In 2015, I wrote the report “Wasted Health” trying to describe the vast health impacts posed by dumpsites, mainly in the developing world, where dumpsites and lack of proper waste management are already a health emergency. But as the story below describes, the human right to good health is systematically violated by the lack of proper waste management and sanitation even in the richest nations of this world.
Scientists in Houston have lifted the lid on one of America’s darkest and deepest secrets: that hidden beneath fabulous wealth, the US tolerates poverty-related illness at levels comparable to the world’s poorest countries. More than one in three people sampled in a poor area of Alabama tested positive for traces of hookworm, a gastrointestinal parasite that was thought to have been eradicated from the US decades ago. These are the findings of a new study into endemic tropical diseases, not in places usually associated with them in the developing world of sub-Saharan Africa and Asia, but in a corner of the richest nation on earth: Alabama. In a survey of people living in Lowndes County, an area with a long history of racial discrimination and inequality, it found that 34% tested positive for genetic traces of Necator americanus, commonly known as hookworm.
Hookworm parasite was thought to be extinct, but remains rampant in the US due to extreme poverty
Hookworm was rampant in the deep south of the US in the earlier 20th century, sapping the energy and educational achievements of both white and black kids and helping to create the stereotype of the lazy and lethargic southern redneck. As public health improved, most experts assumed it had disappeared altogether by the 1980s. But the study reveals that hookworm not only survives in communities of Americans lacking even basic sanitation, but does so on a breathtaking scale. None of the people included in the research had travelled outside the US, yet parasite exposure was found to be prevalent, as was shockingly inadequate waste treatment, explaining the way the parasite entered open water pipes. The parasite enters the body through the skin, usually through the soles of bare feet, and travels around the body until it attaches itself to the small intestine where it proceeds to suck the blood of its host. Over months or years it causes iron deficiency and anemia, weight loss, tiredness and impaired mental function, especially in children, helping to trap them into the poverty in which the disease flourishes.
The peer-reviewed research paper, published in the American Journal of Tropical Medicine and Hygiene, focuses on Lowndes County, home to 11,000 residents, 74% of whom are African American. The average income is just $18,046 a year and almost a third of the population live below the official US poverty line. The most elementary waste disposal infrastructure is often non-existent. Some 73% of residents included in the survey reported that they had been exposed to raw sewage washing back into their homes as a result of faulty septic tanks or waste water pipes becoming overwhelmed in torrential rains.
To make matters worse, proper sewage treatment systems is considered a responsibility of the residents, given the spate of criminal prosecutions that were launched by Alabama state between 2002 and 2008 against residents who were open-piping sewage from their homes. Obviously unable to afford proper treatment systems, people are often afraid to report their problems in a place that lacks basic public infrastructure. In fact, 80% of the county is uncovered by any municipal sewerage system, and in its absence people are expected – and in some cases legally forced – to provide their own. According to The Guardian’s report, a woman was jailed over a weekend for failing to buy a septic tank that cost more than her entire annual income!
Poverty is the world’s deadliest disease
“This is the definition of ‘Make America Great Again’,” said Aaron Thigpen, 29, a community activist who assisted with the hookworm study. “This is the reality of how people are being forced to live.” Thigpen’s cousins live in the trailer park, and he has talked to them about the perils of piping sewage from their homes and dumping it in the open just a few feet away. “They are disgusted about it, they’re sick and tired of living like this, but there’s no public help for them here and if you’re earning $700 a month there’s no way you can afford your own private sanitation.”
The wealth gap is growing within the world’s most powerful countries and the poor are always disproportionately affected by public health hazards. Inefficient sanitation systems aren’t the source but rather the result of the problem these people face, which is none other than unfathomable inequality, in a country were public welfare is long gone. Poverty is the real epidemic that’s causing diseases we all thought to be extinct to flourish in the 21st century.
“Poverty is the world’s deadliest disease”, according to the World Health Organisation’s World Health Report 1995 – Bridging the Gaps. The growing economic gap is literally “a matter of life and death” for millions who pay the price of inequity with their lives. Contrary to overall trends, in several developing countries and in certain growing pockets of poverty life expectancy is actually shrinking, as the poorest die for want of safe water, adequate sanitation and basic health care.
As it has been detailed in the great paper “Global burden, distribution, and interventions for infectious diseases of poverty“, infectious diseases of poverty disproportionately affect the poorest population in the world and contribute to a cycle of poverty as a result of decreased productivity ensuing from long-term illness, disability, and social stigma. The affected populations usually have fewer material, physical, and financial resources to draw from and limited or no access to integrated health care, prevention tools and medications, thus resulting in the most severe adverse impacts. Various social determinants also compound the issue and these include gender dilemmas, unemployment, illiteracy, poor nutrition, indoor air pollution, political instability, and lack of access to proper sanitation and health education, among others. The socioeconomic and physical conditions of those living in poverty create environments that facilitate the transmission of vectors and pathogens consequently leading to long-term illness that further exacerbates poverty by diminishing productivity. A large proportion of these infectious diseases in low- middle- income countries (LMICs) are entirely avoidable or treatable with existing medicines or interventions.
Poverty drives diseases and diseases drive poverty. Wasted Health is the privilege of all the non-privileged and marginalised populations, either in Bangladesh informal settlements, in Alabama’s poor counties or in a refugee camp in Europe…