There are many stories of tuberculosis: of its causes and consequences, of social injustices, and of the communities and individuals impacted by the disease. My research follows tuberculosis across its many instantiations, focusing on San Diego County, California – a region in the Southwestern part of the United States where tuberculosis prevalence far exceeds the national average. My research articulates the ways that representations of the disease are connected with their materializations across global and local contexts.

A central problematic of tuberculosis is that even while effective cures have existed since the mid-20th century, the disease remains a leading cause of death worldwide (Farmer, 2000). The figures are sobering. In 2014, an estimated 9.6 million people developed tuberculosis and 1.5 million died from the disease (WHO, 2015). Although tuberculosis is far less common in the US, prevalence is disproportionately higher among the nation’s immunocompromised, poor and immigrant communities, and people who are un- or under-insured. In the US, four states (California, Texas, Florida, and New York) account for more than half of all tuberculosis, despite comprising one third of the nation’s population (CDC, 2016).

This is, in part, because many of the burdens of tuberculosis extend well beyond the ability of patients to adhere to treatment protocols. Tuberculosis prevalence is also linked to unjust sociopolitical and economic structures, unmet community need, and system-level constraints that predispose many decision makers to orient towards programmatic solutions that focus on solving short-term problems rather than developing long-term, responsive goals.[1]

For tuberculosis control, globally defined protocols function as the primary mechanism through which health authorities speak for the populations they are charged with protecting. While current protocols have generated many successes, they have tended to divert attention from local contexts and knowledges. This has had the effect of fostering disregard for a range of social, economic, and infrastructural factors that are important to understanding the impact of tuberculosis on specific regions and communities.

With this in mind, a core objective of my research is to provide insight into the ways globally disseminated protocols of disease control can obscure or foreclose opportunities to address tuberculosis within distinct local communities. In particular, I engage moments of possibility for preventing and treating tuberculosis by examining some of the alternative practices that are already being taken up in informal ways in community contexts like the Tuberculosis Control and Refugee Health Program of San Diego County.

Working from the vantage point of critical health communication, my research brings together ethnographic observation of local public health practices in San Diego with global research on tuberculosis control efforts in order to provide a multidimensional analysis of tuberculosis as a global disease with diverse regional effects. I consider how disease control is negotiated within Southern California through an examination of the practices and discourses of infectious disease control and through an interrogation of the frictions between globally mandated tuberculosis protocols and the efforts of local agencies.

[1] There is abundant literature on this topic. For selected literature related directly to tuberculosis, see Farmer (1996); Farmer et. al (2006); Gandy and Zumla (2003); Ho (2004); Hurtig, Porter, and Ogden (1999); or Waisbord (2007).

Centers for Disease Control and Prevention. (2016). Reported Tuberculosis in the United States, 2015. Atlanta, GA: US Department of Health and Human Services, CDC.

Farmer, Paul E. (2000). The Consumption of the Poor: Tuberculosis in the 21st Century. Ethnography, 1(2), 183-216. 

World Health Organization. (2015). Global tuberculosis report 2015. Geneva: WHO.