TB Challenge: Partnering to Eliminate TB
in African Americans
A Texas Perspective: An Interview with Phyllis
Vic Tomlinson, TB Program Consultant, DTBE/FSEB
Ms. Phyllis Cruise is a senior public health advisor with CDC assigned
to the Texas Department of Health's TB program.
Vic Tomlinson: In the course of your career, what have you
done to address the issue of health disparities among African Americans
and other minorities?
Phyllis Cruise: Being African American in a primarily Caucasian-dominated
environment, I can not and have not attempted to represent the experiences
or the points of view of all other African Americans. I have attempted
to bring attention to and place on the agenda issues I have encountered
in my public health experience which I found to be beneficial to
most persons regardless of race or ethnicity. Having the opportunity
to work in various geographic parts of the United States, with persons
from all socioeconomic levels as well as numerous racial and ethnic
groups, I developed a broad-based perspective. I have found people
are more similar than different racially. Most of the differences
I have encountered have been defined more by socioeconomic status,
geographic areas, and personal circumstance.
VT: What are the health disparities that exist in Texas?
PC: I will respond to this from the perspective of TB prevention
and control. In Texas, TB morbidity is primarily in the major metropolitan
areas of the state and in the areas of the state that border Mexico.
These are the same areas with the highest concentration of poverty
and minorities. In Texas, persons of Mexican descent are the major
minority group in all areas of the state, followed by African Americans,
who are in the major metropolitan areas but not a significant presence
in the border areas. Along with the racial factors of TB morbidity
there are also the socioeconomic issues of poverty and lack of access
to quality health care. Texas has three of the poorest counties
in the United States. Both Hispanics and African Americans are disproportionately
affected by these issues and are disproportionately represented
by the rates of TB.
VT: What are you doing currently to address health disparities
PC: I again will respond from a TB perspective. I am not the director
of the TB program and I do not have the authority or the responsibility
to make policy or to directly affect change. I provide input to
the director; I am an active participant in a significant number
of the policy discussions and have a voice in the decision-making
process. As one of the developers of the first binational TB projects
in the state and the current supervisor of the three binational
projects, I bring to the “agenda” statewide issues that affect the
Hispanic minority population of the state; and by my work with the
major metropolitan areas, I bring to the agenda issues which affect
both the Hispanic and the African-American populations of the state.
VT: What do we as a country need to do to address health
disparities among African Americans?
PC: The primary causes of health disparities are economics
and societal/ racial inequities; there is a need for better opportunities
for education and employment. We should not allow racist activities
and/or discriminatory activities to be a part of public health activities
or ignore such activities. Also, we must allow more African Americans
and other minorities an active role in public health policy development,
decision making, and implementation. In addition, CDC should have
more African Americans in decision-making positions.
VT: How did you get involved in public health?
PC: I interviewed during a nationwide recruitment for the
sexually transmitted disease (STD) program.
VT: What attracted you to public health?
PC: I was interested in a change, the opportunity to do
something different, and the opportunity to make a difference beyond
my immediate environment.
VT: Which public health programs have you worked with?
PC: All of my public health experience has been with CDC
working for 10-plus years with the STD program before my assignment
to the TB program.
VT: Tell me about your early days of working in TB. What
was it like?
PC: It was very interesting. As I had no previous direct
experience in TB as the director of the program, it was imperative
for me to learn all areas of TB as soon as possible, since I had
direct responsibility for all aspects of the state program. I was
the direct link to the local health departments, to hospitals statewide
and to private providers, and others.
VT: How has the Texas TB program changed over time?
PC: The primary change has been in the amount of state funds
available for the program. Historically the program had been extremely
well funded. The state is currently in a funding shortfall and in
the midst of a major reorganization of all state agencies. The program
was much smaller when I started; there were 9 people in the central
office in Austin. Currently there are 34. In the early 90s, there
was an average of 2,380 cases per year; TB morbidity reported for
2003 was 1,595 cases.
VT: Thanks for your time. Any final thoughts?
PC: I would also add that I consider myself very fortunate
in the career I have with CDC. Few people have the opportunity to
make a difference in the lives of a significant number of persons
during the course of their own lives. Through the work I perform,
I make a difference in the lives of people who I may never meet
or who may never encounter me. I think the opportunity and the work
I do are an important trust that I hold very seriously.