Paper short abstract:

We show the broader causality of tuberculosis in Rio de Janeiro, from macro processes to people's bodies. We argue for a focus on the collective level of reality and specifically on life conditions as a way to provide better care and prevention for tuberculosis in Rio de Janeiro, Brazil.

Paper long abstract:

Despite the historical characterization of tuberculosis as related to poverty, only very recently did WHO explicitly affirm the role of social dimensions in its incidence and the need to address it beyond drug taking. Several studies question simplistic links between poverty and tuberculosis, and its highly unequal incidence demands that we fully address its complexity. And while we cannot immediately change macro processes, it has become evident that actions on the individual level are also insufficient to cure, and to prevent disease transmission, activation and bacterial resistance.

In this paper we look at social causality of multidrug-resistant tuberculosis in Rio de Janeiro, a city with a very high incidence of this form of tuberculosis. We draw on stories of patients and on sensitive theoretical frameworks seeing the disease trajectory through different levels of reality. Tuberculosis appears connected to Rio's integration in current capitalism, implying heavy population concentration, and very precarious and mobility-demanding life conditions for great part of urban population, among other dimensions (Sabroza, 2006; Castellanos, 2004). This is an ideal context for tuberculosis development, and a very hard one to care for people's health. We focus on life conditions, which situate in the collective level, a third level of reality between the individual and the structural. This level allows us to understand the mediations between macro processes and people's bodies, which will enable us to work on disease prevention, and, simultaneously, to identify and overcome obstacles to care in the services and in peoples' lives.