California:
The Avoidable Rise of TB

Jun 21, 2004

A nurse at Kaiser Permanente’s South Sacramento Medical Center was diagnosed with TB (tuberculosis) last March.

Known under such names as consumption and the white plague, TB has been a major cause of deadly epidemics throughout history. But with the development of a vaccine about a century ago, TB was not only brought under control, it was all but eradicated in industrialized countries, including the U.S., for several decades.

In the 1970s, however, TB started to make a comeback in the U.S. There were several outbreaks of TB in the 1980s and 1990s in different parts of the country, including New York, Maine, North and South Carolina, Mississippi, Oregon and Washington. California today leads the rest of the continental U.S. not only in the number of TB cases but also in the rate of infection.

Politicians have been quick to say that TB is brought to the U.S. by immigrants. It’s true that TB has made a big comeback in poor countries (where it had never been totally eradicated). And it’s also true that the rate of TB is higher among foreign-born U.S. residents than the rate among native-born. But to blame the rise of TB on immigrants is nothing but an attempt to divert attention from the real issue. And that issue is the steady decline of the public health system in this country and around the world.

While TB is highly contagious, it is also a disease whose prevention and cure are relatively simple–and they have been known for a whole century. Immunization and regular check-ups are enough to prevent TB in individuals. As for people who have TB, the treatment, which basically consists of various antibiotics, must be continued for about six months so that all the TB bacteria in their bodies are eliminated. This is necessary to prevent someone from spreading TB after he or she recovers.

In other words, TB could easily be eliminated, if the population has access to basic health care services–the entire population, that is.

But, over the past three decades, more and more people, both working and retired, have been losing health insurance benefits, while state and local governments have been gradually dismantling the existing public health care system. Just to give an example from California, in 2002, Los Angeles County closed 11 of its 18 health clinics. These clinics are the only places where workers and poor who don’t have insurance can afford to get any kind of health care. The county also cut at least 80,000 annual child immunization visits and at least 38,000 visits for treatment of communicable diseases, including TB.

This is why TB has resurfaced and why it is spreading–larger and larger layers of the population have no real access to basic health care–immigrants and everyone else without insurance.