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U.S. Department of Health and Human Services


TB Challenge: Partnering to Eliminate TB
in African Americans

Strategies for TB Elimination in African-American Communities

Division of Tuberculosis Elimination (DTBE): As Surgeon General and Assistant Secretary for Health, you led the Department's effort to eliminate racial and ethnic disparities in health. What can we do as private, public, and government partners to narrow the disparities in TB in the African-American community?

Dr. Satcher: In order to narrow the disparities in TB in the African-American community, we must first understand the nature, magnitude, and distribution of the problem: what segments of the African-American community are most at risk for TB, and why that segment is at risk. For example, if we identify that the major segments include persons with HIV/AIDS, persons who are homeless, and persons who are victims of substance abuse, then our efforts must be geared to those areas. As private citizens, of course, we can work within our communities to reduce the risk of the spread of HIV/AIDS; we can work to ensure not only that there are services available for the homeless that will minimize infection with both HIV and TB, but also that people who are affected have access to care, including directly observed therapy. And of course, we can work with the government to make sure that programs are in place to respond to these community needs. So it begins with understanding the problem; secondly, with understanding the risks or causes for the problem; then intervening in various health settings, whether it's private, public, or government, making sure we evaluate what we do to ensure that we are being effective.

DTBE: Does your current role as the Director of the new National Center for Primary Care at Morehouse School of Medicine keep you on the forefront of public health issues? If so, how?

Dr. Satcher: I have been very fortunate to be able to acquire a position at the Morehouse School of Medicine as the Director of the National Center for Primary Care (NCPC), which allows me to continue to work on and with the major public health issues that I was able to deal with as Surgeon General. For example, the mission of the NCPC is to promote excellence in primary care as well as community-oriented primary care programs, as we have a special emphasis on the underserved and the underrepresented and a special focus on eliminating disparities in health. Those are issues that I dealt with as Surgeon General and as Assistant Secretary for Health. It was as Assistant Secretary for Health that I was able to lead the development and implementation of Healthy People 2010. By the same token, I was able to point out the critical role that primary care can and needs to play in dealing with issues such as asthma, hypertension, diabetes, and especially mental health, which had not received much attention before. We are in a position now to deal with all those issues within the context of the Southeastern Clinician Network and improve the quality of primary care providers there. Also, through our Center of Excellence on Health Disparities, we are able to target issues in cardiovascular disease, cancer, diabetes, mental health, maternal and child health, and HIV/AIDS.

DTBE: Can you relate any of your personal experiences with TB?

Dr. Satcher: Well, I must say that I grew up in an environment of poverty and poor access to health care, so there were people in that environment who suffered from TB. I remember meeting them and hearing about them as I was growing up, thus the people who were at highest risk for this disease were known to me as a child. But in medicine of course, especially when working in public hospitals, whether in Cleveland, Rochester, or Los Angeles at the King Drew Medical Center, I've also come to appreciate the people who are at greatest risk for TB and the fact that those persons are generally people who are either homeless, people who are victims of substance abuse, or people who are infected with other diseases like HIV/AIDS. Of course in a place like Los Angeles, a lot of people who come from other countries are at greater risk of having TB and actually contribute over half the new cases of TB in the country today. Finally, as Director of CDC, I facilitated emphasis on the directly observed therapy approach to tuberculosis control. We were seeing an increase in the incidence of TB in this country each year. However, after CDC assigned significant congressionally appropriated funding to New York City, we were able to develop this directly observed therapy model and show that it can be effective. For example, it's one thing to try to give medications to people who are homeless, but they have nowhere to store them, so among other things we provided funding for nurses or others (outreach staff) who would make sure that people got their medicine each day. They observed that they (TB clients) received their medications, and this is an important component of the worldwide strategy for dealing with TB--and it certainly has been an effective one.

DTBE: CDC has not received large increases in funding for TB prevention and control for over a decade; since we cannot advocate directly to Congress for increased funding, what strategies and approaches would you suggest for leveling the playing field to ultimately eliminate this disease?

Dr. Satcher: It is true that persons working in government cannot lobby Congress or advocate for increased funding for their own programs. I think what we can do, however, is empower those who are able to advocate by providing up-to-date information and providing it in a form that is efficient and easy to use. We have to educate, motivate, and mobilize communities against problems like tuberculosis. And when we do that, those communities themselves will get the message to their representatives in the local, state, or federal government that these programs deserve more funding. We must do a better job of empowering advocates with this information and with motivation.

DTBE: How can CDC, working with traditional and nontraditional partners, better engage African-American communities?

Dr. Satcher: Well, CDC needs to better engage African Americans and other underserved communities in all of its programs. And I think that there are at least two or three approaches to that. The first is that CDC must have more people on its team from those communities, people who understand the culture and patterns of those communities and are able to help develop programs that are relevant. By the same token, we must develop partnerships with those communities. Institutions within the African-American community, whether they are schools, churches, or fraternities and sororities, must become partners with CDC just as they did in the campaign to increase immunizations in the early to mid 90s. So, I think that we must make sure that we have a diverse workforce, partner with institutions in the communities, and by the same token, learn more about those communities and educate everybody about the needs of those communities.


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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CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333