SOCIAL DETERMINANTS OF TB
Why poverty, nutrition, stigma and systemic neglect make TB deadlier
Tuberculosis is not just a medical issue, it’s deeply social. In India and across the world, TB disproportionately affects those already living on the margins. Poverty, undernutrition, stigma, housing insecurity, and loss of income are all powerful drivers of the TB epidemic. These factors don’t just increase vulnerability to TB, they make it harder to access diagnosis, complete treatment, or recover fully.
For many, the economics of TB kills. Costs of care, from lost wages to transport, food, and medicines, often push families into debt, disrupt livelihoods, and result in delayed or incomplete treatment. In urban areas, these burdens escalate with high living costs and limited social safety nets. Meanwhile, poor nutrition weakens immunity, increases mortality risk, and undermines treatment outcomes.
These vulnerabilities are compounded by gender, caste, and identity-based discrimination. Women and gender-diverse people often face added stigma, social isolation, and a lack of autonomy in seeking care. (You can read more on the gendered dimensions of TB here.)
WHAT NEEDS TO CHANGE
To break this cycle, India’s response to TB must address the broader social and economic determinants of health. Based on global evidence and lived experiences, we recommend the following steps under the National TB Elimination Programme (NTEP):
Expand and strengthen direct financial support
When Schemes like Ni-kshay Poshan Yojana offer monthly nutrition support, the current amount is inadequate and often delayed. Financial assistance must be incresed, streamlined, and made more accissible, particularly for informal workers, migrants, and marginalized communities
Ensure access to food and
nutrition
Undernitrition is both a coause and consequence of TB. All TB-affected individuals must recieve regular nutritional assessments, counselling, and support, including community-based or PDS-linked food supplementation with locally available, nutrious options
Support for travel and treatment access
Travel vouchers or reimbursements are essential for patients who must travel long distances for diagnosis and treatment, especially in rural and underserved areas.
Enable community-based care systems
Home- and community-based treatment models reduce the burden of clinic visits and improve adherence. Investing in local support systems can improve outcomes while restoring agency to patients.
Post-treatment rehabilitation and livelihoods
TB often disrupts work, especially for those in informal jobs. Skill-building, employment assistance, or small credit lines can help TB-affected individuals rebuild livelihoods and prevent long-term poverty.