Universitas Dian Nuswantoro presents a qualitative exploratory study examining tuberculosis as a wicked problem in coastal urban settlements of Semarang, Indonesia. The study addresses a public health challenge in which poverty, overcrowding, stigma, and inadequate health infrastructure intersect with social, cultural, environmental, and institutional vulnerabilities. The activity focuses on coastal urban settlements identified as high-risk areas for tuberculosis and considers how structures, culture, and communication interact in ways that make effective disease control more difficult.
The study used in-depth interviews with 27 participants comprising tuberculosis patients, household contacts, health cadres, health staff, local stakeholders, and community members. The data were analyzed thematically to examine how social, cultural, and institutional factors shaped tuberculosis vulnerability and control. The findings identified six interrelated features of tuberculosis as a wicked problem in the coastal area. These were euphemistic and stigmatized communication, including widespread avoidance of the term tuberculosis; mis-recognition of symptoms, in which coughing and fatigue were normalized or overlooked; structuring stigma that reinforced social silence and delayed disclosure; culturally embedded illness narratives involving moral, spiritual, and lifestyle explanations; perceptions of health based on functionality, whereby health was associated with the ability to perform daily activities and the urgency of treatment could therefore be minimized; and fragmented health-system responses, including under-resourced outreach, unaligned service hours, and superficial health education.
The study further describes a fragile coastal environment characterized by tidal flooding, high humidity, and overcrowding. These conditions collectively increase tuberculosis exposure, while coastal communities experience compounded ecological and institutional vulnerabilities. The study concludes that tuberculosis elimination efforts in Indonesia must extend beyond biomedical solutions and address cultural beliefs, environmental vulnerability, and weaknesses in the health system. It calls for adaptive, multisectoral, and culturally informed interventions for tuberculosis control in coastal urban contexts. The activity connects poverty-related vulnerability, health, and the conditions of coastal urban settlements. UDINUS frames this evidence as research supporting a more integrated understanding of tuberculosis control in vulnerable urban environments.