A Global Threat

In 1993 the World Health Organization declared Tuberculosis a 'global emergency' (WHO 2002). World wide almost 2 billion people are infected, that is a third of the world's population carries TB bacillus (the bacteria that causes TB) (Pace: 1999, 704; WHO 2002). While only 5-10% of those infected will develop active TB (not including those with HIV, for them the rate is much higher) that still translates to 8 million people becoming sick and 2 million deaths (including those with HIV) each year (WHO 2002). 'It is estimated that between 2002 and 2020, approximately [1billion people] will be newly infected, over 150 million will get sick, and 36 million will die of TB - if control is not further strengthened' (2002).

History

Prior to the 1940s (and indeed for centuries) TB had been one of the world's most deadly diseases (and one of the leading causes of death within the United States). The advent, in the 1940s, of antibiotics capable of defeating the disease created an optimism that TB could soon be controlled and eradicated. In the mid-1980s that optimism proved to be premature, as a progressive world-wide increase of TB incidence dashed hopes of eradication in the near future.

Three main factors contributed to the rise in TB incidence. Increased global migration, rise of HIV, and poorly managed TB control programs. Rapid global migration allows for TB to be spread internationally, making containment difficult. HIV weakens the immune system, allowing those infected with TB to become ill. Thus TB is the leading cause of death among those infected with HIV (Stop TB a 2002; WHO 2002). Poorly managed TB control programs can create the most dangerous form of TB, MDR-TB (Multi-Drug Resistant-TB). This form of TB is resistant to most conventional treatments, and thus poses the greatest threat to TB control (WHO 2002).

Contagious Airborne Disease

Tuberculosis is a contagious airborne infection spread from person to person through TB bacilli (bacteria), which are found in the mucus of infected individuals. These bacilli are propelled into the air by an infected individual with active TB through talking, coughing, sneezing, and spitting. In turn, bacilli are inhaled by any person in close proximity. The newly infected person will retain the TB bacilli for the rest of their lives. If they have a depressed immune system, the infection may progress to active pulmonary TB.

A person with inactive TB may not be aware that they have the infection. If a person with active TB is left untreated they '...will infect on average between 10 and 15 people every year' (WHO 2002). Pulmonary TB is predominantly an infection of the lungs, but can spread to other parts of the body (Pace, 1999). Symptoms of active TB include coughing with blood in mucus that lasts for over two weeks, chest pain, difficulty breathing, fatigue, fever, loss of appetite, and bone pain (Pace 1999: 704; TDR 2003).

Link Between TB and Poverty

'[A] new TB infection is not just the product of poverty, but also creates poverty' (StopTB b 2002).

Tuberculosis transmission and infection is related to the level of poverty in a given region. Globally this is reflected through the number of cases in low income countries. StopTB.org notes that, 'low income countries (i.e. [countries with] GNP per capita less than US$755) account for 65% of TB cases and 71% of deaths. 42% of the world's population lives in these countries' (StopTB b 2002).

This is particularly the case in Africa, which has been experiencing a rise in TB incidence for the past twenty years. The maps below illustrate what has been happening in Zambia and Zimbabwe. In 1980 Zambia's incidence rate was 91 per 100,000 people and Zimbabwe's was 57, this rose to 285 and 89 in 1990 respectively, in 2000 the rate was 478 and 411.

This relationship of TB and poverty can be aggravated by implementation of stringent Structural Adjustment Programs. Governments forced to reduce expenditures often cut healthcare and educational services first. Such actions inflame poverty and create conditions ripe for increased TB morbidity and mortality.

Global Solutions

The global recognition of TB as a problem, from which no nation is immune is the first step towards containing the disease. Also by combating poverty, international organizations and national governments can eliminate the conditions that cause TB, thereby reducing the rate of incidence globally. Implementation of the World Health Organization's recommended DOTS procedures has been shown to be the most effective way of treating TB. 'DOTS combines five elements: political commitment, microscopy services, drug supplies, survelillance and monitoring systems and use of highly [effective] regimes with direct observation of treatment' (WHO 2002). For More information on DOTS and other aspects of the relationship between poverty and TB see the WHO's web site or one of the links below.