Tuberculosis, Commonly Abbreviated as TB and Known

Tuberculosis, commonly abbreviated as TB and known throughout historical literature as consumption, is an infection caused by the Mycobacterium tuberculosis bacteria. (Psy Guy, 2005) Pulmonary TB is the most common type of infection, which affects the lungs. There are several other manifestations of the infection including an infection of the central nervous system, known as meningitis, an infection of the circulatory system, known as miliary TB, as well as infections of the lymphatic system, the genitourinary system, the bones, and the joints. World-wide, tuberculosis infects two billion people. With one-third of all people affected, tuberculosis is easily the most common major infectious disease today. Most of the infections are asymptomatic latent TB infections, which have a ten percent chance of progressing to an active TB disease. If tuberculosis progresses to this point, there is a fifty percent chance of death if no treatment is received. Two million people die from TB every year, most of these occurring in developing countries. Although many people mistakenly consider tuberculosis to be a disease of the past, it is a serious problem today. "The neglect of TB control programs, HIV / AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) are emerging. The World Health Organization declared TB a global health emergency in 1993." (Psy Guy, 2005)

The transmission of tuberculosis occurs through the air, because droplets are released when an actively infected person coughs, sneeze, or spit. Untreated tuberculosis patients may infect as many as twenty people per year, and people with close contact with a patient are at the highest risk of becoming infected. Other factors make a person highly susceptible to TB infection, including having a compromised immune system (such as having HIV / AIDS), having poor health care, being a part of high-risk racial and ethnic minorities, low-income populations, and using illicit intravenous drugs. (Psy Guy, 2005) Minorities are at a significantly higher risk of infection; in 1999, fifty-four percent of TB infections were found in the African-American and Hispanic populations, with another twenty percent of the infections found among Asians. (NIAID, 2002)

The Community: Eastside Oklahoma City

The community in question for this project is located on the East side of Oklahoma City, Oklahoma. The Eastside district of this city is home to the largest African-American community in the entire state of Oklahoma, and Oklahoma City additionally has the largest Hispanic population in the sate. (Balcer, 2005) Although the Eastside of Oklahoma City has been making a great deal of progress in leaving behind its infamous urban blight and neglect, it remains an area with extreme poverty. The area has a high rate of crime, including prominent rates of illicit drug usage. Despite the changes being made in this area, there also remains a lack of necessary community services, such as health care and education, for those in need. These factors (minority communities, poverty, drug usage, lack of adequate community services) make this area more susceptible to high rates of tuberculosis infection. This is connected to the reasons identified as causal factors for the resurgence of TB as a public health concern in America after the steady decline of this disease throughout the last half of the twentieth century. These interrelated forces include:

1. The AIDS epidemic, because AIDS patients are more likely to have a TB infection turn active.

2. The increase of foreign-born immigrants to the United States, from areas with high rates of infection such as Africa, Asia, and Latin America; almost half of all TB cases in the United States are such immigrants.

3. Increased poverty, injected drug use, and homelessness; immune systems are weakened in those with poor nutrition and drug users, and shelters and prisons have rampant TB transmission rates.

4. Failure to treat infections with antibiotics, or to complete the treatment, even if they have been prescribed; lack of health insurance and public assistance for necessary health care, as well as lack of health education all compound this problem. (NIAID)

All of these factors are affecting the Eastside Oklahoma City community, therefore making Tuberculosis a significant threat, as well as making it vital to implement a plan to decrease this threat.

Health Care Status Indicators

According to an Oklahoma Health Department representative, "Strong predictors of access to quality health care include having health insurance, a higher income level, and a regular primary care provider or other source of ongoing health care....Financial, structural, and personal barriers can limit access to health care." (Moon, 2005) Unfortunately, the Eastside Oklahoma City community is rampant with these barriers, leaving this community highly susceptible to health crises including Tuberculosis infection.

Although many officials are quick to point out examples of improvements that have been made in Oklahoma city, for example the "economic diversity" (Balcer, 2005) of the Eastside and the overall decline in poverty in the state as a whole according to recent reports by the Census Bureau, Oklahoma has by no means created an atmosphere free from any poverty-related concerns. There remain 400,000 Oklahomans living below the poverty line (Robinson & Killackey, 2005); in Oklahoma City specifically, twenty percent of the residents were in poverty as of 2003. (U.S. Census Bureau, 2005) In addition, about one-fifth of the population is uninsured, having risen steadily over the past years. (Robinson & Killackey, 2005) To quote the executive director of the Oklahoma Primary Care Association, based in Oklahoma City, "Oh, God -- this is bad." (in Robinson & Killackey, 2005)

These financial problems compound serious health risks for members of this community. High rates of poverty, as well as the other risk factors such as minority groups, foreign-born citizens, crime and drug use, etc., compound with the lack of health insurance to create a very dangerous atmosphere in which tuberculosis is a serious threat. The health care status in this community does not rate very high at all. In addition to the financial barriers, there are structural barriers (lack of medical care providers to meet the need of the community) and personal barriers (such as cultural differences, language barriers, and discrimination.) (Moon, 2005)

Availability and Distribution of Services

Cities that are successfully maintaining a "healthy" community are doing so by recognizing the many factors that combine to contribute to health. It would appear that health services are widely available in America, since there are more physicians per capita and more medical services provided than any other nation in the world. (Norris & Lampe, 1994) However, other factors indicate that America is far from "healthy." There are twenty-two other industrialized nations with a lower infant mortality rate than America, for example, and medical costs are cost prohibitive to many communities. "We may have made America the best place in the world to get sick and experience very high-quality treatment, but we have not made America the best place to become and stay healthy." (Norris & Lampe, 1994) Therefore, the health of communities must depend on the cooperation of the people and organizations within that community, rather than counting on the government to provide the means to avoid health-related disaster.