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T.B. is indeed still with us, primarily due to negligence, poverty, and inadequate public health systems.

I have personally worked in county hospitals, which serve the poor regardless of the ability to pay, and I've seen a disproportionate amount of poor people with active tuberculosis. Poverty tends to confine one to smaller spaces; smaller spaces tend to facilitate the transmission of T.B. via respiratory routes. Another factor normally linked with poverty is educational level-people of poorer backgrounds often have lower educational attainment, and this may have a direct bearing on their ability to proceed with and understand the necessity of completing treatment for this condition on their own. No question that lack of compliance has some effect on the emergence of the resistant strains not to mention on simple transmission.

A more alarming development outside the scope of the U.S. health care system, is the emergence of T.B. in countries without the resources to treat it effectively. In the Soviet prison system, resistant strains have broken out; there is inadequate money to pay for the new line drugs to combat this; stuck with the old drugs,the prison system makes do with outmoded care that leads to increasing outbreaks of resistant strains, and the prison system is an ideal incubator given crowding and personal proximity to spread the disease.

Finally, there might be what I would call a "celebrity factor." T.B. simply doesn't have the same visceral impact upon our sympathies that an AIDS child might have; what many do not understand is that T.B. has the second highest rate of mortality of any infectious disease, and where the AIDS virus is, you will see increasing outbreaks of T.B., due to patients damaged immune systems. As of late, the Gates foundation along with WHO is starting to address these very issues; however, public health in America is not given the same priority that more spectacular medical advances garner, in large part due to profitability, and the fact that those in power rarely have need for public health services, or believe they have no need...

Learn more about this author, Perry Hotter.
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