Traditional medicine in
China, Korea, and Japan: A brief introduction and comparison [WWW document]. Evidence-Based
Complementary and Alternative Medicine. https://doi.org/10.1155/2012/429103
Peck, K. M., & Lauring, A. S. (2018). Complexities of viral mutation rates. Journal of Virology, 92. https://doi.org/10.
1128/JVI.01031-17
Pellis, L., Ball, F., Bansal, S., Eames, K., House, T., Isham, V., & Trapman, P. (2015). Eight challenges for network
epidemic models. Epidemics, 10, 58–62. https://doi.org/10.1016/j.epidem.2014.07.003
Phares, C., & Ortega, L. (2014). Refugee health and cholera. Journal of Biochemistry and Molecular Biology, 58, iv–iv.
https://doi.org/10.1093/cid/cit762
Porter, N. (2013). Bird ﬂu biopower: Strategies for multispecies coexistence in Việt Nam. American Ethnologist, 40,
132–148. https://doi.org/10.1111/amet.12010
Poundstone, K. E., Strathdee, S. A., & Celentano, D. D. (2004). The social epidemiology of human Immunodeﬁciency
virus/acquired Immunodeﬁciency Syndrome. Epidemiologic Reviews, 26, 22–35. https://doi.org/10.1093/epirev/
mxh005
Qiu, J. (2007). China plans to modernize traditional medicine [WWW document]. Nature, https://doi.org/10.1038/
446590a
Rahman, M. H. A. A., Hairon, S. M., Hamat, R. A., Jamaluddin, T. Z. M. T., Shafei, M. N., Idris, N., Osman, M.,
Sukeri, S., Wahab, Z. A., Mohammad, W. M. Z. W., Idris, Z., & Daud, A. (2018). Seroprevalence and distribution
of leptospirosis serovars among wet market workers in northeastern, Malaysia: A cross sectional study. BMC
Infectious Diseases, 18, 569. https://doi.org/10.1186/s12879-018-3470-5
Ramenofsky, A. (2003). Native American disease history: Past, present and future directions. World Archaeology, 35,
241–257. https://doi.org/10.1080/0043824032000111407
Reiner, R. C., Stoddard, S. T., & Scott, T. W. (2014). Socially structured human movement shapes dengue transmission despite the diﬀusive eﬀect of mosquito dispersal. Epidemics, 6, 30–36. https://doi.org/10.1016/j.epidem.
2013.12.003
GLOBAL PUBLIC HEALTH
33
Ren, S.-Y., Gao, R.-D., & Chen, Y.-L. (2020). Fear can be more harmful than the severe acute respiratory syndrome
coronavirus 2 in controlling the corona virus disease 2019 epidemic. World Journal of Clinical Cases, 8, 652–657.
https://doi.org/10.12998/wjcc.v8.i4.652
Ribas, A., Saijuntha, W., Agatsuma, T., Prantlová, V., & Poonlaphdecha, S. (2016). Rodents as a source of Salmonella
contamination in wet markets in Thailand. Vector-Borne and Zoonotic Diseases, 16, 537–540. https://doi.org/10.
1089/vbz.2015.1894
Roca, I., Akova, M., Baquero, F., Carlet, J., Cavaleri, M., Coenen, S., Cohen, J., Findlay, D., Gyssens, I., Heure, O. E.,
Kahlmeter, G., Kruse, H., Laxminarayan, R., Liébana, E., López-Cerero, L., MacGowan, A., Martins, M.,
Rodríguez-Baño, J., Rolain, J.-M., … Vila, J. (2015). The global threat of antimicrobial resistance: Science for intervention. New Microbes and New Infections, 6, 22–29. https://doi.org/10.1016/j.nmni.2015.02.007
Rodríguez, S. G., & Velázquez, J. M. M. (2017). Social epidemiology in HIV/AIDS: What else should we consider to
prevent the HIV/AIDS progression? Social Work in Public Health, 32, 489–499. https://doi.org/10.1080/19371918.
2017.1365032
Rodriguez-Morales, A. J., Gallego, V., Escalera-Antezana, J. P., Méndez, C. A., Zambrano, L. I., Franco-Paredes, C.,
Suárez, J. A., Rodriguez-Enciso, H. D., Balbin-Ramon, G. J., Savio-Larriera, E., Risquez, A., & Cimerman, S.
(2020). COVID-19 in Latin America: The implications of the ﬁrst conﬁrmed case in Brazil. Travel Medicine
and Infectious Disease, https://doi.org/10.1016/j.tmaid.2020.101613
Romero-Sandoval, N. C., Flores-Carrera, O. F., Sánchez-Pérez, H. J., Sánchez-Pérez, I., & Mateo, M. M. (2007).
Pulmonary tuberculosis in an indigenous community in the mountains of Ecuador [WWW Document].
Retrieved March 25, 2020, from URL https://www.ingentaconnect.com/content/iuatld/ijtld/2007/00000011/
00000005/art00014.
Salami, D., Capinha, C., Martins, M. d. R. O., & Sousa, C. A. (2020). Dengue importation into Europe: A network
connectivity-based approach. PLoS One, 15. https://doi.org/10.1371/journal.pone.0230274
Serapioni, M. (2017). Economic crisis and inequalities in health systems in the countries of Southern Europe.
Cadernos de saude publica, 33, e00170116. https://doi.org/10.1590/0102-311X00170116
Shedlin, M. G., Decena, C. U., & Oliver-Velez, D. (2005). Initial acculturation and HIV risk among new Hispanic
immigrants. Journal of the National Medical Association, 97, 32S–37S.
Si, Z., Scott, S., McCordic, C. (2016). Supermarkets, wet markets and food patronage in Nanjing, China. https://doi.
org/10.13140/RG.2.2.12684.62089
Si, Z., Scott, S., & McCordic, C. (2019). Wet markets, supermarkets and alternative food sources: Consumers’ food
access in Nanjing, China. Canadian Journal of Development Studies / Revue Canadienne D’études du
Développement, 40, 78–96. https://doi.org/10.1080/02255189.2018.1442322
Sims, L. D., & Peiris, M. (2013). One health: The Hong Kong experience with avian inﬂuenza. In J. S. Mackenzie, M.
Jeggo, P. Daszak, & J. A. Richt (Eds.), One health: The human-animal-environment interfaces in emerging infectious
diseases: The concept and examples of a one health approach, current topics in microbiology and immunology (pp.
281–298). Springer. https://doi.org/10.1007/82_2012_254
Smith, J. (2019). Overcoming the ‘tyranny of the urgent’: Integrating gender into disease outbreak preparedness and
response. Gender & Development, 27, 355–369. https://doi.org/10.1080/13552074.2019.1615288
Stattner, E., & Vidot, N. (2011). Social network analysis in epidemiology: Current trends and perspectives, in: 2011
Fifth international conference on research challenges in information science. presented at the 2011 ﬁfth international conference on research challenges in information science (pp. 1–11). https://doi.org/10.1109/RCIS.
2011.6006866
Stefanska, I., Romanowska, M., Donevski, S., Gawryluk, D., & Brydak, L. B. (2013). Co-infections with inﬂuenza and
other respiratory viruses. Adv. Exp. Med. Biol, 756, 291–301. https://doi.org/10.1007/978-94-007-4549-0_36
Stein, R. A. (2011). Super-spreaders in infectious diseases. International Journal of Infectious Diseases, 15, e510–e513.
https://doi.org/10.1016/j.ijid.2010.06.020
Still, J. (2003). Use of animal products in traditional Chinese medicine: Environmental impact and health hazards.
Complementary Therapies in Medicine, 11, 118–122. https://doi.org/10.1016/S0965-2299(03)00055-4
Swaleheen, M., Ali, M. S. B., & Temimi, A. (2019). Corruption and public spending on education and health. Applied
Economics Letters, 26, 321–325. https://doi.org/10.1080/13504851.2018.1468549
Syed, J., & Ali, F. (2011). The white woman’s burden: From colonial civilisation to third world development. Third
World Quarterly, 32, 349–365. https://doi.org/10.1080/01436597.2011.560473
Takian, A., Raooﬁ, A., & Kazempour-Ardebili, S. (2020). COVID-19 battle during the toughest sanctions against Iran.
The Lancet, https://doi.org/10.1016/S0140-6736(20)30668-1
Tian, H., Sun, Z., Faria, N. R., Yang, J., Cazelles, B., Huang, S., Xu, B., Yang, Q., Pybus, O. G., & Xu, B. (2017).
Increasing airline travel may facilitate co-circulation of multiple dengue virus serotypes in Asia. Plos Neglected
Tropical Diseases, 11. https://doi.org/10.1371/journal.pntd.0005694
Törnberg, P. (2018). Echo chambers and viral misinformation: Modeling fake news as complex contagion. PLoS
ONE, 13, e0203958. https://doi.org/10.1371/journal.pone.0203958
34
A. FRIEDLER
Trouiller, P., Olliaro, P., Torreele, E., Orbinski, J., Laing, R., & Ford, N. (2002). Drug development for neglected diseases: A deﬁcient market and a public-health policy failure. The Lancet, 359, 2188–2194. https://doi.org/10.1016/
S0140-6736(02)09096-7
Tsai, J., & Wilson, M. (2020). COVID-19: A potential public health problem for homeless populations. The Lancet
Public Health. https://doi.org/10.1016/S2468-2667(20)30053-0
Tuite, A. R., Gallant, V., Randell, E., Bourgeois, A.-C., & Greer, A. L. (2017). Stochastic agent-based modeling of
tuberculosis in Canadian indigenous communities. BMC Public Health, 17, 73. https://doi.org/10.1186/s12889016-3996-7
Turley, R., Saith, R., Bhan, N., Rehfuess, E., & Carter, B. (2013). Slum upgrading strategies involving physical environment and infrastructure interventions and their eﬀects on health and socio-economic outcomes. Cochrane
Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010067.pub2
Uhart, M., Pérez, A., Rostal, M., Alandia, E., Mendoza, A.P., Nava, A., Paula, C., Miranda, F., Iniguez, V., ZambranaTorrelio, C., Durigon, E., Franco, P., Joly, D., Goldstein, T., Karesh, W., & Mazet, J. (2012). A ‘one health’
approach to predict emerging zoonoses in the Amazon. https://doi.org/10.13140/RG.2.1.3549.1609
Unit, B. (2018). Connecting global priorities: Biodiversity and human health, a state of knowledge review [WWW
Document]. Retrieved March 29, 2020, from URL https://www.cbd.int/health/stateofknowledge/.
van der Hoek, W., Morroy, G., Renders, N. H. M., Wever, P. C., Hermans, M. H. A., Leenders, A. C. A. P., &
Schneeberger, P. M. (2012). Epidemic Q fever in humans in the Netherlands. Adv. Exp. Med. Biol, 984, 329–
364. https://doi.org/10.1007/978-94-007-4315-1_17
van Vliet, N. (2018). “Bushmeat crisis” and “cultural Imperialism” in wildlife management? Taking value orientations
into account for a more sustainable and culturally acceptable wildmeat sector. Frontiers in Ecology and Evolution,
6), https://doi.org/10.3389/fevo.2018.00112
Vélez, A. C. G., & Diniz, S. G. (2016). Inequality, zika epidemics, and the lack of reproductive rights in Latin America.
Reproductive Health Matters, 24, 57–61. https://doi.org/10.1016/j.rhm.2016.11.008
Verger, P., Fressard, L., Cortaredona, S., Lévy-Bruhl, D., Loulergue, P., Galtier, F., & Bocquier, A. (2018). Trends in
seasonal inﬂuenza vaccine coverage of target groups in France, 2006/07 to 2015/16: Impact of recommendations
and 2009 inﬂuenza A(H1N1) pandemic. Euro Surveillance, 23. https://doi.org/10.2807/1560-7917.ES.2018.23.48.
1700801
Wang, X., Jia, W., Zhao, A., & Wang, X. (2006). Anti-inﬂuenza agents from plants and traditional Chinese medicine.
Phytotherapy Research, 20, 335–341. https://doi.org/10.1002/ptr.1892
Wang, L.-F., Walker, P. J., & Poon, L. L. M. (2011). Mass extinctions, biodiversity and mitochondrial function: Are
bats ‘special’ as reservoirs for emerging viruses?.. Current Opinion in Virology, 1, 649–657. https://doi.org/10.1016/
j.coviro.2011.10.013
Watkins, R. E., & Plant, A. J. (2006). Does smoking explain sex diﬀerences in the global tuberculosis epidemic?
Epidemiology & Infection, 134, 333–339. https://doi.org/10.1017/S0950268805005042
Webster, R. G. (2004). Wet markets—a continuing source of severe acute respiratory syndrome and inﬂuenza? The
Lancet, 363, 234–236. https://doi.org/10.1016/S0140-6736(03)15329-9
Wen, J., Aston, J., Liu, X., & Ying, T. (2020). Eﬀects of misleading media coverage on public health crisis: A case of the
2019 novel coronavirus outbreak in China. Anatolia, 1–6. https://doi.org/10.1080/13032917.2020.1730621
Wen, T.-H., Lin, M.-H., & Fang, C.-T. (2012). Population movement and vector-borne disease transmission:
Diﬀerentiating spatial–temporal diﬀusion patterns of Commuting and Noncommuting dengue cases. Annals of
the Association of American Geographers, 102, 1026–1037. https://doi.org/10.1080/00045608.2012.671130
Wenham, C., Smith, J., & Morgan, R. (2020). COVID-19: The gendered impacts of the outbreak. The Lancet, 395,
846–848. https://doi.org/10.1016/S0140-6736(20)30526-2
Wever, P. C., & van Bergen, L. (2014). Death from 1918 pandemic inﬂuenza during the First World War: A perspective from personal and anecdotal evidence. Inﬂuenza and Other Respiratory Viruses, 8, 538–546. https://doi.org/10.
1111/irv.12267
Why is Italy’s coronavirus fatality rate so high? [WWW Document]. (n.d.). URL Retrieved March 23, 2020, from
https://www.aljazeera.com/news/2020/03/italy-coronavirus-fatality-rate-high-200323114405536.html.
Wiley, A. S., & Cullin, J. M. (2016). What do anthropologists mean when they use the term biocultural? American
Anthropologist, 118, 554–569. https://doi.org/10.1111/aman.12608
Williams-Guillén, K., Olimpi, E., Maas, B., Taylor, P. J., & Arlettaz, R. (2016). Bats in the anthropogenic Matrix:
Challenges and opportunities for the conservation of Chiroptera and their ecosystem services in agricultural landscapes. In C. C. Voigt, & T. Kingston (Eds.), Bats in the Anthropocene: Conservation of bats in a changing world
(pp. 151–186). Springer International Publishing. https://doi.org/10.1007/978-3-319-25220-9_6
Wolfe, N. D., Daszak, P., Kilpatrick, A. M., & Burke, D. S. (2005). Bushmeat hunting, deforestation, and prediction of
zoonotic disease. Emerging Infectious Diseases, 11, 1822–1827. https://doi.org/10.3201/eid1112.040789
Woo, P. C., Lau, S. K., & Yuen, K. (2006). Infectious diseases emerging from Chinese wet-markets: Zoonotic origins
of severe respiratory viral infections. Current Opinion in Infectious Diseases, 19, 401–407. https://doi.org/10.1097/
01.qco.0000244043.08264.fc
GLOBAL PUBLIC HEALTH
35
Woolhouse, M. E. J. (2002). Population biology of emerging and re-emerging pathogens. Trends in Microbiology, 10,
S3–S7. https://doi.org/10.1016/s0966-842x(02)02428-9
Woolhouse, M. E. J., Haydon, D. T., & Antia, R. (2005). Emerging pathogens: The epidemiology and evolution of
species jumps. Trends in Ecology & Evolution, 20, 238–244. https://doi.org/10.1016/j.tree.2005.02.009
Wu, X., Cai, Y., Huang, X., Yu, X., Zhao, L., Wang, F., Li, Q., Gu, S., Xu, T., Li, Y., Lu, B., & Zhan, Q. (2020). Early
release – Co-infection with SARS-CoV-2 and inﬂuenza A virus in patient with pneumonia, China. Emerging
Infectious Diseases Journal – CDC, 26(6), https://doi.org/10.3201/eid2606.200299
Xu, J., & Xia, Z. (2019). Traditional Chinese medicine (TCM) – does its contemporary business booming and globalization really reconﬁrm its medical eﬃcacy & safety? Medicine in Drug Discovery, 1, 100003. https://doi.org/
10.1016/j.medidd.2019.100003
Xu, J., & Yang, Y. (2009). Traditional Chinese medicine in the Chinese health care system. Health Policy, 90, 133–139.
https://doi.org/10.1016/j.healthpol.2008.09.003
Yue, R. P. H., Lee, H. F., & Wu, C. Y. H. (2017). Trade routes and plague transmission in pre-industrial Europe.
Scientiﬁc Reports, 7. https://doi.org/10.1038/s41598-017-13481-2
Zhan, S., Yang, Y. Y., & Fu, C. (2020). Public’s early response to the novel coronavirus–infected pneumonia. Emerging
Microbes & Infections, 9, 534–534. https://doi.org/10.1080/22221751.2020.1732232
Zhang, J.-J., Dong, X., Cao, Y.-Y., Yuan, Y.-D., Yang, Y.-B., Yan, Y.-Q., Akdis, C. A., & Gao, Y.-D. (2020). Clinical
characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. https://doi.org/10.1111/all.
14238
Zhang, R., Eggleston, K., Rotimi, V., & Zeckhauser, R. J. (2006). Antibiotic resistance as a global threat: Evidence from
China, Kuwait and the United States. Globalization and Health, 2, 6. https://doi.org/10.1186/1744-8603-2-6
Zhao, S., Cao, P., Chong, K., Gao, D., Lou, Y., Ran, J., Wang, K., Wang, W., Yang, L., He, D., & Wang, M. (2020).
COVID-19 and gender-speciﬁc diﬀerence: Analysis of public surveillance data in Hong Kong and Shenzhen,
China, from January 10 to February 15, 2020. Infection Control and Hospital Epidemiology. https://doi.org/10.
1017/ice.2020.64
Zhong, P., Guo, S., & Chen, T. (2020). Correlation between travellers departing from Wuhan before the Spring
Festival and subsequent spread of COVID-19 to all provinces in China. J Travel Med. https://doi.org/10.1093/
jtm/taaa036
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, X., Huang, B., Shi, W., Lu, R., Niu, P., Zhan, F., Ma, X.,
Wang, D., Xu, W., Wu, G., Gao, G. F., & Tan, W. (2020). A novel coronavirus from patients with pneumonia in
China, 2019. New England Journal of Medicine, 382, 727–733. https://doi.org/10.1056/NEJMoa2001017
Zumla, A., Dar, O., Kock, R., Muturi, M., Ntoumi, F., Kaleebu, P., Eusebio, M., Mﬁnanga, S., Bates, M., Mwaba, P.,
Ansumana, R., Khan, M., Alagaili, A. N., Cotten, M., Azhar, E. I., Maeurer, M., Ippolito, G., & Petersen, E. (2016).
Taking forward a ‘One health’ approach for turning the tide against the Middle East respiratory syndrome coronavirus and other zoonotic pathogens with epidemic potential. International Journal of Infectious Diseases,
Mass Gathering Medicine, 47, 5–9. https://doi.org/10.1016/j.ijid.2016.06.012

Turn in your highest-quality paper
Get a qualified writer to help you with

“ GHS 201 FAU Critical Thinking Power & Socioeconomic Inequalities Essay ”

Get high-quality paper

Guarantee! All work is written by expert writers!

Still stressed from student homework?

Get quality assistance from academic writers!

Order now