Tomorrow is World Tuberculosis (TB) Day, which commemorates March 24, 1882, when Dr. Robert Koch announced that he had discovered the cause of TB, mycobacterium tuberculosis. Today, TB is preventable, treatable and curable. Yet in 2016 there were 10.4 million new TB cases and 1.7 million deaths—a higher number of deaths than any other infectious disease globally and more deaths than HIV and malaria combined. This is inexcusable.
While the world committed to end TB as a public health threat by 2030, at the current rate of decline, it will take until 2182 to reach WHO targets, 152 years beyond the target. An effective response to TB in line with the vision of the Sustainable Development Goals to leave no one behind requires concerted effort to address the deep, underlying structural issues, particularly the pervasive human rights violations that drive TB.
TB is a disease of poverty and inequality, and is driven by lack of access to quality health care, including effective medicines and rapid diagnostic tools and inadequate access to determinants of health such as nutrition, sanitation, safe and healthy working environments and health-related information. Poverty and discrimination increase the likelihood of TB exposure and infection, and significantly impact the extent to which individuals have access to TB prevention and quality TB care, services and support.
Some populations are at especially high risk of TB due to social marginalization, environmental, biological and/or other behavioral factors, including indigenous persons, migrants, prisoners and detainees, people who are homeless, miners, people living with HIV, people who use drugs, and children. For example, indigenous persons have TB incidence rates up to 270 that of the general population. Addressing Human Rights Barriers to TB
To address human rights barriers to TB, the O’Neill Institute has partnered with the Stop TB Partnership and USAID to focus on several areas concerning TB and the law, including confinement and TB and the right to health of migrants.
Laws inconsistent with human rights standards fuel the TB epidemic, including those that deprive individuals of the right to liberty of person by allowing for the excessive use of confinement including mandatory hospitalization, treatment and involuntary isolation. Instead of coercive and confinement approaches to TB, countries should prioritize ensuring individuals have access to fully resourced community-based, rights promoting TB programs, which many individuals may understandably prefer to long-term hospitalization and have been shown to be extremely successful, including in the context of MDR-TB in resource-poor settings.
Incarceration and detention, especially in over-crowded prisons that lack the resources to meet minimal prison standards for health, safety and cleanliness, further fuels TB as such settings become TB incubators. Prisoners have been found to have TB prevalence rates up to 1,000 times the general population, due to overcrowding (including due to high incarceration and pre-trial detention rates) and inadequate provision of TB services and non-realization of determinants of health in carcereal settings. Further, laws inconsistent with human rights standards (e.g., laws criminalizing behaviors and identities such as non-adherence to TB medicine, HIV, sex work, drug use, same-sex sexual conduct) and selective enforcement of criminal laws result in high rates of imprisonment and disproportionately impact the poor and marginalized. Legal barriers and lack of underlying determinants of health for migrants also fuel high TB rates, including exclusion from health insurance coverage, lack of provision in law guaranteeing access to health services, and for undocumented migrants, lack of legal status, which may leave migrants vulnerable to occupational risks, exploitation and discrimination. In some high-burden TB countries, discriminatory laws and inadequate labor protections for migrant workers is further compounded by social and economic inequality and stigma. These inequities and rights violations increase the risk of TB for migrants and may also impede access to TB testing and interfere with continuity of care.
To end TB by 2030, countries and the global community must meaningfully respect, protect and fulfill the right to health for all and take concerted efforts to address legal, policy and social barriers for the most vulnerable, including persons deprived of liberty and migrants. If we fail to ensure that migrants and prisoners have access to TB prevention, treatment, care and support, as well as proper nutrition, sanitation and safe, healthy working and living environments, there will be many millions more preventable TB infections and deaths, as well as millions more households facing the catastrophic costs of TB. If countries continue to allow for—and promote—practices such as mandatory and excessive hospitalization, isolation and treatment and fail to invest in rights-promoting community-based care, if we continue on the current path with such an inadequate rate of decline, then we will not end TB as a public health threat until 2182.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.