The unending war between poverty, power, and infectious disease: March’s edition of the Decolonising Global Health blog series
28 March 2025
In this third instalment of our 12-part Decolonising Global Health series, Maju Brunette joins us again as she reflects on the deep-rooted links between poverty, power and the spread of infectious diseases, focusing on tuberculosis (TB) and its disproportionate impact on marginalised communities in the Global South. Writing from Lima on World TB Day, she invites readers to consider how global health can move beyond biomedical responses to address the structural inequalities that allow diseases like TB to persist.
About the author
Maju Brunette is an MSc in Global Healthcare Leadership student at the University of Oxford and Associate Professor [Global Health Equity] at the Ohio State University. Maju is a Peruvian native who champions health equity for historically marginalised communities in the Americas. Drawing on her skills as an engineer and systems thinker, she co-designs global public health interventions through both a decolonising and gender equity lens.
As I write this on 24 March 2025, the global community is honouring World Tuberculosis (TB) Day.
World TB Day is observed annually on March 24 and aims to amplify the urgency of ending tuberculosis – the world’s deadliest infectious disease. Tuberculosis disproportionately affects people living in poverty – an overwhelming majority located in the Global South. Writing from the beautiful city of Lima, Perú, I invite you to join me in an examination of one question – and together, let‘s dare to imagine the end of this ancient disease within our lifetimes!
The question: Is there such a thing as the disease of the poor?
First, let us step back and look at how global poverty might have shaped the story of humanity’s fight against this killer disease. There are some days that it doesn't feel like 2025. With 4,300 lives lost to TB every day, you could be forgiven for thinking it's 1925! Rewriting the story of TB is no longer a choice – it's an urgent necessity. It is my hope that by the end of the twenty-first century, we can refer to Tuberculosis as a thing of the past.
Cuban artist Fidelio Ponce de León’s 1934 painting Tuberculosis (see image below) hauntingly captures the stark reality of this disease in a small Cuban hospital, where patients with elongated necks – a reference to TB’s impact on the body – sit surrounded by looming monks and a skull, a reminder of death’s presence. This powerful artwork serves as a visual testament to the enduring link between illness, poverty and social neglect.
Photo credit: Tuberculosis, 1934; Fidelio Ponce de León (óleo sobre tela; 92 x 122 cm)
We know it will take decades to eradicate extreme poverty. While it is true that we have achieved few milestones in reducing global poverty rates, a broader view of its causes – such as multidimensional poverty – is still missing. It is currently neither widely discussed nor integrated into key health equity and social justice narratives.
Global efforts to eradicate poverty belong to a ‘single story’ – a story that begins with the socio-economic cycle of disease where education, job skills and income are sequentially intertwined. Yet, addressing poverty in global health requires more than just acknowledging its existence; it demands systemic change. The history and widespread geopolitical impact of poverty should be a mandatory course in all undergraduate and graduate medical and health sciences programmes. Additionally, careful attention must be given to the decisions such as who designs the course, the approval processes and how and when they are offered.
Rewriting the story of humanity’s fight against this ancient disease must shift its focus to address the real impact of poverty and powerlessness without ignoring the biomedical components. The International Labor Organization (ILO) decent work agenda offers us a true decolonising view in a world where individuals and societies can begin escaping themselves from the vicious cycle of disease.
In the end, isn’t it that all of us, in our adult phases in life aspire to be productive, contributing to the progress of our global societies? Truly decent work requires dignity, equality, fair income, social protection, safety and health, rights, inclusion and above all, social justice. These are the foundations of healthy and prosperous societies and are essential to tackling the socio-economic drivers of tuberculosis. See below an excerpt from the ILO decent work agenda, which highlights these fundamental principles.
Reimagining a world where TB is eradicated is very close to the heart, roots and decolonising life missions of thousands of healthcare professionals in the Global South - true unsung heroes! It is my hope that we can all rise to the occasion and become curious about why and how the 4,300 deaths taking place daily can be prevented. Having a decolonising mindset offers an optimistic path to achieve that. Changing our mindsets can help us go on to reshape policies, systems and priorities to ensure health equity for all.
Let's keep getting into good trouble. ¡Hasta pronto!
What to read next
‘Manufacturing consent’ in global health education and research: February’s edition of the Decolonising Global Health blog series
28 February 2025
In this second instalment of our 12-part 'Decolonising Global Health' series, we welcome back Maju Brunette to examine the complex dynamics of consent in global health education and research. The series features monthly contributions and perspectives from scholars and practitioners committed to decolonising global health.
Introducing the 'Decolonising Global Health' 12-part blog series: Rejecting the single story
31 January 2025
MSc in Global Healthcare Leadership student Maju Brunette introduces our new 12-part blog series titled, 'Decolonising Global Health'. This series explores critical perspectives on power, equity, and transformation in global health. The first blog, 'Rejecting the single story', reflects on the impact of narratives in shaping global health and the urgent need to move beyond incomplete and inaccurate models.