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  • Print publication year: 2002
  • Online publication date: September 2009

10 - The globalisation of DOTS: tuberculosis as a global emergency

    • By John Porter, Reader in International Public Health Health Policy Unit, Kelley Lee, Senior Lecturer Global Health Policy; Co-director of the Centre on Globalisation, Environmental Change and Health London School of Hygiene and Tropical Medicine, Jessica Ogden, Senior Lecturer in Social Anthropology Health Policy Unit
  • Edited by Kelley Lee, London School of Hygiene and Tropical Medicine, Kent Buse, Yale University, Connecticut, Suzanne Fustukian, Queen Margaret College, Edinburgh
  • Publisher: Cambridge University Press
  • DOI:
  • pp 181-194


The tubercle bacillus is an index by inversion of the real progress of progress of the human race. By it the claim of civilisation to dominate human life may fairly be judged.

J. B. Huber (1907)


In 1993, one hundred and eleven years after the causative organism for tuberculosis (TB) was identified, and half a century after the introduction of clinically effective therapy, the World Health Organisation (WHO) declared the disease a global emergency (WHO 1994). This recognition that the public health community had effectively failed to control such a long-understood and treatable infection is unprecedented. The global strategy in response to the current emergency has centred on the development and implementation of directly observed therapy, short course (DOTS). In a few short years, DOTS has become the dominant strategy in the widely supported, global campaign against the disease, and has proven effective in treating many individual cases around the world.

While the battle against TB is one spanning many centuries, there are notable features of the current crisis that closely link it to the impacts of globalisation on health. Indeed, TB control is a useful case study for understanding how health policy is being shaped by globalisation and, in turn, how globalisation in its current form is being reinforced by such health policies. Globalisation in the late twentieth and early twenty-first centuries is a process changing human societies in complex ways, ‘as capital, traded goods, persons, concepts, images, ideas, and values diffuse across state boundaries’ (Hurrell and Woods 1995).

key readings
Bayer, R., Stayton, C., Desvarieux, M., Healton, C., Landesman, S. and Tsai, W. Y. 1998, ‘Directly observed therapy and treatment completion for tuberculosis in the United States: is universal supervised therapy necessary?’, American Journal of Public Health 88 (7): 1052–8
Farmer, P. 1997, ‘Social scientists and the new tuberculosis’, Social Science and Medicine 44 (7): 347–58
Grange, J. M. 1999, ‘The global burden of tuberculosis’, in Porter, J. D. H. and Grange, J. M. (eds.) 1999, Tuberculosis – an interdisciplinary perspective, London: Imperial College Press, pp. 3–31
Porter, J. D. H. and Ogden, J. A. 1997, ‘Ethics of Directly Observed Therapy for the control of infectious diseases’, Bulletin of the Institute Pasteur 95: 117–27
Walt, G. 1999. ‘The politics of tuberculosis: the role of process and power’, in Porter, J. D. H. and Grange, J. G. (eds.) Tuberculosis – an interdisciplinary perspective, London: Imperial College Press, pp. 67–98