Immigrants bring TB back to London

In the shadows of some of London’s tallest skyscrapers and richest banks lurks a disease borne of the poverty and squalor usually associated with the Victorian era rather than a 21st-century financial capital.

Tuberculosis is staging a comeback in London, where some neighborhoods suffer infection rates found in African countries in which the disease is endemic. The number of cases surged 50 percent in the 10 years to 2009, according to a National Health Service agency.

The airborne bacteria has taken root in a population of recent immigrants, addicts and homeless who live close to affluent business districts and may pose a risk for those they rub elbows with.

“You wouldn’t expect to see that,” says Brian McCloskey, the Health Protection Agency’s regional director for London. “TB is one of the biggest public health problems we have.”

One hotspot is Tower Hamlets, a borough that draws together Canary Wharf, the home of some of Europe’s largest banks, and pockets of poverty that stretch along the Thames’ old docks east of the Tower of London and north past Whitechapel, where Jack the Ripper preyed on prostitutes in 1888.

Tuberculosis, transmitted by coughs and sneezes, doesn’t just strike the needy.

After a worker at a Canary Wharf bank fell ill in 2010, Julian Surey, a nurse at Tower Hamlets Tuberculosis Service in East London, says he was sent with colleagues to her office to screen 14 of her co-workers, a challenge in an open-space environment where employees share keyboards and telephones.
Single Sneeze

“They were hot-desking and it was a nightmare,” Surey says. “People did get concerned.” Some workers demanded to see private doctors rather than be tested and treated by the state- run NHS, the 37-year-old nurse recalled. One person who sat next to the original patient contracted TB, according to Surey. He declined to identify the bank, as did other nurses.

One sneeze can release up to 40,000 droplets and each one can potentially cause infection. An untreated patient can infect up to 15 others a year, the World Health Organization estimates.

The condition, which can remain dormant in the body for decades but spread through the air and require extended courses of antibiotics once it has been roused, is difficult to diagnose, treat and contain.

Drugs are only part of the solution. Tuberculosis is a sensitive subject with social and political ramifications, says Graham Cooke, a senior lecturer in the department of medicine at the Faculty of Medicine at Imperial College London.

In the U.K. capital, 84 percent of the 3,302 people infected in 2010 were foreign-born, according to the HPA, which means they may be grappling with language barriers, fear of stigmatization or homelessness.

“You don’t just give them tablets,” says Surey, who has worked as a nurse in Calcutta, India and Lima, Peru. “You have to understand the community.”

The disease was as prevalent in London as in some of the world’s poorer nations in 2010. The city had 43 cases per 100,000 overall and rates of 65 or more per 100,000 in hotbeds such as Tower Hamlets, some of them on par with Karonga district in Malawi, says Ali Zumla, a professor at University College London. By contrast, New York reports nine cases per 100,000 people and Berlin eight.
Two Cities

The U.K.’s colonial history, which ties it to countries like India, Pakistan, Nigeria and Bangladesh where tuberculosis is rife, plays a role.

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Your papers, please!

 Jonah Goldberg
 
With the Supreme Court taking up Arizona's "show me your papers" immigration law, we're once again thrust into a useful debate over the role of the government and the obligations of the citizen -- and non-citizen. Rather than come at it from the usual angle, I thought I'd try something different.

If there were one thing I could impress upon people about the nature of the state, it's that governments by their very nature want to make their citizens "legible."

I borrow that word from James C. Scott, whose book "Seeing Like a State" left a lasting impression on me. Scott studied why the state has always seen "people who move around" to be the enemy. Around the world, according to Scott, states have historically seen nomadic peoples, herdsmen, slash-and-burn hill people, Gypsies, hunter-gatherers, vagrants, runaway slaves and serfs as problems to be solved. States have tried to make these people stay in one place.

But as Scott examined "sedentarization" (making mobile people settle down), he realized this practice was simply part of a more fundamental drive of the state: to make the whole population legible to the state. The premodern state was "blind" to its subjects. But the modern state was determined first to see them, and then organize them. This is why so many rulers pushed for the universal usage of last names starting around 1600 (aristocrats had been using family or clan names for centuries already). The same goes with the push for more accurate addresses, the standardization of weights and measures, and of course the use of censuses and surveys. It's much easier to collect taxes, conscript soldiers, fight crime and put down rebellions if you know who people are and where they live.

Perhaps the most obvious means of making the populace legible is the identity card or internal passport. The history of the identity card is a fascinating and shockingly complex one. For instance, did you know that identity cards were seen as a war on bigamy in many countries?

Opponents of the Arizona immigration law like to conjure scenes from Nazi Germany, with the Gestapo asking, "Ihre papiere, bitte" ("Your papers, please"). And it's indisputably true that police states, from Nazi Germany to the Soviet Union to Castro's Cuba and the North Korea of the Kims, have a deep relationship with the identity card for obvious reasons. But German officials were saying "Ihre papiere, bitte" long before anyone heard of the Nazis.

The United Kingdom has debated the merits of identity cards several times over the generations. During World War I, Britain's National Registration was hugely controversial because it was seen as too "Prussian." A generation earlier, the Prussians, under Otto von Bismarck, had famously created the first modern administrative state, which included the precursor to America's Social Security system and what today might be called "jobs programs." The Prussians also pioneered the public school system in order to make the people more legible to the state -- imposing common language, political indoctrination and the like.

A system of reliable ID was necessary for conscription and internal security -- government's top concerns -- but it was also necessary to properly allocate the benefits and jobs the state doled out in order to buy popular support, and to enforce school attendance.

And this brings me to our current debate over Arizona's immigration laws. Opponents like to conjure the police-state association of "Ihre papiere, bitte." I think that's wildly exaggerated (and so do several Supreme Court justices, apparently). But as someone who's against a national ID card, I'm sympathetic to the concern nonetheless. The Constitution lists three federal crimes -- treason, piracy and counterfeiting -- but today we have more than 4,500 federal crimes, all because the government in Washington wants to make the American people more legible. I don't want to make that easier with a national ID card.

But what I wish liberal opponents would understand is that in a society where the government "gives" so much to its citizens, it's inevitable that the state will pursue ways to more clearly demarcate the lines between the citizen and the non-citizen.

Most (but by no means all) conservatives I know would have few problems with large-scale immigration if we didn't have a welfare state that bequeaths so many benefits on citizens and non-citizens alike. I myself am a huge fan of legal immigration. But if you try to see things like a state for a second, it's simply unsustainable to have a libertarian immigration policy and a liberal welfare state. Ultimately, if you don't want cops asking for your papers, you need to get rid of one or the other.

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