Controlling Resurgent Tuberculosis: Public Health Agencies, Public Policy,

Abstract The reappearance of tuberculosis as a serious public health threat points up the fallacy of the widely held assumption that medical science had conquered the communicable diseases that were once leading causes of morbidity and mortality. In devising a strategy to prevent the spread of TB, public policymakers must adapt tra-ditional TB control measures to reflect the current problem. Such a strategy can and should include the appropriate use of governmental coercion to compel observance of public health TB control measures. Public health approaches to control of human immunodeficiency virus. with their emphasis on the voluntary cooperation of those infected and at high risk for infection. arc not a model for effective TB control. Addi-tional resources, while needed. will not alone enable public health agencies to bring TB and other communicable diseases under control. In the present debate over health can reform, little attention has been paid to the importance of public health agencies in protecting the public health. The resurgence of TB is a warning of the consequences of neglecting public health agencies and ignoring the socioeconomic problems that underlie it and other communicable diseases. Most Americans have no memory, or only a dim memory, of the ter-rible epidemics of communicable diseases that used to sweep the country periodically. Contrary to conventional wisdom, such epidemics are not a thing of the past. Communicable diseases are emerging and will continue to emerge to threaten public health (Institute of Medicine 1992)