Academic journal article Bulletin of the World Health Organization

Tuberculosis Control and Economic Recession: Longitudinal Study of Data from 21 European Countries, 1991-2012

Academic journal article Bulletin of the World Health Organization

Tuberculosis Control and Economic Recession: Longitudinal Study of Data from 21 European Countries, 1991-2012

Article excerpt

Lutte antituberculeuse et recession economique : etude longitudinale des donnees de 21 pays europeens pour la periode de 1991 a 2012

Control de la tuberculosis y recesion economica: estudio longitudinal de datos de 21 paises europeos, de 1991 a 2012


Tuberculosis control requires a strong public health infrastructure to detect and treat infected people. (1-8) The World Health Organization (WHO) has identified improved case detection and successful treatment as priority actions required to meet target levels of tuberculosis prevention and control by 2015. (9) Such improvements will require expanding surveillance and diagnosis services--especially among more vulnerable groups. (10,13) Over the past two decades, global rates of case detection and treatment success for tuberculosis have risen steadily. (14) However, detection and treatment remain poor in several countries, mostly in eastern Europe and sub-Saharan Africa. (15)

Western Europe has high rates of active case detection and treatment success. (9) However, the 2008-2011 economic recession and resulting cuts in health budgets may have weakened tuberculosis control and prevention programmes. (16) Economic recessions are often accompanied by increases in drug use, homelessness, migration of vulnerable groups and other factors affecting the transmission of tuberculosis. (17) In a scoping study, 27 infectious disease experts predicted that understaffing, recruitment freezes and reductions in the workforce during the recession in Europe that began in 2008 would have a negative regional impact on the control and treatment of various communicable diseases. (18) Tuberculosis was the disease most commonly cited as a cause for concern.

Despite these concerns, several member states of the European Union have introduced user fees or budget cuts to infectious disease programmes since the onset of the recession. Between 2008 and 2010, for example, Latvia shifted approximately 50% of the costs of diagnostic testing to patients and reduced spending on disease control and surveillance by 87%.19 Charges for prescription drugs were also increased in Ireland in 2009-2010. (19) A recession may worsen the negative effect of payments for diagnostic tests or treatment. (20,21) However, not all European countries reduced funding for communicable disease programmes. Estonia reduced health-care spending after the recession began but protected spending on the detection of communicable diseases. Croatia reduced user charges for prescription medication by 33% and both Austria and Germany increased their budgets for infectious disease prevention and control. (16)

Here, we test the hypothesis that the recent economic recession and associated reductions in public health spending resulted in declining rates of case detection and treatment success for tuberculosis in the European Union. We then use mathematical models that account for the nonlinear dynamics of tuberculosis, to simulate the consequences of economic changes on the future trends in tuberculosis incidence, prevalence and mortality.


Data sources

Data on tuberculosis case detection and treatment success rates were taken from the 2014 edition of the WHO's tuberculosis database. (22) Data on total health spending, expenditure on public health services and gross domestic product (GDP) were taken from the EuroStat database. (23) All macroeconomic data were analysed as per capita values and adjusted for inflation and purchasing power to facilitate comparisons across member states of the European Union. At the time of our analysis, data on public health spending were available for 24 of the 28 member states. Data were not available for Belgium, Greece, Romania and Slovakia because these member states either lack a specific budget line or do not report disaggregated expenditure data to EuroStat. As we excluded Cyprus, Luxembourg and Malta because of their small population sizes, most of our final analyses were based on the data from 21 member states (available from corresponding author). …

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