Rosenfield P L, Golladay F, Davidson R K
Soc Sci Med. 1984;19(10):1117-26. doi: 10.1016/0277-9536(84)90317-4.
Parasitic diseases are primarily diseases of poverty. At serious risk are individuals, communities and countries least able to afford the costs of treatment or prevention. In turn, economic development projects which aim to increase income levels may lead to negative results because of increased transmission of parasitic diseases often results. In attempting to analyse the economic consequences of parasitic diseases and the economics of their control, economists have usually relied on the tools of cost-benefit analysis, cost-effectiveness analysis and financial analysis. These efforts are briefly reviewed in the paper. The results have been subject to considerable criticism because of conceptual and methodological problems. For example, most studies have not taken into account the epidemiology and natural history of the disease in estimating the associated economic losses, thereby leading to inappropriate conclusions. The UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases through its Social and Economic Research Scientific Working Group (SER-SWG) is promoting research on the economics of parasitic diseases. In an attempt to improve the usefulness and reliability of such studies, conceptual and methodological approaches have been suggested which are reported on here. To improve the research design of these projects, a conceptual framework is proposed which consists of four components: (1) baseline social, cultural and economic conditions influencing disease transmission; (2) resources already invested in the health system and investments in other related sectors such as agriculture, housing, water supply and sanitation; (3) health consequences resulting from (1) and (2); and (4) social and economic consequences resulting from (3). A key concern in relation to the framework is to determine the most useful basis for linking results from studies of one component to another so as to analyse more systematically the impacts of disease on individuals and society. Such studies are inherently interdisciplinary and close collaboration of economists with medical scientists and disease control programme staff is needed to ensure completeness and reliability of input data and results. Results from these studies could be used to inform national decision-makers about the social and economic consequences of the parasitic diseases and their control and, thus, should strengthen support for increased investment to reduce the parasitic disease burden in developing countries.
寄生虫病主要是贫困人群易患的疾病。最无力承担治疗或预防费用的个人、社区和国家面临的风险最为严重。反过来，旨在提高收入水平的经济发展项目可能会产生负面结果，因为这往往会导致寄生虫病传播增加。在试图分析寄生虫病的经济后果及其控制的经济学时，经济学家通常依赖成本效益分析、成本效果分析和财务分析等工具。本文对这些研究进行了简要回顾。由于概念和方法上的问题，这些研究结果受到了相当多的批评。例如，大多数研究在估计相关经济损失时没有考虑疾病的流行病学和自然史，从而得出了不恰当的结论。联合国开发计划署/世界银行/世卫组织热带病研究和培训特别规划通过其社会和经济研究科学工作组（SER-SWG）正在推动对寄生虫病经济学的研究。为了提高此类研究的实用性和可靠性，已经提出了概念和方法上的途径，本文对此进行了报道。为了改进这些项目的研究设计，提出了一个概念框架，该框架由四个部分组成：（1）影响疾病传播的基线社会、文化和经济状况；（2）已经投入卫生系统的资源以及在农业、住房、供水和卫生等其他相关部门的投资；（3）由（1）和（2）导致的健康后果；以及（4）由（3）导致的社会和经济后果。与该框架相关的一个关键问题是确定将一个组成部分的研究结果与另一个组成部分的研究结果联系起来的最有用基础，以便更系统地分析疾病对个人和社会的影响。此类研究本质上是跨学科的，需要经济学家与医学科学家和疾病控制项目工作人员密切合作，以确保输入数据和结果的完整性和可靠性。这些研究的结果可用于让国家决策者了解寄生虫病及其控制的社会和经济后果，从而应加强对增加投资以减轻发展中国家寄生虫病负担的支持。
