Old Disease, New Challenge

Tuberculosis remains the largest single infectious cause of death in the world. Each year, 8 million people worldwide contract the disease, and 2 million people die. Fully one-third of the world's population—most of them living in developing countries—are believed to be infected with the tuberculosis bacillus. Ten million Americans are thought to be infected, but only 1 in 10 will ever become sick.

While tuberculosis had been brought under control in the United States by the 1970s, it reappeared surprisingly in many areas of the country in the early 1990s. Concentrated largely among low-income populations, it coincided with the spread of AIDS. There was concern that it might reach epidemic proportions. The chronically underfunded public health systems in most cities had difficulty in mounting effective treatment and prevention efforts.

When a major health problem arises, there is always pressure for a large health care philanthropy like the Robert Wood Johnson Foundation to get involved in some way. Even modest foundation support can increase awareness about a problem and signal the importance of the issue to those in the health field. Such was the case with the Foundation's involvement in trying to contain the spread of tuberculosis. Even though the Foundation tended in those years not to work on specific diseases, the special circumstances led the staff to develop a national program, Old Disease, New Challenge, and several single site initiatives.

The account of the Foundation's grantmaking in this area by Carolyn Newbergh, a freelance journalist specializing in health care issues, indicates that the results of the Foundation's efforts were mixed. However, the Foundation learned some lessons from Old Disease, New Challenge about serving difficult-to-reach populations such as migrant farm workers, laborers crossing the United States-Mexican border, and poor people living in inner cities. The lessons might become even more relevant if the globalization of diseases leads to another resurgence of tuberculosis in this country.