Intended for healthcare professionals

Observations Public Health

Antimicrobial resistance is a social problem requiring a social solution

BMJ 2015; 350 doi: (Published 19 May 2015) Cite this as: BMJ 2015;350:h2682
  1. Richard Smith, professor of health system economics and dean, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
  1. Richard.Smith{at}

We need to reverse our dependency on antibiotics, whether or not new ones are discovered

Antimicrobial resistance has reasserted itself on the national and international agenda as a critical threat to public health and health systems. It undermines the very foundations of modern healthcare, from joint replacements to chemotherapy, threatens to reverse the decline in mortality and morbidity from infectious diseases, jeopardises animal health and welfare, and poses potentially crippling financial effects.1 2

It is intrinsically a biological phenomenon, which has, perhaps naturally, led to much of the discussion on tackling it being driven from a biological, and broader scientific, perspective. However, the conditions promoting, or militating against, the biological mechanisms of antimicrobial resistance are deeply social, shaped by cultural, political, and economic processes. Such social aspects include:

  • The ways farmers, vets, and regulatory systems manage livestock production for human consumption

  • How regulatory and fiscal frameworks incentivise or deter antimicrobial development, production, and use

  • How the public and healthcare professionals understand, value, and use antimicrobials

  • The context in which animals and humans interact, and

  • The ways in which particular groups …

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