Mistrust of government medicine among African Americans in Alabama blamed for rural TB outbreak

A tuberculosis outbreak mostly among African Americans in rural Perry County, Alabama—a state that did not expand Medicaid under federal health reform—is being blamed on "generations of limited health care access, endemic poverty and mistrust—problems that are common across the rural South," Alan Blinder reports for The New York Times. Dr. R. Allen Perkins, former president of the Alabama Rural Health Association, told Blinder, "There’s not a culture of care-seeking behavior unless you’re really sick. There’s not support for local medical care, so when something like this happens, you have a health delivery system that’s unprepared.” (NYT map)

As of Monday, 47 cases of tuberculosis have been reported in Perry County in West Alabama, states a press release from the Alabama Department of Public Health. Officials in Perry County, which has about 10,000 residents, have tested around 800 people for tuberculosis, whose symptoms "include cough lasting more than two weeks, shortness of breath, fever, night sweats, weight loss and fatigue. A person may be infected with the TB germ and have no symptoms."

Authorities, who said they expect the number of positive cases to increase, "said the outbreak had spread so widely and lasted so long because patients had been reluctant to disclose their contacts to public health officials," Blinder writes. "Some of that is linked to suspicions that the health officials will report illegal activity to law enforcement, but it is also connected to worries of being ostracized—or at least stigmatized—in a community as small as this one."

Mistrust of government medicine in Alabama dates back more than 80 years to a 1932 Macon County medical study involving African Americans that a federal panel later ruled 'ethically unjustified,' Blinder writes. While many people in Marion, Ala. (located in Perry County), where about 63 percent of the residents are black, said they knew little about they study, "they often said their wariness of medical professionals had been passed on through generations. Some said the dire nature of the tuberculosis warnings made them feel that they had little choice but to consult heath officials."

Another problem is that "the TB outbreak has implicitly reinforced Marion’s chronic divides of race and class, particularly because of a controversial plan to compensate people if they submit to blood screenings," Blinder writes. "With money from a federal grant, health officials in Alabama are offering residents $20 for initial tuberculosis testing, $20 for a follow-up visit and another $20 for keeping an appointment for a chest X-ray, if one has been recommended. Anyone who is found to have been infected can receive $100 for completing treatment." (Read more)