Of a total of 1,261 new TB cases reported to the New York City Department of Health last year, 64 percent involved people born outside the United States, compared with the 18 percent reported in 1992.

The disproportionate rates of infection among immigrant communities is especially evident here, where lack of access to medical care and other social services, along with crowded living conditions, give rise to conditions that favor the spread of the disease.

In Corona, a neighborhood in Queens where waves of immigrant workers from Latin America and Asia have settled in the last decade, the rate of TB reached 36.1 cases per 100,000 in 2001. That is more than double the city’s average of 15.7 and seven times the national rate.

"It’s a dramatic change in the disease," said Sonia Munsiff, assistant commissioner for the Tuberculosis Control Program at the New York City Department of Health. "We are no longer in crisis mode, but in certain places, case rates are many times more than they should be."

In 1992, at the height of an epidemic that ravaged the Black community, the infection rate went as high as 52 per 100,000 people citywide, and 240 in Central Harlem. A 1996 editorial in the Journal of the American Medical Association drew some conclusions about the conditions that allowed for the explosion of the disease.

The article listed overcrowded prisons and shelters for the homeless, the discharge of mentally ill people into the community without adequate support services, and the deterioration of public health programs as contributing factors. In addition, the report cited the increased rates of substance abuse and the HIV epidemic that existed at the time.  
 
Cuts in medical services for immigrants
"Its [TB’s] case rate is a measure of the socioeconomic well-being of our most vulnerable population and by reflection, the state of social justice in this country," the editorial noted. It warned of the need to monitor the impact of cuts in welfare and social security benefits and the effects of limiting access to social and medical services for immigrants.

The 1996 bipartisan Personal Responsibility and Work Opportunity Reconciliation Act, passed under the Clinton administration, excluded immigrants from government assistance programs.

The tuberculosis bacterium is widely associated with congested and bad housing conditions. Transmitted by respiration, it is the leading cause of death due to infectious disease among the world’s adults, killing 2 million a year. According to the World Health Organization an infected person can transmit the infection to 15 to 20 people a year on the average.

The high cost of housing in New York City has forced thousands of working families into overcrowded housing situations. According to a report released in 2000 by the Coalition for the Homeless, the number of housing units considered crowded--more than one person per room--went from 6.5 percent in 1978 to 11 percent in 1999. The number considered seriously crowded, based on a standard of 1.5 people per room, went from 1.5 percent to 3.9 in the same time period.

The New York Times recently described the shift in the rate of infection among immigrants as "a kind of turning back of the clock to the turn of the 20th century, when tuberculosis rippled through the city’s immigrant population, spreading rapidly through tenements and windowless factories."

In the past year New York City officials have also expressed concern that the increase in the cost of housing, combined with a reduction in the number of landlords honoring government vouchers and further cutbacks in social programs, could force thousands of people with AIDS and other disabilities into the streets.  
 
 
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