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'
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.
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).
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.
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).
Between TB and Poverty
TB infection is not just the product of poverty, but also
creates poverty' (StopTB b 2002).
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).
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.
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.
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.