Calls are growing to approach tuberculosis not as a simple infectious disease but as a problem intertwined with social structures. While the number of TB patients in South Korea has steadily declined, cases are increasingly concentrated among socially vulnerable groups such as elderly people living alone, homeless individuals, and foreign workers due to population aging and the rise of single-person households.
According to the Korea Disease Control and Prevention Agency on May 12, the number of domestic TB patients in 2024 stood at 17,944, a decrease of more than 60% from approximately 50,000 in 2011. Various national TB management policies and expanded latent TB treatment are credited for the decline.
Nevertheless, South Korea still maintains the second-highest TB incidence rate among Organisation for Economic Co-operation and Development (OECD) countries. Analysts attribute this to structural characteristics where the impact of past infections persists rather than active transmission of the disease.
Experts point to the reactivation of latent TB as a key reason for high incidence among the elderly. Many people infected during past TB outbreaks develop the disease again as their immune systems weaken in old age. In fact, approximately 60% of domestic TB patients are aged 65 or older.
The added problem of social isolation is making TB management increasingly difficult. Elderly people living alone, homeless individuals, and foreign workers face higher TB risk due to poor nutritional status and limited healthcare access, as well as greater likelihood of treatment discontinuation.
"TB is not a disease that can be solved simply through medical care—it is closely connected to social environments," said Seo Hae-sook, medical director at Seoul Seobuk Hospital. "Going forward, management of single-person households and socially isolated populations will be the core of TB control strategy."
In practice, there are numerous cases where medical support alone does not complete TB treatment. While TB treatment itself places almost no financial burden on patients due to health insurance special calculations, additional costs arise for caregiving, nutritional management, and non-covered tests. Many vulnerable patients struggle to afford even expenses of a few thousand won.
For this reason, the government operates the "TB Safety Belt" program to help vulnerable TB patients receive treatment. The program centers on public medical institutions and aims to prevent treatment discontinuation by providing not only treatment cost support but also caregiving, nutritional management, and patient transfers between hospitals.
Field evidence shows that housing support and medication management significantly improve treatment outcomes. An analysis of homeless TB patients treated at Seoul Seobuk Hospital found that patients connected to facilities providing medication management and housing support after discharge achieved treatment success rates of approximately 95%. In contrast, patients who returned to the community without additional support achieved success rates of only about 70%.
Experts explain that these results demonstrate TB is not simply a medical issue but a social problem connected to housing, welfare, and care policies. As family care networks weaken due to aging and the increase in single-person households, the number of vulnerable individuals is likely to grow further.
"South Korea's TB management policies are internationally successful, but problems with the elderly and vulnerable populations remain," said Cheon Byung-chul, professor of preventive medicine at Korea University. "Without expanding social safety nets like the TB Safety Belt, the pace of TB reduction could hit its limits."