Carrots, sticks and tuberculosis

Reform of the Public Health Act

“…We agree with Richard Coker1 that the vast majority of non-compliant cases of tuberculosis can be dealt with by a mixture of directly observed therapy (DOT) and inducements. However, when DOT fails in a few cases each year, despite intensive team effort and carrots such as housing or food vouchers, the Public Health Act may have to be invoked.…”

Tuberculosis, non-compliance and detention for the public health

“…Since 1993 more than 200 non-infectious individuals have been held in the main detention centre, at Goldwater Memorial Hospital on Roosevelt Island, most for prolonged periods, and some for more than two years. 6 Following New York's lead, the Centers for Disease Control and prevention issued national guidelines advocating similar measures be adopted across all states. 7 Many in the US have followed this guidance and in Britain prolonged detention of tuberculous patients is occasionally advocated despite uncertainties over the legal soundness of this approach.…”

More carrot or more stick or both?

“…Richard Coker describes how a system, with a substantial coercive component even for non-infectious patients, evolved in New York based on a perception of risk which was perhaps fuelled by media hype 1. The reasons why such a system came about can, however, be appreciated from the state of tuberculosis control—or perhaps non-control—in New York in the early 1990s.…”