title: End TB strategy: the need to reduce risk inequalities.
abstract: BACKGROUND
  Diseases occur in populations whose individuals differ in essential characteristics, such as exposure to the causative agent, susceptibility given exposure, and infectiousness upon infection in the case of infectious diseases.
  
  
  CONCLUSIONS
  Concepts developed in demography more than 30 years ago assert that variability between individuals affects substantially the estimation of overall population risk from disease incidence data. Methods that ignore individual heterogeneity tend to underestimate overall risk and lead to overoptimistic expectations for control. Concerned that this phenomenon is frequently overlooked in epidemiology, here we feature its significance for interpreting global data on human tuberculosis and predicting the impact of control measures. We show that population-wide interventions have the greatest impact in populations where all individuals face an equal risk. Lowering variability in risk has great potential to increase the impact of interventions. Reducing inequality, therefore, empowers health interventions, which in turn improves health, further reducing inequality, in a virtuous circle.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK. Gabriela.Gomes@lstmed.ac.uk.|CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vila do Conde, Portugal. Gabriela.Gomes@lstmed.ac.uk.|Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil. Gabriela.Gomes@lstmed.ac.uk.
authors.forename: M Gabriela M
authors.initials: MG
authors.lastname: Gomes
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, FIOCRUZ, Salvador, Brazil.|Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
authors.forename: Maurício L
authors.initials: ML
authors.lastname: Barreto
authors.affiliation: World Health Organization, 1211, Geneva 27, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Glaziou
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Graham F
authors.initials: GF
authors.lastname: Medley
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rodrigues
authors.affiliation: Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands.|Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Jacco
authors.initials: J
authors.lastname: Wallinga
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: S Bertel
authors.initials: SB
authors.lastname: Squire
mesh_terms: D003906:Developing Countries; D014943:Global Health; D054625:Healthcare Disparities; D006801:Humans; D040242:Risk Reduction Behavior; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control*
keywords: Cohort selection; Heterogeneity; Intervention impact; Social inequality; Tuberculosis