New York City Case Study

The problem

If you have tuberculosis and don’t get treatment, there’s a 50–80% chance that you’ll die from it.* If treatment starts but is not completed, the disease mutates. Drugs that should have cured the disease end up strengthening it. As one medication becomes ineffective, others are introduced. If the cycle continues, eventually no drug works.

New York City, 1992

Tuberculosis is a disease of poverty. The vast majority of people who contracted it in New York City in 1992 regularly moved between temporary shelters, health clinics, hospitals, and prison.

Sometimes they received their medicine. Sometimes they didn’t. New York City was on its way to becoming the epicenter of a global TB epidemic.

To control TB five city agencies had to work together. Employees in the prisons, public hospitals, shelters, Department of Health, and Office of Management and Budget were all committed to controlling TB.

For years though, the agencies had worked at cross-purposes. There were annual battles over funding. None of their systems, processes, or procedures was the same. People didn’t know how to work across agencies. Each wanted to do their job well. But for one agency to do its best, it seemed the others had to suffer.

The Solution

First we worked with leaders from all five agencies. They created a Blueprint to Control TB. It was a good plan. But the agencies would have to work in radically different ways to turn the plan into action.

Then we held a 400-person RTSC event. Attendees included prison guards, nurses, shelter directors, epidemiologists, primary care physicians, admissions clerks, budget analysts, building engineers, union officers, and lawyers had three days to figure out how to implement the Blueprint.

Together they learned how TB spreads and how to halt the outbreak. They let go of stories and assumptions about each other that had gotten in the way in the past. And they made commitments to work together in the future.

The Results

The agencies took four immediate actions:

• They pooled their collective needs and created a joint budget. Before they had sent in individual budget requests for funding that guaranteed little coordination in the future
• Regardless of where TB patients were in the city, an integrated technology and information system tracked their location and therapy requirements
• The Bureau of TB Control was launched to coordinate city-wide TB activities
• Cros-agency teams developed and delivered prevention, education, and research programs

New York City 2007

Progress in New York City is still being made sixteen years later:

• There has been a 76% decrease in TB from the high of 3,811 cases in 1992 to 914 last year.
• The Coalition for a TB-Free New York City organized the first annual Community Forum on Tuberculosis in NYC. The forum brought together community leaders, physicians, researchers and other health care professionals representing 19 agencies to share information about TB and discuss strategies for community-based approaches to TB control.
• 2007 marked the third consecutive year fewer than 1,000 reported cases of tuberculosis
• There were fewer than 10 cases of multidrug resistant tuberculosis for the first time since tracking began in 1992

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