A number of factors - cultural, social, political, economic and technical - have determined the nature of society's response to TB. Changes in these factors have brought about changes in society's response. For example, advances in the diagnosis and treatment of TB have greatly modified the earlier perception of TB as a social stigma. Social considerations related to isolation and prolonged sanatorium treatment have become much less relevant. In recent times, consideration of the social aspects of TB involves examining how the individual and the community react to the disease, the level of awareness of TB in the community etc. To break this vicious cycle, the expenditure in a well-conceived TB programme should be considered as an investment.

Treatment default is on two accounts, fault of the patient and, organizational lapses of the services. Inadequate staff and equipment, irregular drug supply etc. outweighs the lapses on the part of patients. Hence, a patient may be called a defaulter only after he/she does not utilise the optimal services provided. The TB social workers' role in India is to strengthen treatment, organization and whenever possible, provide treatment under supervision. Socio-etiological factors in India, example, rise in standard of living leading to better nutrition, less close contact, increase in the host resistance, genetic selection and attenuating virulence of bacilli could lead to the reduction in the problem of TB. Economics of TB should be evaluated as total suffering, that is, loss of work, cost of treatment, due to death and morbidity leading to a vicious cycle of poverty and sickness in the community.