India’s tuberculosis burden is considerable. Every year 1.8 million Indians develop TB - about one fifth of the global figure. There are many factors contributing to the failure of progress to control TB in India. One of them, which is seldom discussed, is social inequality. The issue was, however, raised during a recent special session on tuberculosis organised by the Advocacy to Control Tuberculosis Internationally (ACTION) project.

The meeting discussed such key issues as the failure of many patients to complete the lengthy course of treatment required for TB (usually six months) and the increase in the number of cases of drug-resistant forms of the disease.

The Times of India reports that research associate Sachin Atre, from the Centre for Health Research and Development, told the meeting that, “Drug resistance is often attributed to a patient’s non-compliance with the therapeutic regimen. Non-compliance, however, has many causes, such as poverty, gender discrimination, homelessness, and side effects of the anti-TB drugs themselves, and how they affect individuals in different settings”.

Other speakers noted also that poor people are frequently malnourished, which impairs their immune systems and makes them more vulnerable to TB.

While there is no doubt that TB control programmes in India and elsewhere can be made more efficient, any country where there are massive levels of social inequality will only make limited progress because of the vulnerability of the poor, who are so hard to reach with effective health care.