The destruction of US minority urban communities and the resurgence of tuberculosis: Ecosystem dynamics of the white plague in the dedeveloping world

Techniques from population and community ecology and from conservation biology are applied to the growing tuberculosis (TB) epidemic now focused in many US urban minority communities. Modification of a simple spatial model of TB to include the effects of recurring social, political, economic, and other catastrophes shows that a sudden increase in the rate of such factors can markedly and synergistically lower the threshold area density of susceptible population needed for transmission of the disease from an epicenter into surrounding regions, triggering a sudden outbreak of disease from previously endemic or declining epicenters. Detailed application is made to New York City, where a recurrent process of fire, housing abandonment, and forced population displacement affecting poor minority communities threatens to spread multiple drug-resistant strains of the disease throughout a twenty-four-county metropolitan region containing nearly twenty million people. Our work is to be contrasted with that of Blower et al, who concluded that improvements in social conditions were a relatively minor factor in disease control because of the long relaxation time of the infection process.