Brickman Stynes, M.; (2010) Urban public health and the White Plague: the reemergence and containment of tuberculosis in New York City, 1970 to 2006. Doctoral thesis , UCL (University College London).

Abstract

The reemergence of tuberculosis (TB) throughout urban areas of the global North in the late 1970s and early 1980s prompted illuminating scholarship on the underpinnings of the disease’s modern resurgence. While valuable in their own right, these studies failed to elucidate fully the relationship between tuberculosis and public health infrastructure. In response, this thesis unpacks this complex relationship through a detailed case study of New York City, which experienced a profound resurgence of the disease between the late 1970s and its climax in the early 1990s. Principally, this work explores how changes in New York City’s public health infrastructure between 1970 and 2006 shaped the return of tuberculosis and influenced the City’s subsequent ability to control the disease. More specifically, the study examines if the strength of the public health infrastructure dictates the efficacy of TB control efforts; the pathways through which public health infrastructure and TB may be connected; and which public health infrastructure elements are most important to the City’s ability to keep the disease in check. An analytical framework developed by the Centers for Disease Control (CDC) is adopted and modified, thus organizing this research and atomizing public health infrastructure into four components: workforce capacity and competency, information and data systems, organizational capacity, and fiscal resources. This work charts and critically interrogates the role of these four elements in fluctuating New York City tuberculosis rates. An interdisciplinary approach is employed, which synthesizes insights gained from the medical sciences with analytic methods derived from medical geography, public health, history, and political science. Data comprise semi-structured interviews (with TB policy-makers, researchers, medical workers, and others), coupled with an analysis of public health legislative documents, newspaper articles, time-series tuberculosis rates, and newly uncovered staffing figures and fiscal resource data. Summarily, the thesis finds that public health infrastructure played a decisive role in New York City’s resurgence of tuberculosis and the City’s subsequent ability to control the disease. Each of the four facets of public health infrastructure proved integral to the success of the TB program. Additionally, interconnections between the four elements are revealed, highlighting the potentially far-reaching effects that changes to one element can cause. The findings of this thesis not only demystify the role of public health infrastructure as it relates to TB, but also bolster the work of past researchers who have proposed moving past bio-medically centric perspectives to include socio-geographic elements in tuberculosis initiatives.

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