The Tuberculosis Behavioral and Social Science Research Forum
Section II. Presentations and Panel Discussions
Keynote Session: When Sacred Cows Become the Tigerís Breakfast:
Defining A Role for the Social Sciences in Tuberculosis Control
Jessica Ogden, Ph.D.
Technical Specialist, International Center for
Research on Women
Day 1, Morning Session
Dr. Ogden presented a critical perspective on public health and
TB control paradigms. Her presentation described a multi≠disciplinary
approach to TB control that combines the strengths of the medical
sciences with those of the behavioral and social sciences. Her proposed
approach was informed by lessons learned from directly observed
therapy short-course (DOTS) programs for TB treatment in India.
Dr. Ogden proposed a shift away from some of the ďsacred cowsĒ
of classical public health thinking that emphasize disease control
and elimination toward a social science paradigm focusing on the
interactions among disease control personnel, individual patients,
and the cultural and social contexts in which they live. At the
level of the patient, such a paradigm emphasizes care, with particular
attention to developing trust and fostering patient-provider partnerships.
Outcomes in TB treatment and control are also strongly influenced
by social and cultural contexts, including social structures within
households, communities, and the policy-making environment. For
example, social and cultural influences may determine who can adopt
the sick role (and when), the range of treatment options available,
and the extent to which a person can access and adhere to treatment.
A multidisciplinary, multilevel approach that takes into account
the respective influences and roles of patients, communities, and
households, as well as programs, providers, and policies can help
to answer the following questions related to TB:
- Why donít patients come for treatment?
- Why do they only come when itís too late?
- Why donít they complete their therapy?
- How can we make our programs accessible and acceptable?
- How can we meet the health needs of the community?
- How can we involve communities as participants in their own
Answering such questions in ways that address the multiple levels
of influence is a critical step in improving TB control programs
and the outcomes that they are able to achieve.
here for slideset of presentation