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TB Challenge: Partnering to Eliminate TB
in African Americans
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Strategies for TB Elimination in African-American
Communities
Division of Tuberculosis Elimination (DTBE): As Surgeon
General and Assistant Secretary for Health, you led the Department's
effort to eliminate racial and ethnic disparities in health. What
can we do as private, public, and government partners to narrow
the disparities in TB in the African-American community?
Dr. Satcher: In order to narrow the disparities in TB in
the African-American community, we must first understand the nature,
magnitude, and distribution of the problem: what segments of the
African-American community are most at risk for TB, and why that
segment is at risk. For example, if we identify that the major segments
include persons with HIV/AIDS, persons who are homeless, and persons
who are victims of substance abuse, then our efforts must be geared
to those areas. As private citizens, of course, we can work within
our communities to reduce the risk of the spread of HIV/AIDS; we
can work to ensure not only that there are services available for
the homeless that will minimize infection with both HIV and TB,
but also that people who are affected have access to care, including
directly observed therapy. And of course, we can work with the government
to make sure that programs are in place to respond to these community
needs. So it begins with understanding the problem; secondly, with
understanding the risks or causes for the problem; then intervening
in various health settings, whether it's private, public, or government,
making sure we evaluate what we do to ensure that we are being effective.
DTBE: Does your current role as the Director of the new
National Center for Primary Care at Morehouse School of Medicine
keep you on the forefront of public health issues? If so, how?
Dr. Satcher: I have been very fortunate to be able to acquire
a position at the Morehouse School of Medicine as the Director of
the National Center for Primary Care (NCPC), which allows me to
continue to work on and with the major public health issues that
I was able to deal with as Surgeon General. For example, the mission
of the NCPC is to promote excellence in primary care as well as
community-oriented primary care programs, as we have a special emphasis
on the underserved and the underrepresented and a special focus
on eliminating disparities in health. Those are issues that I dealt
with as Surgeon General and as Assistant Secretary for Health. It
was as Assistant Secretary for Health that I was able to lead the
development and implementation of Healthy People 2010. By
the same token, I was able to point out the critical role
that primary care can and needs to play in dealing with issues such
as asthma, hypertension, diabetes, and especially mental health,
which had not received much attention before. We are in a position
now to deal with all those issues within the context of the Southeastern
Clinician Network and improve the quality of primary care providers
there. Also, through our Center of Excellence on Health Disparities,
we are able to target issues in cardiovascular disease, cancer,
diabetes, mental health, maternal and child health, and HIV/AIDS.
DTBE: Can you relate any of your personal experiences with
TB?
Dr. Satcher: Well, I must say that I grew up in an
environment of poverty and poor access to health care, so there
were people in that environment who suffered from TB. I remember
meeting them and hearing about them as I was growing up, thus the
people who were at highest risk for this disease were known to me
as a child. But in medicine of course, especially when working
in public hospitals, whether in Cleveland, Rochester, or Los Angeles
at the King Drew Medical Center, I've also come to appreciate the
people who are at greatest risk for TB and the fact that those persons
are generally people who are either homeless, people who are victims
of substance abuse, or people who are infected with other diseases
like HIV/AIDS. Of course in a place like Los Angeles, a lot of people
who come from other countries are at greater risk of having TB and
actually contribute over half the new cases of TB in the country
today. Finally, as Director of CDC, I facilitated emphasis on the
directly observed therapy approach to tuberculosis control. We were
seeing an increase in the incidence of TB in this country each year.
However, after CDC assigned significant congressionally appropriated
funding to New York City, we were able to develop this directly
observed therapy model and show that it can be effective. For example,
it's one thing to try to give medications to people who are homeless,
but they have nowhere to store them, so among other things we provided
funding for nurses or others (outreach staff) who would make sure
that people got their medicine each day. They observed that
they (TB clients) received their medications, and this is an important
component of the worldwide strategy for dealing with TB--and it
certainly has been an effective one.
DTBE: CDC has not received large increases in funding for
TB prevention and control for over a decade; since we cannot advocate
directly to Congress for increased funding, what strategies and
approaches would you suggest for leveling the playing field to ultimately
eliminate this disease?
Dr. Satcher: It is true that persons working in government
cannot lobby Congress or advocate for increased funding for their
own programs. I think what we can do, however, is empower
those who are able to advocate by providing up-to-date information
and providing it in a form that is efficient and easy to use. We
have to educate, motivate, and mobilize communities against problems
like tuberculosis. And when we do that, those communities themselves
will get the message to their representatives in the local, state,
or federal government that these programs deserve more funding.
We must do a better job of empowering advocates with this information
and with motivation.
DTBE: How can CDC, working with traditional and nontraditional
partners, better engage African-American communities?
Dr. Satcher: Well, CDC needs to better engage African Americans
and other underserved communities in all of its programs. And I
think that there are at least two or three approaches to that. The
first is that CDC must have more people on its team from those communities,
people who understand the culture and patterns of those communities
and are able to help develop programs that are relevant. By the
same token, we must develop partnerships with those communities.
Institutions within the African-American community, whether they
are schools, churches, or fraternities and sororities, must become
partners with CDC just as they did in the campaign to increase immunizations
in the early to mid 90s. So, I think that we must make sure that
we have a diverse workforce, partner with institutions in the communities,
and by the same token, learn more about those communities and educate
everybody about the needs of those communities.
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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