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Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
Social determinants and risk factors of TB:
how countries do monitor and tackle them?
Pierpaolo de Colombani, WHO Regional Office for Europe, Copenhagen
Wouter Arrazola de Oñate, BELTA, Brussels
Members of the Working Group on Social Determinants of TB and Drug Resistant TB:
Pierpaolo de Colombani (Copenhagen, Denmark), Wouter Arrazola de Oñate (Brussels,
Belgium), Liliana Domente (Chisinau, Republic of Moldova), Araksya Hovhannesyan
(Yerevan, Armenia), Aaron Reeves (Oxford, UK), Alena Skrahina (Minsk, Belarus), Sarah
Simpson (Montluel, France)
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
2
Composition and terms of reference finalized in Sep 2013
Working Group on SD of TB and DR-TB
Six objectives:
1. Map social determinants (SD) + risk factors (RF) collected at
national level through surveillance/survey
2. Recommend on how to improve TB recording/reporting
3. Document past and present interventions for improving the SD
of TB
4. Recommend for addressing SD of TB and ensuring social
protection
5. Produce a paper for possible publication
6. Develop an operational research age
7. Develop an agenda for ACSM
2
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
3
Survey on how NTPs monitor SD/RF (1/3)
Pretested semi-structured questionnaire, English/Russian; e-mailed
to national TB surveillance correspondents
Responses from 47/53 (89%) countries: 28 EU/EEA, 19 non-
EU/EEA, 17 TB high-priority countries (HPC) (no response: Austria,
Israel, San Marino, Slovenia, Turkmenistan)
EU/EEA (%) non-EU/EEA (%) HPC (%)
Requested by ECDC/WHO for reporting:
Nationality/citizenship 96% 95% 88%
Status of imprisonment 54% 79% 76%
Not requested by ECDC/WHO for reporting:
Occupation/employment 68% 89% 88%
Homelessness 57% 79% 71%
Urban/rural 46% 89% 94%
Refugee/displaced/asylum 50% 58% 41%
3
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
4
Survey on how NTPs monitor SD/RF (2/3)
4
EU/EEA (%) non-EU/EEA (%) HPC (%)
Requested by ECDC/WHO for reporting:
Age 100% 100% 100%
Sex 100% 100% 100%
HIV infection 82% 89% 100%
Not requested by ECDC/WHO for reporting:
Diabetes mellitus 54% 63% 59%
Use of alcohol 54% 58% 59%
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
5
Survey on how NTPs monitor SD/RF (3/3)
5
Case Case variables and definitions
Occupation Employed: individual receiving an income from a
employer or a self-employment job
Unemployed: individual without work but available for
and seeking work
Homelessness Individual without stable, permanent, appropriate
housing, or the immediate prospect, means and ability
of acquiring it.
Diabetes
mellitus
Presence of fasting plasma glucose ≥ 7.0mmol/l
(126mg/dl) or 2–h plasma glucose ≥ 11.1mmol/l
(200mg/dl).
(Harmful) use
of alcohol
Intake of 5 or more drinks (60g pure alcohol) on one
occasion monthly or more often during the past 12
months
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
6
2nd Survey: interventions SD
Open-ended question to all national TB focal points
“Describe any non-medical intervention by any actor, past or recent ... “
Qualitative analysis PPHCKN* framework: socioeconomic context (society); differential
exposure (social and physical environment); differential vulnerability (population groups); differential health
outcomes (individual); and differential consequences (individual)
Participation of 12/53 (23%) countries: 7 EU/EEA (Belgium, Latvia, Malta, Netherlands,
Norway, Slovakia, United Kingdom), 5 non-EU/EEA (Armenia, Belarus, FYR Macedonia, Serbia, Ukraine), 3 TB
high-priority countries (Armenia, Belarus, Ukraine)
14 respondents (2 from Belgium and Serbia):
7 top managers of national TB institutes,
4 senior staff in the Ministry of Health and public health institutes
3 were senior staff of nongovernmental organizations
* Priority Public Health Conditions Knowledge Network (PPHCKN)
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
7
To complement survey
• secondary data
• countries of respondents
• case studies on actions addressing poverty and social exclusion
• WHO. Poverty and social exclusion in the WHO European Region: health
systems respond. Copenhagen: WHO, 2010
• European Observatory on Health Systems and Policies. Health system reviews
published on the following countries:
– Armenia (2013), Belarus (2013), Belgium (2010), The former Yugoslav
Republic of Macedonia (2006), Latvia (2012), Malta (2014), Netherlands
(2010), Norway (2013), Slovakia (2011), Ukraine (2010), England (2011),
Northern Ireland (2012), Scotland (2012) and Wales (2012)
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
8
Examples of responses on survey
• Armenia: “Under the Soviet Union, each TB patient received an apartment,
which increased the treatment success and decreased TB transmission”
• Belarus: “rehabilitation centres for former prisoners: i) medical screening and
care; ii) free accommodation and meals; iii) temporary registration and
document recovery; iv) legal assistance; v) social rehabilitation and job
opportunities”
• Latvia : “municipality of Riga provides financial support (public transport,
purchase of food) to patients coming for DOT”
• Norway: “improve socioeconomic conditions: labor laws ensuring fair salaries
and working conditions, progressive taxation, social housing, nutrition program
in schools, health insurance for all, etc.”
• Slovakia: “Health Support Programme for Disadvantaged Roma Community”
• UK: “Health and social care act 2012” duty to local governments ... to reduce
health inequities”
• Norway: taxing alcohol + earmarked to TB control activities
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
9
2nd Survey: Conclusions
Questionnaire design + awareness
Scarce documentation of interventions at the first 2-3 levels of PPHCKN the
framework
Further work needed to systematically document existing social protection
interventions in relation to people with TB
Addressing social determinants and risk factors of TB is priority under
Health 2020 European policy and strategy
End TB Strategy
TB Action Plan 2016-2020 for Europe
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
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Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
11
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
12
Working Group on SD and risk factors
13th NTP Managers’ Meeting
27-29 Jun 2015, The Hague
13
1. Should the working group continue its work?
2. Should it continue along with the current TOR (i.e. develop an
operational research agenda and an ACSM agenda) or differently?
3. New members, more members?
4. Duplication with other initiatives? How to link with them?
5. Questionnaire fatigue in countries?
Questions for discussion