Bartlett's Bizarre Bazaar

I don’t know how Michael Howard sleeps at night. He has resurrected the old racist canard: immigrants bring disease. Please understand, this post is not, in the main, about whether it is appropriate to test people coming in to this country for tuberculosis (TB), or any other infectious disease. Such checks may be entirely sensible. Giving them the sort of prominence that Michael Howard has given them this week certainly is not. It is yet another example of Tory unreason [see here and here for his previous displays of mental confusion]. TB tests are already conducted on people seeking refuge in Britain. Are there hundreds of them, just waiting to cough all over good old English folk on the tube? Do we need to return (a key phrase for translators: ‘go home and die’) thousands of people to the countries they have left?

Well, no. Of the 4,219 tested in Ashford, Kent, only 9 have TB. That is 0.2%. Not, you would presume, the sort of problem that should command a significant degree of attention from the leader of a major political party in the approach to a General Election. Probably not even the sort of thing that should be at the forefront of a health spokesman. More a matter for public health professionals and associated civil servants to work out a suitable practice in consultation with representatives of refugees, surely. Hold on there, the Tories argue, but there has been a rise in TB in Britain over the past 10 years. We here in Britain had virtually eradicated the disease, but look, in 1992 there were 5,798 cases and in 2002 there were 6,891 cases. What is more, two-thirds of people with TB in the UK were born abroad. They must have brought the disease with them, they argue.

Well, if they do argue this they are either dim or the deliberate propagators of ignorance. They can have the call on which label they would prefer to hold. Given that only 0.2% of the people seeking refuge were found to have TB, it demands a leap of faith to suggest that people are coming into the country actually having the disease TB. How do all these foreigners get it then, these dim witted Tories ask? Well, you see, as your medical advisors no doubt told you, one third of the world’s population has the tubercle bacillus in their lungs, and the vast majority of these show no symptoms. There is no reason to believe that there are not many people in Britain, people who have never left Britain, walking around with the tubercle bacillus in their lungs. But these people are not infectious. And neither are people from abroad with the bacillus in their lungs. Only people who have developed TB as a disease, and who are coughing up large amounts of bacteria, are infectious. Prolonged close contact is also necessary, and the BCG vaccination that we should all have received is a pretty effective, but not complete, block.

The Tories, for reasons that will become evident, would have you believe that the tubercle bacillus is the cause of TB. But it is plain for all to see that if the vast majority of the people living with the bacillus in their lungs do not have TB as a disease, then there must be other causes involved. And these causes are social. Good nutrition reduces the incidence of the disease, as does good housing and a healthy living environment. TB in the developed world is, we can say, a disease of poor inner-city dwellers. They have poor diets and an unhealthy crowded living environment. Historically, migrants tend to be poor inner-city dwellers, as anyone with an idea of the waves of migration that have swept through London would know.

As only 0.2% of people seeking refuge actually had TB, is barring these people really the dominant strand of the Tories public health proposals? The burden of TB on the NHS would be reduced by a miniscule number of cases. The danger of infection would be infinitesimally reduced. Of course, what we should understand is that even cruel Howard will not bar refugees with TB from Britain. But he will ban those seeking to migrate to Britain to work from entering if they have TB. Yet TB is a debilitating disease. How many people who cough up blood will, when they do not have a torturer at their back, seek to travel to a cold, wet foreign (and lamentably, hostile) country? How many of these would fulfil the rest of the criteria when applying for a visa? I think we can safely say that if the percentage of people seeking refuge in Britain that have TB is just 0.2%, then the percentage of people coming here without being driven by fear and desperation will be somewhat less. An absolutely tiny number.

So does Michael Howard really want to do anything about TB in Britain? If he already understood all this, then clearly not. If he was ignorant of all this, then, well, is he really a fit leader of a major political party? What would effective action to reduce the rate of TB in Britain look like? Well, number one, according to the testimony of Ian McCartney MP, is the training of doctors to spot the symptoms of a disease we arrogantly assumed to have defeated. Second, we need to place at the head of our national health priorities housing and nutrition. As with TB, we had arrogantly assumed that once the big battles to provide everyone with a decent home and decent, healthy food were won, we could sit back on our laurels. But if we are not fighting these battles, what is there to stop the standards of housing and diet from falling once again. And fall they have. But these are not Tory concerns. And as for calls to improve the housing of immigrants, the reason why this effective brake on TB would be rejected out of hand is the very same reason that the Tories have promoted a policy which can be nothing other than totally ineffective.

All decent politicians, all decent journalists should have attacked Michael Howard’s proposals, not only for the unreason of their formulation but also, and more importantly, because he uses this parade of unreason, this theatre of playing the hardman to appeal to the, if we are being charitable, ignorant and the, if the generous label of ignorance is challenged, wicked aspects of British character – the racist.

But instead we have a press that falsely, but viscously and determinedly, squeals anti-Semitism at one of the few committed and high-profile anti-racist politicians. This, of course, is the big issue of the day, deserving of energy and analysis, not the exploitation of the racist tropes to appeal to racist portion of the electorate, cloaked in the language of medicine and with the glow of public health concern. And cloaked in this language, despite not corresponding to any reality, it seeks to persuade others, to lodge these ideas in a whole new generation.

In the early part of this century British newspapers campaigned against the immigration of dirty Eastern Europeans. They would not only bring crime, the papers wrote, but disease too. These attitudes continued until the 1930s and the people they strove to keep out were Jews.

Michael Howard was not a German war criminal, nor was he a concentration camp guard. But he is not dim, and he knows full well that he shares an argument and a philosophy, and ultimately he hopes to appeal to same ignorant, or just plain wicked, aspects of the British character that thought these two categories of gave insult no real insult at all. How does he sleep?

Postscript: Please also note that there has been a rise in multiple drug resistant TB (MDRTB). Please see my post on ‘suberbugs’ for a discussion on a very similar subject.