Communicable Diseases

Communicable or infectious diseases account for 63% of deaths among children and 48% of all premature deaths, killing more under 21 year olds than any other group of diseases.  HIV/AIDS, TB and malaria are the most serious infections, causing between 5.7-6.0 million deaths a year, primarily in the developing world. New threats have emerged in the shape of the resurgence of diarrhoeal diseases, meningococcal meningitis, haemorrhagic fevers and epidemic encephalitis. A combination of factors are contributing to this, such as weakened or collapsed public health infrastructure due to civil unrest, poverty and uncontrolled human urbanisation, diseases crossing the animal to human barrier, increased drug resistance and environmental changes. Changes are predicted to have a significant impact on the future burden of communicable diseases because the most vulnerable populations and the poor will not have the necessary resources to protect or treat themselves.

Communicable diseases are the major causes of morbidity and mortality among the poor. They are responsible for 59% of deaths and 64% of disability adjusted life years (DALYs) in poor populations and account for the 77% mortality gap between the world's poor and rich. Inequities in spending on health between countries and unequal access to health services and products mean that the greatest impact is on the poor.

Malaria accounts for millions of lost days in productivity and missed schooling and can result in a growth penalty of up to 1.3% per year in some African countries. A malaria stricken family in the developing world can spend over 25% of its income on treatment. AIDS and TB mainly affect the economically active population, resulting in an adverse effect on agricultural and industrial output. In sub-Saharan Africa, life expectancies decreased during 1985-2000 in over 20 countries, mainly due to HIV/AIDS. When more than 8% of adults are infected with HIV, as is the case in several countries of sub-Saharan Africa, the per capita income may be reduced by as much as 0.5% per year. In addition to the direct effects of avoidable disease on life expectancy and productivity, there are negative effects on the rate of return of different types of business and infrastructure investment.

Finally studies indicate that the effect of disease on children, independent of their missed school days, impairs their learning ability and decreases the rate of return on education, thus feeding into the cycle of declining economic productivity.

Tackling communicable diseases will require innovative and interdisciplinary approaches that address cross-cutting issues, as well as strong technical understanding of the diseases.  Integration of programmes within sector-wide or multi-sector programmes or poverty reduction strategies highlight difficulties in focusing on specific diseases, but can also provide opportunities for country-led prioritisation of major health problems. Challenges in the control of diseases include improving access to effective treatment throughout regions, increasing the base of human resources to address the problem and exploring how better to incorporate the private sector in partnerships. There are also technical challenges, such as monitoring drug resistance and ensuring that enough research and development are undertaken for new drugs and prevention tools to replace those which have lost their efficacy. Lack of infrastructure and resources requires long-term commitment and vision to develop strategies which are pro-poor. In the poorest parts of Africa and Asia more than 50% of people are unable to obtain essential drugs. Despite the tremendous progress in communicable disease control in developing countries, better ways are needed to identify how to set priorities in given countries in terms of what to implement as well as how. Cost effectiveness ratios and efficiency arguments in the choice of programmes can be used to inform decision making.

The dynamic nature of communicable diseases necessitates research to respond to change, for example in diagnostics, epidemiology, immunology, operations research and policy.  Downstream applications include looking at delivery systems, forming partnerships between sectors and how sector-wide approaches can benefit priority health issues.  Questions exist still on how the increasing role of the private sector can affect the effectiveness of interventions.

The Malaria Consortium's involvement in communicable diseases includes providing knowledge through research, programme development support, surveillance and monitoring, and sometimes direct care and support.

http://www.gnntdc.org/what/poverty.html