The socio-cultural challenge in public health interventions : the case of tuberculosis in India

Avec Madhukar Pai

Introduction de l’article

As per H. Graham, public health policies need to be reconfigured to improve population health and to address inequalities in the social distribution of health (Graham 2004). These reflections draw upon the fact that social determinants are central to programs and policies regarding prevention and control of diseases such as HIV/AIDS, malaria and tuberculosis (TB). While there is ample literature demonstrating that social factors promote and/or undermine the health of women, men, families and populations, there is limited knowledge about the social processes underlying the unequal distribution of health among specific populations, which in turn is at the root of persistent social disparities (Anderson 2000 ; Marmot 2000 ; Marmot 2005). The aim of these thoughts is to promote a better understanding, thereby a systematic account for how gender and other social processes operate in causing health inequalities in the case of TB management and control. While epidemiological evidence indicates that in low or middle-income countries TB is more prevalent among men than women, studies show that this may be explained by gender differences in the social pattern of interactions (Eastwood & Hill 2004 ; Uplekar et al. 2001). In addition to differences in exposure and risk of infection, there is a difference in the progression from infection to disease as well as in the tuberculosis notification rates in men and women (Holmes et al. 1998). Approximately three million women worldwide contract TB annually and it is estimated that TB accounts for nearly 17 million Disability Adjusted Life Years (DALY) for women with about 750 000 dying of TB every year (Vlassoff et al. 2000 ; WHO 2002). Not only may women have higher rates of progression from infection to disease and a higher case fatality in their early reproductive ages, but consequences of the latter are felt at the household and community levels (Needham et al. 2001). As a disease of poverty, the social implications of TB are heightened among women living and working in resource poor areas, such as those found in urban slum settle ...

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