dollars and disease marrying social, economic and disease dynamic perspectives for public health nim...
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![Page 1: Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London](https://reader035.vdocuments.mx/reader035/viewer/2022062715/56649d975503460f94a8153c/html5/thumbnails/1.jpg)
Dollars and diseaseMarrying social, economic and disease dynamic
perspectives for public health
Nim ArinaminpathyImperial College London
![Page 2: Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London](https://reader035.vdocuments.mx/reader035/viewer/2022062715/56649d975503460f94a8153c/html5/thumbnails/2.jpg)
Roles of transmission models in public health
Supporting healthcare delivery
Informing decision-makingBasic science: contributing to evidence base for policy
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Careseeking(unmeasured confounders)
Health systems
Macroeconomicshocks
National politics with borderless infections
(Klepac et al, PNAS 2011)
Why economics/sociological processes
Individual behaviour(Funk et al, PNAS 2009)
Decision-making under economic constraints
(Edmunds, 200x)
Implementationand
logistics
Marketdynamics
![Page 4: Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London](https://reader035.vdocuments.mx/reader035/viewer/2022062715/56649d975503460f94a8153c/html5/thumbnails/4.jpg)
Careseeking(unmeasured confounders)
Health systems
Macroeconomicshocks
National politics with borderless infections
(Klepac et al, PNAS 2011)
Why economics/sociological processes
Individual behaviour(Funk et al, PNAS 2009)
Decision-making under economic constraints
(Edmunds, 200x)
Implementationand
logistics
Marketdynamics
![Page 5: Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London](https://reader035.vdocuments.mx/reader035/viewer/2022062715/56649d975503460f94a8153c/html5/thumbnails/5.jpg)
Careseeking(unmeasured confounders)
Health systems
Macroeconomicshocks
National politics with borderless infections
(Klepac et al, PNAS 2011)
Why economics/sociological processes
Individual behaviour(Funk et al, PNAS 2009)
Decision-making under economic constraints
(Edmunds, 200x)
Implementationand
logistics
Marketdynamics
![Page 6: Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London](https://reader035.vdocuments.mx/reader035/viewer/2022062715/56649d975503460f94a8153c/html5/thumbnails/6.jpg)
Implementation: logistical/resource factors
• Decision trees for clinical algorithms
• Operations research– E.g. diagnostic tests for TB control
Eg: Rao, Schellenberg & Ghani, 2013Dowdy, Cattamanchi et al, 2011
Central laboratory
Peripheral sites
![Page 7: Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London](https://reader035.vdocuments.mx/reader035/viewer/2022062715/56649d975503460f94a8153c/html5/thumbnails/7.jpg)
Careseeking(unmeasured confounders)
Health systems
Macroeconomicshocks
National politics with borderless infections
(Klepac et al, PNAS 2011)
Why economics/sociological processes
Individual behaviour(Funk et al, PNAS 2009)
Decision-making under economic constraints
(Edmunds, 200x)
Implementationand
logistics
Marketdynamics
![Page 8: Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London](https://reader035.vdocuments.mx/reader035/viewer/2022062715/56649d975503460f94a8153c/html5/thumbnails/8.jpg)
Diseases of poverty
• The ‘big three’: HIV, TB, Malaria• Poverty:
– Increases risk of acquiring infection– Reduces access to essential healthcare
• Economic factors loom large for dynamics of infection
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0
50
100
150
200
250
300
1820 1840 1860 1880 1900 1920 1940 1960 1980 2000
TB
dea
ths/
100,
000/
yrBritain beat TB in the 19th and 20th centuries?
Much of the (slow) decline preceded drugs
Keats1821
E Bronte1848
C Bronte1855
Mansfield1923
Lawrence1930
Orwell1953
Leigh1967
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Russia Hungary
Health in financial crises: Soviet Union in the 1990s
Arinaminpathy, Dye (2010) J.R.Soc.Interface
Strong associations between economic changes and TB epidemiology
Process vs pattern?
Most recent financial crisis?
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Tuberculosis today8.7M new TB cases,1.4M deaths in 2011 1.1M TB/HIV+ cases, 430k deaths
Global Tuberculosis Report, 2012
As yet no effective TB vaccine
But most TB cases are curable with 6-9 months of drug treatment.
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Ecology of TB drug markets
Few manufacturersof TB drugs
Global demand for drugs fragmented amongst many high-burden, low-income countries
Irregular supply, with drugs of uncertain quality
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Ecology of TB drug markets• Global Drug Facility (GDF):
• What impact has the GDF had, on the TB drug market?– Private-sector prices as well as in national TB programmes
• What might be the effects of GDF expansion?
Arinaminpathy, Cordier-Lassalle, Vijay, Dye (2013) Lancet
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Health systems in infectious disease dynamics
Lin, Langley, Mwenda et al (2011) Int.J.Tuberc Lung Dis.
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Photo credit: Peter Small
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Patient trajectories and infectious periods
Kapoor, Raman, Sachdeva, Satyanarayana (2012) PLoS ONE
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Driving questions
• What are the most effective levers, at the public/private interface?
• How might provider incentives be structured, to minimise diagnosis and treatment delays?
• What effects might such interventions have on TB transmission?
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Conclusions
• Economic factors can be an important part of the interface between infectious disease modeling and public health
• Health-economic implications of given interventions have played an important role in decision-making
• Future directions: recognising economic/sociological processes as part of the disease-dynamical system, for public health