Keep the Guard Up Against TB

For the first time in nearly a decade, U.S. health officials are reporting tangible success in the national battle against tuberculosis. But recent progress--testimony to aggressive, flexible and well-funded health programs--is tempered by the ominous prospect of domestic health program cuts.

TB typically is spread through the air by coughing or sneezing. The disease can snuff out life slowly and painfully by laying waste to the lungs. A single carrier usually infects three to four others before the disease is diagnosed and treated, authorities say.

Earlier this month the U.S. Centers for Disease Control and Prevention in Atlanta reported the first known cases in which TB was transmitted aboard commercial airliners. Such a report should not be a cause for panic, but neither should it be seen as a bizarre aberration. Not when the global dimensions of this epidemic are so severe.

Since 1990, the World Health Organization reports, TB deaths worldwide have shot up 26%. About 2 billion people are infected, and 8 million new cases were detected last year.

Thankfully, U.S. victims represent less than 1% of the world total--certainly not a raging epidemic. But public health officials need only be reminded of the 1980s, when a three-decade-long decrease in TB was reversed by shortsighted funding cuts for crucial public health programs, such as mobile screening and health education, particularly among immigrants and homeless people in areas where TB is common.

A bill by U.S. Sen. Nancy Kassebaum (R-Kan.) would shift federal public health programs, many of them operated by the CDC, into a block grant to be distributed by the states. Kassebaum says her goal is not to cut public health funding, but she adds there are no guarantees.

And that uncertainty poses a danger for public health. In a boxing match, the fighter who drops his guard probably will suffer painful consequences. The same could be said of public health policy. And when health policy fails, thousands usually go down for the count.