Saturday, April 23, 2016

Social Spending and Tuberculosis Burden: A Global Perspective

The last week was a bit punishing for me on the infectious diseases consult service. The Gods of Infectious Diseases must have been displeased with me.

Finally back to the blogosphere and finally a paper in a scientific journal that addresses tuberculosis as a social issue and not merely a medical one.

Here is an article published in the Lancet Infectious Diseases on the association between spending on social programs (in % GDP) and the burden of tuberculosis.

Overall, social protection spending levels were inversely associated with tuberculosis prevalence, incidence, and mortality. For a country spending 0% of their GDP on social protection, moving to spending 1% of their GDP was associated with a change of -18·33 per 100 000 people in prevalence, -8·16 per 100 000 people (-16·00 to -0·27; p=0·043) in incidence of TB. Decreased morality was also observed. This lost significance when more than 11% of GDP was spent.

Epidemiology 101: Correlations do not prove cause and effect, but they do generate valuable hypotheses. In this example, it is well known that TB (and other illnesses) are a function of poverty, crowding, sanitation and malnutrition. Social spending alleviates these negative health pressures. There is plausibility in the argument that social spending may impact certain health outcomes.

Poverty has negative health consequences. That much is irrefutable.

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