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.

 
 
 
 

How can cities protect common green space for the future?

Newcastle Town Moor. Image: Chabe01/Wikimedia Commons.

Urban green space comes in a variety of forms – parks, allotments, gardens, ‘strays’ to mention just a few. One of the most iconic is the urban “common” – these are often extensive tracts of green space in or adjacent to large urban areas that provide publicly accountable, open, green, spaces vital for culture, health, wellbeing and biodiversity in the metropolitan context. Examples include Epping Forest and Wimbledon common in London, Town Moor in Newcastle, Mousehold Heath in Norwich, or Clifton Downs in Bristol.

The term “common” creates in the public consciousness notions of communal ownership, control and use. In fact, this is often a misconception. Most urban “commons” are not community-owned assets, and many have different legal identities, and differing degrees of legal protection and security. These are often the result of a history of different political, social and economic forces shaping land use in each metropolitan context. Epping Forest and Town Moor in Newcastle are, for example, protected by Acts of Parliament. Clifton Down in Bristol is a “traditional” common registered under the Commons Registration Act 1965, which guarantees its status as common land.

Other areas commonly regarded by the public as commons are in actual fact simply urban green space that is preserved by some lesser legal protection - for example, through the planning system, which may designate them as green space or as conservation areas within the local development plan. But plans can change, and much green space is lost to development annually.

Indeed, in the age of austerity, local authorities have been driven to sell much green space that they themselves own to raise funds to provide front line local services, like schools and social care. In this context, true urban commons – those that have the legal status of common land – are extremely precious community assets, in that they are protected from development and preserved for future generations.

But do we value them highly enough? Do we appreciate their importance in shaping our community’s consciousness of its own identity and history? Do we use them to the full as recreational open spaces and if not, how can we champion our urban commons and develop new ways to engage the urban public more fully in their use, management and stewardship?   


A new interdisciplinary 3-year project (“Wastes and Strays”) involving academics from Newcastle University, Exeter University, Sheffield University and Brighton University will address many of these issues. The project will explore the complex social and political history of the urban common, as well as their legal and cultural status today, and in doing so devise tools and methods of negotiation, inclusivity and creativity to inform their future.

The project will make in-depth studies of four iconic urban commons: Town Moor, Newcastle; Valley Gardens, Brighton; Mousehold Heath, Norwich; and Clifton Down, Bristol. It will look at the multiple, negotiated historic uses and legal origins of the common in each case, and its contemporary meaning, popular perception, biodiversity and public use.

One strand of the research is closely focussed to encouraging the more extensive use of urban commons as vital green space for recreation and other community uses, important for mental and physical wellbeing. It will be looking to develop new strategies for community engagement with the urban commons as community assets and will work in partnership with local communities and relevant stakeholder groups to generate ideas for the future of urban commons, in the spirit of their negotiated pasts.

The big idea is to generate a multifaceted definition of the urban common to provide a robust base for education initiatives and future public policy guidance, informing their development and use as a diverse cultural and ecological space.

For hundreds of years, these unique, open spaces have played a varied, but important, role in the individual stories of our towns and cities. We need to develop new and imaginative ways to use them and foster a greater sense of community involvement if we are to preserve them for future generations.

Chris Rodgers is a professor of Law at Newcastle University.