Tuberculosis is as much a socio-economic disease as a medical one. Discuss with reference to catastrophic costs and nutritional determinants.

India has cut TB deaths by 38% since 2015, faster than the 35% fall worldwide. Yet it still has about a quarter of the world's new cases [1]. Treatment now saves most patients. New infections persist, though, because TB is driven as much by poverty and hunger as by a bacterium.

Medical dimension: what treatment has achieved

• Treatment coverage rose from 53% (2015) to 92% (2024) [2].
• 94% of patients with drug-susceptible TB (TB that still responds to standard drugs) are treated successfully [1].
• Yet incidence (new cases each year) fell only 21%, from 237 to 187 per lakh [2]. Drugs save lives, but they do not remove the conditions that make people fall sick.

Catastrophic costs: TB as a poverty trap

• WHO counts a household's TB costs as catastrophic when they exceed 20% of household income [1].
• About half of TB-affected households worldwide cross this line [1].
• The measure includes indirect costs (lost income), not just medical bills [1]. Free drugs cannot replace months of lost daily wages.
• TB strikes working-age adults, so families risk debt and having to sell assets. That poverty then raises the risk of further infection.

Nutritional determinants: hunger as a cause

• Undernutrition is a key risk factor, along with HIV, diabetes and tobacco use [1].
• WHO recognises a two-way link: undernutrition raises the risk of active TB, and TB worsens undernutrition [4].
• Ni-kshay Poshan Yojana support was doubled to ₹1,000 a month from November 2024. Food support was also extended to patients' household contacts through Ni-kshay Mitras (community donors who adopt patients) [3]. This shifts support from cure towards prevention.

Poverty → Undernutrition → Active TB → Costs + lost income → Deeper poverty
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The TB–poverty cycle

India's TB gains have come mainly from medicine; what remains of the burden is socio-economic. Four steps could narrow the gap between falling deaths and slowly falling new cases: pay nutrition support at diagnosis, protect patients against lost wages, extend food support to families, and combine TB care with NCD and HIV care. This treatment-plus-social-protection approach fits Article 47, which asks the State to raise nutrition levels and improve public health. It would also help India meet SDG target 3.3 of ending the TB epidemic.