Two birds with one stone

Abstract

As the global burden of disease shifts from infectious diseases, non-communicable diseases are rising up the health agenda with, at first glance, demands for attention and funding that conflict with those of communicable diseases. However, rather then a focus on disease-specific responses, some researchers have suggested a more creative approach. At the International Society for Neglected Tropical Diseases meeting on coinfections held in London, UK, on February 12, Ib Bygbjerg presented his ideas on how certain diseases could be treated together, since the consequences of communicable and non-communicable diseases seem tightly intertwined in low-income and middle-income countries. One example given by Bygbjerg is the association of diabetes with tuberculosis. The interaction between these diseases was recognised in the past but was subsequently forgotten when tuberculosis declined in high-income countries. However, this interaction was reassessed once cases of diabetes began to quickly rise in low-income and middle-income countries with a high prevalence of tuberculosis. People with diabetes are at substantial risk of infection with tuberculosis and people infected with tuberculosis are at risk of diabetes because of induced glucose intolerance and deteriorating glycaemic control. Therefore, tackling both tuberculosis and diabetes together could have a synergistic effect that might increase the efficiency with which both these diseases are managed. Combining approaches to tuberculosis and non-communicable diseases is explored further in our new Series on tuberculosis. In the third paper in the Series, Ben Marais and colleagues discuss the need to integrate health services and control efforts to tackle both tuberculosis and non-communicable diseases. Tuberculosis is a pertinent example of an infectious disease in which this integration is applicable given the close relation between it and non-communicable and other communicable diseases. Marais and colleagues emphasise that, although not immediately obvious, management and control of tuberculosis (and other chronic communicable diseases) have more in common with care for non-communicable than for acute infectious diseases. Both need long-term management, have major problems with treatment adherence, require lifestyle changes, and are mostly managed at the primary health-care level. So, even just consolidating their management would increase efficiency and might improve adherence. The immediate value of a combined approach is clear against the backdrop of the worldwide economic climate. Marais and co-workers promote the benefits of integration to avoid destructive competition between communicable and non-communicable diseases for the limited funds available for health services. They state that “integrated solutions should seek to unlock potential commonalities and synergies and optimise scarce resources”, and they also call for the prioritisation of efficient integration of tuberculosis services with those for non-communicable and other communicable diseases. Although tuberculosis is a prime example of a disease in which a combined approach can be used, it might be most effectively applied to overcome the neglect of some neglected tropical diseases. Particularly since official figures might still underestimate the broader costs and scope of these diseases. One such potentially underestimated neglected tropical disease is Chagas disease. In this issue of The Lancet Infectious Diseases, Bruce Lee and colleagues use a computational simulation model to estimate the overall economic burden of Chagas disease. They show that the related health-care costs pale by comparison with the costs of lost productivity, and that a substantial proportion of this burden is borne in the USA, a country not traditionally thought to be widely affected by this disease. Moving beyond disease-specific outlooks will allow many diseases, be they communicable or non-communicable, to be dealt with in an effective and longlasting fashion. But policy makers must be careful not to restrict themselves and these integrated strategies to diseases that are currently in the limelight. As shown by the work of Lee and colleagues, neglect of diseases such as Chagas disease might be because we underestimate the breadth of their impact. A multidisease strategy might be the only way we can allocate funds to reverse the neglect. For more on non-communicable diseases see http://www.lancet.com/series/non-communicable-diseasesFor more on the International Society for Neglected Tropical Diseases meeting on coinfections see http://www.isntdcoinfections.com/For The Lancet Infectious Diseases Series on tuberculosis see http://www.lancet.com/series/tuberculosis-2013 For more on non-communicable diseases see http://www.lancet.com/series/non-communicable-diseases For more on the International Society for Neglected Tropical Diseases meeting on coinfections see http://www.isntdcoinfections.com/ For The Lancet Infectious Diseases Series on tuberculosis see http://www.lancet.com/series/tuberculosis-2013 Global economic burden of Chagas disease: a computational simulation modelThe economic burden of Chagas disease is similar to or exceeds those of other prominent diseases globally (eg, rotavirus $2·0 billion, cervical cancer $4·7 billion) even in the USA (Lyme disease $2·5 billion), where Chagas disease has not been traditionally endemic, suggesting an economic argument for more attention and efforts towards control of Chagas disease. Full-Text PDF