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lows for consistent information to reach policy makers across all levels of government

3. External Concern. External concern relies on the use of community leaders to communicate need to policy makers.

4. Media Interest. The Committee found the use of the media to create a climate of public interest and concern critical to sustaining policy maker and government interest.

All four factors represent challenges in social mobilization in the United States. Public opinion research clearly shows that the popular perception of tuberculosis is that it is not a problem in the United States (CDC, unpublished data). In part this is due to the demographics of the disease, the majority of those afflicted with tuberculosis are at the margins of society, and to the fact that the disease is once again in decline. There is a technical consensus around tuberculosis as represented by the guidelines jointly endorsed by the American Thoracic Society, the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the Infectious Diseases Society. However, there has been difficulty communicating this consensus while maintaining media interest. News coverage naturally gravitates to unusual and exciting situations. For example, although there is technical consensus that the risk for tuberculosis infection aboard airplanes is low, news coverage has made some people afraid to fly. In another example, although multidrug resistant tuberculosis is a very serious problem, with a potential to worsen in the future, it represents a small and decreasing number of cases in the United States. Still the news media devotes a large part of its coverage to this type of tuberculosis, which generates a frenzied call for tuberculin skin testing in suburban schools. Media interest has to be maintained while communicating information accurately. Finally, external concern is very weak at the national level. Since the American Tuberculosis Association became the American Lung Association, the Christmas Seal Campaign and the selection of the national chairman has focused on other issues other than tuberculosis. External concern has generally tended to come from local groupings and ad hoc alliances. The funding increase for tuberculosis in the 1990s is in large part attributable to the interaction between tuberculosis and HIV. Because of this interaction, AIDS activists provided support for the TB community in obtaining more resources. On a local level, a number of state and city lung associations are active advocates and supporters of the tuberculosis program. In South Carolina, the Lung Association has provided resources for the incentives and enablers program that has served as a model to much of the rest of the nation. In California, as described in the site visit notes, the San Diego Lung Association has been a key supporter in the housing program and in developing community



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