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Voluntary tuberculosis associations
Tuberch,, Lond., (1964), 45, 390
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V O L U N T A R Y T U B E R C U L O S I S ASSOCIATIONS At the 17tl't International Tuberculosis Conference in 1963 one of the panel discussions was on 'Problems in the Organization and Development of Voluntary Tuberculosis Associations'. Some clinicians and laboratory workers might ask whether voluntary associations need exist at all. Some might indeed ask what they are. A speaker from Ghana stated that "the concept of voluntary association for the alleviation of social misery and disease goes back far into history' (Salami, 1964). The associations consist, quite simply, of people who voluntarily associate with each other to llelp alleviate the social misery caused by tuberculosis. The association is voluntary, in that no one is compelled by national laws, customs or regulations to take part. In this particular context. 'voluntary' also implies that the association is unconnected with official organizations, the members of which have a statutory obligation to the controlling authority, even though they themselves have volunteered for the work. Tuberculosis, being an infectious disease, is the concern of the whole population, not of the patient alone. This is recognized in different ways in different societies, according to tile political and economic conditions of each. Thus, in one society the whole cost of controlling tuberculosis and treating individual patients may be borne by the society acting as a whole, througl't the governing body: and many regulations may be accepted that restrict individuai freedom of action. In others, the cost may be borne by the individuals themselves, charitable organizations or insurance associations; and restrictive regulations may be few. But in the great majority of countries, the principle is accepted that a disease with such social implications needs some action by th.e society as a whole. It could be argued tb,at the more efficient the official organizations become, the less need there is for unofficial ones. One speaker in the discussion said tl'tat "we shall never be able to ignore human factors in the control of tuberculosis. We need the faith and loyalty of individuals, and if we fail to use these qualities we are throwing away a vital asset. The most effective expression of these human qualities is voluntary association' (Harley Williams. 1964). But this implies that a non-voluntary~an official~association is necessarily less humane and effective in dealing with people than a voluntary one, whicit is not necessarily true. Another argument in favour of retaining voluntary associations is that, as unofficial bodies, they can more easily create the right atmosphere among the people for tuberculosis control (in which the people themselves must co-operate) than can official organizations; for these are restricted by their responsibility to the governing authority and may be more concerned with carrying out the official policy than with preparing the people to accept it. Moreover, it is claimed, an unofficial association can more readily influence the formation of official policy, as it is closer in thought to the mass of the population and less restricted in the pressure it can bring on local or national governments. According to Meijer (1964) the countries of Western Europe that have the lowest prevalence of tuberculosis are also those in which tuberculosis control was made into a popular movement by national tuberculosis associations. Some countries may already have reached the stage when a voluntary tuberculosis association is unnecessary. It has ' been said that an association 'may be faced with the alternative of amalgamation with another health committee, or non-existence. It is conflict between what we should like and what we can do' (Harley Williams, 1962). This implies that an association may have insufficient public support to keep it going. It may be due to public apathy. It could also be due to public awareness that the association is no longer required. But such an association could still use its resources to help less fortunate countries, if money and personal service remained available. Amalgamation with some organization that retains and can increase its popular appeal implies
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391
that tuberculosis work becomes a submerged activity. Inevitably it will sometime sink. A better solution would be for tuberculosis to remain dominant and the appeal to th.e public to be frankly altruistic. It has been done with leprosy. There may be argument about the need for voluntary associations in rich. countries with. highly organized and efficient social services and a low prevalence of tuberculosis. There can be none for the poorer and less socially developed ones. The primary task of voluntary associations in these circumstances is to 'educate, mobilize and stir public opinion' (Mahmt3od, 1964), to create the atmosphere in which the control measures of official organizations can be most effective, and to stimulate them througll public opinion to do better. Yet there are dangers. A campaign to stimulate public awareness of tuberculosis could, if unwisely directed, go too far. in some countries it is impossible to treat all who already come for help. To discover more could lead to worse treatment for all. unless medical and nursing services and the supply of drugs were increased in proportion to the demand. Enthusiasm and dedication, untempered by realism, may ultimately be harmful. The policy for controlling tuberculosis must be made by those with full knowledge of the general health and economic facts, and with constitutional responsibility for carrying it out. It will be influenced by pressure of public opinion. But those who set out to 'educate, mobilize .and stir' this opinion must act in accord with official policy and at the speed of development deter.mined by it, campaigning for haste, but acting witll discretion. This does not detract from the need for voluntary associations, nor from their value. It merely puts them in their most productive place in the national effort. Tuberculosis is just one of many problems. It must be kept in perspective. The International Un~on against Tuberculosis is a voluntary association. Its constituent members, more than 70, are national tuberculosis associations. (It has, in addition, about 2 ~ 0 individual "ordinary' members, including 27 from Great Britain). Its object is the same on an international scale as that of each of its constituents on the national scale--voluntary association for the alleviation of social misery and disease from the tubercle bacillus. ]'hose wh.o think that the need for voluntary tuberculosis associations in their own countries is declining might give greater support to the international association. Its need is still great. REFERENCES HARLEY~VILLIAMS,J. H. (I964). Bull. int. Un. Tuberc., 35, 377. MAHMOOD,V. (1964) Bull. int. Un. Tuberc., 35, 417. MEIJER, J. (1964). Bull. int. Un. Tuberc., 35, 404. SALAMI,A. C. (1964). Bull. int. Un. Tuberc., 35, 391.
390 LEADING
ARTICLE
V O L U N T A R Y T U B E R C U L O S I S ASSOCIATIONS At the 17tl't International Tuberculosis Conference in 1963 one of the panel discussions was on 'Problems in the Organization and Development of Voluntary Tuberculosis Associations'. Some clinicians and laboratory workers might ask whether voluntary associations need exist at all. Some might indeed ask what they are. A speaker from Ghana stated that "the concept of voluntary association for the alleviation of social misery and disease goes back far into history' (Salami, 1964). The associations consist, quite simply, of people who voluntarily associate with each other to llelp alleviate the social misery caused by tuberculosis. The association is voluntary, in that no one is compelled by national laws, customs or regulations to take part. In this particular context. 'voluntary' also implies that the association is unconnected with official organizations, the members of which have a statutory obligation to the controlling authority, even though they themselves have volunteered for the work. Tuberculosis, being an infectious disease, is the concern of the whole population, not of the patient alone. This is recognized in different ways in different societies, according to tile political and economic conditions of each. Thus, in one society the whole cost of controlling tuberculosis and treating individual patients may be borne by the society acting as a whole, througl't the governing body: and many regulations may be accepted that restrict individuai freedom of action. In others, the cost may be borne by the individuals themselves, charitable organizations or insurance associations; and restrictive regulations may be few. But in the great majority of countries, the principle is accepted that a disease with such social implications needs some action by th.e society as a whole. It could be argued tb,at the more efficient the official organizations become, the less need there is for unofficial ones. One speaker in the discussion said tl'tat "we shall never be able to ignore human factors in the control of tuberculosis. We need the faith and loyalty of individuals, and if we fail to use these qualities we are throwing away a vital asset. The most effective expression of these human qualities is voluntary association' (Harley Williams. 1964). But this implies that a non-voluntary~an official~association is necessarily less humane and effective in dealing with people than a voluntary one, whicit is not necessarily true. Another argument in favour of retaining voluntary associations is that, as unofficial bodies, they can more easily create the right atmosphere among the people for tuberculosis control (in which the people themselves must co-operate) than can official organizations; for these are restricted by their responsibility to the governing authority and may be more concerned with carrying out the official policy than with preparing the people to accept it. Moreover, it is claimed, an unofficial association can more readily influence the formation of official policy, as it is closer in thought to the mass of the population and less restricted in the pressure it can bring on local or national governments. According to Meijer (1964) the countries of Western Europe that have the lowest prevalence of tuberculosis are also those in which tuberculosis control was made into a popular movement by national tuberculosis associations. Some countries may already have reached the stage when a voluntary tuberculosis association is unnecessary. It has ' been said that an association 'may be faced with the alternative of amalgamation with another health committee, or non-existence. It is conflict between what we should like and what we can do' (Harley Williams, 1962). This implies that an association may have insufficient public support to keep it going. It may be due to public apathy. It could also be due to public awareness that the association is no longer required. But such an association could still use its resources to help less fortunate countries, if money and personal service remained available. Amalgamation with some organization that retains and can increase its popular appeal implies
LEADING ARTICLE
391
that tuberculosis work becomes a submerged activity. Inevitably it will sometime sink. A better solution would be for tuberculosis to remain dominant and the appeal to th.e public to be frankly altruistic. It has been done with leprosy. There may be argument about the need for voluntary associations in rich. countries with. highly organized and efficient social services and a low prevalence of tuberculosis. There can be none for the poorer and less socially developed ones. The primary task of voluntary associations in these circumstances is to 'educate, mobilize and stir public opinion' (Mahmt3od, 1964), to create the atmosphere in which the control measures of official organizations can be most effective, and to stimulate them througll public opinion to do better. Yet there are dangers. A campaign to stimulate public awareness of tuberculosis could, if unwisely directed, go too far. in some countries it is impossible to treat all who already come for help. To discover more could lead to worse treatment for all. unless medical and nursing services and the supply of drugs were increased in proportion to the demand. Enthusiasm and dedication, untempered by realism, may ultimately be harmful. The policy for controlling tuberculosis must be made by those with full knowledge of the general health and economic facts, and with constitutional responsibility for carrying it out. It will be influenced by pressure of public opinion. But those who set out to 'educate, mobilize .and stir' this opinion must act in accord with official policy and at the speed of development deter.mined by it, campaigning for haste, but acting witll discretion. This does not detract from the need for voluntary associations, nor from their value. It merely puts them in their most productive place in the national effort. Tuberculosis is just one of many problems. It must be kept in perspective. The International Un~on against Tuberculosis is a voluntary association. Its constituent members, more than 70, are national tuberculosis associations. (It has, in addition, about 2 ~ 0 individual "ordinary' members, including 27 from Great Britain). Its object is the same on an international scale as that of each of its constituents on the national scale--voluntary association for the alleviation of social misery and disease from the tubercle bacillus. ]'hose wh.o think that the need for voluntary tuberculosis associations in their own countries is declining might give greater support to the international association. Its need is still great. REFERENCES HARLEY~VILLIAMS,J. H. (I964). Bull. int. Un. Tuberc., 35, 377. MAHMOOD,V. (1964) Bull. int. Un. Tuberc., 35, 417. MEIJER, J. (1964). Bull. int. Un. Tuberc., 35, 404. SALAMI,A. C. (1964). Bull. int. Un. Tuberc., 35, 391.