Lerner B H
Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle 98105.
Am J Public Health. 1993 May;83(5):758-66. doi: 10.2105/ajph.83.5.758.
New York City began America's first campaign to control tuberculosis in 1893, and the disease declined until the 1970s. Throughout the 20th century, New York relied on three control strategies: screening, supervised therapy, and detention of noncompliant persons. Officials consistently identified the persistent foci of tuberculosis to be minorities and the poor, and they concentrated efforts among these populations. Recently, however, in the setting of rising human immunodeficiency virus infection and homelessness, tuberculosis--including multidrug-resistant strains--has returned to New York with a vengeance. Tuberculosis control in the city has been limited by two problems that hamper many public health programs: (1) antituberculosis measures, while appropriately targeting the poor, have been inconsistently funded and poorly coordinated; and (2) efforts have emphasized detection and treatment of individual cases rather than improvement of underlying social conditions. Renewed efforts by New York and other cities must address these limitations.
1893年，纽约市发起了美国首次结核病防治运动，此后该疾病发病率不断下降，直至20世纪70年代。在整个20世纪，纽约依靠三种防治策略：筛查、监督治疗以及拘留不遵守规定的人员。官员们一直认定结核病的持续高发人群为少数族裔和贫困人口，并在这些人群中集中开展防治工作。然而，近年来，随着人类免疫缺陷病毒感染率上升和无家可归者增多，结核病——包括耐多药菌株——卷土重来，肆虐纽约。该市的结核病防治工作受到两个问题的制约，这两个问题也阻碍了许多公共卫生项目：（1）抗结核措施虽然适当地针对贫困人口，但资金投入不稳定且协调不力；（2）工作重点一直是发现和治疗个别病例，而非改善基本社会状况。纽约市和其他城市必须重新做出努力，解决这些限制因素。
