"So little attention has been given to the tuberculosis
(TB) pandemic because it's a disease of the poor" had said Dr Nils Billo,
Executive Director of the International Union Against Tuberculosis and Lung
Disease (The Union) at the 38th Union World Conference on Lung Health in Cape
Town, South Africa in 2007.
In 2010, before the 41st Union World Conference on Lung
Health opens in Berlin, Germany (11-15 November 2010), the issues around TB and
poverty have only become more severe. At the consultative workshop organized by
the TB and poverty sub-working group of Stop TB Partnership in India (29-30
October 2010), it was clear that TB continues to affect society's most
vulnerable - those who live in abject poverty, are marginalized or economically
and socially isolated. Poverty significantly increases a person's vulnerability
to the disease.
Social and economic determinants at individual, household
and community levels affect a person's vulnerability to TB. Special situations
such as massive population movements - the displacement of people and refugee
flows - and living or working in particular conditions also increase the risk
of a person contracting TB.
In developed countries, ethnic minorities and other
marginalized communities are at a greater risk of contracting the disease. In
Canada for instance, indigenous communities have a 20 to 30 times higher TB
burden than majority ethnic groups, Dr Kim Barker and Dr Anne Fanning from Stop
TB Canada had said to CNS during the 38th Union World Conference on Lung Health
Factors such as social isolation, reduced access to health
services, a lack of trust in the health system and lack of organized community
voices exacerbate the risk of TB spreading. But by identifying these
vulnerabilities to TB, control strategies can become more focussed on reaching
the people most in need.
TB is transmitted more readily in conditions such as
overcrowding, where there are inadequate ventilation and malnutrition.
Improvements in socio-economic conditions will therefore lead to reductions in
TB incidence. This should also lead to improvements in access to care, its
rational use and quality of care.
About one billion people live in urban slums and over the
next 30 years that number is expected to double. In the poorest countries, about
80% of the urban population lives in slums. The poor socio-economic and
environmental conditions that characterize the slums facilitate the
transmission of many communicable diseases including TB. The burden of TB is
often far greater in these urban settings than in rural areas.
There is also increasing recognition of the fact that TB
reduces people's ability to work and earn a living and that TB control
programmes have the potential to reduce poverty.
Poor TB patients in developing countries are mainly
dependent on daily wages or income from petty trading and have no security of
income or employment. In many studies people with TB have been found to have
borrowed money, used transfer payments or sold assets because of their illness.
"We have to create jobs, find income generation
alternatives for those people who are on TB treatment and need financial
support to sustain them through the entire treatment course," said Dr AK
Jha during the TB and poverty consultative workshop in India (29-30 October
2010). The secretariat of the TB and Poverty sub-working group of Stop TB
Partnership has moved now to The Union's South East Asia office in New Delhi,
India since August 2010.
At this TB and poverty consultative workshop, listening to
the experiences from those fighting TB on the frontlines in high burden
settings like in Nepal, Thailand and India, and from five states in India, it
was evident that even where Directly Observed Treatment Shortcourse (DOTS)
programmes are well established, patients with TB face substantial costs prior
to diagnosis. While aggregate costs for poor people tend to be lower than for
those from a higher socio-economic position, the costs as a proportion of
income is much higher for the poor.
Experiences from other programmes like HIV show that it was
usually health-care volunteers or members from affected communities that
reached the most marginalized communities, providing them with TB and HIV care
and treatment services. Home-based care (HBC) experiences for people living with
HIV in most hard-hit communities provide learning lessons.
Poverty has played a leading role in accelerating the spread
of TB. The poor are at the greatest risk for tuberculosis because of poor
housing, poor diet, poor education and risky behaviour.
Let's combat TB by addressing the barriers faced due to
poverty such as infrastructural, housing, employment, educational and