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Dollars and disease Marrying social, economic and disease dynamic perspectives for public health

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. Informing decision-making. Basic science: contributing

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Dollars and disease Marrying social, economic and disease dynamic perspectives for public health

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  1. Dollars and diseaseMarrying social, economic and disease dynamic perspectives for public health Nim Arinaminpathy Imperial College London

  2. Roles of transmission models in public health Supporting healthcare delivery Informing decision-making Basic science: contributing to evidence base for policy

  3. Why economics/sociological processes Decision-making under economic constraints (Edmunds, 200x) Careseeking (unmeasured confounders) Implementation and logistics Individual behaviour (Funk et al, PNAS 2009) National politics with borderless infections (Klepac et al, PNAS 2011) Macroeconomic shocks Health systems Market dynamics

  4. Why economics/sociological processes Decision-making under economic constraints (Edmunds, 200x) Careseeking (unmeasured confounders) Implementation and logistics Individual behaviour (Funk et al, PNAS 2009) National politics with borderless infections (Klepac et al, PNAS 2011) Macroeconomic shocks Health systems Market dynamics

  5. Why economics/sociological processes Decision-making under economic constraints (Edmunds, 200x) Careseeking (unmeasured confounders) Implementation and logistics Individual behaviour (Funk et al, PNAS 2009) National politics with borderless infections (Klepac et al, PNAS 2011) Macroeconomic shocks Health systems Market dynamics

  6. Implementation: logistical/resource factors • Decision trees for clinical algorithms • Operations research • E.g. diagnostic tests for TB control Eg: Rao, Schellenberg & Ghani, 2013 Dowdy, Cattamanchi et al, 2011 Central laboratory Peripheral sites

  7. Why economics/sociological processes Decision-making under economic constraints (Edmunds, 200x) Careseeking (unmeasured confounders) Implementation and logistics Individual behaviour (Funk et al, PNAS 2009) National politics with borderless infections (Klepac et al, PNAS 2011) Macroeconomic shocks Health systems Market dynamics

  8. 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

  9. 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

  10. Tuberculosis today 8.7M new TB cases,1.4M deaths in 20111.1M 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.

  11. Ecology of TB drug markets Few manufacturers of TB drugs Global demand for drugs fragmented amongst many high-burden, low-income countries Irregular supply, with drugs of uncertain quality

  12. 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

  13. Health systems in infectious disease dynamics Lin, Langley, Mwenda et al (2011) Int.J.TubercLung Dis.

  14. Photo credit: Peter Small

  15. Patient trajectories and infectious periods Kapoor, Raman, Sachdeva, Satyanarayana (2012) PLoS ONE

  16. 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?

  17. 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

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