The environment and public health…and poverty

“I know that the Lord secures justice for the poor and upholds the cause of the needy.” – Psalm 140:12

Looking for reading as the weekend draws to a close/want to get your week off to a good start? Here’s a commentary well worth your attention. It comes from The New York Times. It’s by Peter J. Hotez, M.D., Ph.D., and is entitled Tropical Diseases: The New Plague of Poverty.

Why should you and I find the article interesting? Because when it comes to 21st-century challenges, the link between the environment and public health ranks up there with public safety in the face of extreme events such as tornadoes, hurricanes, and all the rest. The latter connection is more obvious, but the consequences may well be higher for the former.

But let’s not try to argue for one over the other. Instead, let’s simply note that the stakes are high enough that the American Meteorological Society has established a Board on the Environment and Public Health, and that it happens to be chaired by none other than Rita Colwell. [You can find the full listing of committee members here. They make a distinguished group[1].]

Here are some excerpts from the article by Dr. Hotez:

“In the United States, 2.8 million children are living in households with incomes of less than $2 per person per day, a benchmark more often applied to developing countries. An additional 20 million Americans live in extreme poverty. In the Gulf Coast states of Louisiana, Mississippi and Alabama, poverty rates are near 20 percent. In some of the poorer counties of Texas, where I live, rates often approach 30 percent. In these places, the Gini coefficient, a measure of inequality, ranks as high as in some sub-Saharan African countries.”

He continues:

“Outbreaks of dengue fever, a mosquito-transmitted viral infection that is endemic to Mexico and Central America, have been reported in South Texas. Then there is cysticercosis, a parasitic infection caused by a larval pork tapeworm that leads to seizures and epilepsy; toxocariasis, another parasitic infection that causes asthma and neurological problems; cutaneous leishmaniasis, a disfiguring skin infection transmitted by sand flies; and murine typhus, a bacterial infection transmitted by fleas and often linked to rodent infestations. 

Among the more frightening is Chagas disease. Transmitted by a “kissing bug” that resembles a cockroach but with the ability to feed on human blood, it is a leading cause of heart failure and sudden death throughout Latin America. It is an especially virulent scourge among pregnant women, who can pass the disease on to their babies. Just last month, the first case of congenital Chagas disease in the United States was reported. 

These are, most likely, the most important diseases you’ve never heard of.

They disproportionately affect Americans living in poverty, and especially minorities, including up to 2.8 million African-Americans with toxocariasis and 300,000 or more people, mostly Hispanic Americans, with Chagas disease. The neglected tropical diseases thrive in the poorer South’s warm climate, especially in areas where people live in dilapidated housing or can’t afford air-conditioning and sleep with the windows open to disease-transmitting insects. They thrive wherever there is poor street drainage, plumbing, sanitation and garbage collection, and in areas with neglected swimming pools.

His prescription? More attention to monitoring and surveillance, especially in poorer areas. Better diagnostic tests. Safer and more effective drugs and vaccines. Incentives for Big Pharma to do the needed R&D. Making diagnostics and therapies more accessible to the clinics that serve the poor. Dr. Hotez points out that with budget cuts threatened for CDC overall and the Parasitic Disease Branch in particular, other institutions will need to step up.

Sound familiar? It should. That prescription could be carried over almost verbatim into the realm of Earth observations, science, and services, and the goal of a Weather Ready Nation. Substitute NOAA and NWS for CDC and PDB and you’re almost there.

A couple of closing points. First, the article makes no mention of climate change. It needn’t. The key issue to be addressed is poverty. However, his proposed solutions are all about harnessing medical technology to deal with special medical problems of the poor. There’s no attempt to deal with the root causes of the poverty itself. This is wholly understandable and defensible. The medical bit is the area of his expertise. And dealing with these particular medical consequences of poverty are far more tractable than dealing with the poverty itself.

In the same way, U.S. vulnerability to weather extremes has its roots in poverty. It’s the poor who live in floodplains and on unstable slopes. It’s the poor who don’t have the deep pockets to mitigate against the effects of heat and drought. It’s the poor who have scant options for evacuation when threats approach…remember the 100,000 folks in New Orleans too poor to find a ride and escape Katrina back in 2005? And, as in the case of those tropical diseases, our ameliorative measures focus primarily on better warnings. Defensible. It’s our remit.

But there’s something a bit unsatisfying about leaving matters there, especially since the issue of poverty enters every facet of American life. It’s at the root of problems ranging from health to education to sustainability to foreign policy. Earth scientists and public-health scientists do well to join with all other elements of humanity to take an interest in local, national, and international approaches to this scourge. In America, in this election year, both political parties offer solutions. They seem to be widely divergent.

If God Himself “upholds the cause of the needy,” then maybe we should as well.

[1] A tip of the hat to Ms. Wendy Marie Thomas, who championed this cause during her years as a member of the AMS Policy Program staff. Just before leaving AMS to join the National Weather Service earlier this month, she helped stand up the Board on Environment and Health, insuring that volunteers would carry her important work forward.

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2 Responses to The environment and public health…and poverty

  1. John Plodinec says:

    While I agree with your general thesis, I beg you to not perpetuate the myth or the people from NOLA who couldn’t evacuate. Simply not true. What is true is that they chose to stay behind for various reasons. The elderly, in particular, didn’t want to leave their pets behind; an important – often overlooked – cause of their dispropoertionate number of deaths. Those communities that paid attention to the real lessons of Katrina (e.g., Charleston, SC) set up programs to ensure that pets as well as people could be evacuated.

  2. William H. Hooke says:

    Thanks, John.

    This is a great comment/point well taken. Certainly there was a range of motives behind all the decisions not to evacuate. What I had to say was written in too much haste! But the idea is that evacuate is an easy decision for many who have their own cars and resources that give them options at the other end of trip. Not all those options require money, but some do. So poverty in many cases is a contributing factor.

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