Understanding the Socio-economic and Environmental Determinants of Antimicrobial Resistance

Overview:

Antimicrobial resistance (AMR) is not only driven by how antibiotics are used. Social inequalities, gender, caste, climate change, healthcare access, and environmental conditions can also shape people’s risk of infections and antibiotic use.

This OHT collaborative article brings together insights from a cross-disciplinary workshop in India to explore how these factors interact and contribute to the emergence and spread of AMR, with lessons that are relevant to other countries, particularly in south Asia and other low- and middle-income settings.

The Question:

How do social and environmental factors, such as gender inequality, caste-based discrimination, climate change, and unequal access to healthcare, affect the spread of antimicrobial resistance?

The Findings:

The authors wanted to look beyond individual antibiotic use and understand how the conditions in which people live, work, access healthcare, and interact with their environment can influence the emergence and spread of AMR.

The discussions highlighted that AMR is closely connected to wider social and environmental inequalities.

• Caste and social discrimination: Marginalized communities may face poorer access to healthcare, sanitation, nutrition, and reliable medicines. Occupational exposures and reliance on informal healthcare can increase infection risks and inappropriate antibiotic use.
• Gender inequity: Social and economic barriers can prevent women from accessing timely healthcare and may increase reliance on self-medication or informal care. Gender norms can also shape antibiotic use and exposure to infections.
• Climate change: Rising temperatures, floods, droughts, changing disease patterns, and climate-related displacement can increase exposure to infections, disrupt healthcare services, and contribute to antibiotic use and the spread of resistance.
• Connected systems: These factors can reinforce one another. For example, poverty and discrimination can limit access to healthcare and sanitation, increasing infection risk and potentially leading to delayed or inappropriate treatment.

The findings suggest that tackling AMR requires more than responsible antibiotic use. It also means addressing the social, economic, health-system, agricultural, and environmental conditions that shape people’s risk of infection and access to appropriate care. The authors call for more inclusive AMR surveillance, better representation of marginalized communities in policymaking, and stronger collaboration across health, agriculture, environment, and social sectors.

Read the article in Cambridge University’s Public Humanities here.