1

Health Impact Framework/Research Paper

TB in South-East Asia

Gabriella Combs

Delaware Technical Community College

NUR 310 Global Health

Tammy Brown

April 22, 2023

 2

To assist in eradicating a global health issue, we must first understand what causes it and

what effects can be seen as a result to better mitigate them. This report will be focused on

tuberculosis in South-East Asia, who according to Bhatia et al. has the highest burden of

tuberculosis in the world. (2020).

There are many important ways a global health issue such as tuberculosis should be

studied. First the determinants of health in the region. Determinants of health are five connected

categories that include genetics, behavior, environment/physical, medical care and social factors.

According to the CDC, lacking in any one of these categories can render a person who belongs

to the South-East Asian community at a much higher risk of contracting tuberculosis. (CDC,

2023). We also look at health indictors, things like access to healthcare, nutrition, knowledge

about health or environment factors. In many places in South-East Asia people suffer from lack

of access to these. Then we can look at the burden of a disease, or the impact a disease has had

which can also be discussed with prevalence and incidence. According to Satyanarayana et al.,

in 2018 44% of tuberculosis cases occurred in South-East Asia. (2021). This is shocking data,

almost half of the percentage of a disease grouped in one area. So once the basic impacts and

terminology can be understood, what is tuberculosis? In summation, tuberculosis according to

the CDC is a bacterial infection caused by “Mycobacterium tuberculosis”. It is spread through

the air and if not treated could prove fatal. (CDC, 2023). This disease primarily effects the

pulmonary system but can also be found in the kidneys and spine.
 3

Now, let’s discuss the global health impact of tuberculosis in South-East Asia by

discussing the Health Impact Pyramid, first, Socioeconomic Factors. Over this large region

socioeconomic factors range vastly. Some areas have ready access to healthcare while others

have none at all. In addition, even in areas where healthcare is accessible it is limited to certain

services. (Bhatia et al., 2020). The next tier, changing the context to make individuals’ default

decisions healthy, this is a difficult one because in some cases lack of education is the issue to be

intervened upon, but then the other cases even if one does have knowledge do they have the

resources to make the healthy choice? The next tier is long-lasting protective intervention. This

topic will dovetail from the previous, changing the views on healthcare can initiate participation

in long-lasting intervention. This tier usually involves things like immunizations (Frieden,

2010). While there is no immunization to prevent tuberculosis you can be tested for exposure to

it, this can be done via blood test or PPD. Clinical Interventions is the fourth tier. This is where

breaking through barriers is key, breaking through beliefs, when necessary, through lack of

access, supplies etc. to intervene and stop the spread with clinical interventions. Counseling and

Education is the fifth and final tier of the pyramid where the role of the nurse is paramount. We

are constantly educating our patients on how to prevent future illness or disease and how to

promote and maintain optimal health. According to Frieden, the tiers at the bottom have a greater

positive impacts than those at the top, more attainable and able to be done. (2010).

So now that we understand what tuberculosis is, how it impacts the South-East Asian

region, and the different lenses to view the issue in order to help what recommendations can be
 4

made for the future. The first recommendation is to improve the socioeconomic status where it is

lacking in this region. According to research presented by Satyanarayana, things like

malnourishment and poor air quality to be factors worsening the spread, however this was not

the case for regions with improved socioeconomic access. (2020). Another recommendation

comes from Frieden, that is to utilize the health impact pyramid from the “bottom up”, the

design of this pyramid builds upon itself by how much change can come from each tier. They

state that the lower tiers reach more people and require less effort making the goal more

attainable. (2010). Finally, changing the perception of tuberculosis to the population. This ties

into the health belief model. Perception is reality, it is important to keep this in mind when

attempting to make change in areas very different from your own.

Currently, many organizations are working together to fight for the end of tuberculosis in

the South-East Asia region. To implement any goals funding is required. Unfortunately, many

road blocks in achieving goals circle back to financial short comings. According to Bhatia et al.

“In 2018, during the first-ever United Nations High-Level Meeting (UNHLM) on TB, world

leaders committed to mobilise US$ 13 billion a year to finance TB prevention and treatment

(TPT) by 2022 and US$2 billion a year for TB research.” (2020). Now that it is 2023 it would be

interesting to start seeing data collected to see if we’ve made improvement toward the ultimate

goal of significantly lowering the burden of tuberculosis in the South-East Asia region.

In conclusion, it is clear that a global health issue is not something that can easily, swiftly

or quickly be rectified. It takes simple measures as well as complex ones as well as education,
 5

access and resources for all peoples involved. It takes dedication and persistence. It takes a

global effort.
 6

References

Bhatia, V., Srivastava, R., Reddy, K. S., Sharma, M., Mandal, P. P., Chhabra, N., Jhalani, S.,

Mandal, S., Arinaminpathy, N., Aditama, T. Y., & Sarkar, S. (2020). Ending TB in

Southeast Asia: current resources are not enough. BMJ global health, 5(3), e002073.

https://doi.org/10.1136/bmjgh-2019-002073

Centers for Disease Control and Prevention . (n.d.). Centers for Disease Control and Prevention .

Retrieved March 29, 2023, from https://www .cdc.gov/tb/

Frieden, T. R. (2010). A framework for Public Health Action: The Health Impact Pyramid.

American Journal of Public Health, 100(4), 590–595.

https://doi.org/10.2105/ajph.2009.185652

Satyanarayana, S., Bhatia, V., Mandal, P. P., Kanchar, A., Falzon, D., & Sharma, M. (2021).
Urgent need to address the slow scale-up of TB preventive treatment in the WHO South-
East Asia Region. The international journal of tuberculosis and lung disease : the

official journal of the International Union against Tuberculosis and Lung Disease, 25(5),

382–387. https://doi.org/10.5588/ijtld.20.0941

Satyanarayana, S., Thekkur, P., Kumar, A. M. V., Lin, Y., Dlodlo, R. A., Khogali, M.,

Zachariah, R., & Harries, A. D. (2020). An Opportunity to END TB: Using the
Sustainable Development Goals for Action on Socio-Economic Determinants of TB in
High Burden Countries in WHO South-East Asia and the Western Pacific
Regions. Tropical medicine and infectious disease, 5(2), 101.

https://doi.org/10.3390/tropicalmed5020101