Department of Ethics, Equity, Trade and Human Rights, World Health Organization, Geneva, Switzerland.
Stop TB Department, World Health Organization, Geneva, Switzerland.
Int J Tuberc Lung Dis. 2011 Jun;15 Suppl 2:30-36. doi: 10.5588/ijtld.10.0691.
Improved tuberculosis (TB) diagnosis and treatment through the DOTS and Stop TB strategies have saved millions of lives; however, their impact on TB incidence has been disappointing and the scale of the epidemic remains overwhelming. To reduce the incidence of TB, the drivers of the epidemic and social determinants of TB need to be addressed. These include co-morbidities and substance use and, moreover, the social and economic conditions that determine both the course of the TB epidemic and exposure to these risk factors. Doing so builds on the history of TB prevention and treatment during the public health revolution that resulted in a dramatic reduction in incidence in many countries. Addressing the social determinants is also imperative to address pervasive inequities in the incidence, mortality and morbidity of TB between different population groups, including in the performance of health systems in delivering diagnostic and treatment interventions, and in the financial consequences of people seeking care. Action on the social determinants can be categorised in terms of health-sector interventions, intersectoral policies impacting across society, and measurement and research to better understand inequities and links between TB and other factors. TB programmes cannot carry out these actions alone; however, they can make important contributions in the delivery of interventions and in advocating and negotiating for intersectoral efforts. The considerable progress seen in the clinical care of TB needs to be sustained; however, the attainment of TB targets, including elimination by 2050, will require expansion of the lens of TB control efforts beyond 'business as usual' to address the social determinants of the disease.
通过直接面视下督导短程化疗（DOTS）和终止结核病策略，结核病（TB）的诊断和治疗得到了改善，挽救了数百万人的生命；然而，它们对结核病发病率的影响令人失望，疫情规模仍然巨大。为了降低结核病的发病率，需要解决疫情的驱动因素和结核病的社会决定因素。这些因素包括合并症和物质使用，以及决定结核病流行进程和接触这些风险因素的社会经济条件。这是建立在公共卫生革命期间结核病预防和治疗的历史基础上的，这导致许多国家的发病率显著下降。解决社会决定因素对于解决不同人群中结核病发病率、死亡率和发病率方面普遍存在的不平等问题也是至关重要的，包括卫生系统在提供诊断和治疗干预方面的表现，以及人们寻求护理的经济后果。社会决定因素方面的行动可以根据卫生部门干预措施、跨社会影响的部门间政策以及衡量和研究来进行分类，以更好地了解结核病与其他因素之间的不平等和联系。结核病规划不能单独开展这些行动；然而，它们可以在提供干预措施方面以及倡导和谈判部门间努力方面做出重要贡献。结核病临床护理方面取得的可观进展需要得到维持；然而，要实现结核病目标，包括到 2050 年消除结核病，就需要将结核病控制工作的视角从“常规业务”扩展到解决疾病的社会决定因素。
