World TB Day: March 24 - 82% of US cases in ethnic minorities
Dr. Robert Koch announced the discovery of the bacteria that causes Tuberculosis on this day in 1882. Today, public health officials are calling for elimination of the disease. While some in our country want to act as if race is no longer an issue, as if 40 years of civil rights legislation have suddenly reversed 400 years of disparities, those of us who work in health care see, everyday, the hard evidence that as a nation, we have a long way to go.
Take tuberculosis - 82% of all reported US cases are in non-Hispanic whites, and 45% are in US born blacks. The northeast and southeast regions are where most of the cases are congregated, and the disease is compounded by substance abuse, HIV, homelessness and incarceration.
10 million people in the world are incarcerated and at risk for tuberculosis. Improved prison conditions - reduction of overcrowding, improved health services and improved nutrition and hygiene to prison populations will do a lot for prevention and control of TB. If the international goal is to eliminate TB by 2015, we must get real about access to health services for the poor and underserved in our communities. The US has the largest penal system in the world. In 2006, 7 million US citizens were incarcerated. 8% of black men, 1 % of white men and 2 % of Latino men are behind bars. Black women are jailed at 3 x the rate of white women.
Support of patients during treating, including direct observation of therapy (DOT) will need to be implemented on a broad scale - including prisons - to treat the 2 billion people infected. That's right - 1/3 of the world's population is infected with TB - most of them poor. $15 billion will be spent educating Californians and $15 billion will be spent incarcerating them. Male high school dropouts are incarcerated at 31 x the rate of young males with college degrees. For black males, the rate is double that - 60 x more likely to end up behind bars. Funding education is funding health prevention - by improving health literacy and access to care, by keeping people out of prison and in the work force - we can prevent communicable diseases like TB and reduce racial disparities in health care and health expenditures.
Thank you CDC for use of photo of overcrowded prison, US.