Integrating Social Protection into Antimicrobial Resistance Response: A Critical Review and Framework Development
1
Public Health, Institute of Tropical Medicine, Antwerp, Belgium
2
Public Health, Independent consultant, Hargeisa, Somalia
Popul. Med. 2026;8(Supplement Supplement 1):A215
ABSTRACT
BACKGROUND:
Antimicrobial resistance (AMR) causes 1.27 million deaths annually, with disproportionate burden in low- and middle-income countries. Current AMR policies emphasize biomedical interventions—stewardship, surveillance, infection control—yet fail to address structural drivers. A growing body of evidence point to the need of considering the social determinants of health in the fight against AMR. Based on this insight one could suggest that social protection interventions would prevent AMR by addressing these upstream determinants. This review critically examines how social protection can address structural AMR drivers and develops an implementation framework.
METHODS:
We reviewed global and national AMR policies and conducted systematic literature searches in Web of Science, Scopus, PubMed, Embase, WorldCat, Semantic Scholar and Google Scholar using terms combining "antimicrobial resistance," "social protection," and "social determinants." We analyzed policies for structural determinants and equity dimensions, distinguished proximal drivers (antibiotic use, transmission) from distal drivers (poverty, infrastructure, climate impacts), and developed an integrative framework mapping six social protection instruments (transfers, insurance, labour policies, services, food programs, housing) to AMR pathways.
RESULTS:
Critical gaps emerge: Although the link between poverty and AMR is gaining attention in global discourse, NAPs overwhelmingly emphasize proximal interventions while ignoring distal structural drivers. Social protection integration is minimal; when present, it focuses narrowly on financial access to care. However, evidence demonstrates effectiveness—nutritional support and social housing reduce susceptibility to recurring infectious diseases (food born, water born, respiratory), cash transfer, labour market interventions and sick leave enable treatment completion, livestock insurance reduces prophylactic antibiotic use in agriculture.
CONCLUSIONS:
Social protection represents evidence-based structural intervention addressing root causes of AMR. The proposed framework provides actionable guidance for integrating social protection into NAP revisions and One Health strategies, advancing equity while enhancing AMR response effectiveness.
Antimicrobial resistance (AMR) causes 1.27 million deaths annually, with disproportionate burden in low- and middle-income countries. Current AMR policies emphasize biomedical interventions—stewardship, surveillance, infection control—yet fail to address structural drivers. A growing body of evidence point to the need of considering the social determinants of health in the fight against AMR. Based on this insight one could suggest that social protection interventions would prevent AMR by addressing these upstream determinants. This review critically examines how social protection can address structural AMR drivers and develops an implementation framework.
METHODS:
We reviewed global and national AMR policies and conducted systematic literature searches in Web of Science, Scopus, PubMed, Embase, WorldCat, Semantic Scholar and Google Scholar using terms combining "antimicrobial resistance," "social protection," and "social determinants." We analyzed policies for structural determinants and equity dimensions, distinguished proximal drivers (antibiotic use, transmission) from distal drivers (poverty, infrastructure, climate impacts), and developed an integrative framework mapping six social protection instruments (transfers, insurance, labour policies, services, food programs, housing) to AMR pathways.
RESULTS:
Critical gaps emerge: Although the link between poverty and AMR is gaining attention in global discourse, NAPs overwhelmingly emphasize proximal interventions while ignoring distal structural drivers. Social protection integration is minimal; when present, it focuses narrowly on financial access to care. However, evidence demonstrates effectiveness—nutritional support and social housing reduce susceptibility to recurring infectious diseases (food born, water born, respiratory), cash transfer, labour market interventions and sick leave enable treatment completion, livestock insurance reduces prophylactic antibiotic use in agriculture.
CONCLUSIONS:
Social protection represents evidence-based structural intervention addressing root causes of AMR. The proposed framework provides actionable guidance for integrating social protection into NAP revisions and One Health strategies, advancing equity while enhancing AMR response effectiveness.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
