Reaching the poor: challenges for the TB programmes in the Western Pacific Region.

Globally over 98% of the deaths caused by tuberculosis (TB) annually are in developing countries. Within the Western Pacific Region the seven countries that account for 94% of the TB prevalence are low or lower middle-income economies. Within countries as well poor and marginalized communities suffer disproportionately from TB. Importantly TB affects the most economically and socially productive age group as 77% of TB deaths occur within the ages of 15 – 54. This evidence points to the important relationship between poverty and TB. The deprivation associated with poverty such as overcrowding poor ventilation and malnutrition increases the rate of transmission and progression from infection to disease. In turn the costs of TB can further impoverish poor households. This is because poor households must dedicate a larger proportion of their income to meet the direct and indirect costs of seeking TB care than the non-poor. The opportunity costs are likewise higher for the poor than non-poor. For the poor a decrease in productivity or an increase in time away from work because of illness leads to a reduction in income. Moreover coping mechanisms employed by poor households during periods of illness may reduce household productivity in the long-term. TB has important social costs as well which are more likely to affect women with TB than men. For example stigma and isolation resulting from TB can reduce an individuals social position. (excerpt)