TB Challenge: Partnering to Eliminate TB
in African Americans
A “New Attitude” to Reduce TB Health Disparities
Vic Tomlinson, Public Health Advisor, DTBE/ FSEB
Vic Tomlinson: In the course of your career, what have you
done to address the issue of TB as a health disparity among African
Americans and other minorities?
Charles Wallace: We've done a number of things in Texas
that look at African Americans or special populations. We received
some federal funding from CDC to look at populations that are most
at risk and a lot of those individuals are African Americans. We
focused primarily on males and looked at HIV infection and substance
abuse. Most of our TB cases here in Texas occur primarily in males.
VT: What are you doing currently to address TB as a health
disparity in Texas?
CW: We applied for some federal support from CDC that targets
African Americans in Texas, but we didn't receive those funds. So,
we tried to realign our budget to focus on African Americans particularly
in the Dallas County area. Also, we tried to work with communities
and organizations across the state having influence with African-American
communities. About 4 years ago we started an initiative called elevator
projects that really focused on targeting African Americans and
other groups as well, but targeting programs that work with African-American
communities. We tried to help African Americans become more aware
of TB and to bring more awareness to our program managers that African
Americans are at higher risk in some communities than some other
VT: What do we, as a country, need to do to address TB as
a health disparity among African Americans?
CW: To be honest with you, I think that what you have to
do with African Americans is much like what you have to do for the
rest of the population. I think that we have not engaged the African-American
community from a public health perspective as much as we should
have. Minority communities are still basically treated as a generic
Sometimes our approach has to be different and unique, more focused
and specific, to ensure that information reaches the African-American
community. Sometimes the funding is not adequate to really put on
a good show or good program for these populations. It's sort of
hit and miss. We need to be putting some sustainable resources in
those areas where populations that are impacted the most are given
enough resources. It's going to take some time to change people's
attitudes, mindsets, and focus on this disease. Right now they are
not focused at all. They think that the disease is forgotten, gone,
and no longer with us. Very few people in the African-American community
know that TB is still around and know how affected the African-American
community really is. We need to have a massive campaign to deal
with this particular disease in foreign-born, African-American,
and other populations that are impacted by TB.
VT: What attracted you to the TB program?
CW: I actually came to the Texas Department of Health working
in the sexually transmitted disease (STD) program, like many others.
After working at a hospital in Haiti, I came back unemployed to
Texas and the position for an STD disease intervention specialist
(DIS) came open. I worked in that position for about a year, and
an opportunity presented itself to work in HIV. I worked in the
HIV program for about 2 years, and then the position of assistant
division director came open in tuberculosis. I applied for that
position and got it. I worked in that capacity for 9 years and then
left to be the director of the Office of Minority Health for the
department for 5 years. Then I came back to TB to serve as director
of the tuberculosis division in the Texas Department of Health.
VT: How has the Texas TB program changed over time?
CW: Actually we went from 4 people to 40 people over time.
We now have around 30 people in the central office program. We moved
from a focus on the general population during the time of 1983-1984
to more of a focus on high-risk populations, with a greater emphasis
on the foreign born. That is a drastic change. I have seen some
growth in funding since 1983-1984. One of the biggest changes has
been the emphasis on global TB from a state perspective and the
collaboration with Mexico on the binational TB projects.
VT: If there were one thing that you could change about
the TB program, what would that be?
CW: The TB program in Texas is going through change, so
one of our short falls has been not having enough resources, from
a state perspective, to do the job that we need to do in TB. Often
we do not have the resources to purchase medications and testing
supplies for the program and usually end up trying to get those
resources from other sources. So, having enough resources would
be a tremendous benefit for the Texas TB program. The other thing
is looking at TB from a global perspective. I really think that
we talk about ending neglect as the badge of our activity, but we
still neglect to understand what that means in the context of special
populations, particularly the African-American population. There
is almost a “deaf-ear” concept, if you will, when it comes to this
particular population, not only with TB but with health conditions
across the board. It's difficult to get folks to really hear the
message that this population is in trouble healthwise. Until people
actually become aware that the only way we will be able to change
conditions is when people are willing to share what the conditions
are, and then react to it in a positive way, we'll continue to see
the same health disparities in TB that we see with other conditions
that African Americans suffer. Sometimes the problem with the foreign-born
overshadows many other populations because that is such a dire situation,
especially here in Texas and other border communities; we cannot
forget that domestic TB is just as significant as foreign-born TB.
TB has always been present as a domestic issue in the African-American
community in this country, but as with many other conditions, it
has been ignored and even neglected to a degree that it has been
allowed to flourish and no one has really cared that much about
it. That is a reflection of just how much people really care about
the population and how much people care about this particular racial
ethnic group. That attitude hasn't changed. Until that attitude
changes, we will continue to have this problem with TB in African
Americans and other health disparities. This is the type of change
that needs to take place on the national level. The road block that
I often run into is getting folks to listen and quickly turn off
the rhetoric of saying that one is too emotional about this issue
and dismiss it as being an emotional appeal as opposed to factual.
I think that facts bear out that TB is a major public health problem
in African-American communities as well as the foreign-born communities
in this state and this country. One cannot be any lesser than the
other when it comes to interventions and resource allocations and
mobilizing all kinds of efforts to make a difference.
VT: Thank you for your time. Any final thoughts?
CW: What's good for African Americans surrounding TB is
good for Caucasian-Americans and all the rest of the population.
If we do the right thing by this particular group that is lowest
on the totem pole, then when it comes to good health quality, it's
going to be good for everybody else. If we allow it to fester and
be neglected, it will certainly impact the health and well-being
of everyone in this country and in the world. We need to be aware
of that and then act accordingly.