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To What Extent is Tuberculosis (TB) a Disease of

Poverty?
The treatment of Tuberculosis, disease that can drive entire country into a deeper poverty,
is cheap and highly effective, yet worldwide the disease remains a serious cause of illness and
death.

What is Tuberculosis ?
Tuberculosis, usually called as TB, is a disease caused by the bacteria Mycobacterium
tuberculosis. It is considered as the serious disease and usually infects the lungs, but sometimes it
also affects other organs. The symptoms are coughing for more than 3 weeks (sometimes
producing thick and/or bloody sputum), fever, weight loss, fatigue, poor appetite, and chest pain.
TB bacteria can infect anyone, from any age range and sex type. But, Tuberculosis
mostly affects adults in their most productive year. The person who infected with TB bacteria
doesnt always falling ill with TB right away. Usually, the person only have 10% risk of falling
ill with TB, but for the one who has bad immune systems, such as people living with
malnutrition or HIV, can have a much higher risk of falling ill. TB infection is classified in one
of two ways:

A latent TB infection, which is not causing symptomatic illness and is not contagious.

An active TB infection which is contagious and can present with such initial symptoms as
cough, blood-tinged sputum, night sweats, and fever.
TB is not only a serious disease, it can also easily spread from person to person via

microscopic water droplets containing the TB bacteria. When person with active TB coughs or
sneezes, it releases the bacteria to the air and a person who inhale these droplets can infected
with TB. In general, kids are not considered contagious, and usually get the infection from
infected adults.

Active TB can happen as a result of person to person exposure or from a sudden


reactivation of a latent TB. But a person cannot get TB from shaking hands, sitting on a toilet
seat, sharing dishes, or hugging.

History of Tuberculosis
Based on the fact from WHO, Tuberculosis is a top infectious disease killer worldwide. It
founded in 24 March 1882 by Robert Koch. In the 18th century in Western Europe, tuberculosis
reached its peak with a prevalence as high as 900 deaths per 100,000. The term White plague
emerged around this time. And known as one of the most dreaded diseases of the 19th century,
TB was the eighth leading cause of death in children 1 to 4 years of age during the 1920s. so
serious as to have been declared a global emergency in 1993. The incidence of tuberculosis is
increasing worldwide, partly due to poverty and inequity and partly to the HIV/AIDS pandemic,
which greatly increases the risk of infection proceeding to overt disease. Around 30% of AIDSrelated deaths are due to tuberculosis.[1]
Globally, TB is still affect so many countries. In 2011, WHO estimates there are 8,7
million new case of TB (13% of the case is from co-inffection of HIV) and 1,4 million people
died because of TB, its included almost one million death of people that HIV negative. (WHO,
2012)
It is principally a disease of poverty, with 95% of cases and 98% of deaths occurring in
developing countries. Although there are still many TB cases in developed country, but the
number is getting smaller each year. For example, as the general standard of living and medical
care improved in the United States, the incidence of TB decreased. The smallest proportion of
TB case is happen in East Mediterania (7,7%), Europe (4,3%), and United States of America
(3%). (WHO, 2012).
Contrary to the developed country, the number of TB case in developing countries are not
getting smaller. For example, based on the newest survey, new TB cases in Indonesia is

estimated reach 1 million case every year or twice from previous estimation. Because of this
thing, Indonesia becomes the second country with the highest TB case, right after India. [2]

Poverty fuels tuberculosis


TB is a disease of poverty. 95% of new TB cases and 98% of all TB deaths are in the
developing world, with more than half of all deaths occurring in Asia. The World Health
Organization estimates that approximately one-third of the worlds population is infected with
TB and globally, low and lower middle income countries (i.e. annual GNP per capita less than
US$2995) account for more than 90% of TB cases and death. 76% of the worlds population
lives in these countries. [3]
It is really interesting if we read what Archbishop Desmon Tutu from South Africa said.
"Tuberculosis is a child poverty, and also it's parent and provider"

[4]

,which basically said that

TB is a product of poverty and brings poverty to the one that have TB.
TB and poverty is like a two side coin. On the first side, poverty can become the reason
of TB epidemic. For example, A lack of basic health services, poor nutrition and inadequate
living conditions all contribute to the spread of TB and its impact upon the community. An
absence of good quality health care facilities is common in poor communities. With no health
services to diagnose or treat patients, there is a longer delay between disease and cure,
perpetuating the spread of TB. [5]
Or another example that happened in Indonesia is, one of the factor that make the number
of TB cases in Indonesia still high is because there are lot of patients who didnt finish the
treatment until the doctor state that the patient is clean from TB. Most of the time, after two
month of treatment, patient condition looks like a healthy person, and the patiens itself didnt feel
any TB symptom. The cost of the treatment become of of the reason why patients are not
finishing their treatment. This example support the fact that poverty can become the reason of
TB epidemic.
The poor lack access to essential medicines for reasons including poverty itself, lack of
outreach, shortages of health workers, taxes and duties on imported drugs, and burdensome

procedures. These reasons apply to TB drugs, even those that are off-patent. (Commission on
Macroeconomics and Health Report, December 2001)
Meanwhile, on the other side, TB can lead to poverty, not only for the patient, but it can
bring poverty to the family too. For example, the patients loss of productivity because of TB
make them unable to work or attend school for 3-4 months on average. This can result in a
significant loss of earnings and/or reduce a childs future earning potential. If a patient dies, a
family loses about 15 years of potential income. Beside that, there is a stigma where People can
lose their jobs, or be excluded from future employment, because of fears surrounding TB.
Women may be divorced, or considered unworthy of marriage, if they are known to have been
affected by TB, making them more likely to experience extreme poverty.[6]

Global Effort to End TB


TB is already become an epidemic and every government and NGO work together to end
TB. Not Only TB, it is very important too to fighting poverty for a better life. Emphasising the
fact that poverty contributes to the spread of TB and that TB contributes to the persistence of
poverty stimulates a global dialogue which is highly relevant both to reversing the spread of TB
and to poverty reduction.
One of the example, stategy to end TB epidemic was the investation made from US
government. The U.S. Government is a leader in the global TB care effort, having invested
almost $3 billion to combat TB. [7]
From 2000-13, more than 37 million people were cured of TB. WHO reduced TB deaths
by almost half since 1990, and the world has achieved the Millennium Development Goal target
of reversing the spread of the disease. [8]
Global elimination of TB as a public health problem, defined as <1 TB case per million
population, is a long-term vision of WHOs End TB Strategy, while the time-bound global target
is to End the global TB epidemic, defined as bringing down the global incidence from >1,000
per million population in 2015 to <100 per million by 2035. [9]

Conclusion
As one of the world most popular disease, Tuberculosis that happen because of the
bacteria, is popular not only because of the number of people that infected. But, the fact that the
number of people that infected is higher in the developing country made it become popular
because it related to poverty too. Since the number of infected people is very high, WHO and
other government need to work together to get rid of this TB epidemic and reach the goal in
2035.

End Notes
1. World Health Organization. WHO 2012 factsheet. 2012.
http://www.who.int/mediacentre/factsheets/fs104/en/
2. Bimantara, Galuh. Tuberculosis di Indonesia Terbanyak Kedua di Dunia. Kompas. 2016.
http://print.kompas.com/baca/sains/kesehatan/2016/03/24/Tuberkulosis-di-IndonesiaTerbanyak-Kedua-di-Dunia
3. Stop TB. Stop TB, Fight Poverty. 2002.
http://www.stoptb.org/assets/documents/events/world_tb_day/2002/1Therelationship.pdf
4. Karamoy, Elisa. TB sebagai salah satu sumber kemiskinan. 2014.
http://www.elisakaramoy.com/2014/06/tb-sebagai-salah-satu-sumber-kemiskinan.html
5. Verywell. Guide to Tuberculosis. 2012.https://www.verywell.com/guide-to-tuberculosisand-the-tb-test-49399
6. Target TB. Poverty and Tuberculosis.2011.http://www.targettb.org.uk/about-tb/povertyand-tb/
7. TB Alert. Global TB Challenges.2010..http://www.tbalert.org/about-tb/global-tbchallenges/tb-poverty/
8. WHO. Strategy to End TB. 2013.
tb/en/index.html
9. WHO.
Towards

TB

elimination

http://www.who.int/entity/tb/strategy/endin

low-incidence

countries.

http://www.who.int/entity/tb/areas-of-work/treatment/elimination/en/index.html/

Other References :
1. Kidshealth. Introduction to Tuberculosis. 2013.
http://kidshealth.org/en/parents/tuberculosis.html
2. AloDokter. Tuberculosis. 2014. http://www.alodokter.com/tuberkulosis

2015.