Systematically combating tuberculosis: How the environment shapes TB risk

Despite major advances in diagnosis and treatment, tuberculosis (TB) remains the deadliest infectious disease worldwide. In a new study published in The Lancet Global Health, researchers at LMU now introduce the concept of the "tuberculogenic environment": the complex interplay of structures, regulations, and living conditions that exposes certain communities to a high risk of TB, even when medical care is available.

The authors, including LMU-affiliated scientists Dr. Mikaela Coleman and Professor Katharina Kranzer (Institute for Infectious Diseases and Tropical Medicine, LMU Hospital), used a systemic approach to view TB not only as a medical problem, but as a consequence of broader systemic forces that influence health and vulnerability.

The "tuberculogenic environment" therefore includes poverty, inadequate housing, limited access to nutritious food, poorly ventilated public infrastructure, and underfunded health services. With its approach, the research team maps the actors and forces—across sectors, institutions, global markets, commercial interests, and environmental conditions—that shape the conditions under which tuberculosis can develop.

According to the researchers, current efforts place too much responsibility on those who are least able to act—people affected by TB and national TB control programs—while overlooking the larger structures that enable the epidemic. Their systems science perspective shows that decision-makers in many sectors share responsibility for combating TB. According to the scientists, eradicating TB worldwide requires coordinated action that promotes equality, protects health, and changes the circumstances that allow TB to continue to thrive.

"We treat people for tuberculosis and then send them back to the same environment where they contracted it in the first place—perpetuating the cycle of disease and poverty," says Mikaela Coleman, one of the lead authors. "These environments are shaped by forces and actors that transcend national TB programs and have unique opportunities to protect communities that live, work, and age in high-risk tuberculosis environments. We ask: Who is responsible for this, and what concrete steps could be taken to address it?"

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