Indrani Gupta a & Pradeep Guin a
a. Institute of Economic Growth, University Enclave, University of Delhi (North Campus), Delhi, 110 007, India.
Correspondence to Indrani Gupta (e-mail: [email protected]).
(Submitted: 06 August 2009 – Revised version received: 11 December 2009 – Accepted: 11 January 2010.)
Bulletin of the World Health Organization 2010;88:199-205. doi: 10.2471/BLT.09.065540
Introduction
Although disease patterns change constantly, communicable diseases remain the leading cause of mortality and morbidity in least and less developed countries. Despite decades of economic growth and development in countries that belong to the World Health Organization (WHO) South-East Asia Region (londonessays.com, most countries in this region still have a high burden of communicable diseases. This raises some urgent concerns. The first is that despite policies and interventions to prevent and control communicable diseases, most countries have failed to eradicate vaccine-preventable diseases. Second, sustainable financing to scale up interventions is lacking, especially for emerging and re-emerging diseases that can produce epidemics. Finally, in the present global economic and political context, it is important to understand how international aid agencies and donors prioritize their funding allocations for the prevention, control and treatment of communicable diseases. Prioritization is especially critical if one accepts the global public good character of communicable diseases.1,2
This paper analyses the current burden of communicable diseases in the region and explores whether the current levels and trends in funding suffice to meet the needs for their control, prevention and treatment. Our analysis considers the health Millennium Development Goals (MDGs) and individual countries’ economic progress. We attempt to understand whether the current focus of disease prevention is appropriate and to ascertain what changes in direction might enable national and global policy-making to deal more effectively with communicable diseases.
Communicable diseases
Disease burden
Although communicable diseases can be categorized in different ways, WHO uses three guiding principles for prioritization: (i) diseases with a large-scale impact on mortality, morbidity and disability, such as human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), tuberculosis (TB) and malaria; (ii) diseases that can potentially cause epidemics, such as influenza and cholera; and (iii) diseases that can be effectively controlled with available cost-effective interventions, such as diarrhoeal diseases and TB.3 According to WHO data on the global burden of disease and the distribution of diseases among countries, communicable diseases contribute slightly more to the total disability-adjusted life years (DALYs) lost in the region (42%) than in the world as a whole (40%).4
According to WHO,5 low-income countries currently have a relatively higher
share of deaths from: (i) HIV infection, TB and malaria, (ii) other infectious diseases, and (iii) maternal, perinatal and nutritional causes compared with high- and middle-income countries. Although these three causes combined pose a lesser burden than non-communicable diseases, they will remain important causes of mortality in the next 25 years in low-income countries. In 2004, all countries of the region except for Indonesia, Maldives, Sri Lanka and Thailand were classified as low-income by The World Bank.
Fig. 1 shows the share of the region’s contributions to world DALYs lost due to infectious and parasitic diseases. The region bears a disproportionate share of diseases such as Japanese encephalitis, leprosy and dengue, which have been eliminated from most of the world. Countries of the region also contribute a higher share of DALYs due to childhood cluster and tropical cluster diseases than the rest of the world. WHO estimates that the region contributes 27% of the global burden of infectious and parasitic diseases, 30% of respiratory infections, 33% of maternal conditions, 37% of perinatal conditions and 35% of nutritional deficiencies. If the first two categories are included under communicable diseases, the region’s contribution to the global communicable disease burden is disproportionately high. Diarrhoeal disease is the leading causes of death in the region and accounts for 26% of all deaths from infectious and parasitic diseases. TB, childhood cluster diseases, HIV infection, AIDS and meningitis are the other four major causes of death in the region. Diseases labelled as a priority by WHO (HIV infection and AIDS, TB and malaria) are common in all 11 countries. For example, the prevalence of HIV infection per 100 000 adult population is 982 in Myanmar, 447 in Nepal and 1144 in Thailand. The prevalence of TB per 100 000 population is 391 in Bangladesh, 253 in India, 244 in Nepal and 789 in Timor-Leste.6
Fig. 1. Share of world DALYs due to infectious and parasitic diseases corresponding to the South-East Asia Region of the World Health Organization, 2004
DALYs, disease-adjusted life years; STDs, sexually transmitted diseases.The data were obtained from the World Health Organization.4
Table 1 shows the annual incidence of selected communicable diseases in the world and in the region. Some of the highest annual incidences worldwide of diarrhoeal diseases, lower respiratory infections, malaria, measles and dengue appear in the region. The percentage of the world’s disease burden contributed by countries of the region is 64 for measles, 36 for TB, 33 for upper respiratory infections, 52 for dengue and 28 for diarrhoeal disease.7 Clearly, communicable diseases present a mixture of challenges for the region, with a variety of them falling under all three WHO categories mentioned above: diseases with high mortality and morbidity, those that can potentially cause epidemics and those that can be controlled with available and proven interventions.