Perceptions of Policy Makers and Impact on Policy Development

Between 1986, when the category of foreign born was first recorded, and 1997, the percentage of new Tuberculosis cases (as well as absolute cases reported) in this population rose dramatically. In 2001, for the first time, more than half of cases nationally were among foreign-born individuals. While elimination is ideally and ethically the ultimate goal for any national strategy, the reality posed by limited resources and the impracticality of widespread screening makes strategies and programs whose main focus is active TB of primary importance at the local and state level. However, it is necessary to recognize the estimated 7 million foreign born individuals who have LTBI and the 140,000 – 210,000 of them who will develop active disease (CDC, 1998). Morally, ethically, and economically, prophylactic treatment is called for, but how do numbers translate into policy and practice? To understand the ways in which those who make and implement TB policy view the foreign born population and the problem of tuberculosis, a Policy Ethnography was conducted in which TB policy makers, program directors and health care practitioners from national, state and local levels were interviewed. Their constructions or understanding of “foreign born”, “culturally different” and the public health priority of LTBI treatment are useful to understanding how epidemiological evidence is translated into public health practice in the provision of health care services to foreign born individuals.