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This paper explores whether the incidence of tuberculosis TB is higher among low income people because they are less likely to seek medical care It investigates two urban districts that compare in terms of race and income level these being Harlem and West Central USA To determine the role of race and economic disadvantage in the incidence of tuberculosis in these geographic areas ethnographic methods were used to analyze the information It appears that there are significant race and class dimensions to the incidence of tuberculosis in these areas but there are other confounding factors such as human immunodeficiency virus HIV and the times at which sufferers sought medical help This study suggests that there is a pressing need to improve our understanding of the socio-economic aspects of problems affecting public health such as TB in the United States People in economically disadvantaged positions living in medically under-served communities are at an increased risk for tuberculosis The disease does continue to be a barometer of poverty and race but there are other significant factors associated with the incidence of TB Studies in South Africa suggest that those qualified as black or coloured had significantly less access to health care and thus stood less chance of being diagnosed than their white counterparts Andersson 1990 Those in this disadvantaged condition tended to suffer disproportionately from other socio-economic related medical factors such as malnutrition and incidence of HIVAIDS that are closely linked with the incidence of TB The pattern is similar in other countries including the USA The problem in the United States is that there is limited population-based data on TB by social class Lifson et al 1999 There is even less data on the incidence of seeking medical care between the onset of symptoms and the visit to a medical center The incidence of TB is indeed higher among low income people because they are less likely to seek medical care But the objective of this
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