Under such conditions, tuberculosis could readily be passed from older adults to adolescents. And unlike rapid disease epidemics, chronic diseases such as tuberculosis took a great toll on the childbearing population and adversely effected the ability to reproduce. Some new evidence shows European contact leading to increased mortality rates among adolescents and young adults. Thus, the eventual declines in Native American population size after European contact become easier to interpret based upon a resurgence of chronic diseases, not only epidemics of new diseases. Here, the social structure and culture of Native Americans are key to understanding the spread of disease.
Tuberculosis persists as a problem of great dimensions.
As in the past, we will not be able to understand and control the medical aspects of these diseases unless we address their social and cultural dimensions.