Equity in Disease Management

Author:

Carran, Spencer Alexander

Graduate Program:

Ecology

Degree:

Doctor of Philosophy

Document Type:

Dissertation

Date of Defense:

April 09, 2018

Committee Members:

Matthew Joseph Ferrari, Dissertation Advisor/Co-Advisor
Matthew Joseph Ferrari, Committee Chair/Co-Chair
Ottar N Bjornstad, Committee Member
Katriona Shea, Committee Member
Ephraim Mont Hanks, Outside Member
Timothy Charles Reluga, Committee Member

Keywords:

Measles
Public health policy
epidemiology
disease management

Abstract:

While the burden of disease-related mortality has declined in many parts of the world, these gains have often been unevenly distributed. Improved access to healthcare for some segments of a population may leaves others behind, either maintaining or exacerbating preexisting inequity in health outcomes and disease burden. This dissertation focuses on how heterogeneity in disease dynamics drives inequities in disease burden, and how management interventions can be developed with an eye to addressing these inequities. To illustrate the role of management in promoting equity in disease burden, I consider a range of heterogeneities in disease processes and consider how they interact with management policy to determine the distribution of risk through a population. Demographic heterogeneity, variation in access to healthcare and vaccination coverage, and differential levels of vulnerability can all lead to subsets of the population bearing a disproportionate share of disease burden. Management interventions which do not take these underlying disparities in disease risk into consideration may reproduce or exacerbate inequity. I find that a crucial aspect of promoting equity in disease management policy is the identification of regions and subpopulations at greatest risk. By preferentially allocating public health resources (particularly vaccination) where they are most needed, management can ameliorate preexisting disparities and result in a more equitable distribution of risk. Adopting this approach not only allows for a more efficient use of public health resources (as shown in chapter 2) but is also necessary to ensure continued maintenance of disease elimination, as I find in chapter 4 that gaps in vaccination coverage anywhere are an impediment to disease elimination everywhere.