Unresolved Issues in Controlling the Tuberculosis Epidemic Among the Foreign-Born in the United States

Tuberculosis (TB), “the world’s most neglected health crisis,” has returned after decades of decline, but has only gradually caught the attention of governments as a formidable threat to public health. By 1984, when TB cases hit an all-time low, federal and state governments stopped supporting the medical infrastructure that once served to contain the disease. State officials around the nation began dismantling laboratory research programs and closing TB clinics and sanitoria. Since 1985, however, TB rates have steadily increased to 26,673 reported cases in 1992, and some have estimated that by the year 2000, there could be a twenty percent increase. By 1993, Congress, realizing that TB could pose a major public health threat, allocated over $100 million to the Department of Health and Human Services for TB prevention and treatment programs. Those funds, however, were sorely needed years before and amounted to only a fraction of what public health officials believe necessary to control TB today.