Paper short abstract:

Infections considered acute in high-income countries persist as chronic causes of mortality in low- and middle-income countries. The ever-widening experiences of chronic illnesses such as obesity and diabetes serve to compound and complicate the disease course of treatable infections.

Paper long abstract:

This presentation takes tuberculosis as a case example to explore acuteness and chronicity in conceptualisations of health and illness. Prior to the antibiotic era, the epidemiology of tuberculosis disease shifted from being a global burden to a problem concentrated in low- and middle-income countries. Socio-economic improvements in high-income countries helped reduce tuberculosis incidence without the need for sophisticated pharmacotherapy. The discovery of antimicrobials, however, skewed the globalisation of disease control efforts towards a singular focus on the production and distribution of standardised drug regimens. Pharmacological interventions created powerful institutional allies in the health sectors for drug manufacturers who supported industrialized production and developing new research programs and markets for their products, but these interventions did not reduce infection rates in a straightforward fashion. By the 1980s, the number of tuberculosis cases doubled in low- and middle-income countries. Moreover, economic growth in low- and middle-income countries after the availability of antimicrobials led to increasing prevalence of drug resistant tuberculosis, especially when public healthcare struggled and private healthcare thrived. The disintegration of the former Soviet Union, for example, contributed to steep rises in tuberculosis, particularly drug resistant disease, which emerged when failing health systems were no longer able to provide adequate treatment. Today, more than 9 million people globally become sick with tuberculosis each year. For more than 1.5 million of these patients, it is a chronic, and ultimately mortal, infection. Compounding this situation is the spread of obesity and diabetes, which have changed both the look and feel of tuberculosis.