¶ … incidence tuberculosis as an Urban Health issue among ethnic minority group in Canning Town, Newham Borough of London. Large scale incidence of tuberculosis (TB) has been a major concern for public health planners in the UK. The report is structured as follows to enhance a greater understanding of the TB rate in Newham and strategies to reduce the TB rates in Newham London. First, the report explores the TB rates in the entire UK. Moreover, the report provides the rational the TB cases in an urban health issue since Newham is a part of London. Moreover, the paper provides overall urban health issues and their implications to urban residents. The paprt explores the TB incidents in London and narrow the incidents to the Newham in London. Moreover, paper compares the TB rates of all important cities in the UK to enhance a greater understanding of urban health issues. Finally, the report recommends strategic intervention to reduce the TB rates in Newham.

Rationale of Tuberculosis is an Urban Health Issue

Large-scale environmental problems due to urbanization have been the major cause of health problems among the UK residents. A recent report presented by Public Health England, (2013) reveals that the UK has highest rates of the TB (tuberculosis) in the western countries, however, the TB is unevenly distributed because certain sub-groups such as minority groups, and new migrants have higher rates of TB incidence in the UK. In 2012, the UK recorded 8,751 TB cases revealing an incidence of 13.9 per 100,000 people. Although, the incidence of TB is relatively stable since 2005, however, majority of people with TB cases are people from high burden countries, born outside the UK. Half of the TB patients were already diagnosed at their countries of origin five years before entering the UK.

Moreover, "7.3% of TB cases had at least one social risk factor (history of homelessness, imprisonment, drug or alcohol misuse); only 43% of these were reported to have started on directly observed therapy." (Public Health England, 2013, p 8).

Similarly, London has approximately 3,426 of TB cases, which is a rate of 41 per 100,000 people. Although, the rate of the TB in London stabilizes after two decades of TB high rates, however, majority of the TB cases are among people born outside the UK, however, TB case is higher among non-UK born ethnic groups such as Somalia, India, and Pakistan. While TB rates continue to increase among the Indian population in London, the TB rate is declining among black Africans. Despite the rate of TB rate in London, "the highest numbers and rates were reported among residents of Newham (366 cases, 117 per 100,000) and Brent (313, 100 per 100,000) local authorities, followed by Ealing (253 cases, 75 per 100,000)" (Public Health England, 2013 p 9).

As being revealed in Table 1 and Fig 1, the average TB rate is very high in Newham compared to TB rates in London in general. When comparing the TB rates in London to the average TB rate in the UK, it is revealed that the TB rate in London is 200% higher than TB rate in the entire UK.

Table 1: TB Rates per 100,000

UK

London

Newham

13.9

41

Fig 1: TB Rates per 100,000 in the Nehman and London

Urbanization has been the major health problem in London, and explosive growth of urbanization in the UK is a major concern to public health planners. Typically, rapid growth of urbanization has been the cause of public health hazard such as water and air pollution, overcrowding, acid rain, which consequently lead to other environmental health problem such as tuberculosis. (Tsouros,1997). Studies have revealed that major cause of death is from communicable disease such as tuberculosis, and other respiratory disease. (Tsouros, 1997, Leeder, Ward and Wilmoth, 2006). Consequently, there is an inverse relationship between chronic diseases and environmental hazard in the urban settings such as London.( City of London, 2008 ),

Newham in London is the most deprived area in England with the population of 308,000. Newham historically has the highest rates of tuberculosis in England, which is "8 times higher than the national average and three times than the London average." (Newham, London, 2012 p 30) . In 2011, over 90% of Newham residents were notified the risks of tuberculosis, while 20% of the residents were born outside the United Kingdom, with approximately 50% of the residents have just arrived in the United Kingdom within the past five years. The figures show that the risks of cases of TB are very high in Newham. In 2011, the notification of tuberculosis for Newham residents increased from 77 cases to 381 cases representing 25% increase compared to the previous year.

In Newham, 121.4 out of the 100,000 residents suffered from tuberculosis in 2011...

However, the TB is not evenly distributed across the Newham because 70% of Newham residents suffering from TB reside the north and east - Manor Park, Green Street, and East Ham. Consequently, low economic status of Newham residents contributes to high rates of tuberculosis in the area. The data presented by the Newham London Borough Council show that Newham is among the most 5% most deprived place in the UK. Typically, the residents suffer from poverty low level of education, and poor health. Moreover, 17% of the working population in Newham is suffering from long-term illness. Thus, tuberculosis continues to be a serious health problem in Newham. Alcoholism, drug misuse, homelessness, mental health issues, and imprisonment are the social risk factors of tuberculosis. At London Borough Newham, one out of 10 tuberculosis patients face these social risks. Moreover, a tuberculosis patient is more likely to develop a disease highly resistance to treatment and drug.
Despite the high rate of tuberculosis at Newham Borough in London, the incidence of tuberculosis is higher among minority ethnic group in the UK. Typically, approximately 90% of tuberculosis patients are born outside the UK, and the incidents of tuberculosis are 10 times greater among minority ethnic group than majority ethnic group in the UK. Essentially, TB is one of the most deadly diseases in the UK, and a leading killer of people infected with HIV.

Health problems associated with TB in Newham make public health planner in London to make TB as one of the important health priorities because the TB is urban health issues. In 2013, London has the population of 8.03 million, and since 2001, the population of entire London continues to increase by 12%. The data from Office of National Statistics show that approximately 145,000 people arrived in London in 2009 representing 2% increase in London population, however, 178,000 people across the UK moved to London in 2009. The increase in London population in the last 10 years leads to the growth of urbanization which assists the spread of TB. Typically, there is a correlation between high TB incidence and urbanization. Urbanization leads to overcrowding which is a factor that leads to a spread of communicable disease such as tuberculosis. The high rates of TB in Newham and London makes the TB to become a public health priority among health planners given that TB is a communicable disease that can spread to other people within a short period. Overcrowding is one of the features of urban setting because of overcrowding assists in spreading TB among urban residents. Essentially, overcrowding in urban setting also affects physical health of the population. (Office of the Deputy Prime Minister, 2004). As being revealed in Fig 2, the number of non-UK born receiving the TB notifications is significantly higher than the number of the UK-born receiving TB notifications. The data reveal that the TB incidence is higher among foreign-born UK residents.

Figure 2 -- London TB notifications rates based on place of birth, 2004 -- 2010

In the next section, the paper discusses the implication and consequences of TB in urban context.

4) Identification and Public Health Issues Newham Borough of London

The report focuses on Newham to enhance a greater understanding of urban health issue in London. Newham is an area of exceptionally complex in London having high level of cultural and ethnic diversity. Essentially, Asian, Black and other minority ethnic groups constitute over 60% of the total population of Newham, and the area is the third fastest growing population in England. Newham has the highest rate of TB in the country, which contributes to the factor making Newham resident to have high level of mortality and morbidity. Many stakeholders such as academic institutions, trusts, Council, and the voluntary organizations have collaborated to improve the health outcomes in the areas. Despite their continual efforts to improve health outcomes in Newham,

"health outcomes remain poor owing to a number of factors including delayed access to care, socio-economic deprivation, structural barriers to making healthy lifestyle choices, poor health education and maternal and childhood malnutrition." (University of East London (2010 p 2).

Public Health England (2013) released the health profile of Newham residents in 2013, and the findings reveal that general health status of Newham residents is the worst in…