While ending tuberculosis (TB) is considered a crucial and worthwhile investment for global health, achieving the UN Sustainable Development Goal of eradicating the disease by 2030 appears to be increasingly unlikely. The link between tuberculosis and poverty is widely acknowledged, as tuberculosis is often referred to as a disease that affects impoverished individuals.

According to the TB Alliance (2017), the World Bank has estimated that tuberculosis reduces 4-7 per cent of the GDP of certain countries. TB causes individuals to exit the workforce, leading to decreased productivity and thereby constraining the GDP of the affected country.

Prior to the onset of the Covid-19 pandemic, there was widespread doubt that meeting the targets for ending tuberculosis would be challenging without a reliable method to disrupt the spread of the disease. Unfortunately, the global efforts to combat tuberculosis have been significantly affected by the pandemic, disrupting routine services.

According to the Global Tuberculosis Report 2020, the reduction of tuberculosis deaths by 14pc between 2015 and 2019 was insufficient to attain the 2030 mortality target, which requires a 35pc decrease.

Pakistan ranks fifth among the 30 countries with the highest TB burden, contributing 5.8pc of all tuberculosis cases globally

Moreover, in 2018, tuberculosis resulted in the 1.4 million deaths which led to a total income loss of $580.1 billion. The largest financial losses were observed in sub-Saharan Africa, which accounted for $200.8bn.

However, if the deaths had been prevented, in Sub-Saharan Africa, these gains in life expectancy would have been even higher, with an estimated increase of 1.31 years at birth and 0.77 years at age 35 years. Following the highest economic losses in South Asia, East Asia and the Pacific, the burden of welfare losses are disproportionately higher in Sub-Saharan Africa, although the impact may not be as obvious due to the lower per-capita incomes in the region.

However, it is evident that low and low-middle-income countries bear the majority of the burden of TB. The Eastern Mediterranean Region accounted for 8.3pc of the total tuberculosis cases reported across all World Health Organisation (WHO) regions worldwide.

Pakistan ranked fifth among the 30 countries with the highest TB burden, contributing 5.8pc of all TB cases globally and bearing around 69pc of the TB burden in the Eastern Mediterranean Region.

In developing economies like Pakistan, the inability to reduce the burden of TB can be attributed to a variety of risk factors, as well as various socio-economic factors such as income, education, gender, and age, among others. Additionally, the absence of a treatment completion tracking system in Pakistan increases the probability of disease relapse resulting from treatment failure.

TB patients face not only medical challenges but also other issues associated with their illness. Many of these patients have inadequate nutrition and reside in congested living conditions. Furthermore, they suffer unemployment challenges and unfavourable attitudes from their family and community.

For instance, in Southern India, the stigma attached to TB led to a greater decline in marriage opportunities for women than for men. Additionally, it is recognised that both male and female individuals affected by TB experience psychological burdens related to their social obligations.

Providing stable infrastructure, effective diagnosis, availability of antibiotics, and multidisciplinary healthcare professionals are fundamental requirements for controlling TB. To ensure the well-being of the population and achieve good economics, governments need to demonstrate commitment towards improving healthcare services.

However, the factors identified as major contributors to the incidence of tuberculosis in Pakistan are poverty, inadequate housing, overcrowding, undernutrition, smoking, consumption of raw milk, and limited access to health and education.

Health disparities are significant in the country, with individuals with varying social, cultural and demographic backgrounds enjoying different levels of health benefits.

Given the high prevalence of TB in Pakistan, gaining a deeper understanding of the socio-economic factors contributing to this disease is crucial. Such an understanding would enable the health department and other government agencies to develop more effective policies aimed at curbing the spread of tuberculosis.

Further, addressing tuberculosis effectively involves recognising the influence of social determinants and systems, necessitating an interdisciplinary approach beyond the biomedical model of disease causation. This approach should integrate crucial social knowledge and concepts such as stigma.

The writer is a research associate at the Social Protection Resource Centre, Islamabad

Published in Dawn, The Business and Finance Weekly, April 17th, 2023