Explanations for 20th Century Tuberculosis Decline: How the Public Gets It Wrong

Abstract

Introduction: Historical analysis of health data indicates that the majority of the decrease in tuberculosis mortality during the past century was caused by improved social conditions and public health interventions. The purpose of this study was to assess lay public perceptions regarding why tuberculosis declined. Materials and Methods: A nationally representative sample of 705 adults was surveyed to identify their perceived reasons for the decline in tuberculosis mortality in the 20th century. Openended questions and responses were coded and placed into eight categories. Results: Approximately 52% of decreasing tuberculosis mortality was attributed to "modern medicine," and 220% to "vaccination." Comparatively few of the respondents attributed decreased tuberculosis mortality rates to public health or improvements in social health determinants of health. Males gave more credit to modern medicine and public health, with less to vaccination; the other racial group gave more credit to public health and less to modern medicine; Hispanics gave more credit to modern medicine and less to vaccinations; and the higher income groups gave more credit to vaccinations and public health, but less to modern medicine. Conclusion: The public overly attributes modern medicine as the primary cause of declining tuberculosis mortality rates, the second leading cause of death in the United States during the early 1900s, and gives little credit to the critical role played by public health and improved social conditions. These misperceptions may hinder societal efforts to address and fund important social determinants of health and public health interventions.

Nutritionally acquired immunodeficiency must be addressed with the same urgency as HIV to end tuberculosis

“…In Chile, addressing malnutrition was a key component of a national TB elimination program [9]. The USA, England, and Wales all saw dramatic reductions in TB in the first half of the 20th century before any medications or vaccines were available for TB [10]. Thomas McKeown and others have attributed these reductions to socioeconomic progressbetter living conditions and better nutrition [11].…”

Edgewood:

“…Around 1900, while tuberculosis (TB) killed an average of 195 people per 100,000 nationally, the rate for Black Americans was 500-600 per 100,000. 1 Even though the microbial cause was discovered in 1882, heredity was thought to play a significant role in the disease well into the 1920s. Rather than attributing malnutrition and poor, overcrowded living conditions, White doctors pointed to Black bodies themselves as the cause of high mortality rates.…”