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Review
. 2015 Nov;7(6):390-9.
doi: 10.1093/inthealth/ihv040. Epub 2015 Jun 23.

Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition

Tolu Oni  1 , Nigel Unwin  2
Affiliations
Review

Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition

Tolu Oni et al. Int Health. 2015 Nov.

Abstract

In today's globalized world, rapid urbanization, mechanization of the rural economy, and the activities of trans-national food, drink and tobacco corporations are associated with behavioral changes that increase the risk of chronic non-communicable diseases (NCDs). These changes include less healthy diet, lower physical activity, tobacco smoking and increased alcohol consumption. As a result, population health profiles are rapidly changing. For example, the global burden of type 2 diabetes mellitus is expected to double by 2030, with 80% of adult cases occurring in low and middle-income countries (LMIC). Many LMIC are undergoing rapid changes associated with developing high rates of NCD while concomitantly battling high levels of certain communicable diseases, including HIV, TB and malaria. This has population health, health systems and economic implications for these countries. This critical review synthesizes evidence on the overlap and interactions between established communicable and emerging NCD epidemics in LMIC. The review focuses on HIV, TB and malaria and explores the disease-specific interactions with prevalent NCDs in LMIC including diabetes, cardiovascular disease, chronic obstructive pulmonary disease, chronic renal disease, epilepsy and neurocognitive diseases. We highlight the complexity, bi-directionality and heterogeneity of these interactions and discuss the implications for health systems.

Keywords: Co-morbidity; Communicable disease; Health transition; Infectious disease; Low and middle-income countries; Non-communicable disease.

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Figures

Figure 1.
Figure 1.
Interaction between TB, Malaria and HIV, and risk factors/disease precursors and non-communicable diseases. BP: blood pressure; COPD: chronic obstructive pulmonary disease. This figure is available in black and white in print and in color at International Health online.
Figure 2.
Figure 2.
Life-course approach to joint communicable and non-communicable disease (NCD) prevention and control.
See this image and copyright information in PMC

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