This article is more than 5 years old. Information may no longer be current.
Improving social welfare could reduce most TB incidence worldwide
Click Here to Manage Email Alerts
Researchers estimated that reaching WHO’s No. 1 Sustainable Development Goal of ending extreme poverty and expanding social protection could reduce 84.3% of the world’s TB burden by 2035.
Daniel J. Carter, MSc, of the department of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, and colleagues said their study, recently published in The Lancet Global Health, confirms the interdependence between WHO’s Sustainable Development Goals (SDGs) and its End TB Strategy.
“WHO’s End TB Strategy arose in parallel with the SDGs with the precise intent of aligning indicators, targets and strategic thinking,” they wrote. “The framing of our study within the broader development agenda should guide policy and practice across the development and health policy landscapes.”
To estimate the impact of SDG 1 on TB incidence, Carter and colleagues developed a conceptual framework that linked indicators of SDG 1 progress to TB risk factors, including malnutrition, HIV infection, housing quality and health behavior.
In a mathematical analysis, ending extreme poverty, defined as living on less than $1.90 per day, and increasing social protection to everyone resulted in a 9.1% annual reduction in global TB incidence. The researchers conducted separate analyses examining the impact of both targets alone. They found that ending extreme poverty reduced 33.4% of global TB incidence and expanding social protection reduced 76.1% of global TB incidence by 2035. Under a scenario in which both targets are met, global TB incidence declined 84.3% (95% CI; 54.7-94.9).
If social protection is expanded only 50% and 10% of the global population remains in extreme poverty, TB incidence would still decline 52.5%.
Based on these results, the researchers noted that progress toward SDG 1 is particularly important because less than 5% of countries are on track to eliminate TB. The CDC recently warned it is unlikely that TB will be eradicated in this century.
“Biomedical innovation is certainly a part of the fight to eliminate TB, but it will not be sufficient,” Carter told Infectious Disease News. “We must start considering poverty elimination and social protection as being a tool for use within the remit of the TB community.”
In a recent op-ed, Carter noted that expanding social protection efforts will require “a substantial amount of political will” and investments in national health programs, such as Brazil’s Bolsa Familia conditional cash transfer and South Africa’s Child Support Grant, as well as international organizations, such as the Global Fund.
“The medical community needs to advocate for and support such systems in their own countries,” Carter said. “Luckily, implementation of social protection programs goes a long way to helping eliminate extreme poverty. Rights-based and state-led social policies that guarantee income security and access to social services over the long term are often more effective than short-term aid provisions. The most effective program is always context dependent — in food-insecure locations, social protection might take the form of food baskets, but in high-income countries, provision of secure housing and secure employment is currently a much more pressing need.”
In a related editorial, Giovanni Battista Migliori, MD, director of WHO’s Collaborating Center for TB and Lung Diseases, Maugeri Care and Research Institute, and Alberto L. Garcia-Basteiro, MD, MSc, investigator at Manhiça Health Research Center in Manhiça, Mozambique, said the study has “major policy implications” and highlights the importance of multisectoral approaches to combat global pandemics.
“Thanks largely to WHO, the technical elements of TB control and elimination are now established throughout most of the world: active case-finding, effective diagnosis and treatment of infectious cases, and management of latent TB infection,” they wrote. “The statistical model presented by Carter and colleagues underlines the need to tackle socioeconomic determinants just as vigorously as these technical elements if we are to see the final demise of TB throughout the world.” – by Stephanie Viguers
References:
Carter DJ. The fight to end TB: Not just against the pathogen. https://www.lshtm.ac.uk/newsevents/expert-opinion/fight-end-tb-not-just-against-pathogen. Accessed March 28, 2016.
Carter DJ, et al. Lancet Global Health. 2018;doi:10.1016/S2214-109X(18)30195-5.
Migliori GB, Garcia-Basteiro AL. Lancet Global Health. 2018;doi:10.1016/S2214-109X(18)30189-X.
Disclosures: The authors report no relevant financial disclosures.