1
|
Bühler N. Precision public health in the making: examining the becoming of the "social" in a Swiss environmental health population-based cohort. FRONTIERS IN SOCIOLOGY 2023; 8:1219275. [PMID: 38162929 PMCID: PMC10754959 DOI: 10.3389/fsoc.2023.1219275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
Expanding the concept of "precision" or "personalized" medicine, personalized health and precision public health designate the use of various kinds of data-genomic, other omics, clinical, or those produced by individuals themselves through self-tracking-to optimize health interventions benefiting the whole population. This paper draws on an ethnography of the implementation of a population-based environmental health cohort to shed light on the reconfigurations brought about by the "personalization" of public health in Switzerland. Combining human biomonitoring and molecular epidemiology, this cohort aims to advance the science of the exposome, a notion referring to the totality of exposures to which individuals are subjected over their lifecourse. Addressing the tension between holism and reductionism, this paper points to the important gap between the promissory horizon of the exposome and the realities of practices. Situations of reductionism are defined as moments of friction and negotiation between different rationales and values, exposing what makes the science of the exposome, including its material, economic, institutional, and methodological constraints, as well as its imaginaries and values. Rather than opposing holism and reductionism, I emphasize that they constitute two sides of the same coin, as they both pragmatically enable action and produce situated versions of the social. This empirical case shows how reductionism operates at the chemical, biological, and populational levels to produce public health scientific and social values. It thus contributes to contextualizing the pragmatic and strategic choices made by scientists, as well as the values they favor, in a research environment marked by the predominance of biomedicine over public health. It shows how the reductionism of the "social environment" was made for a better social integration of the cohort into the Swiss political and scientific landscape of public health. Bringing together actors involved in public health and questions of environmental exposures, this cohort can be interpreted as a biomedicalization of public health research, as well as an attempt to socialize it through the broad category of the exposome.
Collapse
|
2
|
Meka K, Jacob CM, Modi N, Bustreo F, Di Renzo GC, Malamitsi-Puchner A, Briana D, Iaia DG, Fogstad H, Tamvada JP, Moreno IO, Hanson M. Valuing maternal, newborn, child and adolescent health for societal progress - Going beyond the economic orthodoxy of gross domestic product. Acta Paediatr 2023; 112:630-634. [PMID: 36656112 DOI: 10.1111/apa.16677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
AIM In view of the long-standing recognition that gross domestic product (GDP) does not capture the unremunerated work largely conducted by women upon which societal well-being depends, to discuss the implications for GDP of maternal, newborn, child and adolescent health (MNCAH), and its influences on health, well-being and prosperity across the life course and across generations. METHODS A wide-ranging discussion of the informal think-tank The Venice Forum was held over two days, with inputs from invited experts in person and online. RESULTS There was consensus that a strong case could be made for inclusion of unremunerated work largely conducted by women as a positive contribution to GDP in view of its impact on future health and prosperity, and conversely exclusion from GDP of outputs from industries which harm health. CONCLUSION Taken with the current challenges from COVID, climate change and conflict, there is a compelling need to redefine economic progress through equitable models and metrics that incorporate short-/medium-/long-term societal value of activities that improve MNCAH.
Collapse
Affiliation(s)
- Kiran Meka
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Chandni M Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Flavia Bustreo
- Partnership for Maternal, Newborn and Child Health Board, Geneva, Switzerland
| | - Gian Carlo Di Renzo
- Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynaecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Domenico G Iaia
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Helga Fogstad
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Jagannadha P Tamvada
- Southampton Business School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Ivan Ochoa Moreno
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Hanson
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| |
Collapse
|
3
|
Obesity, Pregnancy and the Social Contract with Today’s Adolescents. Nutrients 2022; 14:nu14173550. [PMID: 36079808 PMCID: PMC9459961 DOI: 10.3390/nu14173550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/16/2022] Open
Abstract
Adolescent health and well-being are of great concern worldwide, and adolescents encounter particular challenges, vulnerabilities and constraints. The dual challenges of adolescent parenthood and obesity are of public health relevance because of the life-altering health and socioeconomic effects on both the parents and the offspring. Prevention and treatment strategies at the individual and population levels have not been successful in the long term, suggesting that adolescent pregnancy and obesity cannot be managed by more of the same. Here, we view adolescent obese pregnancy through the lens of the social contract with youth. The disruption of this contract is faced by today’s adolescents, with work, social and economic dilemmas which perpetuate socioeconomic and health inequities across generations. The lack of employment, education and social opportunities, together with obesogenic settings, increase vulnerability and exposure to lifelong health risks, affecting their offspring’s life chances too. To break such vicious circles of disadvantage and achieve sustainable solutions in real-world settings, strong efforts on the part of policymakers, healthcare providers and the community must be oriented towards guaranteeing equity and healthy nutrition and environments for today’s adolescents. The involvement of adolescents themselves in developing such programs is paramount, not only so that they feel a sense of agency but also to better meet their real life needs.
Collapse
|
4
|
Penkler M. Caring for biosocial complexity. Articulations of the environment in research on the Developmental Origins of Health and Disease. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2022; 93:1-10. [PMID: 35240493 DOI: 10.1016/j.shpsa.2022.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
The research field of Developmental Origins of Health and Disease (DOHaD) provides a framework for understanding how a wide range of environmental factors, such as deprivation, nutrition and stress, shape individual and population health over the course of a lifetime. DOHaD researchers face the challenge of how to conceptualize and measure ontologically diverse environments and their interactions with the developing organism over extended periods of time. Based on ethnographic research, I show how DOHaD researchers are often eager to capture what they regard as more 'complex' understandings of the environment in their work. At the same time, they are confronted with established methodological tools, disciplinary infrastructures and institutional contexts that favor simplistic articulations of the environment as distinct and mainly individual-level variables. I show how researchers struggle with these simplistic articulations of nutrition, maternal bodies and social determinants as relevant environments, which are sometimes at odds with the researchers' own normative commitments and aspirations.
Collapse
Affiliation(s)
- Michael Penkler
- Institute of Market Research and Methodology, University of Applied Sciences Wiener Neustadt, Schlögelgasse 22-26, A-2700 Wiener Neustadt, Austria; Department of Science, Technology and Society, Technical University of Munich, Arcisstr. 21, 80333 Munich, Germany.
| |
Collapse
|