Why is it that diseases with an incidence of more than 1 million* in our world population are so prevalent? What contributes to such a high disease burden and mortality rate?
The table below gives a basic overview of four broad determinants of NTD prevalence:
It is no coincidence that more than 70% of territories affected by NTDs are classified as either low-income or lower-middle income countries ( WHO, 2017 ). In addition to this, 100% of these low socioeconomic countries are affected by at least five NTDs (WHO, 2017 ). For example, in Brazil, low-income is a direct predictor of dengue fever, while in Africa poverty is the major “potentiator of leishmaniasis morbidity and mortality” (WHO, 2017 ). Why is this?
From a community viewpoint, lack of economic growth and development leaves room for poor sanitation, malnutrition and limited access to education. To top this off, generally these regions are underdeveloped and isolated so there is poor access to healthcare (Ghose, 2014). This clearly affects individuals within these communities who lack access to safe environments, placing them at higher risk to be infected by parasites causing NTDs.
NTDs also act in perpetuating the cycle of poverty by disabling workers and draining families of money following costly treatments. NTDs can also magnify the physical effects of malnutrition as many intestinal worms cause the loss of iron and vitamin A which affects growth and have detrimental effects in pregnancy ( Sabin, 2014).
2.) Social Inequalities
Ethnicity and gender plays a huge part in access and stigmatization of NTDs within local communities. According to WHO females often find it harder to access treatment due to their perception in many communities as being inferior. Also on this note, different African tribal groups are often shunned and isolated from accessing clinics or certain territories due to stigma.
Lastly, the tribal traditions of many groups, particularly their religious views play a huge role in how they view the medication profession, with sickness often seen as a bad “omen” and a punishment. It is social factors such as these which can make educating communities extremely hard.
3.) Lack of Funding
The reason many people in the first world have never heard of diseases such as trachoma and African trypanosomiasis is due in part to the lack of research and funding put into NTDs ( WHO, 2017). Since first world countries suffer from cancer and diabetes, public funding is focused on these diseases, which diverts research away from NTDs. This decreases awareness of for NTDs and poses a serious ethical concern in regards to how we can morally choose which diseases deserve more or less funding. This leads to less choices for drugs on the market which can treat NTDs!
Chart showing the allocation of funding and people affected by four diseases (Source: Thomson Reuters Web of Knowledge, 2011 )
Pie chart showing the number of drugs on the market (Source: CDC)
As wonderful as it is to want to isolate NTDs as its own issue, the lines blur quite quickly when we start considering treatment, risk factors and causes of NTDs. The challenge in population growth and the refugee risis pose a serious threat in spreading NTDs. These diseases occur and spread when family groups live in close proximity, and with political crises forcing people to leave and find safety, these condition are often over-crowded.
There is also the environmental issue of climate change which bears with it the issues of severe drought and famine which governments need to create policies for and deal with appropriately. In times of crisis such as natural disasters this can be particularly challenging due to the unequal distribution of resources can become a huge issue, with limited access to clean water, sanitation and infrastructure destruction causing problems (CDC, 2010). These issues in poorer nations are hard to deal with, particularly when oppressive dictatorships, limited funds and civil unrest can contribute to poor policy making, placing healthcare on the back-burner.
Picture typical of close-knit communities in Africa ( Source: CDC)
Wouldn’t it be wonderful if issues weren’t this complex? Unfortunately it a a cruel fact that life, and especially health isn’t as black and white as we would hope.