Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis.

Abstract

Tuberculosis (TB) began to decline in the Western world in the mid- to late 1800s. In the United States, the disease receded until the mid-1980s, when that trend was reversed. Although the TB epidemic in the United States subsided in response to public health interventions, it sparked a controversy regarding the relative value of targeted public health measures vs broad social reform. That controversy, which echoed earlier debates calling for structural reform over public health programs, was further strengthened by the historical and demographic studies of Thomas McKeown. His influential thesis maintains that clinical and primary prevention efforts had little effect on TB mortality. In this paper, the historical literature is used to examine whether public health had a significant impact on the decline of TB mortality rates in several countries. Specifically, the paper describes the arguments for and data affirming the efficacy of 2 major public health interventions over time: segregation of those infected with pulmonary TB and eradication of bovine TB. This review finds support for the hypothesis that public health measures, along with other factors, led to falling rates of TB mortality beginning in the late 19th century.

Public health and bovine tuberculosis: what's all the fuss about?

“…Ironically, in the first half of the last century, farmers, consumers and legislators repeatedly resisted attempts to make testing of cattle and, more importantly, pasteurisation of milk compulsory in Britain, despite overwhelming evidence (particularly from the USA [43]) of its positive impact on public health.…”

Lessons From History of Socioeconomic Improvements: A New Approach to Treating Multi-Drug-Resistant Tuberculosis

“…The historical trend of TB mortality decline Several authors (McKeown, 1976;Szreter, 1988;Fairchild & Oppenheimer, 1998) have reported and investigated the decline in mortality due to TB over time. These studies mainly used data from England and Wales during the 19th and early 20th centuries in order to make interpretations about the reasons why TB mortality declined over time.…”

The Social Impact of the Misconceptions Surrounding Tuberculosis

“…78 Due to financial reasons, many sanatoriums released patients before they were completely healthy. 79 The Public Affairs Committee of the U.S. Chamber of Commerce estimated that in the early years of sanatoriums, a third of the patients left while they were still sick. 80 The outside world was well aware that some of the ex-sanatorium patients were not fully healed; as a result, many people viewed ex-patients as contagious.…”