Skip to main content
NCBI home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1998 Jul;88(7):1105–1117. doi: 10.2105/ajph.88.7.1105

Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis.

A L Fairchild 1, G M Oppenheimer 1
PMCID: PMC1508245  PMID: 9663166

Abstract

Tuberculosis (TB) began to decline in the Western world in the mid- to late 1800s. In the United States, the disease receded until the mid-1980s, when that trend was reversed. Although the TB epidemic in the United States subsided in response to public health interventions, it sparked a controversy regarding the relative value of targeted public health measures vs broad social reform. That controversy, which echoed earlier debates calling for structural reform over public health programs, was further strengthened by the historical and demographic studies of Thomas McKeown. His influential thesis maintains that clinical and primary prevention efforts had little effect on TB mortality. In this paper, the historical literature is used to examine whether public health had a significant impact on the decline of TB mortality rates in several countries. Specifically, the paper describes the arguments for and data affirming the efficacy of 2 major public health interventions over time: segregation of those infected with pulmonary TB and eradication of bovine TB. This review finds support for the hypothesis that public health measures, along with other factors, led to falling rates of TB mortality beginning in the late 19th century.

Full text

PDF
1105

Images in this article

1111FIGURE 3
on p.1111
1112p1112-a
on p.1112
1113p1113-a
on p.1113

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Annas G. J. Control of tuberculosis--the law and the public's health. N Engl J Med. 1993 Feb 25;328(8):585–588. doi: 10.1056/NEJM199302253280825. [DOI] [PubMed] [Google Scholar]
  2. Apple R. D. "To be used only under the direction of a physician": commercial infant feeding and medical practice, 1870-1940. Bull Hist Med. 1980 Fall;54(3):402–417. [PubMed] [Google Scholar]
  3. Bayer R., Stayton C., Desvarieux M., Healton C., Landesman S., Tsai W. Y. Directly observed therapy and treatment completion for tuberculosis in the United States: is universal supervised therapy necessary? Am J Public Health. 1998 Jul;88(7):1052–1058. doi: 10.2105/ajph.88.7.1052. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bayer R., Wilkinson D. Directly observed therapy for tuberculosis: history of an idea. Lancet. 1995 Jun 17;345(8964):1545–1548. doi: 10.1016/s0140-6736(95)91090-5. [DOI] [PubMed] [Google Scholar]
  5. Brudney K., Dobkin J. Resurgent tuberculosis in New York City. Human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs. Am Rev Respir Dis. 1991 Oct;144(4):745–749. doi: 10.1164/ajrccm/144.4.745. [DOI] [PubMed] [Google Scholar]
  6. Bryder L. 'Not always one and the same thing': the registration of tuberculosis deaths in Britain, 1900-1950. Soc Hist Med. 1996 Aug;9(2):253–265. doi: 10.1093/shm/9.2.253. [DOI] [PubMed] [Google Scholar]
  7. Caldwell J. C. Health transition: the cultural, social and behavioural determinants of health in the Third World. Soc Sci Med. 1993 Jan;36(2):125–135. doi: 10.1016/0277-9536(93)90204-h. [DOI] [PubMed] [Google Scholar]
  8. Farrow S. C. McKeown reassessed. Br Med J (Clin Res Ed) 1987 Jun 27;294(6588):1631–1632. doi: 10.1136/bmj.294.6588.1631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Guha S. Nutrition, sanitation, hygiene, and the likelihood of death: the British Army in India c. 1870-1920. Popul Stud (Camb) 1993 Nov;47(3):285–401. doi: 10.1080/0032472031000147206. [DOI] [PubMed] [Google Scholar]
  10. Guha S. The importance of social intervention in England's mortality decline: the evidence reviewed. Soc Hist Med. 1994 Apr;7(1):89–113. doi: 10.1093/shm/7.1.89. [DOI] [PubMed] [Google Scholar]
  11. Hotchkiss R. L. Directly observed treatment of tuberculosis. N Engl J Med. 1993 Jul 8;329(2):135–135. doi: 10.1056/NEJM199307083290215. [DOI] [PubMed] [Google Scholar]
  12. Landesman S. H. Commentary: tuberculosis in New York City--the consequences and lessons of failure. Am J Public Health. 1993 May;83(5):766–768. doi: 10.2105/ajph.83.5.766. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lerner B. H. New York City's tuberculosis control efforts: the historical limitations of the "war on consumption". Am J Public Health. 1993 May;83(5):758–766. doi: 10.2105/ajph.83.5.758. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. McFarlane N. Hospitals, housing, and tuberculosis in Glasgow, 1911-51. Soc Hist Med. 1989 Apr;2(1):59–85. doi: 10.1093/shm/2.1.59. [DOI] [PubMed] [Google Scholar]
  15. McKeown T., Record R. G., Turner R. D. An interpretation of the decline of mortality in England and Wales during the twentieth century. Popul Stud (Camb) 1975 Nov;29(3):391–422. [PubMed] [Google Scholar]
  16. Mitchell A. An inexact science: the statistics of tuberculosis in late nineteenth-century France. Soc Hist Med. 1990 Dec;3(3):387–403. doi: 10.1093/shm/3.3.387. [DOI] [PubMed] [Google Scholar]
  17. Murray C. J., Chen L. C. In search of a contemporary theory for understanding mortality change. Soc Sci Med. 1993 Jan;36(2):143–155. doi: 10.1016/0277-9536(93)90206-j. [DOI] [PubMed] [Google Scholar]
  18. Neugebauer R. The uses of psychosocial epidemiology in promoting refugee health. Am J Public Health. 1997 May;87(5):726–728. doi: 10.2105/ajph.87.5.726. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Omran A. R. A century of epidemiologic transition in the United States. Prev Med. 1977 Mar;6(1):30–51. doi: 10.1016/0091-7435(77)90003-2. [DOI] [PubMed] [Google Scholar]
  20. Omran A. R. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q. 1971 Oct;49(4):509–538. [PubMed] [Google Scholar]
  21. Razzell P. E. 'An interpretation of the modern rise of population in Europe' - a critique. Popul Stud (Camb) 1974 Mar;28(1):5–17. doi: 10.1080/00324728.1974.10404576. [DOI] [PubMed] [Google Scholar]
  22. Tomes N. The private side of public health: sanitary science, domestic hygiene, and the germ theory, 1870-1900. Bull Hist Med. 1990 Winter;64(4):509–539. [PubMed] [Google Scholar]
  23. Wallace D. Roots of increased health care inequality in New York. Soc Sci Med. 1990;31(11):1219–1227. doi: 10.1016/0277-9536(90)90127-e. [DOI] [PubMed] [Google Scholar]
  24. Weis S. E., Slocum P. C., Blais F. X., King B., Nunn M., Matney G. B., Gomez E., Foresman B. H. The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med. 1994 Apr 28;330(17):1179–1184. doi: 10.1056/NEJM199404283301702. [DOI] [PubMed] [Google Scholar]
  25. Wilson L. G. The historical decline of tuberculosis in Europe and America: its causes and significance. J Hist Med Allied Sci. 1990 Jul;45(3):366–396. doi: 10.1093/jhmas/45.3.366. [DOI] [PubMed] [Google Scholar]
  26. Wilson L. G. The rise and fall of tuberculosis in Minnesota: the role of infection. Bull Hist Med. 1992 Spring;66(1):16–52. [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES