Despite being treatable, TB remains one of the world’s deadliest infectious diseases, killing over 1.3 million people annually. Often referred to as a "disease of poverty," TB continues to disproportionately affect those living in low-income conditions, where overcrowded housing and food insecurity heighten the risk of infection and progression to disease. The impact is cyclical: TB not only thrives in poverty but also deepens it, as affected individuals face income loss and out-of-pocket expenses that can drive entire households and communities further into economic hardship. Vanleeuw’s research highlights how illness in these social conditions create long-lasting financial hardship and ill health for those with the disease and their families.
“People with TB in our study shared that the disease itself was not their most pressing concern. Instead, their primary struggle was securing enough food each day to feed themselves and their families. They often had to resort to drastic measures such as begging for food to take their medication, and caregivers were pushed to breaking point,” Vanleeuw says. “Many women had to stop working or sacrifice their own health needs to care for sick relatives, worsening the household’s situation.”
The research, carried out over five years in a township near Cape Town, included 72 in-depth interviews with people with TB, family caregivers, healthcare workers, and social security officials. It revealed that food insecurity, income loss, and lack of external support are central struggles for households affected by TB. The transition of TB care from hospital-based treatment to community and home-based care has placed a growing burden on families—particularly on women, who often bear the primary responsibility for caregiving while already facing economic hardship.
While international TB strategies recognize the importance of addressing the socio-economic drivers of the disease, progress at national levels — particularly in South Africa — has been slow. Social grants, food support, and caregiver aid exist in policy but are difficult to access, underfunded, or poorly implemented.
This study calls for an expanded TB response that goes beyond medical care: a combined effort by the health and social protection sectors to provide nutritional, financial, and emotional and hands-on support to both people with the disease and their households. Without this, the cycle of poverty and disease will continue.
Vanleeuw, originally from Belgium, lived and worked in South Africa for 17 years. She currently lives in Finland and works in global and public health research.
Public defence on Wednesday 11 June
The doctoral dissertation of Lieve Vanleeuw in the field of social sciences, titled "Beyond the Illness: How tuberculosis affects households in South Africa, will be publicly examined at the Faculty of Social Sciences at Tampere University at 12:00 on Wednesday 11 June 2025, at Arvo building, Auditorium F115. The Opponent will be Professor Hayley MacGregor, University of Sussex, United Kingdom. The Custos will be Professor Salla Atkins, Faculty of Social Sciences, Tampere University.