“We’ve all got the virus inside us now”: Disaggregating public health relations and responsibilities for health protection in pandemic London

Ben Kasstan; Sandra Mounier-Jack; Katherine  Gaskell; Rosalind  Eggo; Michael  Marks; Tracey Chantler

doi:10.1016/j.socscimed.2022.115237

“We’ve all got the virus inside us now”: Disaggregating public health relations and responsibilities for health protection in pandemic London

Ben Kasstan
, Sandra Mounier-Jack
, Katherine Gaskell
, Rosalind Eggo
, Michael Marks
, Tracey Chantler^*

^*Corresponding author for this work

University of Bristol Law School

Research output: Contribution to journal › Article (Academic Journal) › peer-review

4 Citations (Scopus)

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Abstract

The COVID-19 pandemic has disproportionately impacted ethnic minorities in the global north, evidenced by higher rates of transmission, morbidity, and mortality relative to population sizes. Orthodox Jewish neighbourhoods in London had extremely high SARS-CoV-2 seroprevalence rates, reflecting patterns in Israel and the US. The aim of this paper is to examine how responsibilities over health protection are conveyed, and to what extent responsibility is sought by, and shared between, state services, and ‘community’ stakeholders or representative groups, and families in public health emergencies.

The study investigates how public health and statutory services stakeholders, Orthodox Jewish communal custodians and households sought to enact health protection in London during the first year of the pandemic (March 2020–March 2021). Twenty-eight semi-structured interviews were conducted across these cohorts. Findings demonstrate that institutional relations – both their formation and at times fragmentation – were directly shaped by issues surrounding COVID-19 control measures. Exchanges around protective interventions (whether control measures, contact tracing technologies, or vaccines) reveal diverse and diverging attributions of responsibility and authority.

The paper develops a framework of public health relations to understand negotiations between statutory services and minority groups over responsiveness and accountability in health protection. Disaggregating public health relations can help social scientists to critique who and what characterises institutional relationships with minority groups, and what ideas of responsibility and responsiveness are projected by differently-positioned stakeholders in health protection.

Original language	English
Article number	115237
Pages (from-to)	1-10
Number of pages	10
Journal	Social Science & Medicine
Volume	309
Early online date	7 Aug 2022
DOIs	https://doi.org/10.1016/j.socscimed.2022.115237
Publication status	Published - 1 Sept 2022

Bibliographical note

Funding Information:
Emerging from this critical inquiry is how to offer practical recommendations for PH policy and statutory services, particularly with regards to creating the enabling conditions to share responsibility over health protection in the future. The potential for developing shared aims and collaborations will vary according to context and depend on health governance. We suggest that PH and pandemic preparedness can be bolstered by the mapping of stakeholders, and designing routine services (such as vaccination) with the support of ‘partners in health’ – to borrow the language of anthropologist Paul Farmer (2003) . The mapping of PH relations and design of collaborations is an evolving project because social ecologies are not static, and collaborations should take account of the internal diversity of minority populations. Adequate resources should be allocated to maintaining collaborations that enable PH services to respond quickly to social and epidemiological incidents. Moreover, a collaborative approach to developing ‘shared aims’ in health protection may help to address the challenges of attaining ‘sustainable involvement of communities and their leaders in decision-making spaces of local governance structures’ ( Vanhamel et al., 2021 : 10). Shared aims should be agreed and clearly defined, and monitored and evaluated, especially when supported by funding from central or local government. PH services, however, cannot entirely defer responsibility to stakeholders, and the roles of statutory services cannot be replaced by stakeholders. As emerged in our data, relying on select stakeholders can have unforeseen consequences for pandemic responses. The act of sharing responsibility in health protection involves making concerted attempts to consult directly with households on matters that affect them, and considering constituents within the framework of PH relations.

Publisher Copyright:
© 2022 The Authors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

COVID-19
Judaism
London
Pandemic
Responsibility
Health protection

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title = "“We{\textquoteright}ve all got the virus inside us now”: Disaggregating public health relations and responsibilities for health protection in pandemic London",

abstract = "The COVID-19 pandemic has disproportionately impacted ethnic minorities in the global north, evidenced by higher rates of transmission, morbidity, and mortality relative to population sizes. Orthodox Jewish neighbourhoods in London had extremely high SARS-CoV-2 seroprevalence rates, reflecting patterns in Israel and the US. The aim of this paper is to examine how responsibilities over health protection are conveyed, and to what extent responsibility is sought by, and shared between, state services, and {\textquoteleft}community{\textquoteright} stakeholders or representative groups, and families in public health emergencies. The study investigates how public health and statutory services stakeholders, Orthodox Jewish communal custodians and households sought to enact health protection in London during the first year of the pandemic (March 2020–March 2021). Twenty-eight semi-structured interviews were conducted across these cohorts. Findings demonstrate that institutional relations – both their formation and at times fragmentation – were directly shaped by issues surrounding COVID-19 control measures. Exchanges around protective interventions (whether control measures, contact tracing technologies, or vaccines) reveal diverse and diverging attributions of responsibility and authority. The paper develops a framework of public health relations to understand negotiations between statutory services and minority groups over responsiveness and accountability in health protection. Disaggregating public health relations can help social scientists to critique who and what characterises institutional relationships with minority groups, and what ideas of responsibility and responsiveness are projected by differently-positioned stakeholders in health protection. ",

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note = "Funding Information: Emerging from this critical inquiry is how to offer practical recommendations for PH policy and statutory services, particularly with regards to creating the enabling conditions to share responsibility over health protection in the future. The potential for developing shared aims and collaborations will vary according to context and depend on health governance. We suggest that PH and pandemic preparedness can be bolstered by the mapping of stakeholders, and designing routine services (such as vaccination) with the support of {\textquoteleft}partners in health{\textquoteright} – to borrow the language of anthropologist Paul Farmer (2003) . The mapping of PH relations and design of collaborations is an evolving project because social ecologies are not static, and collaborations should take account of the internal diversity of minority populations. Adequate resources should be allocated to maintaining collaborations that enable PH services to respond quickly to social and epidemiological incidents. Moreover, a collaborative approach to developing {\textquoteleft}shared aims{\textquoteright} in health protection may help to address the challenges of attaining {\textquoteleft}sustainable involvement of communities and their leaders in decision-making spaces of local governance structures{\textquoteright} ( Vanhamel et al., 2021 : 10). Shared aims should be agreed and clearly defined, and monitored and evaluated, especially when supported by funding from central or local government. PH services, however, cannot entirely defer responsibility to stakeholders, and the roles of statutory services cannot be replaced by stakeholders. As emerged in our data, relying on select stakeholders can have unforeseen consequences for pandemic responses. The act of sharing responsibility in health protection involves making concerted attempts to consult directly with households on matters that affect them, and considering constituents within the framework of PH relations. Publisher Copyright: {\textcopyright} 2022 The Authors",

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“We’ve all got the virus inside us now”: Disaggregating public health relations and responsibilities for health protection in pandemic London

Abstract

Bibliographical note

UN SDGs

Keywords

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