This weekend’s protest march in Washington DC highlighted an urgent need for dialogue and concrete steps to repair important national racial divides, yet an important one barely mentioned were disparities in health.
I recently estimated that 12 million Americans suffer from at least one NTD or neglected infection of poverty. Overwhelmingly these are diseases of extreme poverty, and many of those 12 million are impoverished African Americans. The National Institutes of Health describes a health disparity as a gap “that mirror[s] differences in socioeconomic status, racial and ethnic background, and education level”. While HIV/AIDS is probably the best known health disparity that disproportionately affects the black community, in fact it is just one of at least a half-dozen neglected infections of poverty. The point is that these neglected diseases are incredibly widespread and most importantly they actually trap African Americans in poverty in ways that often are non-intuitive. Today, one-quarter of African Americans live below the US poverty line, but in more than a dozen states the poverty level exceeds 30 percent, and disease is a major factor in reinforcing black poverty in America.
Most Americans have never heard of the neglected infections of poverty now affecting impoverished black communities. Toxocariasis is a parasitic worm infection acquired from dirt, soil, and sandboxes contaminated with dog and cat feces, mostly in degraded urban areas and rural environments in the South. The larval worms migrate through the lungs and brain of children to cause pulmonary dysfunction and wheezing akin to asthma, but also cognitive and intellectual deficits. Toxocariasis is not a rare disease. I estimate that almost three million impoverished African Americans have this chronic infection. The fact that it may affect the mental health of so many black children has prompted me to speculate that toxocariasis might be responsible for educational achievement gaps during preschool and the school-aged years.
A related parasitic infection acquired from cat feces is toxoplasmosis, which also disproportionately affects African Americans living in poverty. Indeed the CDC has shown that co-infections with toxoplasmosis and toxocariasis are common. When a pregnant mother acquires toxoplasmosis during pregnancy it can result in a congenital infection that leads to profound mental disabilities, but even when acquired as an older child or adult it can lead to a number of psychiatric and mental illnesses. Still another congential infection is cytomegalovirus infection that also affects African American mothers more than other populations; it too can lead to severe mental disabilities among newborns that last their entire life.
A young African American mother once asked me if these neglected infections could be responsible for seeing all those little special needs yellow buses in her urban neighborhood every morning during the school year. I responded that she just asked an amazing and profound question, but right now we have not even begun to answer it.
The list continues: Trichomoniasis is a parasitic infection that is ten times higher among black women then white women that has been linked to increased rates of HIV/AIDS; blacks account for almost one-quarter of hepatitis C cases; chronic conditions such as asthma and some autoimmune disorders also disproportionately affect African Americans.
Eliminating neglected infections of poverty in Black America can be achieved but it will take work. First, there is a need to raise awareness about these diseases and how they may impair educational and economic achievement in affected communities. We need to conduct studies of active surveillance in the southern US and selected inner cities to better determine the prevalence of illnesses such as toxocariasis, toxoplasmosis, trichomoniasis, congenital cytomegalovirus infection, and hepatitis C. At a minimum we should know as much about these diseases as we do HIV/AIDS. But then we need to conduct extensive studies to determine precisely how these diseases are being transmitted and confirm the links between neglected infections of poverty, cognitive dysfunction, and educational attainment, as well as the role of these diseases in promoting poverty. Such activities will require coordination between the CDC and an exciting new institute of the NIH known as the National Institute of Minority and Health Disparities (NIMHD), but also it will require the establishment of research centers of excellence in the American South such as the recently proposed legislation introduced in the House known as the Ending Neglected Tropical Diseases Act focusing on these diseases both here and abroad.
Peter Hotez MD PhD is Dean of the National School of Tropical Medicine and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics at Baylor College of Medicine. He is also President of the Sabin Vaccine Institute, University Professor at Baylor University, and Fellow in Disease and Poverty at the James A Baker III Institute for Public Policy at Rice University.