Can the economic crisis have an impact on tuberculosis in the EU/EEA?

Editorials Can the economic crisis have an impact on tuberculosis in the EU/EEA? Each year, 24 March marks World Tuberculosis Day in an attempt to raise public awareness about the epidemic. The European Parliament Committee on the Environment, Public Health and Food Safety will exchange their views on tuberculosis (TB) in Europe in a debate on 21 March 2012. In preparation of this debate concerns were raised about the effect of the current economic crisis on TB. Many countries in the European Union (EU) and the European Economic Area (EEA) are in an economic recession. It is acknowledged that a recession or economic crisis can have an effect on the population's health, especially with respect to infectious diseases [1]. There are two main mechanisms through which an economic crisis can have an effect on infectious diseases. Firstly, if due to a decrease in country and individual income, less money is spent on healthcare and social welfare. And secondly, if due to an increase in poverty and stress, the number of people belonging to risk groups for infectious diseases increases. There is evidence that budgets for healthcare are cut in times of economic hardship [2]. Experts from EU/EEA countries predict that there will be an impact of the current global crisis on the financial and human resources available for the control of communicable diseases [3]. Decreased spending on healthcare may result in a reduction of healthcare workers and even of the number and quality of available healthcare facilities, which will have an impact on access to healthcare. Low access to healthcare is associated with longer delays in the diagnosis of TB [4]. This would increase the pool of individuals with infectious TB, as would treatment that is delayed or of insufficient quality. A financial crisis can increase the size of groups with a high risk for TB. For example, it is generally believed that rising unemployment favours criminal behaviour, and that this leads to a larger prison population [5]. On a population level it has been shown that the size of the prison population is associated with TB incidence [6]. Also, unemployment and job insecurity appear to lead to behaviour that increases the risk for TB, e.g. increased alcohol consumption [7,8]. A study of the impact of the New York City's fiscal crisis in 1975 found that the number of homeless people increased by 300% [9]. Homeless people are a well …