CIEH involved in developing collaborative tuberculosis strategy

Public Health England and NHS England have announced an £11.5 million investment as part of a collaborative initiative to decrease cases and ultimately eliminate TB as a public health problem in England. The proposals are set out in a publication launched on 19 January 2015 entitled Collaborative Tuberculosis Strategy for England 2015 – 2020. The strategy was developed after an extensive public consultation that ran during 2014 and to which the CIEH made a detailed submission.

The UK has the second highest rate of TB among western European countries and rates are nearly five times higher than in the US. TB is concentrated in large urban centres, with rates in London, Leicester, Birmingham, Luton, Manchester and Coventry more than three times the national average. Nearly three quarters of all TB cases occur in those born abroad, mainly in high TB burden countries, and 10% of all TB cases had at least one social risk factor (a history of alcohol or drug misuse, homelessness or imprisonment).

The strategy requires the creation of nine TB control boards which will concentrate their efforts on high incidence areas whilst also working across local authority and NHS boundaries to provide universal coverage across England. They will be responsible for planning, overseeing, supporting and monitoring all aspects of local TB control, including clinical and public health services and workforce planning. Work to establish the TB control boards will begin immediately so that the national TB programme can become operational from April 2015. The other key elements of the strategy are concerned with early detection and treatment of cases and contacts.

Ian Gray, CIEH Principal Policy Officer, said: “The adoption of a national strategy is to be welcomed, but it is disappointing that the role of environmental health professionals has not been included when identifying vulnerable groups and effective contact tracing are key features of the strategy. It is also known that completing treatments can be difficult for those people who are homeless or in insecure housing or with drug and alcohol problems. There is often recourse to the local authority health powers to require individuals to be examined and tested and even isolated.”

“It is also important to take into account the clear relationship between TB and deprivation, with significantly higher numbers and incidence rates in more deprived areas. There is recognition in the strategy of the need for systematic, joined-up care between health services, health and social care, public health and housing that specifically reaches under-served or vulnerable groups. However, there are no proposals for increasing the resources for tackling these underlying issues. It is known that social determinants are included among the key risk factors for TB for example: poor ventilation and overcrowding in homes, workplaces and communities increase exposure risk; poverty and poor diet may increase susceptibility to disease and severity of outcome; chaotic lifestyles, for example drug and alcohol misuse, may increase the likelihood of infection and make the treatment harder to complete. All of these need to be addressed if the government’s ambition to ‘eliminate’ TB is to be achieved.”

“Finally, we should remember that this is not the first time that we have had a government action plan. There was similar concern in 2005 when it was reported that TB cases in London had doubled in 20 years. The Chief Medical Officer at that time, Sir Liam Donaldson, stated ‘Our long-term goal is to reduce and ultimately eliminate TB in this country’.”