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The Neglect of Sewage Systems in Low-Income Black Communities Results in Parasitic Infections Affecting Health.


Gut infections take a heavy toll on impoverished black communities with outdated sewage systems. These infections often spread through contaminated soil and water and are among the most common diseases worldwide.

About a quarter of the world’s population is infected with soil-borne infections wormsintestinal parasitic worms that can cause serious health problems.

Additionally, up to 50% of people around the world are infected with Helicobacter pyloribacteria that live in the stomach and can cause ulcers and cancer.

I am a biological anthropologistand it is clear to me that these two types of infections contribute to systemic health inequalities, especially between communities of color in which limited access to medical care and inadequate sanitation systems can both increase and increase exposure to pathogens lead to worse results.

historical, intestinal infections are common in parts of the US where high poverty rates and environmental factors – such as flooding and hot, humid summers – favor the spread of infections.

although many Americans believe these diseases now only occur in lower income countries, research that my colleague and I have challenged this assumption.

Renewed interest in intestinal infections in the US

Launched in 2019, the Rural Embodiment and Community Health Study started with the aim of measuring current infection rates and determining which living conditions contribute to infection risk.

While national infection rates remain unclear due to the lack of large-scale surveys, our preliminary work in 2019 showed that 38% of children sampled in a predominantly Black Mississippi Delta community had intestinal parasitic infections.

Moreover, 80% of those kids showed high levels of intestinal inflammation. Those levels are much higher than that observed in other populations and can lead to various poor health outcomesincluded reduced ability of the intestines to absorb nutrients and stunted growth.

Our more recent 2022 analyzes focused on adults living in the Mississippi Delta and southwestern Illinois, two areas that regularly experience flooding.

A microscopic view of a human hookworm.
Smith Collection/Gado/Getty Images

Of those adults, 73% showed increased intestinal inflammation, while 45% were infected with H. pylorithe bacteria that can cause ulcers and cancer.

Taken together, those results demonstrate widespread intestinal infections and inflammation at all ages in these mostly black, low-income communities.

Long-term intestinal infections and associated inflammation can lead to nutritional deficiencies, limited growth, reduced level of education, reduced labor productivity and increased risk of serious illness later in life, including certain cancers).

A legal challenge in Alabama

The Rural Embodiment and Community Health Study is not alone recognizing the impact of intestinal infections about black communities. One of the most published recent studies on intestinal infections focused on the health impacts of poverty and crumbling sanitation infrastructure in Lowndes County, Alabama, a region marked by a history of racial segregation and inequality.

Researchers found that more than 1 in 3 people tested in Lowndes County were infected with hookworman intestinal worm spread by exposure to sewage that lives in soil and infects humans by burrowing barefoot.

This investigation from 2017 has now led to legal action.

In a landmark May 2023 court ruling, the Biden administration ruled that the Alabama Department of Public Health had discriminated against black residents by denying access to adequate sanitation and imposing fines for resulting sewage problems.

An elderly white man holds hands and walks with a black woman.
President Joe Biden and Catherine Coleman Flowers at the White House on April 21, 2023.
Drew Angerer/Getty Images

This decision has been hailed as one by environmental justice advocates transformative agreement on environmental justice that can raise public awareness of the ongoing health crisis resulting from infrastructure neglect and associated exposure to pathogens.

Community activists – like Catherine Coleman Flowersfounder of the Center for Rural Enterprise and Environmental Justice — said they hope the federal government continues to intervene, leading to similar results in other affected communities.

“This country’s neglect of wastewater infrastructure in the majority of Black communities, both urban and rural, is resulting in a hygiene hell for far too many people, a hell that will only exacerbate climate change,” Flowers said. in an interview in March 2023.

Why are there still parasites in the US?

The story of parasitic infection in the US is two-sided.

On the one hand, the US has successfully controlled many of them parasitic infections. Malaria is one of them.

In addition, advancements in sanitation and household construction mean that many Americans generally do not have to worry about parasitic infections.

But this national success is not complete, as recent findings in low-income Black communities across the country show.

Limited awareness of the ongoing threat of neglected intestinal infections has made it more difficult to identify and treat these diseases in the US than in lower-income countries.

For example, in many countries the drugs needed to treat hookworm infections cost mere pennies, but in the US, where drug prices are not regulated by the federal government, those same drugs can hundreds of dollars.

The recent Alabama court ruling is an important step toward greater national recognition of the role intestinal infections play in perpetuating racial health disparities.

Greater awareness will ideally result in improved access to testing and treatment in affected communities. But more work is needed to assess the full extent of these infections in the US

Even when medical treatment is accessible and affordable, vulnerable individuals often become reinfected as these pathogens continue to spread through the environment. Structural changes are needed to break the cycle of infection and ill health.

Current federal investment in community infrastructure – including water quality – is encouraging but does not go far enough. Ultimately, a concentrated nationwide effort to update and maintain sanitation systems is the best way to finally halt infection transmission and support health equity in the US

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