Breaking silos: Tuberculosis (TB) and poverty. By Bobby Ramakant


Tuberculosis (TB) continues to affect society's most vulnerable - those who live in abject poverty, are marginalized or economically and socially isolated. The poor and vulnerable people are much more likely to suffer from TB due to socioeconomic factors. The poor face significant costs and delays in accessing TB services and treatment outcomes are more likely to be adverse, said Rachael Thomson from Liverpool School of Tropical Medicine (LSTM) who was nominated by the TB and poverty sub-working group of Stop TB Partnership to speak at the Biennial Conference of Irish Forum for Global Health (IFGH) held in Maynooth, Ireland (29-30 November 2010). The IFGH meet was organized by IFGH with support from Combat Diseases of Poverty Consortium (CDPC), Irish Aid and National University of Ireland Maynooth (NUIM).
"In urban Malawi poorer patients face costs six times their monthly income to access a diagnosis from 'free' facilities, and in rural Malawi this cost rises to ten times" said Rachael.
New TB case detection in many countries is low because the poor people are least likely to access TB care services. The process of accessing care is impoverishing making the people accessing care even poorer, said Rachael.
The lack of adequate diagnosis, treatment and cure means the burden of TB in poorer communities continues to increase.
Not surprisingly, the poor people have higher risk of infection, higher prevalence of disease and worse outcome of disease too. Moreover the poor people have greater health care needs, said Rachael.
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 vulnerable 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.
There is a need to combat TB by addressing the barriers faced due to poverty such as infrastructural, housing, employment, educational and nutritional deficiencies.
Rachael explained that poverty is more than economic poverty (living on less than USD 1.25 per day) and encompasses lack of opportunities, voice and representation, and is a major determinant of vulnerability to disease - especially TB.
One of the major steps forward in addressing poverty and TB will be to put health on the poverty agenda and poverty on the health agenda, said Rachael.
Rachael gave an overview of the TB and poverty sub-group of the Stop TB Partnership. TB and poverty is the sub-group of the DOTS Expansion Working Group (DEWG) of the Stop TB Partnership and is a network of individuals and organisations interested in the needs of poor and vulnerable populations with respect to TB. Since September 2010, the secretariat of the TB and Poverty sub-working group of the Stop TB Partnership is housed in the south-east Asia regional office of The Union in New Delhi, India.
A two-days consultative workshop of the TB and poverty sub-working group was also held in Gurgaon, India on 29-30 October 2010 which brought together the national TB programme managers from India, Nepal and Thailand, state TB officers from eight poorest states of India, and partners from various other organizations like WHO, the World Bank, World Vision, GFATM Round 9 members, media (CNS, Asia Tribune), National Partnership for TB care and control in India among others, said Rachael.

(The author is the Director of CNS Stop-TB Initiative and a World Health Organization (WHO) Director-General’s WNTD Awardee (2008). He writes extensively on health and development for Citizen News Service (CNS). Email:, website:

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