Antimicrobial Resistance Causes: Why Social Factors Matter More than Drugs

Why It Matters

AMR threatens health systems and economies worldwide; addressing social determinants is essential to curb resistance sustainably.

Key Takeaways

• Over‑the‑counter antibiotics drive resistance in low‑income regions
• Poor sanitation amplifies infection rates, increasing antibiotic demand
• Weak regulation enables counterfeit drugs, accelerating resistance
• Health education empowers communities to practice antimicrobial stewardship
• Strengthening diagnostics reduces unnecessary broad‑spectrum prescriptions

Pulse Analysis

Antimicrobial resistance (AMR) has moved from a niche concern to a global health emergency, with the WHO reporting that up to 20% of infections in parts of Africa are already drug‑resistant. While the misuse of antibiotics is the most visible symptom, the underlying drivers are largely social: poverty, overcrowding, and limited access to clean water create environments where infections spread unchecked. In such settings, self‑medication and incomplete courses become rational choices for people who cannot afford formal care. Ignoring these root causes means new antibiotics will only provide temporary relief.

Poor sanitation and inadequate waste management act as silent amplifiers of resistant bacteria, turning everyday water sources into reservoirs of infection. Weak regulatory frameworks further compound the problem by allowing over‑the‑counter sales of antibiotics and the circulation of substandard or counterfeit medicines that fail to eradicate pathogens and instead select for resistance. Community‑level interventions—such as clean‑water projects, hygiene campaigns, and school‑based health education—have demonstrated measurable reductions in infection rates and antibiotic consumption. Empowering citizens with clear, culturally relevant messages about antimicrobial stewardship creates a partnership between the public and health providers that can curb misuse.

Policymakers must shift funding from solely drug development toward integrated public‑health strategies that address the socioeconomic determinants of AMR. Investing in affordable diagnostics, expanding universal health coverage, and strengthening supply‑chain oversight can reduce reliance on broad‑spectrum antibiotics while ensuring patients receive effective treatment. International donors and private sector partners are increasingly recognizing that improving housing, nutrition, and water infrastructure yields a higher return on investment by lowering disease burden and, consequently, antibiotic pressure. A coordinated, multisectoral approach that blends medical innovation with social development offers the most sustainable path to reversing the resistance trajectory before it overwhelms health systems worldwide.

Antimicrobial resistance causes: Why social factors matter more than drugs

By Maureen Oluwaseun Adeboye · February 12, 2026

Antimicrobial resistance (AMR) is being talked about more now than ever before, and for good reason. When medicines stop working for common infections, everyone loses. The World Health Organization has described AMR as one of the top global health threats, and in October 2025 published data suggesting that in parts of Africa, as many as one in five infections are resistant to commonly used antibiotics.

That statistic should alarm us. But here’s the thing: If we keep talking about AMR without asking why it’s happening, all we are doing is putting a new label on a problem we already know too well. At its root, AMR is not just about misuse of medicines. It is about a whole ecosystem of social, economic, and health‑system factors that push people toward behaviors that make resistance inevitable. If we don’t address those forces, we risk creating the next wave of AMR with a new “T‑shirt,” same crisis, different packaging.

The roots of misuse

Don’t get me wrong. At the heart of AMR is inappropriate antibiotic use, and in many communities across West Africa, this is impossible to ignore. Self‑medication is common. Antibiotics are easily purchased over the counter without prescriptions or proper diagnoses. Doses are often unfinished. Drugs are used for conditions where they are not indicated at all. These practices fuel resistance by exposing microbes to antibiotics in ways that allow them to adapt, survive, and eventually become resistant.

Still, the question remains: Why?

It is easy to point to the cost of health care and lack of insurance coverage as major drivers. In many low‑ and middle‑income countries, even where national health insurance schemes exist, coverage is often limited to basic consultations and a narrow list of medications, many of which are already widely misused, including antibiotics. More effective or newer drugs are typically out of reach for populations already at higher risk of infection due to poverty, overcrowding, and poor sanitation. As a result, insurance may reduce out‑of‑pocket spending, but it does not break the cycle. It simply shifts who pays for familiar drugs that may no longer work as well as they once did.

Beyond the pharmacy

The bigger problem lies outside the pharmacy. It lies in communities where poor sanitation and inadequate hygiene contribute to the spread of infections and create environments where resistant bacteria thrive. It lies in weak regulatory oversight that allows uncontrolled over‑the‑counter sales of antibiotics and the circulation of substandard and counterfeit drugs, which fail to treat infections effectively and accelerate resistance. It lies in limited public awareness of the long‑term implications of using antibiotics casually, making self‑medication and incomplete treatment seem harmless rather than dangerous.

Introducing newer antibiotics without addressing these realities only keeps us trapped in the same cycle, this time with even more dangerous resistant strains. The fundamental lesson of AMR is that health is more than medicines. Access to clean water and proper waste disposal reduces infection rates and, by extension, the need for antibiotics. Better nutrition, improved living conditions, and basic hygiene strengthen immunity and reduce disease burden long before anyone reaches for a drug.

Empowerment and stewardship

This begins with health education and promotion that empower people to make informed choices in resource‑limited settings. Conversations about antimicrobial stewardship must be had in language simple enough for the average person to understand, so communities can actively partner with health‑care workers and governments in curbing resistance.

Clinicians also have a role to play. In many low‑resource settings, broad‑spectrum antibiotics are prescribed out of necessity due to limited diagnostics, funding constraints, and availability issues. But with stronger regulatory systems and improved diagnostic capacity, antibiotics can be prescribed more judiciously and only when truly needed.

AMR is not just about bacteria learning to outsmart drugs. It is a reflection of social structures, economic inequality, environmental conditions, and how health systems function. Newer antibiotics and expanded insurance coverage are important, but they are only part of the solution. The real long‑term answer lies in raising the standard of living of the average citizen, improving hygiene and sanitation to prevent infections, and reshaping public understanding of how medicines should be used.

As the World Health Organization reminds us, health is not just physical. It is physical, mental, and social well‑being. If we fail to address why infections spread and why people misuse antibiotics in the first place, we will keep facing the same resistance problems over and over again, different drugs, same cycle. AMR isn’t the new kid on the block anymore. It is the predictable consequence of how we live, how we treat illness, and how we manage our health systems. If we want a different future, we must address it at its roots before resistance becomes our norm.

Maureen Oluwaseun Adeboye is a medical student in Ghana.