WHO's commitment to the promotion of equity and pro-poor policies in its disease prevention and control activities is based on the recognition of poverty as a major barrier to health and health care. In the case of TB, the links between poverty and disease burden have been documented for many years.
The level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population. Cases of TB in prisons may account for up to 25% of a country’s burden of TB. Late diagnosis, inadequate treatment, overcrowding, poor ventilation and repeated prison transfers encourage the transmission of TB infection.
In most of the world, more men than women are diagnosed with TB and die from it. TB is nevertheless a leading infectious cause of death among women. As TB affects women mainly in their economically and reproductively active years, the impact of the disease is also strongly felt by their children and families.
People who use drugs are at increased risk of TB, of over 10 times higher than among the general population. The convergence of viral hepatitis, HIV, TB and injecting drug use has become a major health concern and can have important implications for case management.
Poverty is a powerful determinant of tuberculosis. Crowded and poorly ventilated living and working environments often associated with poverty constitute direct risk factors for tuberculosis transmission. Undernutrition is an important risk factor for developing active disease. Poverty is also associated with poor general health knowledge and a lack of empowerment to act on health knowledge, which leads to risk of exposure to several tuberculosis risk factors, such as HIV, smoking and alcohol abuse.