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Health Policy Analysis Paper


The United States considers the TB infection as a major threat to its citizens and implements different programs to fight this dangerous infection. The U.S. government has provided health policy programs against tuberculosis for many decades. Although, there is enough medicine to treat tuberculosis, this disease remains one of the most dangerous in the world as well as in the USA. A large number of centers for disease control are operating all over the country. Nowadays, the government has a great concern about protection and treatment of the disease. For this reason, the U.S. Congress has issued the Comprehensive Tuberculosis Elimination Act of 2014 that forces local health departments to keep this disease under control. Many scholars have overviewed the spread of tuberculosis in the last decades. For this reason, the government urges the authorities and community to implement protective measures to eliminate this disease. This paper aims to examine historical and socioeconomic conditions that have led to development of the policy.


The Historical Background of Tuberculosis in the USA

Meunier (2013) assumes that tuberculosis has a long history. It is about 6,000 years old. The disease originated in Africa and later spread across other countries via trade routes. Many scholars believed that tuberculosis affected animals such as lions that carried the disease across the Atlantic Ocean to America. According to Armus (2011), the 1970s were called “a golden era” for development of TB drugs and treatment. Concurrently, microbiological methods to test for susceptibility to those new drugs were developed. Although tuberculosis often is subject a positive treatment due to antibiotics, it remains one of the most threatening diseases in the United States. Researchers have mostly ceased their efforts aimed at developing new anti-TB drugs in developed countries. However, many pharmaceutic industries in underdeveloped countries continue developing TB drugs. The problem of tuberculosis still exists all over the world and authorities should continue implementing protective measures to stop it. Nowadays, the government encourages various projects to treat the TB with a high standard of care to patients.

The research asserts that tuberculosis has been recognized as an important life-threatening human disease since the beginning of the recorded history (Meunier, 2013). In the 19th and early 20th century, the TB was wide-spread in the world because of improper sanitary conditions, poor hygiene practices, and the lack of immunological defense against the disease. With advent of modern sanitation system and better hygienic practices after the turn of the 20th century, the incidence of the TB steadily began declining, especially in densely populated urban areas (Peters, 2013). The TB, also called the “white plague”, was a leading cause of death in the 19th century in Europe and the United States. Nowadays, the TB is a leading cause of mortality in developing countries and remains an enormous health and economic problem. All these historical, socioeconomic, and health conditions have led to the development of the policy named the Comprehensive Tuberculosis Elimination Act of 2014 in the U.S. Congress.

Conditions that Led to the Development of the Policy

Many people in developed countries such as the USA and Britain consider the TB control as the most successful achievement in the history of medicine. However, there are still regions in the world and some slum areas in developed countries where tuberculosis exists. Thus, the TB threats some population groups in the USA, such as African-Americans and other ethnic minorities, especially the immigrant population. The country observed a tuberculosis outbreak in 2002-2008. For this reason, the U.S. Congress has approved the Comprehensive Tuberculosis Elimination Act of 2014.

According to the research, 2 billion people are infected with tuberculosis in the world and about 15 million of the infected are in the USA (Meunier, 2013). For this reason, the U.S. government and policy makers recognize the importance of providing strict measures to prevent and decrease the rate of the disease. Living conditions of minority groups in the USA make them at risk of TB infection and require improved diagnosis, screening, and treatment. Immigrants from countries where the TB is indigenous are at a greater risk because they could be infected in their countries of origin. Although the total number of TB cases has declined, incidents among foreign-born persons as a percentage of total cases have increased (Peters, 2013). The TB case rate among foreign-born persons in the United States is eleven times greater than among the U.S.-born persons.

Closing the gap between TB rates among foreign-born and native-born Americans is a national health objective. Individuals with untreated TB infection are sources of infection for other individuals. Marcos (2013) argues that TB case rates are higher among racial and ethnic minorities than among whites in the USA. The main indicators are income, crowding, poverty, unemployment, education, and public assistance. Many studies have found that American Indian, Black, Hawaiian, and Puerto Rican individuals, as well as those in the lower socioeconomic strata face the increased risk of death (Madanat, Arredondo, & Ayala, 2015). Thus, reducing socioeconomic disparities and improving access to health care may bring about a decline in overall mortality.

Comprehensive Tuberculosis Elimination Act of 2014

The goal of the Comprehensive Tuberculosis Elimination Act is to fight the TB at the global level. The USA tends to prevent TB infection in the world, thus becoming a world leader in this battle. Introduction of this act has been determined by the threat of the TB in the USA, mainly among minority groups. The research has asserted that the U.S. government agencies declined the amount of programs relating to TB protection, diagnosing, and treatment from 2009 to 2012 (Marcos, 2014). Tuberculosis seemed to be almost eliminated in the United States at the time. However, recent records have shown that the disease still remains present and threatens the population of many countries as well as the USA. The legislative process strengthens efforts meant to eliminate the TB and its consequences.

The act is aimed at eliminating the threat of the TB in the United States and encouraging the country authorities to maintain leadership against tuberculosis globally. Being a public health threat, the growing number of tuberculosis infection cases requires the authorities to implement more active measures and programs to protect people from the dangerous disease. The reporting of tuberculosis began in 1953 and findings of 2012 showed that there were only 9,951 new cases of the TB in the USA. Since then, the research has declined in this direction although the statistics proves that TB cases have begun to increase in number. The state and federal authorities have been alarmed about the need to reinforce protective measures to stop the disease. Decrease of funding for the TB research has become one of the main issues.

Peters (2012) assumes that the Comprehensive Tuberculosis Elimination Act is based on changes to existing state laws. These laws have been considerably modified and adapted to targeted goals. By 2009, the TB research that was funded by the U.S. federal agencies that cared about TB treatment was under decline. For this reason, the Congress has issued a number of suggestions to reinforce their work. Many authorities consider that progress relating to the TB allows them to shorten the length of treatment. However, records of the TB epidemiology have shown that the authorities have to improve and continue the research. The TB policy may bitterly contested by certain factions within the Congress, the Senate, and the President.

The Political Climate at the Time

The political climate at the time of the Comprehensive Tuberculosis Elimination Act adoption was determined by public dissatisfaction because of the decline in the health care services, particularly with the increasing rates of the TB infection. Some scholars evaluated it as the worst in the United States. According to the research, the 113th Congress had the lowest support rate since 1974 (Marcos, 2014). Admittedly, a great amount of respondents (about 83%) was dissatisfied with the job of the Congress. It was obvious that the government gave an opportunity to other countries to prevent the infection in their own countries by eliminating tuberculosis in the United States. However, there were some people in the Congress who detracted efforts aimed at investing money in the elimination of the TB in other countries.

In 2010, a number of TB laws encouraged state and local authorities to prevent and control the disease in the United States. The Advisory Council for the Elimination of Tuberculosis (ACET) requested all agencies to provide measures that prevented the spread of the TB infection. The ACET issued recommendations to all 50 states and the District of Columbia. TB programs were developed to control legal counsel, TB program staff, and federal public health organizations by providing a wide range of protective measures, expertize, and experience. The state and federal health care authorities provided workshops where participants reviewed retention of protective programs and provided feedback on laboratory provisions. Major supporters of the measures were the Congress, the Senate, and the President. Some of the Comprehensive Tuberculosis Elimination Act’s detractors were international public control agenda, global health care organizations, and national institutes of health.

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Historical and socioeconomic conditions that have led to the development of the policy have demonstrated the importance of the Comprehensive Tuberculosis Elimination Act of 2014. It is aimed at controlling the rate of TB cases in the United States and other countries. Although, tuberculosis treatment has achieved considerable advances, the world community still faces serious problems in this respect. These problems should not be neglected by the world authorities. Due to high achievements in medicine, the United States should be a worldwide leader in prevention, diagnosing, and treatment of tuberculosis.

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