Public Interventions and Health Inequalities in Recomposed Natural and Social Ecosystems of the Mekong Sub-Region – SOREMA

1- Scientific context and objectives
Two simultaneous phenomena infer a reorganization of health policies in the Mekong sub-region (Cambodia and its borders with Vietnam and Laos): the persistence of malaria and its severe forms; as well as the emergence of resistance to anti-malaria treatment. Two priorities need to be conciliated: to reduce inequalities towards malaria infection and to maintain treatment efficacy. The four objectives of the project are:
- to identify the mechanisms generating health inequalities through the evolution of malaria and the spread of drug resistance.
- to demonstrate ecological changes related to human movements, for they reconfigure the dynamics of infection and lead to a recrudescence of infection and drug resistance.
- to put malaria in a historical perspective, allowing to understand under which framework and in which directions are new health policies evolving.
- to analyse relationships between international strategies, national policies, local interventions and integrated knowledge. The former ones are now reformulated at a time when the risk of spread of drug resistance is predominating on the global agenda.
The originality of this project lies in an integrated interdisciplinary approach. The synthesis of knowledge among 13 researchers (in anthropology, sociology, geography, history, economy, entomology, epidemiology and medicine, biology) will allow to propose a consistent and articulated analysis framework, clarifying links between population movements, geo-ecological transformations, epidemiological and entomological variables and health inequalities.

2- Project description and methodology
There are two significant foci:
i. the question of the heterogeneity of malaria exposure related to the emergence of anti-malarial drug resistance. We will look into the parameters which influence inequalities towards the disease in a changing society (increased human circulation, transformation of ecological systems).
ii. The problematic related to human and spatial colonization, to public health interventions and to the resistance phenomenon. This historical exploration is a needed platform to consider the central question aiming at taking into account current and future health activities.
The methodology associates an extensive exploration of themes specific to the Mekong sub-region. It includes the spatial identification of the infection, of the mechanisms producing health inequalities, of the population movements and of the spread of the resistance. For this purpose, it proposes a fine analysis of 3 main areas selected for their representativeness in the diversity of malaria. The analysis will put forward the modalities of reorganization of health inequalities. It will be undertaken in multiple micro-sites in each of the three areas and will focus on: 1/ The dynamics of inequalities towards malaria; 2/ The changes affecting social and natural ecosystems; 3/ the international health policies and its local impact; 4/ the underlying historical conditions; 5/ the relationships between local and global knowledge; 6/ the original strategies associating health initiatives and social services.

3- Expected results and valorisation
Traditional scientific products (articles, books) will be associated with modern techniques of dissemination (online reviews and articles, website, presentations and meetings). Besides, the project aims to provide critical outcomes which development stakeholders could use. A workshop around the “research and action” theme, along with a publication, will contribute to value the results.