The TB Challenge
“Partnering to Eliminate TB in African Americans”
A Newsletter from the Division of Tuberculosis Elimination, Field Services and Evaluation Branch Fall 2003
TB in African Americans: Data from the William “Bill” Burley
2002 Surveillance Reports
Zachary Taylor, M.D.,Chief, Field Services and Evaluation Branch
TM
In Memory of
Black, non-Hispanic persons continue
IN THIS ISSUE: to have a disproportionate share of TB
Reported TB Cases by Race/Ethnicity
United States, 2002
William “Bill”
cases in the United States. In 2002, Burley
4,439 cases of TB occurred in black,
TB in African Americans 1 non-Hispanic persons. This represents Hispanic
White, non-Hispanic
(20%) Public Health
(27%)
30% of all cases. The rate of TB in American Indian/
Alaska Native Advisor
blacks is 12.6 cases per 100,000 (1%)
ACET & CDC Cosponsor population, compared to 1.5 cases per Asian/Pacific Islander
(22%)
Consultation 1 100,000 population in white, non- Black, non-Hispanic
(30%)
Hispanic persons, resulting in a
black:white rate ratio of 8.4. This newsletter is dedicated to William "Bill"
Social & Culture Burley. Bill served from 1984 to1996 at CDC
Dimensions of The proportion of TB cases in African in the Division of Tuberculosis Elimination as
Health Behaviors Americans is even greater if only TB Although rates of TB in both blacks and a program consultant. During Bill's career in
2 whites have declined substantially over public health, he helped all of us to better
cases occurring in US-born persons are
examined. In 2002, there were 7,296 the past decade, the disparity remains understand the underserved and the often
cases reported in US-born persons, 48% and is the legacy of poverty, racism, and forgotten; he constantly pushed all of us
of all TB cases reported in the US. Of poor access to care. To close the gap, toward a better understanding of health
those cases in US-born persons, 3,387 increased efforts must be made to disparities and inequalities. Bill succumbed to
occurred in black, non-Hispanic eliminate TB in African Americans in leukemia in 1996, but his memory remains
persons, representing 47% of all US- the United States. with us, and his life's work is a legacy to us all.
born cases.
POSTAGE & FEES PAID
ACET ACET and CDC Cosponsor Consultation- -TB in America:
FIRST-CLASS MAIL
Permit No. G-284
Disparities in the Southeast
PHS/CDC
CDC H. David Crowder, Section Chief, Field Operations Section 1
The Advisory Council for the public health leaders, policy and The discussion groups identified a number of
Elimination of Tuberculosis (ACET) decision-makers, religious and unmet needs and provided important
and the Centers for Disease Control and community leaders, state and local comments and specific recommendations for
Prevention (CDC) cosponsored a health department representatives, and activities that will raise awareness and
consultation with national non- others representing a broad spectrum of stimulate actions in order to address and
governmental African-American views. reduce TB in racial/ethnic minorities. The
organizations and agencies whose needs identified included heightening
programs could have an impact on TB The first day of this consultation awareness; forming a national advocacy
control efforts in the African-American provided participants with an overview group; reducing the stigma associated with
population. This was an initial step in of the TB problem and more specific TB; educating the public and policy makers
addressing the disparities between the information about TB in African with fact sheets to influence political will;
tuberculosis (TB) case rates of African Americans. On the second day, designing culturally appropriate educational
Americans and those of other US-born participants were assigned to small materials; better educating the medical
racial/ethnic groups in the Southeastern breakout groups and asked to develop community and legislators, including the
United States. The consultation was specific recommendations for Congressional Black Caucus, about TB and
DEPARTMENT OF HEALTH & HUMAN SERVICES
intended to raise awareness about the accelerating the decline in TB rates health disparities in racial/ethnic populations;
Centers for Disease Control and Prevention (CDC)
disparity, solicit support for eliminating among US-born African Americans in and addressing the private-provider
TB in US-born African Americans, and the Southeastern states. disconnect. The recommendations from the
develop recommendations for discussion groups can be found below.
accelerating the decline in TB rates During the breakout sessions the
among US-born African Americans in participants were asked a number of Recommendations
the Southeastern states. predetermined questions that covered Send TB experts to communities and
several major topics, including level of community organizations to speak about
Penalty for private use $300
The consultation, entitled “TB in community TB knowledge, how to the problem and what we can do about it.
America: Disparities in the Southeast,” increase awareness of the TB problem,
Atlanta, Georgia 30333
was held on May 13 and 14, 2003, at the how to mobilize community resources, Use a number of venues to get the
Official Business
Sheraton Colony Square Hotel in and how to enhance relationships message out, including public service
Atlanta. Approximately 40 people between TB control programs and announcements, billboards, former
attended this consultation (not including African-American communities in patients, National Minority Health
observers from CDC). The participants order to improve TB elimination Education Network, media resources that
comprised a diverse group that included activities. have a largely African-American
academicians, health care providers, audience, direct person-to-person (even
one ACET & CDC cont. on page 2
The Social and Cultural Dimensions of Health-Seeking Behaviors
Joseph Kinney, Project Director, South Carolina Department of Health and Environmental Control
In August 2002, the South Carolina Department of When the clinical/biomedical factors are examined Develop and implement an awareness and
Health and Environmental Control (DHEC) received within the context of the socioeconomic findings, educational campaign to 1) raise levels of
supplemental CDC funding designated for they suggest a possible association between these information and awareness about tuberculosis
“Intensification of TB Prevention, Control, and two factors and the identification and treatment of disparities; 2) promote changes in consumer
Elimination Activities in African-American tuberculosis. As an example, low educational levels behaviors to foster best health practices and
Communities in the Southeastern United States.” play a role in the inability of patients to understand improve quality of life; and 3) encourage and
South Carolina recognized that to intensify and the treatment of tuberculosis. A TB nurse or promote culturally based and culturally
target activities toward US-born African-Americans, physician may misinterpret patients not following competent health care practices and interventions
and to accelerate the decline and elimination of instructions as “noncompliance.” Yet, the reason by health care providers.
tuberculosis, it was necessary to examine the social may be the lack of understanding of the terms,
and cultural dimensions of health-seeking behaviors unfamiliarity with medical systems, or the inability Involve and use the community more effectively.
as shaped by knowledge, beliefs, and values and their to read the materials provided as reinforcement for Include minorities in key roles where significant
associations with TB health delivery systems. clinical visits. minority input may be missing and needed.
Reinforce collaborative efforts to build
A retrospective study was done by the University of The lack of funding to address tuberculosis partnerships with agencies, community
South Carolina, Institute for Families in Society, to educational and outreach efforts may contribute to groups, and faith-based organizations.
identify the knowledge, beliefs, and values of the perception within the African-American
African Americans diagnosed with or at risk for TB community that TB is not important or is no longer a Develop and reinforce multidisciplinary
in the Northeast Corridor of South Carolina. Fifty- public health priority. approaches to TB management.
two face-to-face interviews of patients were Establish linking and contract arrangements
completed and twenty key informant interviews The preliminary cultural factors identified suggest with other health department professionals,
were completed with community and governmental the need for careful attention to the training of nurses i.e., health educators, nutritionists, social
stakeholders. and related personnel working with tuberculosis, workers.
with increased emphasis on patient education
Expand the use of current resources by
In summary, the socioeconomic factors (a strong through the use of culturally appropriate materials
association between poverty, rural residence, lower that foster cross-cultural communication between Facilitating greater use of minority and
educational attainment, unemployment, and lack of patients and providers. Stigma and the legacy of mainstream media to educate and report on
access to health care) serve as determinants in relationships in the South cannot be ignored - - TB is TB health care issues.
tuberculosis cases. Disparities between African a disease that has traditionally been associated with
Americans with tuberculosis and other racial groups issues of disparity. We believe these steps will enhance the
place this group at higher risk for poor health identification, adherence, and treatment of
outcomes and for nonadherence to treatment. The Several recommendations and a summary tuberculosis among African Americans in South
data suggest that the elimination of tuberculosis may recommendation are as follows: Carolina.
be achieved only through an effort that addresses
these factors with local networking and public-
private partnerships.
Associate Director for Health
Disparities Named ACET and CDC Cosponsor (Cont.) New Team Leader
Hazel D. Dean,
door-to-door) education, and local gathering Gail Burns Grant was
Sc.D., M.P.H., is the
points (churches, shelters, emergency rooms, recently selected for a
new Associate
liquor stores). Team Leader position in
Director for Health
DTBE/FSEB. As Team
Disparities in the
Seek out and partner with the private sector, Leader in the Field
Office of the
CBOs, and other organizations that serve the Operations Section I, Ms.
Director, National
African-American community. Grant is primarily
Center for HIV, STD,
responsible for providing
and TB Prevention (NCHSTP). Dr. Dean has worked
Involve public school systems and form assistance and guidance for TB project areas in the
in the NCHSTP's Division of HIV/AIDS Prevention
partnerships with historically black institutions Southeastern United States and for providing TB
for 11 years. Since February 2003, she has served as
of higher learning. Health departments should project oversight to the states of Georgia and South
supervisor of the Research and Dissemination Team in
strive to ensure that the racial/ethnic composition Carolina and the city of Chicago--all recipients of TB
the HIV Incidence and Case Surveillance Branch. Dr.
of their staff is similar to that in the communities. federal grant funds targeted to intensify TB
Dean has contributed significantly to efforts to
prevention, control, and elimination activities in
develop strategies for using HIV surveillance and
Place TB on the Secretary's Health Disparities African-American communities.
other scientific data to guide HIV prevention and care
Report and on the agenda of the American Public
program planning at the local, territorial, and state
Health Association conference.
levels and has contributed to methods to describe the
HIV epidemic in minority and other underserved
Minority Health Resources:
CDC should improve or establish relationships
populations. Dr. Dean has authored or co-authored a
Visit the CDC web page at www.cdc.gov, click on
with a variety of organizations such as the
host of scientific articles in peer-reviewed journals
Health Topics and select M to view
National Medical Association, the Black
and written reports and book chapters on HIV/AIDS
announcements, upcoming conferences,
among racial and ethnic minorities and incarcerated
Women's Project, and African-American meetings, trainings, reports, publications, and
populations. She serves on CDC, departmental, and
fraternities and sororities. other minority health-related resources.
national advisory work groups and committees; she
has received numerous national awards for her work
Improve the relationships between health
and for enhancement of diversity in the workplace. Dr.
departments and African-American
communities. TB programs must acquire a CONTACT US ...
Dean received her bachelor's degree in biology from
Spelman College, and her master's degree in public
better understanding of black culture, maintain a If you have story ideas or articles to share, or would
level of respect for the individual, evaluate and like to provide comments, please e-mail Gail Burns
health in international/health/biostatistics and
Grant at gab2@cdc.gov or call 404 639-8126.
doctorate of science degree in biostatistics from
improve community access to TB services, and
create more community coalitions. To add/delete someone on our mailing list, please
Tulane University.
contact Vivian Siler, Management & Program Analyst,
DTBE/FSEB, by e-mail at vas6@cdc.gov or
404 639-5319.
two