[Tuberculosis among the socially vulnerable populations; perspectives from human security concept]

Tuberculosis (TB) has been and will continue to be the disease of the poor and the socially vulnerable. Current TB epidemiology in Japan shows increasing proportion of TB among the economically and socially poor or vulnerable populations. Though there is no universally recognized set of the definitions, the economically poor who are covered under the social security services including the homeless, foreign migrants, or the aged over 80 years may be considered as consisting the "socially vulnerable population" for TB in Japan. TB among the socially vulnerable has several characteristics, for example, patients are often detected with severe conditions due to delayed diagnosis, and have high defaulter rate during treatment, which causes immature death, or drug-resistant disease. Stop TB Strategy by WHO, responding to the Millennium Development Goals, proposes a new approach which focuses on empowering the patients and the community. Observations from various studies show that DOTS contributes to empowering the patients and the communities. Further effort will be needed to reorient TB programs towards the perspective of patients' empowerment. Solely relying on static analyses of TB among the socially vulnerable has its limitations. Dynamic approach, which utilizes human security concepts such as empowerment and patients' perspective, will be required not only to control TB among the socially vulnerable population but also to holistically tackle the problem of TB for Japan.