How did modern London become “the tuberculosis capital of Europe”?

The Royal London Hospital in Whitechapel, in London's East End. Image: Getty.

Poverty, overcrowding, poor housing conditions... All these things, we learnt from a London Assembly report published last week, are contributing to an increase in the incidence of tuberculosis in the city.

The fact this most Victorian of diseases is on the rise is not exactly new information, either. In 2005, the BBC reported that the capital had 20 times the TB rate of the rest of the UK, and in 2010, the Telegraph described the city as “the TB capital of Europe”.

But how bad can it really be? The Tackling TB in London report is fairly explicit:

There were over 2,500 new cases of TB in London in 2014, making up approximately 40 per cent of all cases in the UK. One third of London’s boroughs exceed the World Health Organisation “high incidence” threshold of 40 cases per 100,000 population. And some boroughs have incidence levels as high as 113 per 100,000 people – significantly higher than countries such as Rwanda, Algeria, Iraq and Guatemala.


Tuberculosis is caused by the mycobacterium tuberculosis bacteria, and mostly affects the lungs. The symptoms include persistent coughing, fever and tiredness. It's spread by coughing and sneezing, but don't start getting righteous on tube snifflers - you'd need to be in prolonged contact with an infected person to contract the disease.

It's not incurable, but patients can need to take antibiotics for up to six months – more if the strain of TB turns out to be one that’s resistant to drugs. The other danger is from latent TB - where a person is a carrier but doesn't actually have the symptoms.

TB had already been eradicated in the UK – but the disease has made a slow and steady return, thriving on overcrowding in deprived boroughs, poverty and Dickensian housing conditions. As Dr Onkar Sahota, chair of the Greater London Authority’s health committee, explains:

"The causes are complex and far from simply medical. TB affects those who most need our help: migrants, the elderly, prisoners, homeless people and those who are marginalised from society. TB has a relationship with deprivation as well as clinical causes.

“We know TB disproportionately affects prisoners, homeless people and people with substance abuse issues, and high quality TB care services are not universally available to all Londoners."

As to where the disease is on the increase, some boroughs are beset by far more cases than others. Here's a chart showing the 10 boroughs with the highest rates of infection:

Given the unfailing reliability with which some sections of the media crowbar the words “migration” and “ticking time-bomb” into their tuberculosis stories, it's no surprise that a lot of people think migrants are bringing the disease to the UK. But the World Health Organisation (WHO) refutes this, stating that there's “no systematic association” between migration and infectious diseases, adding that “communicable diseases are associated primarily with poverty”.

The writer of the report alluded to by the Telegraph, Professor Alimuddin Zumla of University College London, has made the same point. He noted that, while the increase in TB cases has been mainly among people born outside the UK, they appear to have been infected here rather than in their country of origin. With many migrants to London living in poverty, sleeping rough or in poor quality, overcrowded homes, it's hardly a surprise that they are more at risk.

Crucially, WHO advise against limiting access to medical assistance for immigrants, legal or otherwise. Suddenly, charging migrants to use the NHS doesn't seem like quite such a clever idea.

The homeless, another high risk group, are finding help in Hackney. The council has partnered with Homerton University Hospital to reduce what was once the highest rate of TB infection in London. Any homeless person with TB is given accommodation for the duration of their treatment, even if they're not actually eligible for housing in the first place.

The result? The borough's infection rate has dropped, and in July this year, the Homerton Hospital team won an award for their work.

In Newham, the borough with the current highest rate of infection (and, not coincidentally, one of London's most deprived), the council has partnered with the NHS Newham Clinical Commissioning Group to screen for latent TB when residents register with a GP. Newham was also one of the first councils to introduce a crackdown on “slum” landlords to try and tackle overcrowding.

The London Assembly's recommendations include a city-wide education programme, extending Hackney's housing plan to other boroughs and universal provision of the BCG vaccination. With around 1m people living in poverty, and with housing conditions as poor as they are, Londoners' health is also falling through the inequality gap.

You can read the report here (PDF).

Beth Parnell-Hopkinson is a senior editor at Londonist.


What does the fate of Detroit tell us about the future of Silicon Valley?

Detroit, 2008. Image: Getty.

There was a time when California’s Santa Clara Valley, bucolic home to orchards and vineyards, was known as “the valley of heart’s delight”. The same area was later dubbed “Silicon Valley,” shorthand for the high-tech combination of creativity, capital and California cool. However, a backlash is now well underway – even from the loyal gadget-reviewing press. Silicon Valley increasingly conjures something very different: exploitation, excess, and elitist detachment.

Today there are 23 active Superfund toxic waste cleanup sites in Santa Clara County, California. Its culture is equally unhealthy: Think of the Gamergate misogynist harassment campaigns, the entitled “tech bros” and rampant sexism and racism in Silicon Valley firms. These same companies demean the online public with privacy breaches and unauthorised sharing of users’ data. Thanks to the companies’ influences, it’s extremely expensive to live in the area. And transportation is so clogged that there are special buses bringing tech-sector workers to and from their jobs. Some critics even perceive threats to democracy itself.

In a word, Silicon Valley has become toxic.

Silicon Valley’s rise is well documented, but the backlash against its distinctive culture and unscrupulous corporations hints at an imminent twist in its fate. As historians of technology and industry, we find it helpful to step back from the breathless champions and critics of Silicon Valley and think about the long term. The rise and fall of another American economic powerhouse – Detroit – can help explain how regional reputations change over time.

The rise and fall of Detroit

The city of Detroit became a famous node of industrial capitalism thanks to the pioneers of the automotive age. Men such as Henry Ford, Horace and John Dodge, and William Durant cultivated Detroit’s image as a centre of technical novelty in the early 20th century.

The very name “Detroit” soon became a metonym for the industrial might of the American automotive industry and the source of American military power. General Motors president Charles E. Wilson’s remark that, “For years I thought what was good for our country was good for General Motors, and vice versa,” was an arrogant but accurate account of Detroit’s place at the heart of American prosperity and global leadership.

The public’s view changed after the 1950s. The auto industry’s leading firms slid into bloated bureaucratic rigidity and lost ground to foreign competitors. By the 1980s, Detroit was the image of blown-out, depopulated post-industrialism.

In retrospect – and perhaps as a cautionary tale for Silicon Valley – the moral decline of Detroit’s elite was evident long before its economic decline. Henry Ford became famous in the pre-war era for the cars and trucks that carried his name, but he was also an anti-Semite, proto-fascist and notorious enemy of organised labor. Detroit also was the source of defective and deadly products that Ralph Nader criticized in 1965 as “unsafe at any speed”. Residents of the region now bear the costs of its amoral industrial past, beset with high unemployment and poisonous drinking water.

A new chapter for Silicon Valley

If the story of Detroit can be simplified as industrial prowess and national prestige, followed by moral and economic decay, what does that say about Silicon Valley? The term “Silicon Valley” first appeared in print in the early 1970s and gained widespread use throughout the decade. It combined both place and activity. The Santa Clara Valley, a relatively small area south of the San Francisco Bay, home to San Jose and a few other small cities, was the base for a computing revolution based on silicon chips. Companies and workers flocked to the Bay Area, seeking a pleasant climate, beautiful surroundings and affordable land.

By the 1980s, venture capitalists and companies in the Valley had mastered the silicon arts and were getting filthy, stinking rich. This was when “Silicon Valley” became shorthand for an industrial cluster where universities, entrepreneurs and capital markets fuelled technology-based economic development. Journalists fawned over successful companies like Intel, Cisco and Google, and analysts filled shelves with books and reports about how other regions could become the “next Silicon Valley”.

Many concluded that its culture set it apart. Boosters and publications like Wired magazine celebrated the combination of the Bay Area hippie legacy with the libertarian individualism embodied by the late Grateful Dead lyricist John Perry Barlow. The libertarian myth masked some crucial elements of Silicon Valley’s success – especially public funds dispersed through the U.S. Defense Department and Stanford University.

The ConversationIn retrospect, perhaps that ever-expanding gap between Californian dreams and American realities led to the undoing of Silicon Valley. Its detachment from the lives and concerns of ordinary Americans can be seen today in the unhinged Twitter rants of automaker Elon Musk, the extreme politics of PayPal co-founder Peter Thiel, and the fatuous dreams of immortality of Google’s vitamin-popping director of engineering, Ray Kurzweil. Silicon Valley’s moral decline has never been clearer, and it now struggles to survive the toxic mess it has created.

Andrew L. Russell, Dean, College of Arts & Sciences; Professor of History, SUNY Polytechnic Institute and Lee Vinsel, Assistant Professor of Science and Technology Studies, Virginia Tech.

This article was originally published on The Conversation. Read the original article.