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Dollars and disease Marrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London
Dollars and diseaseMarrying social, economic and disease dynamic
perspectives for public health
Nim ArinaminpathyImperial College London
Roles of transmission models in public health
Supporting healthcare delivery
Informing decision-makingBasic science: contributing to evidence base for policy
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
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
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
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
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
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
0
50
100
150
200
250
300
1820 1840 1860 1880 1900 1920 1940 1960 1980 2000
TB d
eath
s/10
0,00
0/yr
Britain beat TB in the 19th and 20th centuries?Much of the (slow) decline preceded drugs
Keats1821
E Bronte1848
C Bronte1855
Mansfield1923
Lawrence1930
Orwell1953
Leigh1967
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?
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.
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
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
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
