Tuberculosis in Newham Borough of London: an urban health profile

Tuberculosis in Newham Borough of London

The Urban Health Profile

It is true that as long as there have been human beings on planet earth there has been a certain amount of struggle against disease and creatures that carry disease along with bacteria and viruses. These are the types of struggles and successes which have determined whether or not civilizations would triumph or be defeated, and these are the struggles which will no doubt be a part of the human experience for years to come. Just as human beings feel like they have some sort of leverage and superiority over illness a disease such as over strains of bacteria through antibiotics, strains of bacteria eventually became resistant to antibiotics and ended up conquering this form of treatment: "A relationship based on interdependency between humans and micro-organisms exists with one achieving dominance over the other throughout history" (Choudhury & Mayo, 2003).

This paper looks at the epidemic and issue of tuberculosis in the Newham Borough of London along with the practical and theoretical work on the urban health issue that is necessary for this overall assessment. The practical aspect of this assessment includes the observation and data collection necessary, and the theoretical assessment includes the aspect which is informed by the wider scope of literature. As a result of the fact that the study concerns the Newham Borough of London, the study will be carried out there. The rationale for choosing this particular study and issue is clear: Newham not only has the highest rate of tuberculosis in London, it also has the highest rate of tuberculosis in the entire western world. Historically, the UK has long had a problem with incidences of tuberculosis, with it being highest in the 19th century, and then falling organically, even long before specific measures designed to thwart tuberculosis, such as things like chemotherapy and immunization (Choudhury & Mayo, 2003). Immigration along with an overall demographic change was some of the things which contributed to tuberculosis decline. Though Newham has been found to have the highest rate of TB in the entire UK; what's more the rates have been found to be increasing. This state of emergency indicates part of the need for serious treatment, prevention and understanding of this condition because of the fact that the condition has been increasing at such a steady rate. That statistic was issued ten years ago; today there has been progress, but the issue still remains something rather pertinent.

The media is making more and more people aware of the fact that Newham is the place to catch tuberculosis more than anywhere else in London. This is a fact which is hurting the economy of Newham, causing fewer visits and less tourism to this region as a whole. In 2012, "366 cases of TB were recorded which is 16.9 per cent more than Ealing - the next worst borough for the disease - where 313 people were diagnosed with the condition. This means that out of every 100,000 people in Newham, around 118 will contract TB - a potentially fatal, infectious disease which normally affects the lungs. The report, published on today by Public Health England, shows that around 40 per cent of all cases of TB in the country were contracted in London" (York, 2013). As Doctors in the area have reported, more and more people are seeking treatment, with 85% of people completing treatment within a year, but more needs to be done with prevention. And even more needs to be done with controlling the spread of the infection as a priority in London as a whole (York, 2013).

It was during the millennium when incidence of tuberculosis (TB) received more attention in the neighbourhoods throughout London as rates of the disease spread and more experts in the health and sciences decided to study it. Rates of the disease were climbing in places like the inner city boroughs and were being driven up by things like ethnicity and poverty (Beckhurst et al., 2000). Beckhurst and colleagues wanted to determine which factors were most salient in the distribution of cases of tuberculosis most of all. "The Borough of Newham in the East End of London is made up of 24 electoral wards and has one of the highest notification rates in the United Kingdom. Our analysis showed that the percentage of the population who were non-white made a strong contribution to the variance in TB rates between wards (p < 0.0001), but the age distribution of the population and Jarman scores for poverty did not, the latter because the entire borough is deprived. Measures to control TB should be targeted at those areas where members of the community are most at risk" (Beckhurst et al., 2000). Thus, part of all control measures regarding this disease need to be focused on containment of the condition. This means targeting the areas within Newham where people are most at risk and determining how to best protect individuals from developing this condition.

Rates of Tuberculosis

As already alluded to, the rates of tuberculosis are part of the reason why studying this issue in Newham is such a pressing issue. Newham and Brent are the areas just outside of London that have the highest rate of tuberculosis in the western hemisphere. "In North East London, rates in Newham increased steadily from 2002, and remain high, while rates in Hackney have declined... Rates among the UK born populations were above 20 per 100,000 populations in Haringey, Newham, Brent, Hackney and Lewisham. Rates in the non-UK born were above 150 per 100,000 in Newham, Brent, Ealing and Hounslow (Appendix A v). These figures should, however, be interpreted with caution due to the small numbers and population estimates involved" (HPA, 2011). Researchers have found that when it comes to population groups living in London, they are at a bolstered risk for getting tuberculosis, and that the absence of any rates in decline for many of them is more evidence for the fact that there is no successful strategy in controlling and minimizing the burden of tuberculosis in London. Certain areas of Newham demonstrate that there is an increased risk of tuberculosis and that the bulk of all highly targeted prevention activities need to focus on these high risk groups as targeting these groups is most cost effective (HPA, 2011). For example, one manifestation of this is that Indian ethnicities generally face and confront this affliction more than other groups.

In 2007 the concentration of tuberculosis in Newham continued to be problematic and concerning. "TB is concentrated in particular areas of London ranging from a low of

As a particular communicable disease, experts have found that the overall rates of these disease tend to be higher in tower hamlets within Newham (235 new incidences per 100,000) and in City and Hackney (204 incidences per 100,000 people) than in Newham (124 per 100,000) population (NHS, 2011). These numbers are a demonstration of the high number of cases "on Campylobacter reported in Tower Hamlets in 2009 and the high number of Mumps in City and Hackney in 200918. However, the rate of all communicable diseases in Newham has more than doubled since 2006 from 14 (per 100,000) to the current rate of 37 (per 100,000) with the rate of mumps having seen the greatest rise in 2009" (NHs, 2011).

Conclusions and Recommendations

These failures represent the downfall of the entire public health system of the UK. In order to stop the spread of TB in this particular area, there needs to be a more concerted measure of support to assist those afflicted with the disease combined with prevention. While this is no small task, as tuberculosis is one of the most common infections in the world, there are still ways to make the outbreak which is centered around Newham to be more contained and to have lower numbers of incidences each year. More money needs to be invested into the public health system as a whole to create informal quarantines of the sick, so that they can more aptly prevent the spread of the disease. Coughing, sneezing and even talking are all elements which can cause bacteria to be released into the surrounding air and infect the rest of the community, so some form of sustainable quarantine needs to be engaged in. The rest of the vulnerable populations within Newham need aggressive fortification of their own personal health systems so that they can adequately fight off infections -- particularly the babies, children and seniors who live in Newham, along with substance abuse users, homeless people, and people who have HIV or AIDS. There must be legitimate ways to limit exposure to TB and to quickly treat those who have TB. None of these pillars of public health are in place and the community is suffering for it.

Part Three: Extended Essay Plan

Tuberculosis in the Newham Borough of London

Newham is a charming suburb of London which boasts a range of positive aspects and desirable qualities, such as the Rosetta Art Centre, along with a range of leafy public parks and other open spaces which make Newham such a desirable area. However, Newham is still an area under development and it still has a lot of work which needs to be done when it comes to attracting more economic activity and allowing the neighbourhood evolve to its full potential. Part of the reason that Newham is in dire need of more economic development and jobs creation is because of the fact that there is a high population of immigrants which come to the neighbourhood and who bring with them lower levels of income and sometimes diseases, bacteria, and viruses from their nations of origin. Certain complications in connection to this circumstance are as follows. For instance, Newham was an area that was among the lowest for the uptake of the pneumococcal vaccine and the third highest for those uptaking the seasonal flu vaccine for at risk groups; this vaccine was offered as a means of preventing infection in groups who are more at risk for suffering from complications of infection. Newham is still an area where there are a lot of residents who are generally at risk for a range of infections due to a result of socioeconomic and biophysical factors.

Health Issues of Newham

Overall weakness and a propensity of communicable diseases is one of the major factors and issues in connection with Newham. For instance, Newham still had the highest rate of hospital admissions as a result of asthma in 2007; this was because some of the various triggers for asthma are factors which are strongly connected to aspects of this geographical area. "Newham had the highest rate of tuberculosis diagnoses in the country for 2004/06. This may be a reflection of the local population, which may have a high percentage of persons in at risk groups, such as people who have recently emigrated from countries with high rates of TB" (hpa.org, 2013). This factor is exacerbated by the fact that Newham has a high rate of people living there with HIV (in 2007); people with HIV have generally weaker immune systems and can thus be more effectively preyed upon by things like the HIV virus (HP.org, 2013).

Urban Health Issue

One of the reasons why this is such an aggravated urban health issue is because the life expectancy of residents of Newham is lower than that of London of the nation of England as a whole: "For women the gap between Newham and England and London is narrowing, but for men the gap has widened. Female life expectancy is 81.1 years, 1.5 years less than the England average. Male life expectancy is 76.2 years, nearly 2.5 years less than the England average" (Aston-Mansfield). Obviously, one can clearly conclude that the incidences of TB have a lot to do with this lower rate of overall life expectancy in this borough. These numbers make this a truly serious urban health issue without a doubt.

Furthermore, a close look at the data demonstrates that the rates of tuberculosis over time have not gone down, they've gone up. This shows without a doubt that the strategies for treatment and containment are absolutely ineffective. In 2011 alone, the diagnoses for TB in Newham rose by 77 cases to 381 which marked an overall rise of 25% since 2010 and 40% since 2006. TB is not evenly distributed throughout Newham: the bulk of the cases (70%) live in 3 particular areas in the north and east of this neighborhood, at Green Street, Manor Park and East Ham (Aston-Mansfield). This demonstrates how serious the consequences are in fact for London and England as whole: TB is an incredibly communicable disease. The fact that this first-world nation has had such issues in adequately dealing with it demonstrates that it is indeed a serious illness that requires immediate attention and strategic interventions or the rates of the disease will continue to rise. Not just in Newham, but spreading without a doubt to London and parts of England as well.

Recommendations

The nation of England and the United Kingdom as a whole needs to make a greater investment of money and of time in containing, preventing and treating TB in Newham. There needs to be a more realistic and organized quarantine of people who display symptoms, and a more strategic preventative strategy for treating immigrants and the poor, along with other populations who no doubt carry latent strains of the disease. Without more aggressive action, there will no doubt be dire consequences on the whole of England and the UK in their entirety.