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U.S. Department of Health and Human Services


TB Challenge: Partnering to Eliminate TB
in African Americans

A Texas Perspective: An Interview with Phyllis Cruise

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 in Texas?

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.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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