Towards tuberculosis elimination: an action framework for low-incidence countries

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.

Discerning the meaning of human suffering through the discourse of Judeo-Christian scriptures and other faith teachings

When confronted with the meaning of human suffering, many experts from a variety of professional disciplines admit to being incapable of formulating, on the basis of scientific method, a coherent explanation or rationale. Within that perspective, this article proposes another approach to the dilemma-that of reflection rooted in faith. The author examines the discourse of the Judeo-Christian scriptures and the comprehensive and cohesive doctrine developed by Pope John Paul II to find and track an evolving theology on the meaning of human suffering-one that includes understanding of this phenomenon as a "punishment for sin or evil," a test for fidelity, an occasion for God to show mercy and love, and a redemptive act by which Jesus took on all human suffering through his own death on the Cross and gave a salvific meaning to suffering through his resurrection from the dead. Further scriptural reflection and later Christian doctrines acknowledged that the suffering of other believers has its own redemptive value and that human suffering presents an occasion for all believers to respond with compassion and care to the pain of others.