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.

Poverty alleviation reduces the risk of tuberculosis transmission and the risk of progression from infection to disease. It also helps to improve access to health services and adherence to recommended treatment. Actions on the determinants of ill health through “health-in-all-policies” approaches will immensely benefit tuberculosis care and prevention. The required social, economic and public health policies include those that:

• pursue overarching poverty reduction strategies and expanding social protection;
• reduce food insecurity;
• improve living and working conditions;
• improve environment and living conditions in prisons and other congregate settings;
• address the social, financial, and health situation of migrants; and
• promote healthy diets and lifestyles, including reduction of smoking and harmful use of alcohol and drugs.

Addressing the social determinants of health is a shared responsibility across disease programmes and other stakeholders within and beyond the health sector.

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Journal articles

Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: The role of risk factors and social determinants. Social Science and Medicine 2009; 68 :2240–2246

Lönnroth K, Castro K, Chakaya JM, Chauhan LS, Floyd K, Glaziou P, Raviglione M. Tuberculosis control and elimination 2010-50: cure, care, and social development. Lancet. 2010; 375:1814-29.