Global Health Policy Analysis: On Tuberculosis Around the World

Introduction

Cases of tuberculosis continue to be reported in all corners of the world despite the efforts of international and regional health organizations. It has not been easy to contain the disease which takes new forms every day. The TB virus that was first reported in 300 BC when the early man died of the disease is different from the virus that is currently being reported. This means that health care researchers must constantly identify new forms of the disease. Tuberculosis is one of the diseases which make the body to loose its immunity and then make way for other opportunistic diseases to attack a patient. The disease is communicable and therefore must be contained. Many years ago, vaccines were introduced to counter the disease; however the new forms being reported have made it difficult for the disease to be handled appropriately (Lee & Kent, 2002).

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Review of the Literature

Health organizations are encouraging governments to implement health care policies that will contain the disease. Health care practitioners must follow strict hygienic measures when treating people with TB. Once a case has been reported, the disease must be treated completely Health care organizations have not been able to contain the disease because they are unaware of its prevalence. Despite millions of new cases of the disease that are reported around the world, people who die of the disease without their families knowing that they had tuberculosis. Family members of the sick may not take steps to prevent its spread. Among the policies implemented is for awareness on the community on the occurrence of the disease and how it can be diagnosed early. The community must observe safety precautions to prevent exposure to the disease. The WHO also recommended that public health care institutions assist in the diagnosing and treating the disease.

The treatment of tuberculosis may be far too expensive for many people (Lee & Kent, 2002). Most people in African countries usually rely on traditional medicine men that may have very little knowledge on the disease (Columbus, 2006). The few health care facilities that are capable of treating the disease may be too far away from their patients. Mobile health clinics may not be available in remote areas of Asia and even if they are, they may not be effective due to their irregularity. There is therefore a need to educate people about how tuberculosis spreads and how it can be treated (Condon & Sinha, 2008). The mistake that most health care institutions make is to teach about TB without telling people how and where they can obtain treatment. This only makes people anxious. They imagine that they have been infected with the disease and think that they will die soon since they cannot access the necessary medication. This makes the situation even worse as it may make some of the suspected individuals to be sidelined by the rest who fear contracting the disease from them

Findings

According to the statistics that have been collected on the tuberculosis, it is most widespread in congested and unhygienic environments. The TB virus lives in the air and in the sputum. It may also be spread through the sharing of personal items like food containers. Studies reveal that the people who are most vulnerable to the disease are low-income and living in unsanitary conditions. Tuberculosis spreads quickly and its spread is difficult to control. The virus will take an average of three weeks before the immune system senses its effects. By this time, the affected individual may have unknowingly spread it to others. The virus is also most prevalent among people with HIV/AIDS. This is another factor that makes tuberculosis to be so dreaded. Most people who have been infected with HIV/AIDS will die of TB (Jacobsen, 2008). Most people that suspect that they have been infected with the TB virus may fear going for medical checkups for fear of being found to be HIV positive. Other people living with TB will be kept away from the public and keep their illness a secret for fear of being stigmatized.

Tuberculosis mortality rates, by country
Figure 9. Tuberculosis mortality rates, by country

Studies carried out in 2000 have revealed that 10 million people around the world were infected with tuberculosis in 2000. Most of these people were also living with HIV/AIDS. In 2005, more than 20 million people with the virus were also on medication. The life expectancy of TB patients has also declined from 65 years in the 1980’s to 47 years due to other complications that come with modernization; many of the people who die from the disease are between the ages of 25 and 35.

Demographic

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New TB Cases and New TB Cases Rates

The spread and the mortality rate of TB vary by location. Some TB viruses have become resistant to certain medications and vaccines. International health care organizations had succeeded in containing the disease until these newer strains of the virus appeared. Vaccination is considered to be the best weapon against infection (Lee & Kent, 2002). The people who were most at risk were those that who had not been vaccinated. The vaccine contained the virus, so that body would create antibodies to resist the infection.

People Living With Tuberculosis

Over thirty million people have been estimated to be living with TB worldwide, according to world health organizations (WHO). The survey was carried out in hospitals and other health care institutions in Europe and the Middle East. Due to the rising demand to combat the disease, there are government health care institutions in United States that are taking care of people who are living with the condition (Patel & Rushefsky, 2006). Their immune systems are so compromised that the medication may not work for them. The medicines that are used to treat TB are strong and require the person to follow a good diet. People with weakened immune systems lose their appetite, and must take Multivitamin syrups to ensure that their systems are strong enough to tolerate the medication.

TB Death Rates

The mortality rate from TB succumb continues to arise at an alarming rate because of the new strains that have gone unreported. Most health care institutions were ignorant of the new strains of the disease (Columbus, 2006). Before the World Health Organization announced the discovery of a newer strain of the virus, many people had already died from it. They had been diagnosed and treated for the common TB virus but had not responded to the drugs. To date, not all health care institutions are equipped with have the equipments that are able to diagnose and confirm the illness. As the US, Europe and Asian governments increase the availability of facilities for treating TB in public health care centers, people continue to die of the disease.

According to a study that was carried out by the PLos medicine general, it was revealed that most of the funds that were released to Europe, the Soviet Union and central and eastern countries were used for TB cases. Between the year 1992 and 2000, there was a 16.6 % increase in death rates that resulted from tuberculosis. The rise in the disease was attributed to new forms of TB that were becoming rather resistant to the drugs. Eve n though there are usually provisions for health care and also to take care of the any urgent medical needs, most nations that were politically unstable in the Middle East and Africa found it difficult to handle the disease (Columbus, 2006). With the tough measures that the international financial institutions placed on them before they were given the loans, it made it even difficult for them to combat the disease. The IMF requires that every country that has to qualify for the loans must also show the ability to repay it at an appropriate time. However much of the help was extended to the countries through the United Nations and other charity health organizations around the world.

HIV/TB Cases

There is a very close association between HIV/AIDS and TB; most of the reported cases of TB are among people living with HIV/AIDS. This is mainly because TB occurs in people whose immune systems have been weakened. People who are healthy may be able to resist the disease even if they are living with someone who has it (Saucier & Lundy, 2009). A person in the advanced stages of AIDS is vulnerable to other infections which include TB. Studies have revealed that most of the people that succumb to aids are usually infect by TB. Due to reduced immunity, the AIDS patients become easily vulnerable to the TB virus which may ultimately eat up their already weak bodies and hence leading to death.

The Role of the Government

Governments can play a vital role in minimizing the occurrence of tuberculosis by passing health care policies. In these efforts, the government can support hygienic measures that will protect their citizens (Gable, Gamharter & Goston, 2007. This can be done through the media, learning institutions and health care centers. They can also utilize private and none governmental organizations in spreading information about TB. People tend to trust the government in efforts to fight such threats, this is because of the wide coverage that they have and the fact that they have the greatest authority among the citizens. The governmental is able to declare a ban on eating at public places and also facilitate quarantines which are some of the measures employed to counter the prevalence of the disease. This has been observed in nations such as Korea, South Africa and India.

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National and International Health Agencies

National and international health organizations have been of great help major boost to Asian and African health care institutions in combating tuberculosis (Columbus, 2006). They have always made governments aware of the new cases that are being reported (Williams, 2003). The WHO has been at the forefront in collecting data on the occurrence of the disease worldwide. It gives statistical records of the places and groups of populations that are most vulnerable to the disease. These governmental and nongovernmental organizations also go a long way in defining control and protection measures that can be used to protect people from TB. The United Nations and WHO collaborate with regional and national health care researchers to find new cases and also how they can come up with measures that will fight the disease.

The IMF has been extending loans to several countries to help cab the spread and occurrence of the disease. Studies that were carried out by the Cambridge and Yale universities revealed that there was a 13.9% increase of new cases of TB that were being reported every year. The number of people that were also leaving with the virus was also rising with 13.2%. This was the main reason why the IMF had to increase the amount of money that they were disbursing to countries to help them fight the disease. The IMF was however still employing strict measures especially to Asian and African countries before they were give n the loans (Columbus, 2006). There were certain conditions that this countries needed to fulfill before they were considered to be eligible. This was also a major drawback that hindered them from effectively fighting TB. It was considered that TB is a serious disease that needs urgent intervention procedures to enable the country to fight it.

Non-Government Organizations

The United Nations works with nongovernmental organizations to combat the spread of tuberculosis. This is basically because they are very reliable and can be made to reach specific areas that are at risk. The government may at times be entangled with many other projects which may minimize on their affectivity to handle urgent matters. There are also certain governments that cannot be trusted with such responsibilities due to high rates of corruption. Where certain deficiencies have been recorded in the government of the day, WHO and UN will prefer to use nongovernmental organizations. This has been facilitated through partnership with other local organizations such as children’s homes and other charity organizations.

The Obama Administration’s New Global Health Initiative on TB

The Obama administration is determined in its fight against tuberculosis. The administration’s global health initiative has launched a worldwide campaign against TB. New developments in research and development can enable the government to effectively handle the new cases that are being reported. Communities are also being taught about hygiene w. Control and prevention of new cases is being implemented through training of health care staff on the new diagnostic and treatment strategies. The Obama administration is collaborating with international health organisations such as WHO and UN to come up with strategies that will minimize the spread of tuberculosis.

Impact on Developing Countries

According to the World Health Organization, South Africa is among the countries with the highest number of tuberculosis strains. The highest prevalence of TB in South Africa is in the Western Cape Province. However, a significant risk in the hospital based transmission of tuberculosis has been noted in healthcare facilities at Tygerberg Hospital in KwaZulu-Natal province (Gandhi et al., 2006). Studies indicate that concurrent human immunodeficiency virus, poverty, ignorance, overcrowding, and other related factors have hampered the control efforts of those tasked with the responsibility of controlling the disease globally (Gandhi et al., 2006).

Tuberculosis has an effect on the development of the nation. When one member of a family is sick, the family tends to be paralyzed as they will have to leave all other activities to take care of the sick. Most cases of TB are reported in developing countries. This means that most of the resources for development projects will be channeled into health. TB has impeded the growth of most developing nations like those of Africa and Asia.

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Leadership Responsibility of Developed Countries

Developed countries have to encourage the development of developing nations. Such leaders are required to invest into some of their activities and help them when they are faced with a crisis. Developing nations lack the skills and resources to facilitate their own growth. One country like the US may decide to facilitate the provision of diagnosis equipments to public health centers which will hasten the diagnostic procedures. They can also venture into nongovernmental activities that are aimed at sensitizing the community on the prevalence of the disease.

Global Financial Institutions: Input

TB cases are becoming very urgent medical projects that find most government unprepared for the same due to inadequate facilities and political instability (World Health Organization, 2007). They are able to intervene when the situations become too tough for other organizations and governments to handle. However, some African countries have complained of being neglected and left out of such assistance. Most developing countries have expressed dissatisfaction with global financial institutions (Condon & Sinha, 2008). International financial institutions such as the IMF impose very strict measures that they have to agree to before they are given assistance. This has delayed the efforts of health care organizations such as World Health Organization in combating the disease.

Discussion

Health care determines the status of a country’s economy. Tuberculosis is a viral disease that is as tough as HIV/AIDS. According to World Health Organization, (2007), “the high treatment interruption rates, the HIV epidemic, and low cure rates have all contributed to the emergence of multi-drug resistant TB.” This health problem has been blamed on the adoption of inappropriate treatment programs, as well as patient factors that include a lack of adherence to the treatment regimen. The multi-drug resistant strain to certain TB cases can be attributed to a systematic failure by the global community to contain this curable disease (Gandhi et al., 2006). TB takes a very short period to develop and in its later stage, urgent measures must also be taken. The early symptoms of the disease resemble those of the flu. During this stage, the disease can be spread accidentally. By the time the infection has been diagnosed, the person may have infected others and need to be isolated. TB outbreak may be very serious especially if it has been reported in a learning institution. There may not be adequate facilities to diagnose and treat the victims which may make it spread even more. However, a lack of systematic health behavior training, patient resistance to change, and low self-efficacy has affected the deployment of intervention strategies (Weyer, 2006).

Health care institutions have not had enough finances to advance to medical facilities to TB patients. Most developing countries have been unable to obtain the resources to curb the disease. The World health Organization and the United Nations have not been able to coordinate with health care research institutes. Statistics of the new infections being recorded and those that have succumbed to it keep changing. New research information about the disease has not been able to be facilitated on a regular basis which makes health organizations to rely on outdated information. This information on new drugs is not facilitate and hence not being able to effectively fight the disease. Political instability and change in government leadership especially in Africa have also been a major drawback in the fight against the disease (Columbus, 2006). Health organizations that are closely working with the governments have to keep making adjustments whenever a new leadership comes in. new leadership may also come in with newer policies that may not necessarily support the efforts of international organizations to fight the disease.

Conclusion

Tuberculosis is a health issue that requires urgent measures. The paper has looked at the prevalence of the disease and the efforts that are being made to combat it. However, the joint efforts of the international community and national organizations can fight the disease. There is a need for awareness programs. There is a stigma associated with the disease due to its relation with HIV/AIDS. These efforts may include rehabilitation of those that have been stigmatized by TB, as well as patient education on subjects such as the importance of cough etiquette and the use of surgical masks. Patient education also involves counseling. Environmental controls that can be as simple as opening windows have been used to reduce the number of infectious droplets. More complex methods are the use of mechanical ventilation systems, germicidal irradiation, and HEPA filtration. These measures are useful in wards, TB clinic waiting areas, and in-patient areas (Fourie, 1996). The main method of prevention is vaccination. Behavioral counseling has been quite successful in containing transmission. These measures, coupled with early diagnosis, risk counseling, and training of prevention services, have been adopted to contain new infections in the most highly affected areas.

Recommendations

Stricter measure should be employed to limit the spread of the disease. Since new strains of the virus are being reported, governments should invest more in research and development. Hygiene should also be encouraged. Better housing should be constructed in slums and sanitation facilities must be improved. Mobile clinics utilized to should separate the sick from the healthy. There should also be an equal distribution of proper housing and medical facilities among communities. Poverty is considered to be one of the contributing factors towards the spread of diseases which include tuberculosis. Despite the other efforts that may be employed to fight TB, it may not be easy to completely get rid of the disease unless the issues of poverty are completely dealt with. It is foe this reason tat most non governmental organizations are engaged in awareness programs that are aimed at reducing poverty. The IMF has also been challenged to empower the indigenous communities with the aim of making them to be aware of the measures that they can take to prevent them from succumbing to such illnesses.

References

Columbus, F. (2006). Politics and economics of Africa. New York: Nova Science Publisher.

Condon, B. and Sinha, T. (2008). Global lesson from the TB pandemic: Economic, financial, legal and political implications. New York: Berlin Heidelberg Springer.

Condon, B. and Sinha, T. (2008). Global lessons from the AIDS pandemic economic, financial, legal and political implications. Berlin: Berlin Heidelberg Springer.

Gable, L., Gamharter, K. and Goston, L. (2007). Legal aspect of HIV/AIDS: A guide for policy and law reform. Washington, DC: World Bank.

Jacobsen, K. (2008). Introduction to global health. Boston, Massachusets: Jones & Bartlett Learning.

Lee, K., and Kent, B. (2002). Health policy in a globalizing world. Cambridge, United Kingdom: Cambridge University Press.

Patel, K. and Rushefsky, M. (2006). Health care politics and policy in America. California: M.E. Sharpe Publishers.

Saucier, K. and Lundy, S. (2009). Public health nursing. USA: Jones and Bartlett Publishers.

Williams, B. (2003). Harm reduction programs and Russian legal system. London: Family Health International.

World Health Organization. (2007). Global tuberculosis control: surveillance, planning, financing. Geneva: World Health Organization publication.

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