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Social scientists and the new tuberculosis

¹Department of Social Medicine, Harvard Medical School, Boston, MA, USA.

Social Science & Medicine (1982)

|February 1, 1997

Summary

Tuberculosis (TB) persists globally, especially among vulnerable populations. Social factors like poverty and inequality, not just HIV or drug resistance, drive the multi-drug resistant TB (MDR TB) epidemic.

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Area of Science:

Public Health
Epidemiology
Medical Anthropology

Background:

Tuberculosis (TB) remains a leading cause of death globally, particularly among young adults.
Despite effective chemotherapy, TB persists in low-income countries and resurges in impoverished communities within industrialized nations.
The rise of HIV and multi-drug resistant TB (MDR TB) are often cited as primary drivers of this setback.

Observation:

The patterned distribution of MDR TB, particularly in marginalized communities like homeless shelters and inner cities, suggests significant social determinants.
The emergence of MDR TB in regions with no prior history, such as Haiti, highlights the complex interplay of social forces.
A case study of a young Haitian man with MDR TB illustrates the impact of social factors on disease epidemiology.

Findings:

Large-scale social forces, including poverty, economic inequality, political violence, and racism, significantly influence the TB epidemic.
The current understanding of TB's distribution and course may be limited by social science research making unsubstantiated causal claims.
MDR TB's epidemiology is deeply intertwined with socioeconomic conditions and systemic inequalities.

Implications:

Future sociomedical research on MDR TB needs to adopt more nuanced strategies to understand its complex etiology.
Addressing social determinants is crucial for effective public health interventions against TB and MDR TB.
Integrating anthropological insights with epidemiological data can provide a more comprehensive understanding of global TB patterns.

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