The threat from AMR
Antimicrobial resistance (AMR) is a growing threat to public health, with the potential for devastating health and social consequences. Both mortality and morbidity are predicted to rise as rates of AMR increase. In time, the risks of life-threatening complications from drug-resistant infections could outweigh the benefits of routine medical interventions, such as surgery or chemotherapy.
The economic impact of AMR is also potentially catastrophic. It is estimated that AMR currently costs the EU approximately €1.5 billion each year, and forecasts suggest that AMR could cost the global economy US0 trillion by 2050 if current trends continue.
What causes AMR?
AMR occurs when microorganisms (e.g. bacteria, viruses, fungi) develop resistance to previously effective drug treatments. AMR is a natural evolutionary process that cannot be reversed, but increases in resistance can be limited by responsibly using antimicrobials. Although drug-resistance in all microorganisms is concerning, efforts are especially focused on tackling the problem of antibiotic resistance in bacteria.
The threat to human health from antibiotic resistance is driven by inappropriate antibiotic use in both humans and animals. It is estimated that antibiotic use in the UK is split equally between humans and animals. Use of critically important antibiotics is rising in animals, despite falling in humans. Nonetheless, rates of antibiotics prescribed to humans have been rising in recent years, despite previous reductions in prescriptions.
How can we slow AMR?
Tackling this crisis will involve co-ordinated efforts across all levels of society. International organizations and national governments will need to coordinate research and policy efforts. In both human and veterinary medicine, public health officials, researchers, and healthcare professionals will need to ensure that best practice is implemented as widely as possible. The public also have their part to play, in their roles as patients, parents, farmers, and pet owners.
The One Health approach is based upon the principle that human, animal, and environmental health are intertwined. This is especially true in the case of AMR, as resistance can (and does) develop in bacteria that infect both humans and animals.
What can Health Psychology offer?
One area that health psychologists investigate is how the beliefs that individuals hold can influence their behaviour. Misconceptions about when antibiotics should be used are common amongst the public, leading to inappropriate use by some. Amongst doctors and vets, prescribing decisions are based on both clinical factors, such as symptoms and disease severity, and non-clinical factors, such as beliefs about the expectations of the other person.
Health psychologists also develop and test theory-based interventions that assist people in changing their behaviour. Health psychologists are already involved in cross-disciplinary work with human and veterinary medical professionals to develop behaviour change interventions aiming to improve antibiotic prescribing.
Society needs to recognise the value of antibiotics and use them sparingly. To achieve this, we need attitudinal and behavioural change at multiple levels. Health psychology theories can inform targeted interventions with clinicians and patients, as well as population-level educational campaigns, to encourage the responsible use of antibiotics.
Review on AMR: www.amr-review.org
Public Health England Review: https://www.gov.uk/government/publications/antibiotic-prescribing-and-behaviour-change-in-healthcare-settings
Antibiotic Guardian Campaign: http://antibioticguardian.com
Sarah E. Golding, PhD Student and Trainee Health Psychologist, University of Surrey