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Growing consensus indicates that progress in tuberculosis control in the low-and middle-income world will require not only investment in strengthening tuberculosis control programs, diagnostics, and treatment but also action on the social determinants of tuberculosis. However, practical ideas for action are scarcer than is notional support for this idea. We developed a framework based on the recent World Health Organization Commission on Social Determinants of Health and on current understanding of the social determinants of tuberculosis. Interventions from outside the health sector-specifically, in social protection and urban planning-have the potential to strengthen tuberculosis control. (Am J Public Health. 2011;101:654-662. doi:10.2105/AJPH.2010.199505)
In December 2009, at the International Union Against Tuberculosis (TB) and Lung Disease's World Conference in Cancun, Mexico, Mario Raviglione, director of the World Health Organization (WHO) Stop TB Department, made a clear commitment to ''moving beyond the TB box.''1 His remarks echoed an emerging shift within the TB sector toward recognizing the importance of social and economic development policies and interventions in supporting TB control.2
We welcome this timely shift in emphasis but recognize too that practical ideas for action are scarcer than is notional support for the idea. In this article, we briefly described why we think this shift occurred. We developed a framework informed by the recent WHO Commission on Social Determinants of Health (CSDH)3 and WHO work on the social determinants of TB^sup 2^ that guided our ideas for action in this area. We also described 2 non-healthsector domains in which we think program and policy action is feasible and could reduce the public health burden caused by TB in key settings. Finally, we call for a new era of research, action, and evaluation in this field.
RECENT INTEREST IN SOCIAL DETERMINANTS OF TUBERCULOSIS
The increased focus on addressing the social determinants of TB has been stimulated from both within and beyond the TB sector. A key driver has simply been the increasing number of TB cases and their inequitable distribution throughout the world. Not only did 2010 see more cases of TB than ever before in human history, but these cases continue to cluster among disadvantaged groups such as the poor,4,5 the hungry,6-8 and ethnic minorities.9,10 In addition, debate continues about the effectiveness of the Directly Observed Therapy-Short Course...