The tuberculogenic environment
Tuberculosis persists as the world's deadliest infectious disease, despite improved diagnostics and effective treatment. The tuberculogenic environment describes the sum of influences, vulnerabilities, policies, life conditions, and health factors that sustain the tuberculosis pandemic in vulnerable communities. The persistence of these environments is attributable to challenges upstream of the health system, involving sectors such as trade, taxation, finance, agriculture, employment, social services, and education. The availability, affordability, access, and acceptability of safe infrastructure (including housing), nutritious foods, protection against harmful consumption (tobacco, alcohol, sugar, etc), and adequately resourced health services are all linked to tuberculosis risk. Yet people affected by tuberculosis and national tuberculosis control programmes continue to bear almost the sole responsibility for a problem that is largely beyond their control. Reframing tuberculosis through the lens of complex systems science highlights the array of decision makers who, by action or inaction, have a shared responsibility to end tuberculosis as a global pandemic.
Authors
- Emily MacLean (ORCID: https://orcid.org/0000-0001-9272-0985)
- Kavindhran Velen (ORCID: https://orcid.org/0000-0001-8577-3915)
- Palwasha Khan (ORCID: https://orcid.org/0000-0002-0873-8355)
- Sarah Bernays (ORCID: https://orcid.org/0000-0001-7628-8408)
- Mikaela Coleman
- F. A. Underwood
- Madhavi Bhargava (ORCID: https://orcid.org/0000-0001-7480-566X)
- Leonardo R. Martinez
- Tenzin Kunor
- Sian Magee
- Madhukar Pai
- Ben J Marais
- Collins Timire
- Anurag Bhargava
- Katharina Kranzer
- Claire J Calderwood
Institutions
- Boston University (US)
- The University of Sydney (AU)
- Results for Development Institute (US)
- Yenepoya University (IN)
- Manipal Academy of Higher Education (IN)
- Royal Free London NHS Foundation Trust (GB)
- Ministry of Health and Child Welfare (ZW)
- McGill University Health Centre (CA)
- Sydney Hospital (AU)
- London School of Hygiene & Tropical Medicine (GB)
- Biomedical Research and Training Institute (ZW)
- International Union Against Tuberculosis and Lung Disease (FR)
- McGill University (CA)
- Ludwig-Maximilians-Universität München (DE)
Publication Details
- Journal
- The Lancet Global Health
- Published
- 2026-02-16
- DOI
- https://doi.org/10.1016/s2214-109x(25)00478-4
- Citations
- 1
- Primary Topic
- Tuberculosis Research and Epidemiology
- Type
- article
- Field-Weighted Citation Impact
- 32.78
Funders
- Wellcome Trust
- European Commission
- Canadian Institutes of Health Research
- European and Developing Countries Clinical Trials Partnership