Focusing on lower-middle-income countries in the Global South, this book examines the postcolonial epidemiology of tuberculosis in India, Papua New Guinea, and Bangladesh through personal, community-level, and intervention narratives. Through an interdisciplinary framework, it aims to interpret TB not only as a biomedical problem but also with the explicit goal of ‘providing a brief historical and contemporary social analysis of tuberculosis as a communicable disease’ (p. 7). The volume spans ninety-six pages across seven chapters, with a brief introduction and conclusion. It is a compact work in which a substantial number of chapters were written by the editors.
Arnab Chakraborty and Janaka Jayawickrama, in Chapter 2, offer a wide-ranging historiography of tuberculosis and engage with scholarship from across the world, spanning the United States to the Philippines and France to Shanghai. The author traces how, from the 1990s onward, a period characterized by a refocused international emphasis on tuberculosis, the disease took on a catastrophic form through its convergence with HIV/AIDS and its entanglement with underdevelopment and changing lifestyles. Chapter 3, by Paul H. Mason, stands as one of the volume’s most compelling contributions. Centring on Daru Island in Papua New Guinea, the author interrogates the social dimensions of tuberculosis within this community. The analysis foregrounds the convergence of TB with local socio-economic structures, bilateral health-sector agreements with Australia, and the precarious circumstances confronting affected individuals. The chapter examines the life history of Aluni, a TB patient who travelled to Australia for treatment under the Torres Strait Treaty, leaving her husband and two children behind for four years. During her absence, her husband died of TB after being denied access to treatment in Australia due to the absence of provisions for dependents. Compelled to rely on inadequate local care, his condition deteriorated. The chapter identifies how people, political action, and structural factors resulted in the outcome: ‘TB does not kill people; people kill people’ (p. 31).
In Chapter 4, Neil Brimnes provides a social history of tuberculosis control in the Third World, with a focus on India, to demonstrate that the disease was shaped by factors beyond medicine alone. He shows how the state, tuberculosis research programs, and persistent economic constraints functioned as continuous barriers to effective intervention. Significantly, Brimnes moves beyond institutional analysis to foreground public habits and the weaknesses of institutional structures as central to the problem. Although the essay adopts a largely chronological and descriptive approach, it successfully traces how tuberculosis prevention evolved amid multiple social and structural challenges in India. Brimnes contends that the National Tuberculosis Programme (NTP) in India ended with the rise of the Revised National Tuberculosis Programme (RNTCP) and DOTS in 1997, under pressure from the WHO, the World Bank, and global TB elimination initiatives. He attributes the failure of the NTP to poor district-level implementation, chronic underfunding, and a transformation in the ideological approach to public health from the 1960s onward. He also traces an important shift in WHO policy through the case of Tanzania. Initially, WHO criticized Tanzania’s program for abandoning BCG vaccination and emphasizing cure over prevention. However, after 1990, following a change in the head of WHO’s TB section, the organization began to endorse features of the Tanzanian strategy. Central to his argument is the critique offered by D. Banerji, a key architect of the NTP, who rejected the RNTCP as a transplanted ‘global North’ model that disregarded India’s existing and glorious TB control experience. Brimnes concludes that many features of the NTP, such as free drugs and systematic monitoring, were carried forward into the newly launched programme.
Chapter 5, S Zaman and M Rifat, with their substantial experience in public health, NGO practice, and TB research in Bangladesh, emphasise the contribution of community health workers. The authors describe a cadre comprising BRAC’s (Bangladesh Rural Advancement Committee) ‘Shasthyo Shebikas’ (women healthcare service providers), rural doctors, informal providers, community clinic personnel, and drug retailers. This network successfully extended WHO-supported DOTS (Directly Observed Treatment, Short-course) to grassroots communities. Designated ‘local treatment supporters’, they monitored patients and ‘facilitated seamless linkage to community health facilities for comprehensive TB management’ (p. 66). The authors further argue that increasing population pressure, urbanization, and socio-economic shifts have driven many community workers to pursue other income sources, thereby challenging the viability of the program.
Chapter 6, Janaka Jayawickrama and Arnab Chakraborty, underscores the critical role of community groups in disaster risk reduction, with a specific focus on communicable diseases. Through case studies from Cuba and Vietnam, the authors argue that community participation must complement top-down approaches. In Cuba, decentralized decision-making and robust database management between 2005 and 2015 significantly reduced mortality during successive cyclones. In Vietnam, inter-agency collaboration between the Ministry of Agriculture and Rural Development, the Ministry of Environment, and the Red Cross Society facilitated effective typhoon and flood mitigation through mangrove afforestation. The Sri Lankan case further illustrates a community-based disease control model centred on family doctors, nurses, and preventive health activities. The authors conclude by advocating for the integration of grassroots expertise, including traditional practitioners, birth attendants, and students, alongside academics and policymakers in strategic planning to enable a more effective, community-led response to communicable diseases.
Although the volume offers important insights, several chapters lack sufficient critical analysis. Chapter 5, for instance, offers a strikingly ‘glorious’ account of TB control in Bangladesh. It depicts government-NGO collaboration in wholly favourable terms but fails to address key challenges including weak integration with local NGOs, gender disparities, and the financial burden of out-of-pocket payments (OOP). Chapter 6 repeatedly foregrounds community-based approaches to mitigating disasters and communicable diseases; it remains largely detached from the book’s primary concern with tuberculosis. A further limitation is the book’s silence on both the role of transnational corporations (TNCs) in shaping Global South healthcare sectors, and the human and environmental costs that John Madeley terms ‘Big Business’ for the ‘global poor’.Footnote 1 Another important concern is the substantial proportion of chapters authored by the editors themselves, a practice that departs from conventional academic standards and limits the diversity of perspectives. Greater inclusion of scholarship grounded in Global South regional contexts, which carry distinct analytical weight, would have more effectively articulated local manifestations of tuberculosis within broader global frameworks.
