URBANISATION, MIGRATION, & TB

The Overlooked Epidemic in Our Cities

As India continues to urbanise rapidly, the public health challenges within cities have grown more complex. TB is one of the most significant yet under-recognised threats in urban settings. According to UN projections, by 2050 nearly two‑thirds (68 %) of the world’s population will live in urban areas, adding about 2.5 billion new city dwellers globally United Nations. India, China, and Nigeria together are expected to account for around 35 % of that urban growth, with India alone adding roughly 416 million urban residents by mid‑century

TB thrives in overcrowded, poorly ventilated environments. Urban slums, informal settlements, and densely populated areas are often hotspots for TB transmission. These settings are marked by limited access to quality healthcare, poor sanitation, air pollution, and a lack of social protection, conditions that make both prevention and recovery more difficult.

Migrants and the Urban Poor: Facing TB Without Support

Migrants, daily wage workers, construction labourers, domestic workers, and other informal sector employees are among the most vulnerable to TB in cities. Constant mobility, insecure housing, lack of documentation, and unfamiliarity with local health systems leave them at high risk — often without the means to access consistent or affordable care.

These populations frequently experience:

Delays in diagnosis due to poor awareness and access
Interrupted treatment because of migration or informal work conditions
Fear of stigma, discrimination, and job loss if they disclose illness
Exclusion from state schemes due to the lack of proof of residence or identity

Urban TB often remains invisible in data and policy, leaving these communities without adequate protection or services.

High-Risk Populations in Urban Areas

In addition to migrant workers and the urban poor, other high-risk groups include:

People living with HIV
Transgender and gender-diverse individuals
People who use drugs or alcohol
Incarcerated populations
Homeless individuals
Older adults with limited care support

These groups face intersecting forms of marginalisation that increase both their risk of TB and the barriers they encounter in accessing care. Their needs are often left out of mainstream TB programming and policy.

What High-Quality Urban TB Care Should Look Like

TB care in urban areas must be adapted to reflect the lived realities of vulnerable populations. At SATB, we advocate for:

Community-based screening and services that reach people where they live and work
Integration of TB care with mental health, nutrition, and social protection services
Continuity of care across districts and states, especially for mobile and migrant populations
Protection of privacy and confidentiality to reduce fear and stigma
Stronger coordination between the public and private health sectors
Greater investments in urban health infrastructure and data systems

Our Approach

At Survivors Against TB, we believe urban TB care must be people-centred, inclusive, and rights-based. We work with survivors, communities, health providers, and policymakers to ensure that the realities of life in urban India are not ignored in the TB response.

Cities must be seen not just as centres of growth, but as critical spaces for public health innovation and equity. A TB-free India depends on our ability to build TB-free cities — and that begins with ensuring the most marginalised are not left behind. We work with city governments and states to help them build inclusive community centred urban TB strategies.