Disease and Poverty: The Hidden Cost of Being Poor

We tend to think of disease as sort of natural disaster, like a kind of biological tsunami. While that’s true to an extent (some amount of disease is unavoidable), this view is dangerous because it suggests that no one is to blame for disease outbreaks, and that they cannot be prevented. And that—to put it mildly— is a bunch of hogwash.

In health, as in everything, the game is rigged in favor of the rich. It turns out that it’s not just the big top-down social structures that empower the wealthy. Inequality affects everything, right down to our immune system, stacking the deck from the ground up. The socioeconomic class you were born into directly relates to your chances of survival. That’s true not just in the near-term, meaning whether or not you survive childhood, but throughout your life.

The meek’s inheritance

Poverty is one of the greatest (arguably the greatest) causes of illness and premature death around the world. Poverty is a public health double whammy: it leaves people more vulnerable to disease by depriving them of adequate food, water, shelter, and support, and it prevents people from accessing healthcare when they do fall ill1,7. Living in poverty keeps people from getting educated, making them more likely to participate in risky health behaviors like smoking, because they do not understand the danger. It also limits choice. For example, the poor often have limited access to healthy food options, leaving them more likely to eat calorie-dense, high-fat food that deteriorates their health7.

Not only can being poor prevent you from getting medical attention, getting treated can also make you poor. The poor often cannot afford healthcare, if it’s available at all. But the expense can also cause an economically secure family to fall into poverty, which then leaves them more likely to get sick in the future, creating a terrible cycle. It’s easy to see how this happens. Healthcare expenses add up quick, from the cost of medicine to the wages lost due to sickness. These costs can spell disaster. The severe illness or death of the main breadwinner can be financially catastrophic for the household, and may permanently impoverish the remaining family members7.

As with everything, deep economic misfortune is not shared equally. The world’s poorest citizens are concentrated in areas that have been historically exploited and disenfranchised, including sub-Saharan Africa and eastern and southern Asia5. In high-income countries, a legacy of racism and xenophobia have left minorities much more likely to live in poverty. For example, in America, 45.8% of young black children (under age six) live in poverty, compared to 14.5% of young white children3. The global burden of social and health inequality falls particularly hard on women, aided by gender inequality2,7. Worldwide, women suffer from a higher rate of disease than men, especially very poor women7.

disease and poverty
What a weight to carry.

Live poor, die young

The World Health Organization estimates that 45% of the global disease burden is caused by diseases of poverty5. That’s right, the connection between poverty and illness is so powerful that there is an entire group of diseases defined by the association: diseases of poverty. These include HIV/AIDS, tuberculosis (TB), malaria, and the so-called neglected tropical diseases, like dengue, rabies, and Chagas disease2.

These conditions take a massive toll, measured in the millions and billions. Of the 2.7 billion people living in poverty around the world, more than 1 billion suffer from neglected tropical diseases1. In 2010, HIV/AIDS killed 1.5 million people, TB killed 1.2 million, and malaria killed 1.17 million. In 2012, 91% of the deaths from malaria occurred in Africa, and 86% involved children under the age of five2.

The conditions of poverty itself also give rise to a suite of deadly conditions. These include malnutrition, diarrheal diseases (which claim a staggering 1.8 million lives per year), and respiratory infections due to air pollution.

Chronic diseases, like cancer, cardiovascular disease and diabetes, also disproportionately affect the poor. The poor are more at risk of getting a chronic disease, and of dying from it early. This inequality is often most striking in high-income countries like the United States. These conditions can last for decades, and require long-term care, which can greatly increase their cost and exacerbate the negative poverty-healthcare cycle I talked about earlier7.

What is especially tragic about these conditions is that most of them can be prevented with established approaches or treated with existing medicines2,5. They should not happen. But, as discussed above, healthcare and health education are often not available to those who need it most.

The lasting effects of poverty

Poverty in childhood affects health for a lifetime, even if you stop being poor. The conditions common to poverty, like malnutrition, can have lasting effects like impaired growth or cognitive development2. However, it’s more than that. All else being equal, children who are raised in poverty still have a greater risk of developing health problems later in life than those who are not. These include many diseases that are common in America: heart disease, stroke, and some cancers4.

Scientists have not determined what drives this; some have speculated that the conditions of poverty prime the immune system for later illness4. For now, it’s clear that even if you somehow claw your way out of poverty, you may still suffer its costs.

The toll of history

Disease does not happen in a vacuum. It is a symptom of historical inequality and structural violence, including racism, sexism and xenophobia1, and it is often the direct result of poverty. Until those of us in positions of relative privilege take responsibility and address these underlying causes, the world will not be free of the enormous burden created by preventable illness and death. And—make no mistake—we will all be to blame.

References

  1. Alsan, MM, M Westerhaus, M Herce, K Nakashima, and PE Farmer. 2011. Poverty, global health and infectious disease: lessons from Haiti and Rwanda. Infectious Disease Clinical North America, 25:611-622.
  2. Bhutta, ZA, J Sommerfeld, ZS Lassi, RA Salam, and JK Das. 2014. Global burden, distribution, and interventions for infectious diseases of poverty. Infectious Diseases of Poverty, 3:21.
  3. Economic Policy Institute. 2012. The State of Working America: Key facts. Washington, DC. Economic Policy Institute. 13 December 2016. http://stateofworkingamerica.org/fact-sheets/poverty/
  4. Miller, GE, and E Chen. 2013. The biological residue of childhood poverty. Child Development Perspectives, 7:67-73.
  5. Stevens, P. 2004. Diseases of poverty and the 10/90 gap. International Policy Network.
  6. Sumner, A. 2012. Where do the poor live? World Development, 40:865-877.
  7. World Health Organization. Chronic diseases and poverty. Web. 8 December 2016. http://www.who.int/chp/chronic_disease_report/part2_ch2/en/

Image Credit

Julie, D. File DSC00930 Burma Shan State Table Land Heavy Transportation on the Path to Indein. Creative Commons. 13 December 2016. https://commons.wikimedia.org/wiki/File:DSC00930_Burma_Shan_State_Table_Land_Heavy_Transportation_on_the_Path_to_Indein_(4679157162).jpg

 

 

Virus Hunters: Searching for Microbes in the Wild

We’re just a big, hairy afterthought to life on earth. This world belongs to microbes; we just live on it, and not always comfortably. If the viral particles (which are just a fraction of all microbes) on Earth− a staggering 1 x 1031− were laid end to end, they would stretch 100 million light years away. Yet while we know that there are tons of microbes on earth, we don’t know how much diversity there is among their ranks. The total number of microbial species is unclear and the estimates vary widely, ranging from a low of around 120,000 to tens of millions or more.3 Regardless of the exact number, it is obvious that−to date− we have only scratched the surface of microbial diversity.

Unfortunately, in this case, what we don’t know can hurt us. While the vast majority of microbes are benign, there are plenty that can do us ill, literally. There are currently about 1,400 known human pathogens (microbes that cause disease, including viruses, bacteria, fungi, protozoa, and helminthes). While that’s far less than 1% of the microbial species on the planet, they do plenty of damage.3 Searching for new microbes promises not only to increase our knowledge of life on earth, it may also be a chance to safeguard human life.

Virus hunters

In recent years, we have heard a lot about zoonoses (diseases that spillover from animals to humans), and with good reason (see my post on the issue). Of the 335 novel (new) infectious disease that were reported from 1940-2004, 60.3% came from animals, and most of those came from wildlife.2 Although the exact origins of some pathogens are hard to trace, it’s clear that many of the most lethal diseases afflicting humans (e.g. SARS, Ebola, etc.) have come from our wild or domesticated brethren. With increasing agricultural intensification and greater and greater encroachment into natural areas, there is every reason to expect the future to hold more of the same.

While that is a terrifying fact, it shouldn’t be paralyzing. So why aren’t we acting against these microbial horrors now, while we have the chance? Well there’s a rub: normally we have to wait until someone gets sick to identify a pathogen or even recognize the start of an epidemic5, especially of a new disease, and by then it’s (by definition) too late.

That’s all beginning to change. Over the past two decades, several groups of scientists have started to turn the tables on microbial pathogens, especially viruses. Instead of waiting for them to find us, these researchers are setting out to find them.

virus hunters
Mugshot.

On the hunt

Perhaps the most prominent virus hunter is Dr. Nathan Wolfe, a visiting professor at Stanford University who has dedicated his career to seeking out pathogens around the globe.5 He works with a large team; in 2007, Wolfe founded the Global Virus Forecasting Initiative, a nonprofit research institute, and in 2008, he founded Metabiota, Inc., a for-profit sister company that provides disease surveillance, forecasting, and epidemic data.1,5 Wolfe and his collaborators work in more than 20 countries, focusing on Central Africa and South Asia, regions where large groups of people live cheek by jowl with the animals they depend on, either for bushmeat (tropical wild game, including monkeys, gorillas, and chimpanzees, among many other species) or for agriculture.4,5

The group has set up listening posts across their study regions where they survey for pathogens, regularly sampling animals and humans alike. Possibly more importantly, they educate locals about the risks of exposing themselves to the bodily fluids of animals.4 What they have found in the course of their work is both surprising and disturbing. Along with discovering several new viral species, they have uncovered much more viral spillover between animals and humans than anyone expected. Their results from Central Africa are particularly alarming: 1% of hunters sampled in Cameroon had simian foamy virus (SFV), a retrovirus that is a relative of HIV.5 Although thankfully SFV doesn’t cause illness in those infected, it’s presence shows that the barrier between humans and animals is more permeable than we thought.

These findings have made a significant impact, inspiring greater surveillance efforts and raising awareness. But despite the best efforts and frightening discoveries of Wolfe and his team, we will all remain at risk while we allow large chunks of humanity to suffer, impoverished and ignored. In Central Africa, bushmeat is a principal protein source; the region consumes at least 2 million tons per year. This may seem unthinkable or willfully self-destructive, given what we now know may be lurking in the meat, but although many residents of the region are no longer ignorant of the risks, they still have no other options. The alternative is often hunger or malnutrition for themselves and their families.4 So while the risks of illness are potentially enormous, they aren’t as immediate or as certain as an empty stomach.

Make no mistake: we may die of disease, but it’s poverty that’s killing us.

References

  1. Hope, B. Virus Hunter Metabiota Finds Niche in Epidemic Research. The Wall Street Journal Online. 20 May 2015. Web. 23 October 2015.
  1. Langreth, R. Finding the Next Epidemic Before It Kills. Forbes.com. 6 November 2009. Web. 23 October 2015.
  1. Editorial Staff. 2001. Microbiology by numbers. Nature Reviews, 9: 628.
  2. Specter, M. The Doomsday Strain. The New Yorker Online. 20 December 2010. Web. 23 October 2015.
  1. Wolfe, A. Nathan Wolfe: On the Hunt for New Viruses. The Wall Street Journal Online. 12 December 2014. Web. 23 October 2015.

Image source: NIAID, https://commons.wikimedia.org/wiki/File:Ebola_Virus_Particles_(4).jpg

For more on Dr. Wolfe’s work, check out his TED talk.