title: Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition.
abstract: In today's globalized world, rapid urbanization, mechanization of the rural economy, and the activities of trans-national food, drink and tobacco corporations are associated with behavioral changes that increase the risk of chronic non-communicable diseases (NCDs). These changes include less healthy diet, lower physical activity, tobacco smoking and increased alcohol consumption. As a result, population health profiles are rapidly changing. For example, the global burden of type 2 diabetes mellitus is expected to double by 2030, with 80% of adult cases occurring in low and middle-income countries (LMIC). Many LMIC are undergoing rapid changes associated with developing high rates of NCD while concomitantly battling high levels of certain communicable diseases, including HIV, TB and malaria. This has population health, health systems and economic implications for these countries. This critical review synthesizes evidence on the overlap and interactions between established communicable and emerging NCD epidemics in LMIC. The review focuses on HIV, TB and malaria and explores the disease-specific interactions with prevalent NCDs in LMIC including diabetes, cardiovascular disease, chronic obstructive pulmonary disease, chronic renal disease, epilepsy and neurocognitive diseases. We highlight the complexity, bi-directionality and heterogeneity of these interactions and discuss the implications for health systems.
authors.affiliation: Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, South Africa Clinical Infectious Disease Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa tolullah.oni@uct.ac.za.
authors.forename: Tolu
authors.initials: T
authors.lastname: Oni
authors.affiliation: Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Bridgetown, Barbados MRC Epidemiology Unit, University of Cambridge, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Unwin
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology*; D003141:Communicable Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003695:Delivery of Health Care; D019456:Health Transition; D006801:Humans; D008875:Middle Aged; D011635:Public Health Administration
keywords: Co-morbidity; Communicable disease; Health transition; Infectious disease; Low and middle-income countries; Non-communicable disease