A persistent cough that eats away a poor man’s wage: Tuberculosis as a poverty sickness

India has the highest burden of Tuberculosis with two deaths occurring every minute in the country, the World Health Organisation (WHO) states.

Though committed to eliminate the disease by 2025, India staggered to meet the mark, with about 2.4 million cases reported in 2024.

However, as per the government records, there has been a significant 21 percent reduction in the number of cases since 2025. 

While recognised as a respiratory illness, tuberculosis is a poverty disease which thrives in poor living conditions, malnutrition and crowded places. The medical factors causing the disease are considered but there is little to no recognition of the social enablers of the sickness.

Tuberculosis continues to be a disease primarily affecting the poor, causing them to discontinue the treatment midway due to the economical burden which comes with it.

Medical poverty trap

Tuberculosis (TB) often results from a compromised immunity, influenced by both genetic and environmental factors. While the disease can also affect higher income groups, the primary burden of the disease falls on the poor.

TB is an infectious illness caused by Mycobacterium Tuberculosis and spreads easily through inhaling germs. It takes about a minimum of six to nine months to get diagnosed and treated for the disease. With antimicrobial resistance on the rise, some antibiotics could relatively work slower than others, increasing the period of treatment to up to two years.

For daily wage workers, the immediate consequence of the diagnosis is the loss of job and subsequently the loss of wage. This causes them to fight two enemies at the same time, a persistent illness and increasing poverty. Even if there is no loss of money, there will be loss of working capacity.

Even though the treatment remains free under the National Tuberculosis Elimination Program (NTEP), the economic burden stays.

As per a study, the out-of-pocket expenditure could range between Rs 2,125 and Rs 12,205, with even higher costs if the treatment gets prolonged.

Overcrowded spaces and poor nutrition

If the afflicted person lives in overcrowded housing or locality, the risk of spread is high. In many cases, the disease can affect whole families living in closed spaces.

People affected by the illness are not able to hold up jobs and spend more time at home. Some of them live in poorly ventilated spaces, causing the disease to spread to other family members through air droplets. If the children get affected, the poverty trap gets tightened across generations.

If the breadwinner gets afflicted, this has a direct impact on the nutrition of the patient and the family, with them missing out on essential nutrients.

The stigma associated with the disease can isolate the person or family affected, with them getting little to no community support from neighbours and extended family.

Due to lack of resources, some fail to complete the treatment, others wait for death.

A higher risk

As per experts, the treatment for Tuberculosis needs consistent counselling, nutrition and community support. Terminating or interrupting the treatment can increase the emergence of drug-resistant bacteria which is unresponsive to mainstream antibiotics, making it a serious public health threat.