There is little doubt that the scourge of tuberculosis is, at least in part, a consequence of poverty. It is the poorest and most vulnerable people in the world who are most susceptible to catch, develop and die from TB. But is TB not only a consequence, but also a cause of poverty, restricting efforts to achieve wider Millennium Development Goals. This point is increasingly pertinent in the current financial and political climate, where public purse strings are tightening and politicians are under immense pressure to demonstrate ‘value’ for the tax payers’ money they spend. Making the case that investing in TB is not only an act of compassion, but makes hard-headed economic sense and complements wider international development goals is more important than ever.
On an individual level there is of course anecdotal evidence of the economic hardship caused by TB. Breadwinners being struck down by the disease and unable to work to support families, children being forced to work to supplement diminished family incomes or unable to attend school due to illness, mothers being forced to leave their homes because of the stigma surrounding the disease….. the examples of economic suffering caused by TB are endless.
However, to convince donor and recipient governments to invest in TB programmes we need to look at the wider costs and benefits. We need to ask ‘is the cost of treating TB justified by the economic benefits from doing so?’ and in addition, ‘is spending one dollar on preventing or treating TB, more likely to reduce poverty and suffering than spending that dollar on something else – say helping a village cope with the impact of climate change?’
Happily, some work has already been done looking at these questions. The imaginatively titled 2007 study by the World Bank – ‘The Economic Benefits of Investment in Tuberculosis Control’ – looked at just this issue. The report suggests that countries could earn significantly more than they spend by investing in tuberculosis diagnosis and treatment. In the 22 high-burden endemic countries, the marginal benefits of implementing the Global Plan to Stop TB exceeded marginal costs by a whopping factor of 15.
It is, of course, very difficult to measure whether one dollar spent on TB is more effective than spending that dollar on another development priority. However, some people have had a go. The Copenhagen Consensus 2008 bought together a range of highly recognised economists to compare the relative effectiveness of investment in different polices. Relative to other international development spending, it put fighting TB in the top half of policies to pursue, albeit 13th out of 30.
It is a moral imperative that the world works to eradicate TB – a curable and devastating disease. But it also makes clear economic sense to place more resources in fighting TB. As the ‘age of austerity’ takes grip across public spending, this is an increasingly important message to put to both donor and recipient governments.