Tuberculosis in Mexicans: Learning From the Past to Provide Lessons for the Present

BENJAMIN GOLDBERG, A dedicated physician working at the Municipal Tuberculosis Sanitarium of Chicago, Illinois, and a member of the Department of Pathology at the University of Illinois College of Medicine, was a pioneer in introducing early accounts of the public health challenges imposed by a new racial “type”: Mexicans. His 1929 Journal article, excerpted here, was originally read before the American Public Health Association's Vital Statistics Section at the association's 57th annual meeting, held in Chicago, Illinois, on October 18, 1928.

Goldberg was a conscientious medical practitioner and public health scientist of the post–World War I era. In this landmark essay, he articulated with passion and conviction a series of nativistic and protectionist arguments discouraging immigration to safeguard the health of US citizens, which he described as the “supreme law.” Goldberg labeled human immigration as a force to reckon with in public health, while also endorsing an abiding concept of that era: that “primitive races” such as Native Americans, and now the Mexicans, had yet to develop immunity from various communicative diseases. As a result, Mexicans suffered greater casualties from diseases such as tuberculosis, which no longer affected as greatly the more “advanced races,” such as non-Hispanic Whites. He warned that the entry of a new race to the country was an emerging threat to US public health.

Goldberg's reference to health disparities via attributions to inferior races such as Mexicans, and in the parlance of the day, “Negroes,” echoed his day's erroneous scientific accounts of “racial immunity,” and the biological survival of the fittest, as certain racial groups were believed to inherit good genes conferring upon them wide-ranging immunity, contrasted with inferior races, whose “quality of stock” made them susceptible to many diseases, including tuberculosis. These beliefs, of course, contrast sharply with contemporary science, which views health disparities as devoid of racialized notions of “quality of stock,” emphasizing instead the interaction of ecological, social, and economic conditions as determinants of racial disparities in health. As we celebrate the 100th year of the Journal, we note that it has had a strong publication record that has guided the examination of racial issues from many different perspectives. This includes the examination of the causes of race-based inequalities and health disparities to understand how racial discrimination and racism can influence the development of racial/ethnic inequalities in health.^1-3

Despite Goldberg's controversial views, he can be credited with introducing into the Journal (as early as 1929) the need to examine “Mexican race/ethnicity” as an emerging cultural group of special interest to public health scientists, practitioners, and politicians. This analysis of data from a Mexican population, as presented by Goldberg, is perhaps the first article within the Journal that examined Hispanic health. Decades later, three landmark studies published in the 1970s and 1980s^4-6 triggered a series of accounts regarding the health problems of Mexican Americans, which served as a platform for the development of an epidemiological and systematic account of Hispanic health data. Later, the Hispanic Health and Nutrition Examination Survey conducted from 1982 to 1984 generated the first comprehensive knowledge regarding the health of Hispanics in the United States, and a compendium of these studies was included in a 1980 Journal supplement.⁷

In the 80 years since Goldberg's contribution, a variety of negative and positive sociopolitical views of Mexicans have been espoused, triggering the commitment of the scientific community to explore in detail and with scientific rigor the social determinants of Hispanic health disparities, including the well-known concept of the Hispanic paradox.⁸ Goldberg attempted to lend scientific credibility to support his views by citing local epidemiological data that highlighted racial health disparities in tuberculosis rates. Goldberg's perspectives serve as historical accounts, but these views are still evident within contemporary society in the midst of debates about health disparities and health care reform. It is a historical fact that during periods of economic prosperity Mexicans and other immigrants have been welcomed by many in the United States as sources of cheap labor. However, during periods of economic downturns these views have turned to antagonism and to the demonization of immigrants— views used to justify their expulsion and repatriation.⁹

The findings in the 2010 Journal supplement on the science of the elimination of health disparities indicate the way in which responsible public health science and practice can be exercised to improve health equity and protect local communities from communicable diseases; the supplement authors also addressed real economic concerns over strains on public health resources. These goals can be achieved based on the use of better science that moves beyond the unfortunate discrimination and scapegoating prompted by inaccurate models of disease causation used during a bygone era. We can and should learn from the past. We now have a historical opportunity to improve the nation's health, given our enhanced understanding of what it takes to address and eliminate health disparities. History tells us that the accounts of questionable scientific theories regarding the superiority of Whites and the inferiority of Mexicans and other races/ethnicities are part of the past. We look to the future with confidence to achieve health equity and social justice in public health. n