TB Is a Disease of Dispossession: 2023’s Record Cases and the Communities on the Front Lines

Tuberculosis does not spread randomly. It follows the geography of poverty — and poverty follows the geography of colonial extraction. In 2023, TB reached its highest recorded global incidence since WHO tracking began in 1995: 10.8 million new cases, including 6.0 million men, 3.6 million women, and 1.3 million children — with 1.25 million deaths. TB is now the leading infectious disease killer in the world. The eight countries carrying the largest burden — India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, South Africa — are not coincidentally the regions most deeply disrupted by centuries of colonial rule that dismantled existing health systems, extracted human and material resources, and created the structural conditions in which a curable disease still kills. Understanding the role of colonialism in shaping global health policy is inseparable from understanding TB.

TB is not a disease of biology — it is a disease of dispossession. The communities bearing the heaviest burden are those whose health systems were dismantled by colonial rule. Until that is named, no technical solution is sufficient.

The Numbers: What 2023 Revealed

The WHO South-East Asia Region recorded the largest share of new cases — 45% of all new infections — followed by the African Region at 24% and the Western Pacific Region at 17%. 7.1 million people received treatment for TB in 2023. In the United States, an estimated 13 million people are living with latent TB infection — harboring the bacteria without active symptoms, at risk of developing the disease at any time. These numbers are not abstractions. They represent families, communities, and entire regions whose health infrastructure was never resourced to match need — not because of geographic fate, but because of political choices made under and after colonial rule.

What these numbers reveal most starkly is the gap between what TB science can do and what the communities most affected are actually receiving. A disease that has been curable for decades continues to kill over a million people per year. A vaccine exists — and yet coverage is uneven. Treatment regimens that work are out of reach for communities who cannot absorb the cost of six months of daily medication, clinic visits, and the income lost to illness. The TB crisis in 2023 is not a failure of medicine. It is a failure of political will — and an indictment of a global health architecture that was never designed to serve the communities it most affects.

The Economic and Social Toll: Who Bears the Weight

When TB strikes, it strikes across the whole household. The person who falls ill loses income; the family absorbs the care burden; children’s education is interrupted; savings, if any exist, are depleted. In low- and middle-income countries where social safety nets are thin or absent — conditions that are themselves colonial inheritances — TB pushes families into poverty and keeps them there. Children are particularly vulnerable: when a parent or caregiver falls ill, the disruption cascades through food security, schooling, and the long-term economic trajectory of the next generation. The social stigma of TB compounds the economic harm, driving people away from care and creating cycles of delayed diagnosis and prolonged transmission.

Like the malaria epidemic in sub-Saharan Africa and the climate-driven surge in dengue fever’s expanding reach, TB reminds us that the infectious disease burden falls most heavily on communities already navigating poverty, colonial healthcare legacies, and underfunded public health systems. This is not coincidence. It is the predictable result of systems designed to extract rather than invest — and the generations-long cost of that calculus showing up in the bodies of those who never had a say in it.

The economic weight of TB is invisible in most global health conversations because the communities bearing it are under-represented in those conversations. When researchers calculate the cost of TB, they rarely account for the generational cost — the child who drops out of school when a parent falls ill, the family that loses its home to pay for treatment, the community that loses its knowledge holders before their time. These are the real costs, and they compound in ways that no spreadsheet can fully capture.

Antibiotic Resistance: When the Drugs Stop Working

Antibiotic resistance in TB is an escalating crisis. In 2023, 121,000 people were on treatment for drug-resistant TB — yet only about two in five people with drug-resistant TB could access the treatment they needed. Multidrug-resistant TB (MDR-TB) develops when people cannot complete the full antibiotic course — which happens not because of patient failure but because of system failure: medications unavailable, unaffordable, or requiring clinic visits that people cannot afford to make. Standard TB treatment takes six months. MDR-TB treatment can take years, requires toxic second-line drugs, and fails more often.

MDR-TB is not just a health issue but a security threat — it spreads from person to person in strains that standard drugs cannot touch. Most TB drugs available today were developed decades ago. New drug development requires investment that historically has not flowed toward diseases that disproportionately kill poor, Black, and Brown communities. The pharmaceutical logic is identical to the colonial logic: resources flow where profit is greatest, not where need is most severe.

The Funding Gap: What 26% of What’s Needed Looks Like

To reach the global target set for 2027, TB programs need US$22 billion annually for prevention, diagnosis, treatment, and care. In 2023, only 26% of that amount was available. That is not a rounding error — it is a structural decision about whose lives merit investment. The communities bearing the highest TB burden are also the communities least represented in the institutions that make global health funding decisions.

This is not incidental. It is the ongoing logic of colonial health policy: extract resources from the Global South, under-invest in its health systems, then frame the resulting disease burden as a development problem requiring Northern expertise and charity rather than as the predictable outcome of centuries of extraction requiring reparative investment. Without adequate financial support, countries cannot buy medications, improve healthcare infrastructure, or train the community health workers who are the backbone of TB control where it works best.

The Knowledge Is Already There: Community Health Workers on the Front Lines

The most effective TB responses on record are not top-down technological interventions — they are community-led. Community health workers in high-burden countries bring TB knowledge into households, support treatment adherence, reduce stigma, identify cases before they reach crisis, and reach populations that formal clinics never do. These workers — disproportionately women, disproportionately from the communities most affected — are not auxiliary to the healthcare system. They are the healthcare system where the system otherwise does not reach.

New diagnostic tools, vaccines, and shortened treatment regimens matter — and global collaboration is advancing them. But those tools serve communities best when the people delivering them are trusted members of those communities, supported with fair wages, adequate supplies, and institutional respect. That is what closing the TB gap actually requires: not charity, not innovation exported from abroad, but solidarity — and the structural investment, including reparative investment, that backs it up.

Ubuntu Village’s model in East Harlem reflects exactly this principle. Community health navigators who are from the community — who speak its languages and understand its histories, who can translate between the clinical world and the lived world — are not a supplement to care. They are the infrastructure of care. The TB crisis, like every public health crisis that falls hardest on communities of color, will not be solved by more technology alone. It will be solved by investing in people: in the trusted messengers, the relationship builders, and the healers who know that health is never just about the body in isolation but about the community that holds the body in relation.

References

• ✦WHO — Tuberculosis Fact Sheet
• ✦The Global Fund — Fight to End Tuberculosis: A Moment for Progress
• ✦Our World in Data — Tuberculosis Death Rate
• ✦CDC — Tuberculosis Data and Statistics

---

Related Reading

• ‣ Colonialism and Global Health Policy
• ‣ Reparations and Healing: A Public Health Argument
• ‣ Mirror Neurons and Communal Healing
• ‣ Epigenetics and Ancestral Memory: What Your Body Remembers

Michele Mitchell is the Founder, President & CEO of Ubuntu Village Inc., a 501(c)(3) nonprofit with programs in Kenya, Uganda, and Nigeria. A writer, advocate, and community strategist working at the intersection of ancestral wisdom, public health, and community power, Michele leads Ubuntu Village’s work to center communities as the protagonists of their own healing. She writes from the conviction that science and spirit are complementary, that healing is relational, and that community is the medicine. Read more about Michele, or connect with her on LinkedIn.