title: Economic inequality caused by feedbacks between poverty and the dynamics of a rare tropical disease: the case of Buruli ulcer in sub-Saharan Africa.
abstract: Neglected tropical diseases (NTDs) have received increasing attention in recent years by the global heath community, as they cumulatively constitute substantial burdens of disease as well as barriers for economic development. A number of common tropical diseases such as malaria, hookworm or schistosomiasis have well-documented economic impacts. However, much less is known about the population-level impacts of diseases that are rare but associated with high disability burden, which represent a great number of tropical diseases. Using an individual-based model of Buruli ulcer (BU), we demonstrate that, through feedbacks between health and economic status, such NTDs can have a significant impact on the economic structure of human populations even at low incidence levels. While average wealth is only marginally affected by BU, the economic conditions of certain subpopulations are impacted sufficiently to create changes in measurable population-level inequality. A reduction of the disability burden caused by BU can thus maximize the economic growth of the poorest subpopulations and reduce significantly the economic inequalities introduced by the disease in endemic regions.
authors.affiliation: UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier I, Université de Montpellier II, Montpellier, France Ecole des Hautes Etudes en Santé Publique, Rennes, France Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA andres_garchitorenagarcia@hms.harvard.edu.
authors.forename: Andrés
authors.identifier: http://orcid.org/0000-0001-6225-5226
authors.initials: A
authors.lastname: Garchitorena
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Calistus N
authors.initials: CN
authors.lastname: Ngonghala
authors.affiliation: UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier I, Université de Montpellier II, Montpellier, France Ecole des Hautes Etudes en Santé Publique, Rennes, France.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Guegan
authors.affiliation: Service d'épidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun. UMR 912 - SESSTIM - INSERM/IRD/Aix-Marseille Université Faculté de Médecine, Marseille, France.
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Texier
authors.affiliation: Ecole des Hautes Etudes en Santé Publique, Rennes, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Bellanger
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bonds
authors.affiliation: UMMISCO, UMI IRD-UPMC 209, Bondy, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Roche
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D054312:Buruli Ulcer / Q000191:economics* / Q000453:epidemiology*; D006233:Persons with Disabilities; D006801:Humans; D018803:Models, Economic; D008962:Models, Theoretical; D058069:Neglected Diseases / Q000191:economics* / Q000453:epidemiology; D011203:Poverty; D012424:Rural Population; D012959:Socioeconomic Factors
keywords: coupled ecological-economic systems; individual-based model; neglected tropical diseases