Although it is well recognised that silicosis is one of the most common occupational lung diseases worldwide, exposure to silica dust in the workplace plays an even larger role in global health as it contributes to the Tuberculosis (TB) epidemic. TB is now the most prevalent and most deadly infectious disease worldwide accounting for 1.3 million deaths per year. Silica dust exposure, even without clinically evident silicosis, has been demonstrated to increase the life-long risk of TB. Furthermore, occupational silica dust exposure among workers who are HIV positive in high-burden TB countries is a deadly combination increasing the risk of active TB by 15-fold. Global TB efforts are almost exclusively focused on case identification and treatment with few resources going to prevention. Silica dust controls in the workplace can be an effective TB prevention strategy that has yet to be fully understood and embraced by global health funders. Low cost silica dust controls have been demonstrated even in resource constrained informal sector enterprises. Investments in dust controls in the workplace to prevent disease are more cost effective than programs to identify and treat cases of TB. Countries with a high burden of TB and HIV with large mining and construction sectors should be prioritised. There is increased recognition that the global response to the TB epidemic is falling short and that drug-resistant TB is a growing threat. Occupational health professionals can play an instrumental role in making the case that silica dust controls should be incorporated into global health strategies to help meet the UN Sustainable Development Goals to end TB by 2030.