Trade, foreign policy, diplomacy and health

3. Tuberculosis control

Jim Yong Kim, Aaron Shakow, Arachu Castro, Chris Vande, Paul Farmer

The burden of tuberculosis: Economic burden (2)

  • TB and poverty closely linked
  • Self-medication encourages the emergence of drug-resistant TB strains
  • The global burden of TB amounts to approximately $12 billion annually

TB and poverty are closely linked. Malnutrition, overcrowding, poor air circulation and sanitation-factors associated with poverty-increase both the probability of becoming infected and the probability of developing clinical disease. Together, poverty and the tubercle bacillus form a vicious cycle: poor people go hungry and live in close, unhygienic quarters where TB flourishes; TB decreases people's capacity to work, and adds treatment expenses, exacerbating their poverty. Meanwhile, the poor receive inadequate health care , preventing even the diagnosis of their tuberculosis. Treatment, if received at all, is often erratic or simply incorrect.The poor are also less likely to seek and receive care from medical practitioners when ill, and are two to three times more likely than other income groups to self-medicate. Self-medication encourages the emergence of drug-resistant TB strains, further increasing the impacts on the poor and the risks to others in society.

The global burden of TB may be summed up in economic terms through a few brief computations. Given 8.4 million sick, according to the most recent WHO estimates, the bulk of them potential wage-earners, and assuming a 30% decline in average productivity, the toll amounts to approximately $1 billion yearly. Two million annual deaths, with an average loss of 15 years' income, adds an additional deficit of $11 billion. Every twelve months, then, TB causes somewhere near $12 billion to disappear from the global economy.