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The Southeast suffers from the highest rates of TB of any region in the United States, with most of the cases occurring among African-Americans, according to a report presented at a recent meeting of the Advisory Committee to Eliminate Tuberculosis (ACET). "This isn’t really new information, but it’s good to see the issue getting some attention," says Henry Blumberg, MD, associate professor of medicine in the division of infectious diseases at Emory University in Atlanta. "If we’re really serious about eliminating TB in the U.S., we’re going to have to give this issue more attention and more resources."
One way to increase resources significantly would be to extend Medicaid eligibility to TB patients in high-burden states such as Georgia, Blumberg says. For hospitals like Grady Memorial, a perennially cash-strapped facility serving Atlanta’s indigent population, having access to Medicaid funds would "generate some badly needed revenues," Blumberg adds.
When it comes to making better use of available resources, TB control programs in the Southeast should work harder to recruit African-American staff members and should strive to promote better cross-cultural fluency among white staff, asserts Charles Wallace, PhD, MPH, director of the Texas TB control program. "People who are different from blacks have a hard time working with them," he says "Too often, the attitude [among white outreach workers] is to give the patient his dose and get out quickly," he says.
Historically, blacks have been under-represented in public health departments, especially in TB, says Wallace. Blacks continue to be reluctant to seek careers in public health fields, in part because relatively few blacks are represented in positions of authority, he says.
The Southeast leads other regions not only in TB rates but in high rates of other chronic diseases, including hypertension, diabetes, and heart disease, notes Carol Pozsik, RN, MPH, head of TB control in South Carolina. "It’s a longstanding health disparity, with historical roots in poverty and poor education," she explains. A 1998 study that studied the link between poverty and TB rates among blacks concluded that lower socioeconomic status accounted for over half of blacks’ higher rates of TB.1
The biggest problem the Southeast faces is a lack of funding, she says. Extending Medicaid benefits to TB patients would certainly make a big difference, but with the economy in recession and states like South Carolina cutting back on already meager public-health budgets, she doesn’t expect to relief anytime soon, she adds.
The ACET meeting resolved to spend more time studying the issue, perhaps with an eye to publishing an article on the subject in the CDC’s Morbidity and Mortality Weekly Report.
1. MF Cantwell, MT McKenna, E McRay, et al. Tuberculosis and race/ethnicity in the United States. Am J Respir Crit Care Med 1998; 157:1016-1020.