Increased expenditure on social security has benefits for TB control in the EU

Increased expenditure on social protection programmes – sickness, disability and unemployment benefits, old age pensions, housing support – is associated with improved tuberculosis (TB) control, according to an analysis of data from European Union (EU) countries published in Lancet Infectious Diseases.

“Social protection spending is strongly associated with lower tuberculosis case notification, incidence, and mortality rates,” comment the authors. “Our results suggest that increasing social protection expenditure by $100 per capita could reduce tuberculosis incidence by 1.7%.”

In March 2014, the World Health Organization’s (WHO’s) World Health Assembly voted to include social protection as a pillar of its global TB strategy. This reflects a growing awareness of the important connection between TB control and social factors such as poverty, malnutrition and poor housing.

With this new policy in mind, an international team of investigators looked at the relationship between social protection expenditure and TB control between 1995 and 2012 in the 21 countries that are now members of the EU.

Data on TB case notifications were obtained from the European Centre for Disease Prevention and Control and European Surveillance System 2014 databases. Data on case detection, treatment success, prevalence and mortality rates were obtained from WHO sources. Information concerning expenditure on social protection programmes was obtained from the most recent edition of EuroStat.

Overall, the authors found a strong relationship between increased per-person expenditure on social protection and lower TB incidence (p = 0.003) and mortality (p = 0.01) rates.

Cross-national analysis controlling for GDP and expenditure on public health showed that each $100 increase per person in social protection expenditure was associated with a fall per 100,000 population in the number of TB notifications (-1.53%, p = 0.01), TB incidence rates (-1.70%, p = 0.02), non-HIV-related TB mortality rates (-2.74%, p = 0.01) and all-cause TB mortality rates (-3.08, p = 0.01).

“Our findings add to the empirical evidence that investing in social protection is justified, not just because it is fair and protects the most vulnerable populations, but also because it contributes to measures to reduce the global burden of tuberculosis,” write the authors. “Social protection programmes are likely to provide a vital component of a robust tuberculosis prevention strategy, especially for vulnerable groups.”

There was no significant relationship between increased social spending and TB prevalence, case detection, or treatment success rates.

Increased expenditure on old age pensions was especially beneficial in terms of TB control, each $100 per-person increase reducing notification rates by approximately 4% (p = 0.01). “Our results indicate a clear benefit for elderly recipients for social welfare in terms of improved tuberculosis outcomes,” comment the investigators.

But they warn that decreased expenditure on social welfare programmes due to economic austerity measures “might increase the prevalence of vulnerable groups and undermine tuberculosis prevention and control.”


Reeves A et al. Social protection and tuberculosis control in 21 European countries, 1995-2012: a cross-sectional modelling analysis. Lancet Infect Dis 14: 1105-12, 2014.