Bann, DA

Burrone, MS

Campo, PO

Cuervo, LG

Milla, MA

Monroy, M

Stuwe, L

Suarez, AA

UCL Discovery

GLOBAL	JOURNAL	OF	MEDICINE	AND	PUBLIC	HEALTH	 			 	 1	 www.gjmedph.org	Vol.	5,	No.	1	2016																																																																																																																																																																												ISSN#-	2277-9604		A	social	epidemiology	workshop	 in	Central	America:	Advancing	a	 regional	policy	on	research	for	health			Maria	A	Milla	1,	Michele	Monroy-Valle	2,	Andrés	A.	Agudelo-Suárez	3,	Luis	Gabriel	Cuervo	4,	Louisa	Stuwe	4,	David	Bann	5,	Maria	S	Burrone	6,	Patricia	O	Campo	7					Social	 Epidemiology	 has	 as	 a	 major	 premise	 that	health	 and	 disease	 distribution	 are	 determined	 by	social	interactions	and	collective	human	activities.1		It	requires	understanding	the	strengths,	weaknesses,	opportunities	and	 threats	 that	each	 society	has,	and	knowledge	 of	 the	 related	 social	 and	 structural	characteristics.	 Social	 Epidemiology	 seeks	 to	understand	 the	 influence	 of	 these	 factors	 on	population	health,	and	to	understand	and	address	the	causal	 mechanisms	 relevant	 to	 health.	 In	 this	 way,	public	 health	 benefits	 from	 the	 Social	 Epidemiology	approach	 that	 provides	 essential	 data	 to	 inform	policies	and	policy	dialogues—those	within	the	health	and	 development	 sectors,	 as	 well	 as	 health	 care,	primary	prevention,	and	the	development	and	use	of	new	knowledge.2		As	 professors,	 researchers	 and	 members	 of	 the	International	 Epidemiological	 Association	 (IEA)	 –	Latin	 American	 chapter	 and	 former	 participants	 in	the	 IEA	 4th	 International	 Course	 on	 Epidemiological	Methods	held	 in	Lima,	Peru	 in	May	2012,	we	felt	the	need	 to	 disseminate	 knowledge	 and	 strengthen	academic	 networks,	 using	 Central	 America	 as	 a	starting	point.	Countries	in	the	Northern	Triangle—El	Salvador,	Honduras	and	Guatemala—have	worrisome	inequalities	 in	 their	 health	 and	 social	 systems	 that	perpetuate	poverty	and	make	them	lag	behind	other	countries.	 	 Importantly,	 they	 also	 need	 a	 cadre	 of	epidemiologists	 to	 guide	 health,	 science,	 and	 other	development	policies.	Much	of	the	research	in	Social	Epidemiology	 happens	 in	 academic	 environments	that	 are	 not	 even	 based	 in	 the	 Central	 American	countries,3	 as	 a	 result	 of	 being	 out	 of	 the	 context,	usually	without	inputs	 from	decision-makers,	consumers,	and	 other	stakeholders	who	 can	 bring	key	 insights	and	perspectives	that	complement	the	 research	process	 and	policy	development.	There	 is	 a	perceived	paucity	 of	opportunities	to	 build	 a	critical	 mass	 of	 trained	 experts	 through	 training	placements	 for	 researchers	 from	 the	 Americas,	 on	these	issues.4		Based	 on	 the	 experience	 of	 a	 prior	 Social	Epidemiology	 workshop	 at	 Harvard	 University	 in	2009,	 we	 designed	 a	 workshop	 geared	 towards	increasing	 these	 capacities	 in	 Latin	 America.	 A	suggestion	 then,	 was	 to	 apply	 theoretical	frameworks	 that	 helped	 explain	 social	 and	 health	inequity	 and	 inequalities.	 The	 proposed	 agenda	considered	four	main	aspects	of	Social	Epidemiology:	theoretical	evolution;	methodology;	current	trends	in	GJMEDPH	2016;	Vol.	5,	issue	1	1Universidad	Católica	de	Honduras	2University	of	San	Carlos	of	Guatemala	3Public	 Health	 Research	 Group,	University	of	Alicante,	Spain	and	Faculty	of	 Dentistry,	 University	 of	 Antioquia,	Colombia	4Pan	 American	 Health	 Organization/	World	Health	Organization		5University	 College	 London,	 United	Kingdom		6School	 of	 Public	 Health,	 Faculty	 of	Medical	Sciences,	National	University	of	Cordoba	7University	of	Toronto,	Canada		*Corresponding	Author:		Conflict	of	Interest—none			Funding	 —	 Maria	 Soledad	 Burrone’s	contribution	was	 supported	 in	 part	 by	 the	National	 Institute	 of	Mental	 Health	 under	award	 U19MH095718,	 and	 the	 Dr.	 Lisa	Oehler	 Award,	 University	 of	 Göttingen,	Germany.						 	 2	 www.gjmedph.org	Vol.	5,	No.	1	2016																																																																																																																																																																														ISSN#-	2277-9604		Commentary	research	 and;	 interventions	 contrasting	 trends	 and	frameworks	 between	 North	 America	 and	 Europe	versus	Latin	America.	The	 latter	aspect	was	 inspired	by	Krieger’s	 remarks	 focusing	on	aspects	of	process,	history	 and	 embodiment.2	 One	 of	 the	 goals	 of	 our	workshop	 was	 to	 understand	 lessons	 learned	 in	different	 scenarios	 to	 create	 a	 benchmark	 to	 guide	future	analyses	and	interventions.5	–	7			We	also	considered	the	mandates,	guiding	principles,	goals	 and	 objectives,	 and	 implementation	considerations	 in	 PAHO/WHO’s	 Policy	 on	 Research	for	 Health	 (CD49/10)6	 which	 has	 been	 approved	 for	implementation	 in	 PAHO	 (Member	 States	 and	 the	Pan	 American	 Sanitary	 Bureau)	 in	 2009.	 This	 policy	determines	 the	 need	 to	 strengthen	 national	 health	research	 systems,	which	 is	 fundamental	 to	 attaining	health	 with	 equity.	 It	 calls,	 among	 other	 things,	 for	the	 development	 of	 research	 agendas	 and	 the	development	of	capacities	and	strategies	to	seize	the	benefits	 of	 research	 for	 health,	 with	 equity.	 Social	Epidemiology	plays	a	key	role	in	several	of	the	policy	items	and	has	been	a	key	topic	also	in	the	discussions	held	at	the	Latin	American	Conferences	on	Research	and	 Innovation	 for	 Health,	 as	 reflected	 in	 the	conference	reports.7		This	 conceptual	 and	 methodological	 approach	allowed	us	to	assemble	a	wide	series	of	international	experiences	 and	 methodologies	 in	 Antigua	Guatemala	 from	November	 17	 -	 20,	 2015	with	more	than	 50	 highly	 recognized	 professional	 experts	 and	leaders	in	Social	Epidemiology	traveling	from	at	least	14	 countries;	 the	 workshop	 was	 entitled	 SEWAG	(Social	Epidemiology	Workshop	Antigua	Guatemala).	SEWAG	 participants	 engaged	 in	 a	 rich	 and	 ongoing	exchange	 of	 ideas	 about	 social	 determinants	 of	health	 and	 their	 relevance	 towards	 improving	population	health.	The	workshop	built	on	the	concept	of	research	for	health,	as	presented	in	PAHO’s	Policy,	hence	 understanding	 contributions	 beyond	 the	health	sector.2		Workshop	 participants	 identified	 the	 trends	 and	some	research	needs	for	Latin	America,	and	reached	conclusions	such	as:	1. There	is	a	need	for	a	regional	research	center	on	 Social	 Epidemiology,	 and	 to	 strengthen	national	research	for	health	systems.	2. The	approach	of	implementation	science	can	be	 a	 fundamental	 contribution	 to	 improving	health	research	in	the	region.	3. There	is	a	need	to	map	the	regional	resources	available	 to	 date	 on	 social	 epidemiology,	public	health	and	research	for	health,	in	order	to	 take	 full	 advantage	 of	 them	 as	 these	spaces	 for	 opportunities	 arise.	 The	mapping	tools	 should	allow	 real	 time	 information	and	build	 on	 the	 tools	 that	 enable	 participation	and	 quality	 data	 built	 around	 social	 media	and	 other	 strategies	 that	 allow	 capturing	valid	information	in	real	time.			4. The	 importance	 of	 supporting	 champions:	identifying	 national	 research	 for	 health	leaders	 that	 feed	national	maps	of	 resources	using	tools	such	as	the	Health	Research	Web,	support	 these	 health	 professionals	 through	constant	 training	 and	 Train	 the	 Trainer	courses	in	their	own	countries.	5. The	 relevance	 of	 communication	 tools	 and	social	 media,	 such	 as	 social	 networks	 to	accrue	and	disseminate	knowledge,	 research	interests,	 opportunities,	 exchange	 of	 ideas,	academic	 exchange,	 and	 collect	 real	 time	data.	6. A	 follow-up	 to	 SEWAG	 to	 build	 on	 the	momentum	 achieved	 throughout	 the	meeting.		7. The	need	to	build	a	cadre	of	experts	with	the	know-how,	 networking,	 partnerships	 and	drive	 needed	 to	 integrate	 research	knowledge	 with	 policies	 for	 health	 and	development.			As	 pointed	 out	 before,	 it	 is	 very	 important	 to	“socialize”	 research	 efforts	 among	 all	 public	 health	actors,	 first	 of	 all	 to	 share	 findings	 and	 improve	decision-making	 and,	 as	 a	 next	 step,	 to	 avoid	research	waste.		In	summary,	we	understood	that	priorities	have	to	be	defined	 as	 soon	 as	 possible,	 and	 be	 framed	 around	existing	 regional	 policies.	 This	 involves	 an	understanding	 of	 all	 the	 factors	 involved,	 including				 	 3	 www.gjmedph.org	Vol.	5,	No.	1	2016																																																																																																																																																																														ISSN#-	2277-9604		Commentary	political,	 socio-economic,	 cultural	etc.,	 that	promote	equity	 in	 the	 region,	 especially	 in	 Central	 America,	through	robust	functional	health	research	systems.	It	also	 means	 recognizing	 the	 present	 needs	 and	weaknesses	 of	 these	 systems,	 the	 limitations	 in	access	to	knowledge,	and	the	need	to	build	a	cadre	of	experts,	 as	 well	 as	 to	 establish	 a	 wealth	 of	opportunities	 to	 develop	 and	 support	 human	resources	with	 expertise	 in	 implementation	 sciences	such	as	Social	Epidemiology.		ACKNOWLEDGEMENT	AND	CONTRIBUTIONS	All	 listed	 authors	 made	 substantial	 contributions	 to	the	 manuscript	 and	 stand	 by	 its	 final	 version.	 In	addition	to	the	authors	we	want	to	acknowledge	the	Pan	 American	 Health	 Organization	 for	 its	sponsorship	of	the	event,	the	staff	at	PAHO/WHO	HQ	and	 country	 offices	 in	 Guatemala	 and	 Honduras	 for	their	 logistical	 support,	 the	 Spanish	 Agency	 for	International	 Cooperation	 and	 Development	 AECID	for	 hosting	 the	 meeting	 at	 their	 Antigua	 training	center,	the	Embassy	of	Spain	in	Guatemala,	Regional	Programme	 for	 Food	 and	 Nutrition	 Security	 in	Central	America	(PRESANCA	II),Regional	Programme	on	 Information	 Systems	 for	 Food	 and	 Nutrition	Security	 (PRESISAN),	 the	 Central	 American	Integration	 System	 (SICA)	 and	 the	 European	 Union	for	 the	 sponsorship	 and	 involvement	 as	 a	 regional	organization	 in	 this	 event,	 and	 the	 in-kind	 support	received	 from	 the	 Universidad	 Rafael	 Landívar,	 the	Institute	 of	 Chemical	 and	Biological	 Research	of	 the	San	 Carlos	 University	 in	 Guatemala,	 and	 the	Honduran	Society	for	Nutrition	and	Obesity.			REFERENCES	1. Oakes	 JM,	 Kaufman	 JS.	 Methods	 in	 social	epidemiology.	 San	 Francisco,	 Calif.:	 Jossey-Bass;	2006.	2. Krieger	 N.	 Theories	 for	 social	 epidemiology	 in	 the	21st	 century:	 an	 ecosocial	 perspective.	 International	Journal	of	Epidemiology.	2001	Aug	1;30(4):668–77.	3. Kaufman	JS,	Mezones-Holguin	E.	Una	epidemiología	social	para	América	Latina:	una	necesidad	más	allá	de	la	 reflexión	 sobre	 la	 inequidad	 en	 salud	 [editorial].	Rev	Peru	Med	Exp	Salud	Publica.	2013;30(4):543–6.	4. Scientific	 and	 technical	 journal	 articles	 by	 country	1981	 –	 2015,	 World	 Bank,	http://data.worldbank.org/indicator/IP.JRN.ARTC.SC		5. Barata	RB.	Epidemiologia	social.	Revista	Brasileira	de	Epidemiologia.	2005;8(1):7–17.		6. Pan	 American	 Health	 Organization.	 Policy	 on	Research	 for	 Health.	 Proceedings	 of	 the	 49th	Directing	 Council	 of	 PAHO,	 61st	 Session	 of	 the	Regional	 Committee	 of	 the	WHO	 for	 the	 Americas,	28	 September-2	 October	 2009.	 Washington,	 DC:	PAHO;	2009.	(Document	CD49/R10).	7. Reports	 of	 the	 Latin	 American	 Conferences	 on	Research	 and	 Innovation	 for	 Health	(http://www.paho.org/LACRIH):	2008	http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=17305&Itemid=270&lang=es			2009:	http://www1.paho.org/hq/dmdocuments/2010/followUp-1LA-cuba2009.pdf	2011:	http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=20414&Itemid=270&lang=en			

A social epidemiology workshop in Central America: Advancing a regional policy on research for health

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A social epidemiology workshop in Central America: Advancing a regional policy on research for health

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