Race Against TB: A call to action
24 February 2011
In the autumn, Race for Health was delighted to publish, alongside TB Alert, an important set of recommendations about ensuring race equality in health around tuberculosis.
The heart of the matter concerned three key points. First, the incidence of tuberculosis in Britain has risen steadily over the last 20 years, alongside the impact experienced disproportionately by black and minority ethnic (BME) communities. This is unacceptable.
Second, we have the means to tackle the problem. Standardised and fully funded TB services, at all stages of the pathway from public and professional awareness through to treatment completion, could rapidly and cost-effectively reduce the scale of this problem.
Third, we need changes in service design and delivery. They should involve multi-sector partnerships involving the health sector, local government, third sector organisations and service users.
Given these overarching considerations, our goal in co-publishing these recommendations has been to raise understanding of the challenges and about good practice. But we came together with TB Alert to do more than that. As W.B. Yeats said, ‘Education is not about filling the pail, but about lighting the fire.’
This joint initiative is crucially about action – about what we are going to do. The knowledge is there. Action, however, also requires the will and the organisational commitment.
The actions we seek are practical and fairly straightforward, set out in 15 recommendations. They argue for a specialist commissioning approach to TB. London, in particular, given its high levels of TB, should have city-wide commissioning. Third sector organisations skilled in the experiences and needs of their communities – and those, like TB Alert, with longstanding expertise in the field – should be at the heart of support for commissioning and provision.
Despite funding cuts elsewhere, TB should receive more not less cash (ring-fenced), to take account of historic underfunding, growing need and the cost effectiveness of minimising onwards transmission.
We have found a great need to standardise service delivery for dealing with TB, based on best practice and demonstrated clinical effectiveness. But the clinical and social approaches to TB control should be more closely linked, providing a more patient-centred approach that understands a person’s condition within their social and appropriate cultural context.
In that context, directly observed therapy (DOT) should be recognised as a universally effective policy to increase compliance and tackle drug resistant TB. However, it should not be introduced as a coercive model but one involving sensitive engagement with the patient’s broader needs.
We also draw attention to the need for awareness-raising about TB among clinicians and also the role of pharmacists in spotting cases. Finally, we call for screening for TB at UK ports of entry to be reviewed. Procedures are neither up to date, nor effective.
Fulfilling this agenda will need firm commitment to challenging race inequality. Our recommendations – and the earlier summit of TB experts, out of which they evolved – demonstrate how dealing with inequality can be the most cost effective way of improving health for everyone. It demonstrates once more that race equality is a mainstream, not a side, issue.
Helen Hally, National Director, Race for Health
Read the full report.
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