Positioning zoonotic disease research in forced migration: A systematic literature review of theoretical frameworks and approaches

Abstract

Background The emergence and transmission of zoonotic diseases are driven by complex interactions between health, environmental, and socio-political systems. Human movement is considered a significant and increasing factor in these processes, yet forced migration remains an understudied area of zoonotic research–due in part to the complexity of conducting interdisciplinary research in these settings. Objectives We conducted a systematic review to identify and analyze theoretical frameworks and approaches used to study linkages between forced migration and zoonotic diseases. Methods We searched within eight electronic databases: ProQuest, SCOPUS, Web of Science, PubMed, PLoSOne, Science Direct, JSTOR, and Google Scholar, to identify a) research articles focusing on zoonoses considering forced migrants in their study populations, and b) forced migration literature which engaged with zoonotic disease. Both authors conducted a full-text review, evaluating the quality of literature reviews and primary data using the Critical Appraisal Skills Programme (CASP) model, while theoretical papers were evaluated for quality using a theory synthesis adapted from Bonell et al. (2013). Qualitative data were synthesized thematically according to the method suggested by Noblit and Hare (1988). Results Analyses of the 23 included articles showed the increasing use of interdisciplinary frameworks and approaches over time, the majority of which stemmed from political ecology. Approaches such as EcoHealth and One Health were increasingly popular, but were more often linked to program implementation and development than broader contextual research. The majority of research failed to acknowledge the heterogeneity of migrant populations, lacked contextual depth, and insufficient acknowledgments of migrant agency in responding to zoonotic threats. Conclusions Addressing the emergence and spread of zoonoses in forced migration contexts requires more careful consideration and use of interdisciplinary research to integrate the contributions of social and natural science approaches. Robust interdisciplinary theoretical frameworks are an important step for better understanding the complex health, environment, and socio-political drivers of zoonotic diseases in forced migration. Lessons can be learned from the application of these approaches in other hard-to-reach or seldom-heard populations.

Zoonoses in the margins: environmental displacement and health outcomes in the Indus Delta

“…The multifaceted factors determining health have been described by WHO as the 'social determinants of health': the non-medical factors determining health outcomes, including socio-economic, living conditions, food insecurity, conflict and access to (health) services [36]. Similarly, studies into zoonotic disease emergence and transmission increasingly use inclusive frameworks such as One Health, Ecohealth and Planetary Health to improve the consideration of linkages between veterinary, human, and ecosystem health [37]. While these new approaches are valuable in terms of describing health outcomes within environmental and planetary boundaries, especially in light of climate change, these rarely focus on the underlying mechanisms creating health inequalities, or the 'determination' rather than the determinants of health [38].…”

The Spread of Infectious Diseases in Migration Routes Between Caravans and Resident Communities: Modelling Yellow Fever in Central America

“…However, a superficial interpretation of this assumption can stigmatize migrants as mere vectors of diseases to be blamed for such phenomena. [2][3][4] In contrast, people on the move seeking better living conditions are the most vulnerable to infectious disease outbreaks. The reason for fleeing a home country is frequently associated with the exact causes of climate-sensitive, (re)emerging diseases: a changing climate that deteriorates living conditions and reshapes the geographic distribution of vectors and other components of infectious diseases.…”

Migrant health during public health emergencies: The Ebola crisis in Uganda

“…From a One Health perspective, these impacts are caused by increased stress at the human-animal-environmental interface due to exposure to new endemic diseases, insufficient access to health services and WASH, and limited coping mechanisms of the local environment, including natural resources like flora and fauna. All these factors are, under the One Health approach, associated with the emergence and spread of infectious diseases [ 9 , 10 ].…”

“…Inclusive policies are even more critical during public health emergencies, where resources are always stretched. Such policies would help refugees and migrants stay healthy, including mental health, and engagement with healthcare actors and host communities while also protecting host communities from an increased risk of infectious disease [ 9 ]. In light of the above, outbreak response plans such as the Uganda Ebola response plan needs to keep inclusion at the core of their strategy [ 5 ].…”