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A major motivator has been the presumptive laws and the need to eliminate smoking as it is so consistently related to the diseases that are the focus of presumptive legislation

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It is encouraging that the Collaborative TB control strategy for England 20152020 34 which is currently being updated, has given more pre-eminence to addressing social determinants of TB, including for example recommendations on closer collaboration between local authorities and health services to address socio-economic risk factors of TB, dedicated TB services for homeless and those attending substance misuse services, fast-track access to social care and accommodation for homeless for the duration of their treatment, continuity of TB care between prison and the community, and the systematic monitoring of social determinants of TB 34