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.


The mountain in North Wales that tried to stop the UK’s blackout

Elidir Fawr, the mountain in question. Image: Jem Collins.

Last Friday, the UK’s National Grid turned to mush. Not the official term perhaps, but an accurate one after nearly one million people were left without power across the country, with hundreds more stranded at train stations – or even on trains (which isn’t nearly as fun as it might immediately sound). 

Traffic lights stopped working, back-up power failed in hospitals, and business secretary Andrea Leadsom launched an investigation into exactly what happened. So far though, the long and short of it is that a gas-fired power station in Bedfordshire failed just before 5 o’clock, followed just two minutes later by Hornsea offshore wind farm. 

However, amid the resulting chaos and inevitable search to find someone to blame for the outage, a set of mountains (yes, mountains) in North Wales were working extremely hard to keep the lights on.

From the outside, Elidir Fawr, doesn’t scream power generation. Sitting across from the slightly better known Mount Snowdon, it actually seems quite passive. After all, it is a mountain, and the last slate quarry in the area closed in 1969.

At a push, you’d probably guess the buildings at the base of the mountain were something to do with the area’s industrial past, mostly thanks to the blasting scars on its side, as I did when I first walked past last Saturday. 

But, buried deep into Elidir Fawr is the ability to generate an astounding 1,728 megawatts of electricity – enough to power 2.5 million homes, more than the entire population of the Liverpool region. And the plant is capable of running for five hours.

Dubbed by locals at the ‘Electric Mountain’, Dinorwig Power Station, is made up of 16km of underground tunnels (complete with their own traffic light system), in an excavation which could easily house St Paul’s Cathedral.

Instead, it’s home to six reversible pumps/turbines which are capable of reaching full capacity in just 16 seconds. Which is probably best, as Londoners would miss the view.

‘A Back-Up Facility for The National Grid’

And, just as it often is, the Electric Mountain was called into action on Friday. A spokesperson for First Hydro Company, which owns the generators at Dinorwig, and the slightly smaller Ffestiniog, both in Snowdonia, confirmed that last Friday they’d been asked to start generating by the National Grid.

But just how does a mountain help to ease the effects of a blackout? Or as it’s more regularly used, when there’s a surge in demand for electricity – most commonly when we all pop the kettle on at half-time during the World Cup, scientifically known as TV pick-up.

The answer lies in the lakes at both the top and bottom of Elidir Fawr. Marchlyn Mawr, at the top of the mountain, houses an incredible 7 million tonnes of water, which can be fed down through the mountain to the lake at the bottom, Llyn Peris, generating electricity as it goes.

“Pumped storage technology enables dynamic response electricity production – ofering a critical back-up facility during periods of mismatched supply and demand on the national grid system,” First Hydro Company explains.

The tech works essentially the same way as conventional hydro power – or if you want to be retro, a spruced up waterwheel. When the plant releases water from the upper reservoir, as well as having gravity on their side (the lakes are half a kilometre apart vertically) the water shafts become smaller and smaller, further ramping up the pressure. 

This, in turn, spins the turbines which are linked to the generators, with valves regulating the water flow. Unlike traditional UK power stations, which can take hours to get to full capacity, at Dinorwig it’s a matter of 16 seconds from a cold start, or as little as five if the plant is on standby.

And, designed with the UK’s 50hz frequency in mind, the generator is also built to shut off quickly and avoid overloading the network. Despite the immense water pressure, the valves are able to close off the supply within just 20 seconds. 

At night, the same thing simply happens in reverse, as low-cost, surplus energy from the grid is used to pump the water back up to where it came from, ready for another day of hectic TV scheduling. Or blackouts, take your pick.

Completed in 1984, the power station was the product of a decade of work, and the largest civil engineering project commissioned at the time – and it remains one of Europe’s largest manmade caverns. Not that you’d know it from the outside. And really, if we’ve learned anything from this, it’s that looks can be deceiving, and that mountains can actually be really damn good at making electricity. 

Jem Collins is a digital journalist and editor whose work focuses on human rights, rural stories and careers. She’s the founder and editor of Journo Resources, and you can also find her tweeting @Jem_Collins.