Tuberculosis Essay Research Paper TUBERCULOSIS SummaryThis paper

Tuberculosis Essay, Research Paper

TUBERCULOSIS

Summary

This paper explores whether the incidence of tuberculosis (TB) is higher among low income people because they are less likely to seek medical care. It investigates two urban districts that compare in terms of race and income level, these being Harlem and West Central, USA. To determine the role of race and economic disadvantage in the incidence of tuberculosis in these geographic areas, ethnographic methods were used to analyze the information. It appears that there are significant race and class dimensions to the incidence of tuberculosis in these areas, but there are other confounding factors . such as (human immunodeficiency virus) HIV and the times at which sufferers sought medical help. This study suggests that there is a pressing need to improve our understanding of the socio-economic aspects of problems affecting public health, such as TB in the United States.

Background

i. Statement of the problem

People in economically disadvantaged positions living in medically under-served communities are at an increased risk for tuberculosis. The disease does continue to be a barometer of poverty and race, but there are other significant factors associated with the incidence of TB. Studies in South Africa suggest that those qualified as black or coloured had significantly less access to health care, and thus stood less chance of being diagnosed than their white counterparts (Andersson 1990). Those in this disadvantaged condition tended to suffer disproportionately from other socio-economic related medical factors, such as malnutrition and incidence of HIV/AIDS that are closely linked with the incidence of TB.

The pattern is similar in other countries, including the USA. The problem in the United States is that there is limited population-based data on TB by social class (Lifson et al. 1999). There is even less data on the incidence of seeking medical care between the onset of symptoms and the visit to a medical center. The incidence of TB is indeed higher among low income people because they are less likely to seek medical care. But the objective of this study is to suggest that there are other critical factors in the complex social dimension of public health problems associated with TB. These will be discussed in parts iii and iv of this section.

ii. Literature review

During the 1980s and 1990s, there have been dramatic transformations in the epidemiology of tuberculosis in the United States (Bloch et al. 1996). As TB morbidity began to increase in 1985, after an all-time U.S. low, a significant number of studies were begun to explain the phenomenon. Some of the conclusions of this study will be based on the extensive current literature attempting to explain this recent increase in TB morbidity. Two of the most important factors have been the available evidence on HIV co-infection, and the incidence of TB among the foreign-born. Alan Block et al. (1996) have done an excellent exploratory study of this theme, entitled .The need for epidemic intelligence.. The study sends the powerful message to a U.S. audience of the importance of further research into the implications of race and social class in areas like urban health policy. This is particularly true in cases of the emergence of a multidrug-resistant tuberculosis (MDR TB).

Some work has also been done on the regional variations of TB in the United States that is of great value for studies like this one. For instance, Subroto Baerji et al. (1996) have researched and written a study entitled .Tuberculosis in San Diego County: a border community perspective., which takes into consideration a population in transition and the effects on the incidence of TB in that district. Pappas Dievler (1999) has done a similar investigation of Washington D.C., specializing in the HIV/AIDS angle and the implications of social class and race for urban public health policy making.

Some interesting work has also been done on the epidemiology of TB in low-income areas. A.R. Lifson et al. (1999) have done a study called .Tuberculin skin testing among economically disadvantaged youth in a federally-funded job training program.. For this study, the valuable aspect of Lifson et al..s paper was the following finding: that differences in geographic region of residence were not significant after adjusting for other factors. This has implications for the importance of screening groups at risk for tuberculous infection, as well as for public health policy and services offered in high-risk areas.

It has also proven useful to investigate international cases wherein race and class factor in. N. Andersson.s study .Tuberculosis and social stratification in South Africa. (1990), suggests that poverty, race and the incidence of tuberculosis were a global phenomenon. In the South African case, the risk of TB for people categorized by the state as .black. or .colored. are 27 and 16 times (respectively) as related to the risk for whites. The author argues that whites with the disease stand a greater chance of being diagnosed than their black counterparts, namely because of their improved access to health care. There is much to be learned in the American context by viewing the incidence of TB among low-income, medically under-served communities in other districts and countries.

Finally, because TB is a soc