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Applying scientific rigour to improve equity and access to TB services

Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2012) 'Applying scientific rigour to improve equity and access to TB services'. Public Service Review: UK Science and Tec, Vol 6, pp. 168-169.

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Abstract

Poverty is a loaded term, but it has defined the global approach to health within the Millennium Development Goals that are to be met by 2015. In this article we use the term 'poor' to refer to a range of disadvantage (not just income poverty) including a lack of material wellbeing, of infrastructure, and of power and voice. Different tools are used to measure this poverty, including both qualitative measures such as social ranking, and quantitative measures such as asset scores. These tools give proxy measures by which poor and non-poor women, men, girls and boys can be described in different contexts.

It is well recognised that the risk of developing tuberculosis (TB) is greater among the poor than among the non-poor. Less obvious is the fact that the converse relationship is also important. TB itself diminishes the livelihoods of affected individuals both through the lost productivity associated with chronic ill health and through the direct and indirect costs incurred by patients in their pathway to diagnosis, treatment, and cure.1 The concept of a pathway to TB cure is illustrated in Fig.1. This illustrates two concepts that underpin this article.

First, the majority of TB cases arising in the community are poor. Second, the poor face barriers that affect them more than they affect the non-poor as they proceed along the pathway. The result is that poorer patients tend to 'drop out' of the pathway while non-poor patients tend to follow the pathway through to a successful conclusion. The extent of the drop-out or delay illustrated for each stage of the pathway is hypothetical, and will vary according to local context.

The actual pathways followed by patients are complex. Many are characterised by delays and by repeated visits to multiple care providers, which are costly to patients in terms of time and resources and can serve to increase the drop-out rate at each stage.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Depositing User: Helen Rigby
Date Deposited: 23 Jul 2012 15:27
Last Modified: 06 Feb 2018 13:04
URI: http://archive.lstmed.ac.uk/id/eprint/2867

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