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2 Slow Motion Disaster Postindustrial Poverty and the Return of TB Tuberculosis in the 1990s was like a fire burning in the wrong part of town, a flood in Bangladesh, a famine in Sudan. It was something to be driven past, to be seen on TV or perhaps in a movie. For the average American, it was somewhat exotic because it was so segregated, so walled off from the mainstream middle-class majority. It was a Third World disease, and in the United States of the 1990s the Third World existed on the South and West Sides of Chicago, on the Lower East and Upper West Sides of New York, in the Bronx and Uptown, Brownsville and Englewood. In spite of trade and transportation systems shrinking the world, and the end of legal segregation brought about by the Civil Rights Movement, tuberculosis in 1990s America remained a disease of poor people, black people, immigrant people, the addicted, the overcrowded, the unemployed, and the underfed.1 The patterns of tuberculosis affliction in the United States of the late twentieth century reflected the fragmentation of life experience across boundaries of class and race and the growing social inequalities in the postindustrial era. “Postindustrial poverty,” according to William DiFazio, is characterized by “nihilism with permanently declining occupational opportunities for the lower classes” (DiFazio 57). He argues that a “vocabulary shift” in the post-1960s period transformed “the language of possibility” and the “language of advocacy” into the “language of individual achievement ” (DiFazio 42). Poor people, rather than being viewed as agents of change, or even helpless victims, were recast as defective objects in need of fixing, and whole categories of humanity were defined as “problems” to be managed and administered. By the time I started working in TB control , tuberculosis had become entangled with many of these categories. Just as “homeless” became synonymous with “bum” (in spite of the common sentiment that it can “happen to anybody”) so did tuberculosis become identified with its so-called “risk factors.” The category of “TB patient” and those of homeless, alcoholic, drug addicted, unemployed, and HIV positive became nearly interchangeable. Like homelessness and addiction, tuberculosis is most threatening when it is visible, and the drama of tuberculosis in the 1990s was all about visibility. The much33 publicized “resurgence” of TB in the early nineties managed to break the surface of mass consciousness for a few media moments, and this media exposure definitely helped convince people that TB was a problem. The numerous articles produced in this time, however, bear some scrutiny, and some application of historical perspective. In November 1992, a group of young public health workers, myself among them, were sent into the field to control the resurgence of tuberculosis that purportedly held New York City under siege. We had just completed three days of intensive training in contact investigation techniques , conducted by representatives from the Centers for Disease Control (CDC). Before letting us go, they told us: “You people are like the soldiers going into Somalia. This is a war, and you are on the front lines. Good luck.” This was during the time of the United Nations’ attempted intervention in that small African nation, a military-led mission which had ambiguous goals and mixed results. At the time, however, it was portrayed as a humanitarian endeavor with the noble purpose of saving innocent suffering people from malevolent forces. The statement above, comparing soldiers with public health workers, well illustrates a brand of rhetoric that posits disease as a sort of hostile entity, a “killer” that preys on humanity. In this perspective, the medical and public health systems are envisioned as national defenses against a dangerous microbial invasion. In the case of tuberculosis, this can be particularly misleading, because the disease, although deadly and infectious, actually poses relatively little danger to most middle-class Americans. This is not to say that the threat of tuberculosis , to individual and public health, is not real. The disease was certainly alive and well in the inner city in the 1990s, and in spite of greatly improved control efforts, it has not gone away. I would like to argue, however, that the “war in Somalia” metaphor of modern tuberculosis control, while attempting to serve a greater good, also helps to perpetuate myths and to obscure some of the most basic facts about the illness—most significantly, its intimate connection to persistent poverty and social inequality. At the same time, however, this particular...

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