Tackling tuberculosis systematically: How the environment shapes TB risk

Despite major advances in diagnostics and treatment, tuberculosis (TB) remains the world's deadliest infectious disease. In a new study published in The Lancet Global Health, LMU researchers now introduce the concept of the “tuberculogenic environment”: the complex interplay of structures, rules, and living conditions that keep certain communities at high TB risk, even when care is available.

The authors including LMU-affiliated scientists Mikaela Coleman, PhD, and Professor Kathrina Kranzer (Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital) apply systems thinking to reframe TB not just as a medical issue, but as a consequence of broader systemic forces shaping health and vulnerability.

The "tuberculogenic environment" includes poverty, inadequate housing, limited access to nutritious food, poorly ventilated public infrastructure, and under-resourced health services. With their approach, the research team is mapping the actors and forces – across sectors, institutions, global markets, commercial interests, and environmental conditions – who shape the settings that enable tuberculosis.

According to the researchers, current efforts place too much responsibility on those least able to act – people affected by TB and national TB control programs – while overlooking the broader structures that sustain the epidemic. Their systems science perspective reveals that decision makers across many sectors share responsibility for ending TB. Achieving global TB elimination, the scientists argue, will require coordinated policies that promote equity, protect health, and transform the environments in which TB continues to thrive.

"We treat people for tuberculosis and then return them to the same environments that first made them sick – perpetuating a cycle of disease and poverty”, says Mikaela Coleman, joint first author of the publication. “These environments are shaped by forces and actors upstream of National TB Programmes, with unique leverage to protect the communities who live, work, and age in tuberculosis high-risk settings. We're asking: who is responsible, and what could they actually do about it?"

Mikaela Coleman et al.: The tuberculogenic environment. The Lancet Global Health 2026