Download Where diseases get economic

Dollars and disease
Marrying social, economic and disease dynamic perspectives
for public health
Nim Arinaminpathy
Imperial College London
Roles of transmission models in public health
Supporting healthcare delivery
Basic science: contributing
to evidence base for policy
Why economics/sociological processes
Careseeking
(unmeasured confounders)
Decision-making under
economic constraints
(Edmunds, 200x)
Individual behaviour
(Funk et al, PNAS 2009)
Implementation
and
logistics
National politics with
borderless infections
(Klepac et al, PNAS 2011)
Macroeconomic
shocks
Market
dynamics
Health systems
Why economics/sociological processes
Careseeking
(unmeasured confounders)
Decision-making under
economic constraints
(Edmunds, 200x)
Individual behaviour
(Funk et al, PNAS 2009)
Implementation
and
logistics
National politics with
borderless infections
(Klepac et al, PNAS 2011)
Macroeconomic
shocks
Market
dynamics
Health systems
Why economics/sociological processes
Careseeking
(unmeasured confounders)
Decision-making under
economic constraints
(Edmunds, 200x)
Individual behaviour
(Funk et al, PNAS 2009)
Implementation
and
logistics
National politics with
borderless infections
(Klepac et al, PNAS 2011)
Macroeconomic
shocks
Market
dynamics
Health systems
Implementation: logistical/resource factors
• Decision trees for clinical algorithms
Eg: Rao, Schellenberg & Ghani, 2013
Dowdy, Cattamanchi et al, 2011
Central laboratory
• Operations research
– E.g. diagnostic tests for TB control
Peripheral sites
Why economics/sociological processes
Careseeking
(unmeasured confounders)
Decision-making under
economic constraints
(Edmunds, 200x)
Individual behaviour
(Funk et al, PNAS 2009)
Implementation
and
logistics
National politics with
borderless infections
(Klepac et al, PNAS 2011)
Macroeconomic
shocks
Market
dynamics
Health systems
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
Britain beat TB in the 19th and 20th centuries?
Much of the (slow) decline preceded drugs
300
C Bronte
1855
TB deaths/100,000/yr
250
200
150
Mansfield
1923
Keats
1821
E Bronte
1848
Orwell
1953
Leigh
1967
100
50
Lawrence
1930
0
1820 1840 1860 1880 1900 1920 1940 1960 1980 2000
Health in financial crises: Soviet Union in the 1990s
Russia
Hungary
Strong associations
between economic changes
and TB epidemiology
Process vs pattern?
Most recent financial crisis?
Arinaminpathy, Dye (2010)
J.R.Soc.Interface
Tuberculosis today
8.7M 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.
Ecology of TB drug markets
Few manufacturers
of TB drugs
Global demand for drugs
fragmented amongst
many high-burden, lowincome countries
Irregular supply, with
drugs of uncertain quality
Ecology of TB drug markets
• Global Drug Facility (GDF):
Arinaminpathy, Cordier-Lassalle,
Vijay, Dye (2013) Lancet
• 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?
Health systems in infectious disease dynamics
Lin, Langley, Mwenda et al
(2011) Int.J.Tuberc Lung Dis.
Photo credit: Peter Small
Patient trajectories and infectious periods
Kapoor, Raman,
Sachdeva, Satyanarayana
(2012) PLoS ONE
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?
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