BACKGROUND: The increasing global burden of tuberculosis (TB) is linked to human immunodeficiency virus (HIV) infection. METHODS: We reviewed data from notifications of TB cases, cohort treatment outcomes, surveys of Mycobacterium tuberculosis infection, and HIV prevalence in patients with TB and other subgroups. Information was collated from published literature and databases held by the World Health Organization (WHO), the Joint United Nations Programme on HIV/Acquired Immunodeficiency Syndrome (UNAIDS), the US Census Bureau, and the US Centers for Disease Control and Prevention. RESULTS: There were an estimated 8.3 million (5th-95th centiles, 7.3-9.2 million) new TB cases in 2000 (137/100,000 population; range, 121/100,000-151/100,000). Tuberculosis incidence rates were highest in the WHO African Region (290/100,000 per year; range, 265/100,000-331/100,000), as was the annual rate of increase in the number of cases (6%). Nine percent (7%-12%) of all new TB cases in adults (aged 15-49 years) were attributable to HIV infection, but the proportion was much greater in the WHO African Region (31%) and some industrialized countries, notably the United States (26%). There were an estimated 1.8 million (5th-95th centiles, 1.6-2.2 million) deaths from TB, of which 12% (226 000) were attributable to HIV. Tuberculosis was the cause of 11% of all adult AIDS deaths. The prevalence of M tuberculosis-HIV coinfection in adults was 0.36% (11 million people). Coinfection prevalence rates equaled or exceeded 5% in 8 African countries. In South Africa alone there were 2 million coinfected adults. CONCLUSIONS: The HIV pandemic presents a massive challenge to global TB control. The prevention of HIV and TB, the extension of WHO DOTS programs, and a focused effort to control HIV-related TB in areas of high HIV prevalence are matters of great urgency.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/215525/ira20017.pdf

The growing burden of tuberculosis: global trends and interactions with the HIV epidemic.

Between Facts and Norms: Contributions to a Discourse Theory of Law and Democracy

A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life. These early experiences can affect adult health in 2 ways—either by cumulative damage over time or by the biological embedding of adversities during sensitive developmental periods. In both cases, there can be a lag of many years, even decades, before early adverse experiences are expressed in the form of disease. From both basic research and policy perspectives, confronting the origins of disparities in physical and mental health early in life may produce greater effects than attempting to modify health-related behaviors or improve access to health care in adulthood.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=184019&pdfFileName=jsc90003_2252_2259.pdf

Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention

The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report

Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2009.159491

Obesity Stigma: Important Considerations for Public Health

CONTEXT: Since the early 1980s, the black-white gap in life expectancy at birth increased sharply and subsequently declined, but the causes of these changes have not been investigated.

OBJECTIVE: To determine the contribution of specific age groups and causes of death contributing to the changes in the black-white life expectancy gap from 1983-2003.

DESIGN AND SETTING: US vital statistics data from the US National Vital Statistics System, maintained by the National Center for Health Statistics. Standard life table techniques were used to decompose the change in the black-white life expectancy gap by combining absolute changes in age-specific mortality with relative changes in the distribution of causes of death.

MAIN OUTCOME MEASURE: The gap in life expectancy at birth between blacks and whites.

RESULTS: Among females, the black-white life expectancy gap increased 0.5 years in the period 1983-1993, primarily due to increased mortality from human immunodeficiency virus (HIV) (0.4 years) and slower declines in heart disease (0.1 years), which were somewhat offset by relative improvements in stroke (-0.1 years). The gap among males increased by 2 years in the period 1983-1993, principally because of adverse changes in HIV (1.1 years), homicide (0.5 years), and heart disease (0.3 years). Between 1993 and 2003, the female gap decreased by 1 year (from 5.59 to 4.54 years). Half of the total narrowing of the gap among females was due to relative mortality improvement among blacks in heart disease (-0.2 years), homicide (-0.2 years), and unintentional injuries (-0.1 years). The decline in the life expectancy gap was larger among males, declining by 25% (from 8.44 to 6.33 years). Nearly all of the 2.1-year decline among males was due to relative mortality improvement among blacks at ages 15 to 49 years (-2.0 years). Three causes of death accounted for 71% of the narrowing of the gap among males (homicide [-0.6 years], HIV [-0.6 years], and unintentional injuries [-0.3 years]), and lack of improvement in heart disease at older ages kept the gap from narrowing further.

CONCLUSIONS: After widening during the late 1980s, the black-white life expectancy gap has declined because of relative mortality improvements in homicide, HIV, unintentional injuries, and, among females, heart disease. Further narrowing of the gap will require concerted efforts in public health and health care to address the major causes of the remaining gap from cardiovascular diseases, homicide, HIV, and infant mortality.

https://jamanetwork.com/journals/jama/articlepdf/206131/joc70019_1224_1232.pdf

Trends in the Black-White Life Expectancy Gap in the United States, 1983-2003

Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted. Operationalizing these models in research and practice has been challenging. Examining the role of criminal law enforcement in the "risk environment" of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This paper reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels - laws; management of law enforcement agencies; knowledge, attitudes, beliefs and practices of front-line officers; and attitudes and experiences of IDUs - and that such research can be the basis of interventions within law enforcement to enhance IDU health.

https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID937013_code139924.pdf?abstractid=937013&mirid=1

Addressing the 'Risk Environment' for Injection Drug Users: The Mysterious Case of the Missing Cop

Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted, but using these models in research and practice has been challenging. Examining the role of criminal law enforcement in the “risk environment” of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This article reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels—laws; management of law enforcement agencies; knowledge, attitudes, beliefs, and practices of frontline officers; and attitudes and experiences of IDUs—and that such research can be the basis of interventions within law enforcement to enhance IDU health.

/pdf/addressing-the-risk-environment-for-injection-drug-users-the-64asnfy4db.pdf

Scott Burris

Papers

Trends in the Black-White Life Expectancy Gap in the United States, 1983-2003

Addressing the 'Risk Environment' for Injection Drug Users: The Mysterious Case of the Missing Cop

Addressing the “Risk Environment” for Injection Drug Users: The Mysterious Case of the Missing Cop

Workshop report: AIDS and stigma: a conceptual framework and research agenda

Reducing sexual transmission of HIV from those who know they are infected: the need for personal and collective responsibility.