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. 2016 Apr;16(4):473-9.
doi: 10.1016/S1473-3099(15)00401-6. Epub 2015 Dec 23.

Association between spending on social protection and tuberculosis burden: a global analysis

Andrew Siroka  1 , Ninez A Ponce  2 , Knut Lönnroth  3
Affiliations

Association between spending on social protection and tuberculosis burden: a global analysis

Andrew Siroka et al. Lancet Infect Dis. 2016 Apr.

Abstract

Background: The End TB Strategy places great emphasis on increasing social protection and poverty alleviation programmes. However, the role of social protection on controlling tuberculosis has not been examined fully. We analysed the association between social protection spending and tuberculosis prevalence, incidence, and mortality globally.

Methods: We used publicly available data from WHO's Global Tuberculosis Programme for tuberculosis burden in terms of yearly incidence, prevalence, and mortality per 100,000 people, and social protection data from the International Labour Organization (ILO), expressed as the percentage of national gross domestic product (GDP) spent on social protection programmes (excluding health). Data from ILO were from 146 countries covering the years between 2000 and 2012. We used descriptive assessments to examine levels of social protection and tuberculosis burden for each country, then used these assessments to inform our fully adjusted multivariate regression models. Our models controlled for economic output, adult HIV prevalence, health expenditure, population density, the percentage of foreign-born residents, and the strength of the national tuberculosis treatment programme, and also incorporated a country-level fixed effect to adjust for clustering of datapoints within countries.

Findings: Overall, social protection spending levels were inversely associated with tuberculosis prevalence, incidence, and mortality. For a country spending 0% of their GDP on social protection, moving to spending 1% of their GDP was associated with a change of -18·33 per 100,000 people (95% CI -32·10 to -4·60; p=0·009) in prevalence, -8·16 per 100,000 people (-16·00 to -0·27; p=0·043) in incidence, and -5·48 per 100,000 people (-9·34 to -1·62; p=0·006) in mortality. This association was mitigated at higher levels of social protection spending, and lost significance when more than 11% of GDP was spent.

Interpretation: Our findings suggest that investments in social protection could contribute to a reduced tuberculosis burden, especially in countries that are investing a small proportion of their GDP in this area. However, further research is needed to support these ecological associations.

Funding: National Institutes of Health National Center for Advancing Translational Science (University of California, Los Angeles [CA, USA] Clinical and Translational Science Institute).

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Figures

Figure 1
Figure 1
Levels of social protection (excluding health) expenditure as a percentage of national GDP
Figure 2
Figure 2
Bivariate relationship between social protection and TB prevalence rate*
Figure 3
Figure 3
Effect of a one percent of GDP increase in social protection spending with 95% confidence bands (N=664)*
See this image and copyright information in PMC

Comment in

  • Fighting poverty to prevent tuberculosis.
    Saunders MJ, Evans CA. Saunders MJ, et al. Lancet Infect Dis. 2016 Apr;16(4):395-6. doi: 10.1016/S1473-3099(15)00434-X. Epub 2015 Dec 23. Lancet Infect Dis. 2016. PMID: 26725447 No abstract available.

References

    1. World Health Organization . Global TB Report 2014. WHO; Geneva, Switzerland: 2014.
    1. World Health Organization . The Global Plan to Stop TB. Geneva, Switzerland: 2006.
    1. World Health Assembly Secretariat . Global strategy and targets for tuberculosis prevention, care and control after 2015. World Health Organization; Geneva, Switzerland: 2014.
    1. ILO. Social Protection Floors Recommendation. Geneva: 2012.
    1. Lonnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med. 2009;68(12):2240. - PubMed

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