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.


Uber has introduced a levy to fund electric vehicles in London. But who exactly is benefiting?

Bleurgh. Image: Getty.

Uber is introducing a levy of 15p per mile on London users to help fund a transition to electric vehicles and help tackle air pollution. Its goal is to encourage half its drivers to go electric by 2021 and to go fully electric by 2025.

There are a number of benefits to the idea. Moving to cleaner transportation is an important public good with a myriad of general health benefits. It should be an urgent priority for all UK cities. But the question of who pays for this transition is fundamental to whether it is done fairly. As a process, change needs be done in partnership with people, not to them.

So who is actually being asked to foot the bill for this much needed transition? Fresh analysis by the New Economics Foundation shows that while the PR benefits are likely to accrue to Uber, its consumers and drivers will foot the bill in its entirety, while also taking on much of the risk.

Uber estimate that drivers will be eligible for £4,500 in funds to purchase a new electric vehicle after three years of service – the maximum period of time for which drivers can accrue credit. By comparison, the cost of a cheap second-hand electric car meeting Uber’s requirements for UberX costs in excess of £12,000, while a second hand vehicle suitable for UberLux would set drivers back around £45,000.

For those drivers receiving around £4,500, this would still imply the need to contribute thousands of pounds, if not tens of thousands, in personal funds. Even after allowing for a fall in prices for electric vehicles, drivers are being asked to make a minimum contribution of between 55 per cent and 85 per cent towards the total cost of electrification. The remainder of the cost will be met indirectly by consumers – either in the form of higher charges or else being priced out Uber’s services altogether.

Where drivers don’t have access to this sort of cash, the expectation will be that they borrow – which means taking on the risk of debt repayments while earning close to minimum wage. Being able to keep the 15p levy once driving an electric vehicle is unlikely to cover the cost of new interest payments. But failure to use the scheme at all could mean unemployment after 2025.

While drivers are forced into arrears to consolidate their jobs, Uber may also find itself with a considerable surplus from the scheme, as a result of drivers leaving the platform early or choosing not to apply for the grant. Uber has suggested that any surplus will be reinvested into supporting facilities, such as charge points for electric cars. But this means that the cost of moving to green infrastructure is coming at the expense of extra private debt for drivers (which could otherwise have been funded out of the levy). Such a trade-off is simply incompatible with a green transition that is morally just.

The shift in strategy from Uber towards more renewable transport technology is clearly welcome on environmental grounds. Doing so solely at the expense of consumers drivers is not. For any transition to be fair, Uber needs to meet its share of the costs.

Duncan McCann is a Researcher at the New Economics Foundation. He tweets @DuncanEMcCann. You can find NEF’s work on transport here.