The main features of TB as a community problem are well known. Its incidence is rare among people who lead an open air life and among those who live in small communities, but it increases in proportion to the degree of overcrowding. Among other factors contributing to the spread of the disease, mention may be made of malnutrition and undernutrition, unhygienic housing and environmental conditions and, certain occupations, particularly those associated with the inhalation of dust containing fine particles of silica.

No age, sex or race is exempted from TB. In countries where the disease has been prevalent for a long time, susceptibility to infection is highest among infants and a varying measure of protection becomes developed as the years go by, through small doses of infection being picked up by most individuals. For instance, only a small proportion of those who get infected, in Europe and America, develop the disease or die of it, while the majority acquire a considerable degree of protection from it. On the other hand, in communities exposed to TB for the first time, example, primitive races coming in contact with persons from the highly tuberculised countries, the disease occurs in a virulent form and the rate of its spread is rapid. In countries with a long history of TB infection, it is only among infants that conditions exist which approximate to those of the highly susceptible communities.

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.