Reimagining AMR Governance for a World in Polycrisis

Earlier this month, Dahdaleh research fellow Raphael Aguiar attended the International Public Policy Conference (IPPC) in Chiang Mai, Thailand, where he presented in the panel “The Governance of Urban Ecosystem/Human Health.”  The panel was chaired by Evelyne de Leeuw, Marie-Christine Therrien,  Antoine Boudreau LeBlanc, and Nicolas Antoine-Moussiaux. It focused on the complex interactions between urban ecohealth systems, human and non-human interactions in urban environments, ecological degradation, public administration and the polycrisis. The panel asked how local governments and other actors can govern such complexity in ways that are equitable, anticipatory, and transformative.

His presentation, “Governing Antimicrobial Resistance through an Urban Political Ecology Lens,” started arguing that antimicrobial resistance (AMR) must be understood not just as a biomedical or technical problem, but as a socioecological issue deeply shaped by urbanization, governance failures, health inequities, exploitative nature-society relations, and systemic threats. Raphael introduced Urban Political Ecology (UPE) as a framework that look at the metabolic nature of cities and other urban forms. Urban metabolisms help us understand how global networks of capital, regulatory projects, supply chain infrastructures, water, food, medicine, and waste circulate and shape AMR risks. This can happen in cities and other urban forms such as informal settlements, confined animal feeding operations (CAFOs), and other infrastructures of agro-industrial production and circulation that expand urban society and increase vulnerabilities to emerging and resistant pathogens. "The spatialization of AMR risks brings attention to the need, and calls for, practical insights supporting equitable AMR policies."

Drawing on research supported by his postdoctoral fellowship at the Dahdaleh Institute, Raphael illustrated how UPE can deepen and expand existing One Health (OH) approaches to AMR governance. Building on insights gained over the past year, he introduced a new initiative that seeks to galvanize the role of cities and communities in governance frameworks addressing AMR. Rather than seeing communities as passive or vulnerable objects, our initiative positions them as governance actors reimagining the kind of society we want to live in. If cities became the terrain on which global health threats unfold, governance and policy must recognize and leverage the agency of cities and communities as local actors shaping our future.

As key take aways, Raphael argued that the governance of AMR as an example of governance of polycrisis, must be reimagined. “It is not enough to anticipate and mitigate risks; we must jointly and collaboratively reimagine the conditions under which health is possible. Our research aims to offer theoretical and practical tools by providing a framework for addressing AMR as part of the polycrisis, and by challenging AMR governance to move beyond coordination towards transformation, building situated governance frameworks co-designed by communities, and responsive to the crisis of our times. Sincere thank you to Roger Keil and Mary Wiktorowicz for their steadfast partnership and contributions throughout this scholarly journey”

As a postdoctoral fellow at the DI, I benefited from its interdisciplinary environment, which emphasizes equity, planetary health and foresighting. These principles directly informed the theoretical and methodological approaches of my work. Importantly, the Institute fostered an intellectual community where governance, urbanization, equity, and planetary health are treated not as buzzwords, but as necessary frameworks to rethink global health challenges. By encouraging interdisciplinary research, the Institute enabled me to contribute to the global conversation on AMR governance from a critical urban health perspective.

— Raphael Aguiar

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