23 September 2018

[Op-ed] TB, NCDs, and resilient health systems for all

This week, the United Nations will host two high-level meetings on tuberculosis and noncommunicable diseases, which are meant to spur new action around both global threats. Hopefully, the meetings will also be used to highlight the numerousconnections between TB and NCDs.

Many of the risk factors for TB and NCDs are shared, including diabetes and smoking: diabetes triples a person’s risk of developing TB; tobacco smoking increases the risk of TB, as well as the risk of dying from TB. There is also ample evidence that preventing diabetes and abstaining from smoking contribute to healthier pregnancies and childhoods.

At a basic level, countries of people living with or at risk of TB or NCDs need the same thing: Resilient, sustainable health systems that meet the needs of their populations, including the most vulnerable. To prevent death, sickness, and catastrophic health costs, we need to address health risks whether they’re from infectious or noncommunicable diseases.

NCDs are both a cause and a consequence of poverty. NCDs are a greater threat to global economic development than natural disasters, crime, and corruption. Infections and environmental exposures associated with poverty contribute to death and disability from NCDs. Likewise, TB is a cause and consequence of poverty: It thrives among people with poor nutrition, health status, and housing conditions.

TB, an airborne disease, is responsible for nearly 4,700 deaths each day. TB has a cure rate of over 90 percent — if diagnosed and treated promptly and appropriately. Globally, NCDs are the leading cause of death. Annually, 41 million people worldwide die from NCDs, including cancer, cardiovascular disease, diabetes, respiratory diseases, and mental disorders. Most deaths — 75 percent — occur in low- and middle-income countries.

All countries face challenges in building health systems that meet the needs of their populations, particularly the most vulnerable. Right now, certain groups often get excluded, and they’re likely to keep getting excluded if we don’t take specific steps to include them. Children provide a good example.

How would we build health systems differently, and what impact would we see, if we started with the needs of the population and supported the flexibility to address those needs?

Millions of children, adolescents, and young people live with or are affected by NCDs. Yet the World Health Organization defines premature deaths from NCDs as those affecting people ages 30-70. There is no strategic reason for this; it’s primarily because many countries traditionally have not collected NCD data on children. This means that children and adolescents are left out of many NCD discussions—and will not be screened or treated.

Meanwhile, it is estimated that there are roughly 1 million annual cases of childhood TB and 250,000 childhood deaths — counted as age 15 and below. Many of these cases and deaths are misclassified as caused by pneumonia and malnutrition. Children have a much higher rate of certain life-threatening forms of TB, such as meningitis and disseminated—where multiple organs are involved—disease, and chest X-rays are an important part of diagnosing children for TB. However, that requires having the right equipment, so WHO recommends that high-burden countries base TB diagnoses on sputum microscopy—which means that TB in children will often be missed, and they will not be treated.

About the authors

Mandy Slutsker

Mandy Slutsker has over 10 years of experience working in global public health. She joined RESULTS Educational Fund in April 2010 where she now works as a policy and advocacy manager for ACTION, a global health advocacy partnership that spans 13 countries across five continents. Mandy coordinates the partnership’s advocacy on tuberculosis and HIV, has served on the World Health Organization Civil Society Task Force for TB, and currently co-chairs the TB High-Level Meeting Civil Society and Affected Communities Advisory Panel.

Aaron Emmel

Aaron Emmel is manager of global health advocacy initiatives for the American Academy of Pediatrics and co-chair of the Global Health Council’s NCD Roundtable.