Lessons from tuberculosis control for public health.
Tuberculosis (TB) control in many ways exemplifies evidence-based public health practice, rigorously implemented, with appropriate emphasis on the central importance of political support for success. With more than 30 million patients treated in the past decade, TB control has important implications for managing both communicable and non-communicable diseases. Simple diagnostic tests, meticulously proven standardized treatment regimens with assured drug supply, supportive case management and a superb information system that tracks the progress of every patient, all facilitate effective program implementation. TB control shows that public health programs, including those that require long-term treatment in the primary care system, can be effective in poor countries; however, TB rates are heavily influenced by the social, environmental and epidemiologic context, emphasizing that treatment is not enough and that socio-economic factors may be more important determinants of epidemiologic trends than treatment programs. TB control is effective when it combines two essential components: a practical, implementable, proven technical package, and political commitment. Political commitment is also essential to implement other interventions that can improve health, including healthier air, water and food, as well as programs to prevent or reduce tobacco smoking, cardiovascular disease, cancer, obesity and other growing public health problems. By implementing evidence-based practices, ensuring operational excellence, using information systems that facilitate accountability and evaluation, and obtaining and maintaining political support, we can address the public health challenges of the twenty-first century.
Frieden
T R
TR
New York City Health Department, New York, NY 10013, USA. tfrieden@health.nyc.gov