Tuberculosis

Also called: TB · Topic: Human Capital: Education, Health and Demographic Dividend · NCERT: Beyond NCERT

Meaning

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It spreads through the air when a person with active lung TB coughs or sneezes. It mainly attacks the lungs, but it can also harm other parts of the body.

TB matters for economics because it hits people in their working years. They lose income, families sink into poverty, and the country loses human capital (the skills and health that make workers productive). India has about a quarter of the world's new TB cases, the largest share of any country.

Explanation

How TB spreads and who falls sick

The chain of spread: a person with active lung TB coughs → the bacteria float in the air → people nearby breathe them in.
Infection is not the same as disease:
Many infected people never fall sick. Their body keeps the bacteria "asleep". This is called latent infection.
When the body's defences weaken, the sleeping bacteria become active. The person falls ill and can now infect others.
High-risk groups: people with HIV, undernutrition or diabetes, and people who use tobacco.
Each of these weakens the body's defences.
So TB control also needs work on nutrition and on non-communicable diseases (NCDs, illnesses like diabetes that do not pass from person to person).
Food as prevention: research shows a good diet can cut TB infections by nearly 50%.

Types: drug-susceptible vs drug-resistant TB

DS-TB (drug-susceptible TB): the bacteria still respond to the normal first-line medicines.
MDR-TB (multidrug-resistant TB): the two main TB drugs no longer work. WHO still calls MDR-TB a public health crisis and a health security threat.
RR-TB (rifampicin-resistant TB): the key drug rifampicin no longer works.
How resistance grows:
Long treatment courses → patients stop halfway → the surviving bacteria become harder to kill.
This makes MDR-TB a clear example of antimicrobial resistance (AMR), the wider problem of germs no longer responding to medicines.

How TB is measured

Incidence is the number of new TB cases in a year, usually given per lakh population.
Mortality is the number of people who die of TB.
Treatment coverage is the share of estimated TB cases that are found (notified) and treated.
Treatment success rate is the share of treated patients who are cured or complete treatment.
Catastrophic cost (WHO): a household faces catastrophic cost when its total TB costs are more than 20% of its household income.
Total costs have three parts: direct medical costs, direct non-medical costs (such as travel and food), and indirect costs, mainly lost income.

Worked example 1: the fall in incidence

India's incidence went from 237 to 187 per lakh between 2015 and 2024.
Fall = (237 − 187) ÷ 237 × 100 = 50 ÷ 237 × 100 ≈ 21%.

Worked example 2: catastrophic cost (illustrative numbers)

A household earns ₹1,00,000 a year, so the 20% line is ₹20,000.
The medicines are free. But travel and extra food cost ₹6,000, and the patient loses ₹30,000 of wages while unable to work.
Total cost = ₹36,000, which is 36% of income. That is catastrophic, even though no one paid for the drugs.

Why TB is a human capital issue

Lost labour: health gives an uninterrupted labour supply. A sick worker without care stays away from work, so output is lost (Class 11 logic).
Poverty trap:
Poverty → poor food → higher TB risk.
TB → lost wages and costs → deeper poverty.
About 50% of people treated for TB and their households worldwide face catastrophic costs.
External benefit:
Treating one patient also protects the neighbours, because that patient stops spreading the disease.
A free market would therefore supply too little TB care. This is the case for the state to act through preventive and curative medicine.

In India

Nodal ministry: the Ministry of Health & Family Welfare (MoHFW). The main programme is the National TB Elimination Programme (NTEP).
Latest WHO figures:
Mortality: India's TB mortality has fallen 38% since 2015. The global fall is 35% (WHO Global Tuberculosis Report 2026).
Treatment success: India's success rate for DS-TB is 94%.
Incidence: down 21% (237 → 187 per lakh, 2015–2024), against 12% globally.
Treatment coverage: up from 53% (2015) to 92% (2024).
Screening: the TB Mukt Bharat Abhiyaan screened more than 25 crore people between 7 December 2024 and 8 November 2026.
Nutrition support, Ni-kshay Poshan Yojana:
It pays patients through DBT (direct benefit transfer, money sent straight to a bank account).
The payment was raised from ₹500 to ₹1,000 a month from 1 November 2024, and support was extended to patients' families.
About ₹4,322 crore has gone to 1.35 crore patients since April 2018.
Only about 62% of patients notified in 2021 got even one payment, and payments are often late.
Drug-resistant TB:
The 6-month BPaLM course (a newer combination of tablets) is now part of the national programme.
More than 15,000 MDR/RR-TB patients have started on it.
Health-system link:
Ayushman Arogya Mandirs give primary care, which is where TB is first detected.
Out-of-pocket spending (money patients pay themselves) is still about 39% of total health spending (National Health Accounts 2021-22).

Don't confuse with

Mortality vs incidence: the 38% fall is in deaths (2026 report). The 21% fall is in new cases (2025 report). Elimination is judged on new cases, not on deaths.
Treatment success rate vs treatment coverage: 94% is the success rate for DS-TB. 92% is coverage, the share of estimated cases notified and treated.
DS-TB vs MDR-TB: the 94% success figure covers only drug-susceptible TB. A separate 2026 government document gives an overall success rate of 90% against a global 88%. Always state which group a figure refers to.
Catastrophic cost vs out-of-pocket expenditure: out-of-pocket spending counts only what patients pay for care. Catastrophic cost also counts lost income, measured against a 20%-of-household-income line.

Prelims Hooks

TB is caused by a bacterium (Mycobacterium tuberculosis), not a virus. It spreads through the air. High-risk groups: HIV, undernutrition, diabetes and tobacco use.
WHO region with the most new TB cases: South-East Asia (35%), then the Western Pacific (27%), then Africa (25%). Trap: Africa is not second.
Country ranking: India (~25%) → Indonesia (10%) → Philippines (6.8%) → China (6.5%). Trap: China is not second. About 88% of new cases are in 30 countries.
Catastrophic TB cost = total costs above 20% of household income, including indirect costs such as lost wages.
The WHO Global TB Report 2026 gives 2025 data: 1.13 million TB deaths worldwide. Trap: report year vs data year.
The BPaLM regimen cuts MDR-TB treatment to 6 months. Ni-kshay Poshan Yojana pays ₹1,000 a month from 1 November 2024.

Mains Points

TB is a socio-economic disease, not only a medical one.
It strikes working-age adults → lost wages push about half of affected households worldwide into catastrophic costs → hunger rises → TB risk rises again.
So free medicines alone are not enough. Income and nutrition support must reach the household on time. Today only about 62% of patients notified in 2021 got even one Ni-kshay payment.
Deaths are falling faster than new cases, so prevention must come next.
Better coverage (53% → 92%) and 94% DS-TB success have cut deaths by 38%. Incidence has fallen only 21%.
The next gains will come from early detection and from food support for household contacts. A good diet can cut infections by nearly 50%. Extending support to families is a step in this direction.
TB control is a public good and a health-security issue.
Each treated patient protects others (an external benefit). This justifies state provision under the human-capital and market-failure argument.
Drug-resistant TB links to AMR. Scaling up the 6-month BPaLM course (15,000+ patients so far) and reporting DS-TB and MDR-TB success rates separately would show where the programme is weakest.

Human Capital: Education, Health and Demographic Dividend