Incentives like cigarettes and chocolates aided in combating a TB epidemic

It was described as a major offensive against a public health crisis that was afflicting an impoverished post-war Glasgow. In 1957, the city recorded Europe’s highest death rate from tuberculosis (TB), prompting health officials to launch an ambitious “X-ray now” mass-screening campaign that examined over 700,000 individuals within five weeks. A force of 12,000 volunteers mobilized nearly three-quarters of Glasgow’s population to undergo checks, with health authorities providing the inducement of free prize draws for those who participated in X-rays. These draws offered prizes such as TVs, holidays, and cars, alongside more unusual rewards like cigarettes, chickens, and chocolates. The significant achievement of the 1957 programme led to 2,369 people with TB being identified and treated, but a recent study conducted by the University of Glasgow has revealed broader advantages. Researchers discovered that because the screening initiative curtailed the widespread circulation of TB in the city, an estimated 4,599 cases were prevented in the subsequent five years, preserving countless lives. Peter MacPherson, a professor of global public health at the University of Glasgow, expressed his hope that the insights gained from 1957 could assist current efforts to eradicate TB, as the disease continues to claim over 1.2 million lives annually worldwide. He stated: “This mass screening had a huge impact, doubled the rate of people being detected with TB and really accelerated the reduction in cases.” He added: “There really is nothing comparable in the world in terms of the programme’s scale.” MacPherson further remarked: “We can learn a lot from what has been done historically – it was real civil enterprise, people’s motivations were to help their neighbours as at that time probably everyone knew someone who was affected by TB.” The rapid screening programme in Glasgow utilized a total of 37 mobile X-ray units, staffed by radiographers temporarily assigned from cities across the UK. An intensive promotional campaign for the programme featured loudspeaker vans and an illuminated tram car touring the city, aeroplane banner advertising, and two specially-commissioned campaign songs broadcast at football matches. Every person who underwent a chest X-ray received a badge, and randomly selected individuals seen wearing badges were given small gifts such as chocolates, chickens, and cigarettes. Additionally, participants could enter prize draws where refrigerators, TVs, washing machines, holidays, furniture, and a car were available to be won. Prof MacPherson noted that some of the prizes, such as cigarettes, are “things we would not recommend nowadays,” but also mentioned that researchers involved in the study were impressed by the extent of the volunteer effort that contributed to the programme’s success. He commented: “12,000 volunteers was remarkable, the people of Glasgow really came together for this going door to door and encouraging people to come forward.” He emphasized: “TB is quintessentially a disease of poverty” and explained: “Post-war Glasgow had some of the highest rates in Europe of TB and that was really driven by overcrowding and substandard housing, really poor nutrition after WW2 and air pollution.” He further commented: “Nowadays the centres of the TB infections are Africa, Asia and South America and we still have guidelines for mass screening for TB but we really don’t have a good handle on what works and this historical evidence from Glasgow can really help these places I think.” Tuberculosis is a bacterial infection transmitted through inhaling tiny droplets from the coughs or sneezes of an infected person. While TB can be treated with antibiotics, it can be fatal if left untreated. The World Health Organization estimates nearly 11 million people fell ill with TB worldwide last year, with more than a million of them dying. Typical symptoms include: Figures released by Public Health Scotland last month indicated that the number of TB cases in Scotland increased by just over 40% in 2023, reaching its highest level since 2017. The data showed 283 instances of the disease were recorded last year, compared with 201 in 2022. Public Health Scotland reported that the incidence of the disease among people born overseas was 19.2 times higher than for those born in the UK, and a “strong” link persists between TB cases and areas of deprivation. Prof MacPherson stated that the increase demonstrated the necessity for even a country with low incidence, such as Scotland, to maintain vigilance, and further suggested that the effects of the Covid pandemic could have interfered with the diagnosis of TB cases. He explained: “The symptoms of TB are similar to Covid in some ways so with the focus so much on Covid you may not have been appropriately investigated TB cases at that that time.”