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.

 
 
 
 

The Fire Brigades Union’s statement on Theresa May’s resignation is completely damning

Grenfell Tower. Image: Getty.

Just after 10 this morning, Theresa May announced that she would resign as Britain’s prime minister on 7 June. A mere half an hour later, a statement from Royal Institute of British Architects president Ben Derbyshire arrived in my inbox with a ping:

“The news that Theresa May will step down as Prime Minister leaves the country in limbo while the clock ticks down to the latest deadline of 31 October. While much is uncertain, one thing remains clear – a no deal is no option for architecture or the wider construction sector. Whoever becomes the next Prime Minister must focus on taking the country forward with policies beyond Brexit that tackle the major challenges facing the country such as the housing crisis and climate change emergency.”

I was a bit baffled by this – why would the architecture profession try to get its thoughts into a political story? But then Merlin Fulcher of Architects Journal put me right:

Well you know construction is a larger contributor to GDP than financial services, and most of the work UK architects do is for export, and at least half of the largest practice (Foster + Partners) are EU, so there's a lot at stake

— Merlin Fulcher (@merlinfulcher) May 24, 2019

So, the thoughts of the RIBA president are an entirely legitimate thing to send to any construction sector-adjacent journalists who might be writing about today’s big news, and frankly I felt a little silly.

Someone else who should be feeling more than a little silly, though, is Theresa May herself. When listing her government’s achievements, such as they were, she included, setting up “the independent public inquiry into the tragedy at Grenfell Tower” – a fire in a West London public housing block in June 2017 – “to search for the truth, so nothing like it can ever happen again, and so the people who lost their lives that night are never forgotten”.

Matt Wrack, general secretary of the Fire Brigades Union, is having precisely none of this. Here’s his statement:

“Many of the underlying issues at Grenfell were due to unsafe conditions that had been allowed to fester under Tory governments and a council for which Theresa May bears ultimate responsibility. The inquiry she launched has kicked scrutiny of corporate and government interests into the long-grass, denying families and survivors justice, while allowing business as usual to continue for the wealthy. For the outgoing Prime Minister to suggest that her awful response to Grenfell is a proud part of her legacy is, frankly, disgraceful.”

A total of 72 people died in the Grenfell fire. At time of writing, nobody has been prosecuted.

Jonn Elledge is editor of CityMetric and the assistant editor of the New Statesman. He is on Twitter as @jonnelledge and on Facebook as JonnElledgeWrites.

Want more of this stuff? Follow CityMetric on Twitter or Facebook.