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

 

 

Tuberculosis: Sick Chic

Aliases: tuberculosis, TB, consumption

At first glance, tuberculosis (TB) seems an odd choice for May’s theme, language, but in fact, the disease has a distinguished literary lineage. As early as the mid-1700s, TB gained a reputation as a romantic disease. Socially the illness was understood as a disease of passion, an idea that the Romantics (Byron, Shelley, and their compatriots) enthusiastically built upon, coopting TB into a sort of nineteenth century emo cliché: a disease afflicting the sensitive and soulful. This linked TB and creativity, contributing to the literary concept of “romantic agony”, and providing an early example of the tortured artist stereotype that (tragically) still persists.

The portrayal of TB as a relatively painless death that elevated the dying, connecting them to the sublime and granting them an aura of grace became widespread and pervaded the literature of the 1800s. Writers from Dickens to Brontë used TB’s spiritual significance to craft beatific ends for their characters, especially the young, and poignant demise by TB remained a literary mainstay for over a century.

The fictional accounts of TB reflected contemporary fashion. In the 1800s, it was in vogue to appear tubercular, meaning thin, pale and delicate. The disease was associated with gentility and vulnerability, and was considered particularly attractive in women. The impact of this inversion of illness as beauty continues to be felt in modern culture and is evidenced in trends like the “heroin chic” look of the 1990s and the societal fixation with female thinness2.

tuberculosis
How emo can you go?

Cause: TB is caused by Mycobacterium tuberculosis, a bacteria that generally infects the lungs, but can affect all parts of the body. The bacteria are transmitted when a naïve (not previously exposed) person breathes in the bacteria released by an infected person when s/he coughs, sneezes, speaks, or sings. Although TB is quite infectious, it is possible to have close contact with someone who is sick without contracting the disease; the CDC states that TB is not transmitted by shaking hands, kissing, sharing food, drink, or toothbrushes (WHY WOULD YOU SHARE A TOOTHBRUSH? IS THERE NO DECENCY LEFT IN THE WORLD?). If exposed, you’re more likely to develop TB if you have an impaired immune system1.

Consequence: There are two types of TB: latent infection and disease. Most instances of TB infection result in latent TB infection, which is asymptomatic (has no symptoms) and noninfectious (it can’t be transmitted). However, if the infected person’s immune systems stops suppressing the growth of the offending bacteria, the infection may become active disease (where the bacteria multiply unchecked). TB disease results in both general and respiratory symptoms, including chest pain, a cough that lasts 3 or more weeks, coughing up blood, weight loss, chills, fever, night sweats, weakness, and fatigue1.

Cure: There are two tests used to determine TB infection status: a skin test and a blood test. If TB is detected, further tests are done to determine if it is latent infection or active disease. Latent TB infections may be treated, if they are deemed at high risk of progressing into an active infection. Treatment for both latent infection and TB disease depend on a cocktail of antimycobacterial drugs; treatment of latent TB is usually short, while TB disease requires a 6-9 month course of medication1.

Finally, a PSA: if you are interested in the topics covered in this post and have not read Susan Sontag’s book, Illness as Metaphor, get out there and get a copy. It is fantastic.

References

1. Division of Tuberculosis Elimination. “Tuberculosis (TB)”. Centers for Disease Control and Prevention. 13 March 2012. Web. 14 May 2014. http://www.cdc.gov/tb/topic/basics/default.htm

2. Sontag, S. Illness as Metaphor. New York: Vintage Books, 1978. Print.

Image source: Portrait of Lord Byron by Thomas Phillips, http://en.wikipedia.org/wiki/Lord_Byron