COLUMN LEFT / ALEXANDER COCKBURN : The Cure for Tuberculosis: a Just Economy : TB is a disease tied more to the economic condition of its victims than to new germs.

Now, on the heels of the AIDS plague, comes a new epidemic in the United States: a recurrence of tuberculosis, with rates of incidence not seen here for more than a generation. From an all-time low of 22,000 cases in 1985, the American Lung Assn. now estimates there are 50,000 fresh cases a year. Worse still, the new strains of TB are resistant to traditional antibiotics and require far more complex treatment.

For the younger folk, TB has been one of those names from a distant past, like polio or diphtheria. It certainly brings back memories for me.

In Ireland in the 1950s, TB was still a big killer. Somewhere around 1956, my father reported he was no longer strong enough to swing his legs over the edge of the bed and we took him off for an X-ray and found that TB had taken over most of his lungs.

He spent the next two years in Sarsfield Court, a sanitarium outside Cork. His ward had originally been designed for children, with each cubicle separated from its neighbor by glass walls. A nurse at one end could thus keep an eye on 30 patients, mostly Irish farmers.

The theory of the curative effects of high, dry air didn’t have much purchase in low-lying Sarsfield. My father’s shoes soon acquired a rich green mold, like a home-grown vaccine.

Eventually he emerged, minus bits of his lungs but in fine overall health. TB ceased to be one of the great Irish scourges. At the time we all assumed the defeat of TB was attributable to vaccines, but this wasn’t the case at all. TB got pushed back in Ireland because living standards improved, particularly in the 1960s. Diets got better and housing got better. Sanitation got better. People’s resistance grew stronger. Economically speaking, Ireland headed out of the Third World.

The same is true in the United States. TB was beaten back chiefly by economic improvement, with help from one of the very few determined government efforts in preventive medicine: Prohibition.

Prohibition, which began with the 18th Amendment in 1918 and ended with passage of the 23rd Amendment in 1933, gets a bad rap these days, with an iconography of riotous speak-easies and wholesale flouting of the laws against liquor. Actually, launched by purposeful idealism, Prohibition achieved some remarkable social effects, notably in the area of health.

Prohibition had a cross-impact on TB because of diet. Alcoholics frequently get their calories from liquor, not food, thus lowering their resistance to TB. For Massachusetts, an area typical of the Eastern Seaboard, the TB death rate per 100,000 in 1870 was 460. By 1900 it had declined to 264 and by 1930 the incidence was down to 68 per 100,000.

Today in New York’s central Harlem, rates of TB incidence (not deaths) are running at 220 per 100,000, which is 35 times the rate in the prosperous upper East Side neighborhoods. Another stark figure from New York is that 40% of AIDS patients have TB.

Partly because of this coincidence of vaccine-resistant strains of TB bacilli and the presumptively fatal AIDS virus, the spotlight is on “killer germ/killer virus” threats (the New Yorker recently ran a widely noticed article on new death viruses from the rain forests). Less discussed is the readily identifiable social and economic underpinning of the new epidemics.

Tuberculosis is a disease of poverty and social neglect. Much of the world is poor and so, worldwide, TB remains a killer more deadly than malaria. Each year 3 million people die from it.

What we are experiencing now is the “Third Worldization” of American health due to widening income differentials and slashes in public spending over the last 15 years.

To a mind-set conditioned by the premises of 19th-Century allopathic medicine (disease is caused by germs), the idea of intimate linkage between sickness and economic policy is distasteful, no matter how vivid the evidence.

But the linkage between, say, a rise in the unemployment rate and fatalities from stroke or heart disease is quantifiable. A study published by the Economic Policy Institute in mid-October displayed the findings of Mary Merva and Richard Fowles of the University of Utah. They associated a rise in the unemployment rate from 5.5% to 7.5% in the 1990-92 recession with about 35,000 additional deaths due to heart disease and nearly 3,000 due to stroke over a two-year period.

So it’s not surprising, given the economic onslaught on the cities, that TB is back. Now, in consequence of these and kindred regressive policies, we have the plagues of poverty, for which social idealism remains the one true cure.