The role of social scientists in global health crises

Introduction

The coronavirus disease 2019 (COVID-19) pandemic exposed stark global inequities, fragilities, and unsustainable practices that pre-dated the pandemic and intensified its impact. It is increasingly evident that today’s global challenges cannot be solved by biomedical perspectives alone (1-4). But the role of social scientists in preparedness and response to global health crises has not always been clear. As a panel of social scientists connected through a global health network, in this commentary, we reflect on some of the key lessons from the COVID-19 pandemic and explore how a social science lens can contribute to future global health challenges. This panel resulted from a virtual webinar discussion with eight social science experts from Ecuador, New Zealand, the Philippines, Singapore, and the United States. Each holds a position in academia and does work focusing primarily on health. The overall objective of the discussion was to examine current and future directions and priority areas for social scientists in global health, using the lessons from the COVID-19 pandemic. The webinar was organized by the Association of Pacific Rim Universities (APRU) and the Philippine Social Science Council (PSSC). APRU is a network of leading universities linking the Americas, Asia and Australasia, which brings together thought leaders, researchers, and policy-makers to exchange ideas and collaborate on effective solutions to the challenges of the 21st century. APRU leverages the collective education and research capabilities of its members into the international public policy process. PSSC is a non-profit organization of professional social science associations and social science research and instructional institutions in the Philippines. It has 14 regular member associations representing various social science disciplines and 40 associate member institutions.

Discussion

The role of social scientists

COVID-19 is not only a biomedical phenomenon but also has important socio-cultural, psychological, and economic considerations. Horton [2020] argued that COVID-19 should be viewed as a syndemic in that it is more than a complex interaction between a biological state and social interactions across different conditions (5). The necessary response cannot be limited purely to a public health, epidemiologic modelling, or medical lens. Rather, it is an amplifier of the socioeconomic and cultural determinants of health. There was an early focus on understanding the causes and etiology of COVID-19, with emphasis on exacting epidemiological information and surveillance to guide government-led responses. What was missed in the early days of the pandemic response was a holistic perspective on what a pandemic is and what responses were required beyond a biomedical lens. As seen in Table 1, we have six key recommendations for the role of social scientists in global health grouped into two broad categories: research and support for policy-making.

Research

Reflecting on the lessons of COVID-19, we believe that social scientists can have an important impact at all levels of society (global, regional, national, and community) through the human and collective element of our work. We should not just refer to the number of deaths from newspaper headlines; we must go further, looking into the deeper societal issues through the lens of our own perspectives (6). Motivating populations to undertake evidence-based public health recommendations can be a major challenge. It is apparent that, to learn from the events of the past few years, we must engage to represent voices of the affected and attest to the human impact of global health crises. The context and the lived experiences of people in different communities, especially marginalized and vulnerable groups, is particularly important. Social scientists are well-positioned to contribute because they are adept at drawing upon collateral and deliberate evidence to critique the evolution of social phenomena. Our research can highlight the social injustices exposed by the pandemic, for example, the higher incidence of violence against women, or the reasons why people refused to get vaccinated.

Our research can also provide critical insight into designing effective interventions for a given population (1-4). To do so effectively, we need to think and work across disciplines; there is always room for transdisciplinary critical engagement and collaboration. We should attempt to build a stronger interdisciplinary approach to what we do (2). There is a recent call for social science research to be integrated into biological and behavioral sciences research to adequately address global health challenges (1-4). While it may seem basic for academics and people involved in the philosophy of science and knowledge, the practice of true cross-disciplinary work presents difficulties for scientists, policy makers, and the general public. We may struggle to actually make ourselves as citizens and as individuals available and open to different ideas. As an example, one of the authors joined the Commission of COVID-19 Response of the Journal of Global Health Sciences, a multi-disciplinary panel made up of scientists from around the world, including social sciences. This commission collaborated on research on COVID-19. In addition, another co-author created a working group of 20 researchers from many disciplines and countries who collaborated on a survey of more than 3,300 respondents on COVID-19 attitudes and behaviors.

As social scientists, we play an important role as information brokers. While we were grappling with the ravages of the pandemic in the real world, an equally important challenge was how to deal with the “infodemic”, defined by the World Health Organization as too much information including false or misleading information in digital and physical environments during a disease outbreak (7). This infodemic was most pronounced in the online space. Our role has moved beyond deploying social science theory and evidence for social change; we are also well-placed to contribute to efforts to counter the proliferation of misinformation via social media (8). The challenge remains how best to broker information between different stakeholders and to help the public through “health data sense-making”. This involves competence in integrating data-driven approaches—together with a sound understanding of complex human communication and behavioral processes—in processing different forms of health data (9). As an example, during the HIV pandemic, we have learned a great deal from socio-behavioral science that can be applied to other global health crises, in particular that individual behavior must be understood within its interpersonal and societal context (10).

The large amount of information and speed at which COVID-19 data were being generated was overwhelming. Understanding how to effectively and practically take advantage of the information in advocating for health was challenging for many communities and community health organizations. But without incorporating data from underserved communities, even the most advanced machine learning algorithms can be perpetuate biases in data (11). Social scientists are well-positioned to provide insight into human behavior. For example, social scientists used their skills to learn about information transmission networks and examined news-sharing behaviors to establish effective communication systems during the COVID-19 pandemic (12).

As a result of the pandemic, social scientists working in the health context have found that the scientific process, meaning how we do social science, has changed. Science usually takes place in the confines and privacy of the halls of academia. Since the pandemic, our work has been catapulted to the public space. If we think about how we do social science research, the whole process is inherently messy. What changed is that this messy, cyclic process played out in the public realm; where anyone could examine what we missed or what incorrect assumptions were made. And without an understanding of the scientific process, public trust in the research process can be eroded. Social scientists increasingly need to grapple with ambiguity without a road map. The truth is we do not have all of the answers and that is part of the process. So, we must practice humility, and work harder to build more trust in our research. How well our research is perceived and utilized depends not only on trust in the process but how well we communicate it. For example, as highlighted by other social scientists, even the words used to frame the pandemic are important in risk communication and influence the public’s perceptions of vulnerability (13,14). Harvey [2023] pointed out that naming the disease “COVID-19” with an acronym did not readily communicate a public health message and therefore reduced the perceived public importance of public health measures (14).

Sometimes we speak a very dense language understood only by other fellow social scientists. We must learn to communicate our research in ways that can be understood and digested by laypeople, as well as by researchers in other disciplines/fields. Social scientists can use a systematic approach to design message content and delivery to create more persuasive messaging for public health crises (13-15). Ali & Davis-Floyd [2020] argued that the use of military vocabulary such as “lock-down” and “war” was effective because it allowed the Pakistani government more latitude to enforce public health measures during the COVID-19 pandemic (13). It is our job to help the public to digest the information and piece together the truth; or if not the truth, a truth that is critical, one that is digestible while also not oversimplified.

Support for policy decision-making

Policy is essentially about social change; it is asking populations to do things differently, to nudge movement in one direction or another through policy, legislation, and practice. Effective policy-making requires an understanding what is tolerable and acceptable in populations, and the diversity of levels of tolerance and acceptability for change across populations (2-4,16). As social scientists, we must be mindful of the lived realities of the communities we serve and whether policies will actually make sense in real life. For example, Ali [2021] used ethnographic research to understand the impacts of contradictory government policies in Pakistan dealing with people who had died from COVID-19 on the community (17). And during the 2013-2016 West African Ebola epidemic, anthropologists conducted community-based research on burial practices to help the government create appropriate public health interventions to mitigate the spread of disease (18).

We put a lot of emphasis on evidence-based decision-making, evidence-based teaching, and evidence-based practice. As academics, we have often been perceived as living in our own little bubbles, raising the question of whether we were capable of truly proposing real-world solutions. We should examine our work through an epistemological lens. We should reflect on what is evidence and perhaps revisit the different forms of evidence and knowledge, including those that aren’t consistent with the dominant views. For example, when a very broad, one-size-fits-all approach to COVID-19 was promoted by some governments, it was our job to question this (19). Social science research aims to mitigate misunderstandings and misrepresentations through a deep understanding of the worldviews of participants (20). Our skills in collecting information from different communities can help reflect the unique positions of diverse populations. This isn’t something learned through textbooks; this takes deep relationships within communities, built over time. Social scientists are adept at engaging with others and can contribute to policy-making processes. We should utilize our skills to bridge the gap between communities and policy-makers to design relevant, culturally sensitive, and effective interventions. Since the 1940’s, anthropologists have focused on understanding cultural differences in health behaviors; one example is Kleinman with his “explanatory model” of illness to improve healthcare providers’ understanding of the cultural dimensions of health (21). Further, COVID-19 disproportionately affected minority communities; social scientists conducting community-based research provided important insight why vaccination rates were lower in these groups. This understanding was useful in addressing misinformation and to enact programs and policies to meet the needs of these groups (22-25).

Faced with pressing challenges and limited resources, governments urgently need robust evidence to inform critical policy decisions during crises (26). Unfortunately, social scientists are seldom asked for their opinion by policymakers. Governments must be encouraged to increase the visibility of the role of diverse sciences, including the social sciences, as well as biomedical sciences, in the discussions and debates around health issues. As another example, one of the co-authors of this paper was invited to the WHO’s Technical Working Group on COVID-19, which has since become the Technical Working Group on Social Science in Health Emergencies. She was also appointed as a member of the Republic of the Philippines’ National Immunization Technical Advisory Group on COVID-19; and in August 2022 as a member of the Department of Health’s (DOH) Scientific Advisory Group of Experts for Emerging and Re-Emerging Infectious Diseases. She is the only social scientist on both advisory bodies, which aim to create policy around infectious disease outbreaks for the Philippines. Finally, another co-author worked as a social scientist with the Health Technology Assessment Council, a project of the Philippines Departments of Science and Technology and of Health, to evaluate the evidence for technological tools to fight the COVID-19 pandemic.

The role of social scientists is also the role of action. The disruptions brought about by the pandemic spawned the emergence of new actors, coalitions, and other stakeholders, giving us an opportunity to utterly shape and reshape our societies but also citizen-state relations. Working with governments, especially local governments, is paramount. Directives can be issued by national governments and national entities, but at the end of the day the real action is at the local government level. If you want change, local governments play a big role in policy-making and implementation. Contributing our voice is important for social scientists because we may have different lenses than others. Scheper-Hughes reminded us that our work “should be at the margins, questioning premises, and subjecting epistemologies that represent powerful, political interests to oppositional thinking” (27). This discourse is critical to policy change (19). It is not enough to generate data but we must go beyond that to provide our informed, evidence-based opinions to our leaders to advocate for appropriate policies.

Real-time data are absolutely critical when dealing with global health crises. The luxury of employing methodologies that took months to prepare, administer, and analyze did not exist during the pandemic. We saw in the early days of the pandemic that the public was so enthusiastic about the novelty of gaining access to public health epidemiology data, that it became part of the global discourse. “Flattening the curve” became a phrase that most people were familiar with. This was quite a transition. In many parts of the world, we felt that public health had been sidelined pre-pandemic, that it had lost its resonance and value in the broader health system in the real world. But we have seen that putting data in the hands of the people has value. All of a sudden, the public felt they had some perspective, some commentary, some agency to contribute to a global crisis. We now have these exceptionally accessible beguiling databases, data visualization tools at our fingertips. We can now track data within our own cities as well as see what’s happening in the other parts of the world.

The world as we know it fundamentally changed with COVID. One major implication is with increasing digitization, online social media platforms have become so prominent that we face a different world. The question for social scientists is what is the net effect in terms of human interaction? We must be mindful of how we use and interpret evidence-based research for public health. We need to always adopt the lens of inequity in how we collect and interpret the data. Often, we are tempted to make sense of the data by applying some machine learning or artificial intelligence algorithm to see what the data tells us. But we need to ask ourselves ‘what is not represented in the data? And who is not represented in the data?’ We cannot ignore our traditional inquiry methods—the interviews, ethnographies, surveys. Using all these tools collectively will give us a bigger picture. Big data is not big enough; we must be mindful of different voices being represented. This means we need to use different tools to hear different voices. It is worth noting that we also need to enforce reporting of data. Without accurate reporting, there is no “real-time”; the data will be meaningless. We ought to use our research to take a step back and see what drives people to seek help and to report (or not). Real-time data are dependent on how people actually think about the importance of the data that they are inputting.

Increasingly there is a need to bring together data from health information systems and social media. We need to invest in developing more tools in which we can detect trends using social media data. Walmart, Target, Starbucks and even Facebook have access to real-time data by the minute, and they’re not even in the business of saving lives. We already know that in politics, social media dictates what is going to be discussed in the mainstream public opinion. During the lockdown when we were working from home, we were restricted from going into the field to conduct interviews and surveys. So how can we keep abreast of the pulse of communities? Social media and search engine platforms can serve as population monitoring functions, providing a preliminary sense of what’s going on in the communities. Analyzing prominent questions and concerns of the public via social media can help us to understand public attitudes and reactions to crises and how these shifts over time (28-31). For example, in the COVID-19 pandemic, Tsao et al. [2021] employed social media analysis of 81 studies to understand the public’s fears and concerns as a real-time response to the evolving crisis (28). We must invest resources because we will save money and lives if data are generated in a way that can be understood by policymakers, practitioners, and the public.

Conclusions

The COVID-19 pandemic provided an extraordinary opportunity to examine societies under extreme pressure —health care systems, local and national economies, and socio-cultural practices within communities. Now more than ever, the gaps and weaknesses in systems that underpin health have been exposed, inviting a reconsideration of the value of a range of sources of knowledge. Our responsibility as social scientists is to conduct research that has direct relevance to the communities we serve so we must ensure that our research reflects the diversity of our communities. Social scientists can also help to combat misinformation by being more transparent about the research process, and by interpreting data in a way that others can digest and understand. By utilizing tools and technologies increasingly available, we can also help guide policymakers to make evidence-based decisions and ensure that the voices of marginalized communities are heard. Social scientists must use research to influence the present and to shape the future. We need to work harder to ensure that our research is integrated into other fields to provide a more holistic view of the impact of global health crises on diverse populations and potential acceptable solutions.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Public Health and Emergency. The article has undergone external peer review.

Peer Review File: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-69/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-69/coif). M.W. serves as the Editor-in-Chief of Journal of Public Health and Emergency from July 2023 to June 2025. N.T.C.C. reports membership in Philippines’ Scientific Advisory Group of Experts (SAGE) for Emerging & Re-Emerging Infectious Diseases (EREID SAGE) (August 2022–present), Philippines’ Inter-Agency Technical Working Group on Genetically Modified Mosquitoes (September 2023–present), WHO Social Science TWG on Health Emergencies (September–December 2023), WHO Social Science Working Group on COVID-19 (August 2020–June 2022), Strategic Advisory Group of the WHO Foundation (May–October 2022) and Philippines’ National Immunization Technical Advisory Group (NITAG) for COVID-19 Vaccines (December 2020–July 2022). M.M.P.C. reports collaborations with other academic institutions for lectures and research. J.R.G. reports lectures for Baylor University Summer Programs at USFQ and collaboration with Cornell University. L.M.P. reports consulting fees as TV UP resource person and report writer, and Commission on Population and Development writer for Strategic Plan of Action and Research Agenda. L.M.P. also reports that the International Science Council and Asean Association of Social Science Research Council (AASSREC) funded travels to Paris and Thailand respectively. Besides, L.M.P. is member of the Philippine Statistics Authority Board, the Philippine Statistical Training Institute Board, the Philippines Communication Board of Trustees, the College of Mass Communication Foundation, Inc., and the Grants Steering Committee of the AASSREC. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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