How London became the tuberculosis capital of Western Europe

View of London. Image: Robert Lamb/Creative Commons.

I was recently diagnosed with tuberculosis, which was quite the shock since I’d assumed it to be a disease left behind in Victorian slums – only briefly making a comeback to kill off heroines in old Westerns. But there I was being prescribed strong antibiotics by a very serious nurse, realising that despite my naivety, the disease has made a big comeback in London in the past 15 years.

A 2015 report from the London Assembly found that one third of London’s boroughs exceed the World Health Organisation's (WHO) ‘high incidence’ threshold of 40 cases per 100,000 people. The boroughs of Newham, Brent, Ealing and Hounslow have some of worst rates in the country, comparable with significantly less developed countries such as Rwanda, Algeria and Guatemala. It is no wonder that the capital has picked up the rather unsavoury title of ‘TB capital of Western Europe’.


Varying TB rates across London. Image: London Assembly

Having TB means being infected by ‘Mycobacterium tuberculosis’, which manifests in one of two ways within a person. If ‘active’, the bacteria is damaging your body and you can infect other people. Symptoms include a loss of appetite, weight loss and a persistent cough that may bring up blood. If treatment cannot be accessed it can lead to death.

Luckily for me, and everyone forced to commute with me on the Victoria Line, my tuberculosis is ‘latent’. This means that I’m both symptomless and not infectious. If untreated, latent TB has around a one in ten chance of becoming active, but a three-month course in antibiotics takes this down to one in 100.

Anti-immigration groups like the now-obsolete BNP were quick to claim a connection between TB’s resurgence and London’s high immigrant population. But this doesn’t tell the whole story: although 74 per cent of cases in London do occur in people born abroad, it is highly unlikely they could have brought active TB into the UK. People applying for visas from countries with high incidence rates are required to get medically screened.


The disease instead ‘activates’ here, particularly in areas that are strongly linked with deprivation and the associated poor housing, poor nutrition and general ill health. Newham is in one of the poorest boroughs in London and comparable levels of poverty can be seen in the other ‘high incidence’ areas.

Health inequality plays a big part in TB getting a foothold in the city, with many affected having inadequate access to inadequate services. If it wasn’t already, this means limiting access to healthcare for migrants would be a terrible idea. The restrictions around healthcare imposed under the ‘hostile environment’will likely deter people from receiving treatment that they need. Untreated carriers of active TB spread the disease and drug-resistant strains are on the rise.

The WHO estimates that two billion people across the world are infected with tuberculosis. Although I’m soon to be TB-free, London is still very much under threat. A co-ordinated approach is needed; not just improving outreach programs among vulnerable demographics, but also tackling the socio-economic causes. This Victorian disease should be resigned to history and not allowed to become a feature of modern London.

 
 
 
 

CityMetric is now City Monitor! Come see us at our new home

City Monitor is now live in beta at citymonitor.ai.

CityMetric is now City Monitor, a name that reflects both a ramping up of our ambitions as well as our membership in a network of like-minded publications from New Statesman Media Group. Our new site is now live in beta, so please visit us there going forward. Here’s what CityMetric readers should know about this exciting transition.  

Regular CityMetric readers may have already noticed a few changes around here since the spring. CityMetric’s beloved founding editor, Jonn Elledge, has moved on to some new adventures, and a new team has formed to take the site into the future. It’s led by yours truly – I’m Sommer Mathis, the editor-in-chief of City Monitor. Hello!

My background includes having served as the founding editor of CityLab, editor-in-chief of Atlas Obscura, and editor-in-chief of DCist, a local news publication in the District of Columbia. I’ve been reporting on and writing about cities in one way or another for the past 15 years. To me, there is no more important story in the world right now than how cities are changing and adapting to an increasingly challenging global landscape. The majority of the world’s population lives in cities, and if we’re ever going to be able to tackle the most pressing issues currently facing our planet – the climate emergency, rising inequality, the Covid-19 pandemic ­­­– cities are going to have to lead the way.

That’s why City Monitor is now a global publication dedicated to the future of cities everywhere – not just in the UK (nor for that matter just in the US, where I live). Our mission is to help our readers, many of whom are in leadership positions around the globe, navigate how cities are changing and discover what’s next in the world of urban policy. We’ll do that through original reporting, expert opinion and most crucially, a data-driven approach that emphasises evidence and rigorous analysis. We want to arm local decision-makers and those they work in concert with – whether that’s elected officials, bureaucratic leaders, policy advocates, neighbourhood activists, academics and researchers, entrepreneurs, or plain-old engaged citizens – with real insights and potential answers to tough problems. Subjects we cover include transportation, infrastructure, housing, urban design, public safety, the environment, the economy, and much more.

The City Monitor team is made up of some of the most experienced urban policy journalists in the world. Our managing editor is Adam Sneed, also a CityLab alum where he served as a senior associate editor. Before that he was a technology reporter at Politico. Allison Arieff is City Monitor’s senior editor. She was previously editorial director of the urban planning and policy think tank SPUR, as well as a contributing columnist for The New York Times. Staff writer Jake Blumgart most recently covered development, housing and politics for WHYY, the local public radio station in Philadelphia. And our data reporter is Alexandra Kanik, whose previous roles include data reporting for Louisville Public Media in Kentucky and PublicSource in Pittsburgh, Pennsylvania.

Our team will continue to grow in the coming weeks, and we’ll also be collaborating closely with our editorial colleagues across New Statesman Media Group. In fact, we’re launching a whole network of new publications, covering topics such as the clean energy transition, foreign direct investment, technology, banks and more. Many of these sectors will frequently overlap with our cities coverage, and a key part of our plan is make the most of the expertise that all of these newsrooms combined will bring to bear on our journalism.

Please visit citymonitor.ai going forward, where you can also sign up for our free email newsletter.


As for CityMetric, some of its archives have already been moved over to the new website, and the rest will follow not long after. If you’re looking for a favourite piece from CityMetric’s past, for a time you’ll still be able to find it here, but before long the whole archive will move over to City Monitor.

On behalf of the City Monitor team, I’m thrilled to invite you to come along for the ride at our new digs. You can follow City Monitor on LinkedIn and on Twitter. If you’re interested in learning more about the potential for a commercial partnership with City Monitor, please get in touch with our director of partnerships, Joe Maughan.

I want to thank and congratulate Jonn Elledge on a brilliant run. Everything we do from here on out will be building on the legacy of his work, and the community that he built here at CityMetric. Cheers, Jonn!

To our readers, on behalf of the City Monitor team, thank you from all of us for being such loyal CityMetric fans. We couldn’t have done any of this without you.

Sommer Mathis is editor-in-chief of City Monitor.