Menus Subscribe Search

Follow us


America’s Hidden Diseases

• November 06, 2010 • 5:00 AM

Americans living in high poverty bear the burden of more than 20 common diseases that the medical establishment largely does not monitor, diagnose or treat, studies show.

Millions of poor Americans living in distressed regions of the country are chronically sick, afflicted by a host of hidden diseases that are not being monitored, diagnosed or treated, researchers say.

From Appalachia to the Mississippi Delta to the segregated inner cities of the Great Lakes and Northeast, they say, and from Navajo reservations to Latino communities along the U.S.-Mexico border, more than 20 chronic diseases are promoting the cycle of poverty in conditions of inadequate sanitation, unsafe water supplies and rundown housing.

“These are forgotten diseases among forgotten people,” said Peter Hotez, a microbiologist at George Washington University, president of the Washington, D.C.-based Sabin Vaccine Institute and co-founder of the institute’s Global Network for Neglected Tropical Disease Control. “If these were diseases among middle-class whites in the suburbs, we would not tolerate them. They are among America’s greatest health disparities, and they are largely unknown to the U.S. medical and health communities.”

Now, based on a study published by Hotez for the Public Library of Science in 2008, the U.S. House of Representatives has passed the Neglected Infections of Impoverished Americans Act. The bill would, for the first time, require the Secretary of Health and Human Services to report to Congress within the next 12 months on the country’s neglected diseases of poverty and recommend funding to address them. After passing in the House in September, the bill has not advanced since it was introduced in the U.S. Senate.

“The first step is to raise awareness of these diseases,” Rep. Henry Johnson, the Georgia Democrat who introduced the bill, said after the Sept. 29 vote. “Today is an important step in recognizing the threat and moving toward a solution.”

Over the course of the 20th century, deaths from infectious diseases declined rapidly in the U.S., and polio, tuberculosis, typhoid fever and malaria no longer represent a serious health threat here. But diseases that are common and chronic among the poor of Africa, such as Chagas, a leading cause of heart failure and stroke among Latinos; cysticercosis, which causes convulsions; and ascariasis, which causes abdominal pain and fever, also likely afflict millions of people living in the American South, in Appalachia and along the U.S.-Mexico border, Hotez said. These illnesses are spread, respectively, by parasites in insects, tapeworms in raw pork and roundworms in soil.

Most of the diseases named in the legislation have not been surveyed in the U.S. for decades, if ever. None are tracked by the U.S. Centers for Disease Control and Prevention, though between 4 million and 10 million Americans could be infected, Hotez said. Drugs are available to treat a number of the neglected diseases, he said, but doctors are not trained to diagnose them.

“These are not even rare diseases,” Hotez said. “Yet there’s so little research on them, we don’t know the full extent of their impact, how they are transmitted, or how they contribute to disability. We do not have good diagnostic methods. We can’t even begin to think about controlling these diseases.”

The website of the Centers for Disease Control and Prevention lists six “major neglected infections of poverty” in the U.S., all of them parasitic or viral diseases, and notes that they can cause birth defects, epilepsy, hearing loss, infertility, blindness and heart failure. The site says that improved tracking, testing and treatment is needed to reduce illness and death.

The CDC conducts public health surveillance only at the request of states, and the states have not asked the agency to track of any of the diseases on Hotez’s list, said Susan Montgomery, an epidemiologist with the CDC’s Division of Parasitic Diseases and Malaria. Based in part on blood donor data, she said, the agency estimates that 300,000 Americans are afflicted with Chagas, and that between 60 and 300 babies are born with the disease in the U.S every year. But the agency does not formally collect reports from states about cases of Chagas here.

“There’s an information gap,” Montgomery said. “These are diseases that are disproportionately affecting parts of our population who are living in poverty, but it’s in the context of many other health challenges our country is facing, including obesity, diabetes, HIV and tuberculosis. The states have not determined that those are diseases that they want the CDC to conduct surveillance for. They are not being monitored in the public health system. They may be diseases that physicians are not aware of and don’t think to test for.”

If the Senate passes the new bill, the CDC will conduct a review of existing data on the neglected diseases and try to identify the information gaps, Montgomery said.

According to a report by Families USA, the National Institutes of Health in 2007 accounted for 76 percent of $376 million in U.S. government spending for research on eight globally neglected diseases, including three that afflict hundreds of thousands of Americans — Chagas disease, dengue fever, which can be fatal, and leishmaniasis, a centuries-old disease that produces skin ulcers. Tuberculosis and malaria received nearly three-quarters of the funds. (And the private market sees more opportunity in battling the scourge of baldness.) Overall, the Families USA report said, NIH funding for the eight diseases represented less than 1 percent of the agency’s total research budget of $29 billion.

In 2009, the National Institute of Allergy and Infectious Diseases, which is part of the NIH, spent $367 million of its $4.7 billion budget researching most, but not all, of the 24 neglected U.S. diseases listed by Hotez, not counting stimulus funds, the institute staff said. At the same time, $1.6 billion went to biodefense and emerging infectious diseases.

Still, $367 million is “not a trivial amount of money, by any means,” said Lee Hall, chief of parasitology and international programs for the institute. There is ongoing and substantial government research on most of the diseases on Hotez’s list, and the research helps both the developing world and the U.S., he said. The work itself is difficult because parasites must often be grown in live animals, so the institute helps researchers by providing them with biological material for the lab, Hall said. To date, there are no licensed vaccines for any of the parasitic diseases that afflict humans.

“The NIH has had a long-standing commitment to these diseases, and we have supported research on them for a very long time,” Hall said. “I’ve spent most of my career on parasitic diseases, many of which fall into this category. I don’t think we’ve neglected these diseases at all.”

Yet even as research goes forward, the public health problem persists.

According to a study published by Hotez in 2009, trichomoniasis, or “trich,” one of the most common sexually transmitted diseases in the world, afflicts up to 29 percent of African-American women in the South and impoverished inner cities of North, approaching rates in Nigeria, where 38 percent of women are infected. People with trichomoniasis are more susceptible to HIV. About 880,000 African-American women in the U.S. are infected with the parasite that causes trichomoniasis, Hotez said.

Hotez’s list includes bacterial diseases spread by rats and lice in the poor neighborhoods of Baltimore and Detroit; parasitic diseases from Africa, prevalent among the “Lost Boys and Girls of Sudan” who resettled in the U.S.; parasitic diseases among the Inuit of Alaska who eat infected seal and caribou meat; and CMV, or cytomegalovirus, a congenital virus that infects an estimated 10,000 infants in America yearly. Babies with CMV develop hearing and vision loss, sometimes years later.

Along the U.S.-Mexico borderlands and in the Gulf Coast region, Hotez said, up to 200,000 people living in poverty may be infected with dengue fever, a viral disease that is transmitted by mosquitoes. Dengue can lead to failure of the circulatory system.

In the 1970s and 1980s, Hotez said, 30 percent of rural black children in the South tested positive for toxocariasis, or roundworm, a parasitic disease that is transmitted through the feces of dogs and cats. Toxocariasis causes abdominal pain, swollen glands and vision loss and may be linked to the rise in asthma among inner-city children. Extrapolating from old data, Hotez estimates that between 1.3 million and 2.8 million poor Americans are infected with toxocariasis today.

“These are truly neglected problems,” he said. “People have these diseases for years, and during this time, they promote poverty. They interfere with child growth and development and, in some cases, impair intelligence and cognition. They affect pregnancy outcomes and are co-factors in the AIDS epidemic.”

As reported in Miller-McCune, Hotez has previously challenged both drug makers and policymakers to divert more funding to the neglected diseases of poverty in the developing world.

“They have no advocacy,” he said. “It’s been very frustrating.”

Subscribe to Miller-McCune

Melinda Burns
Former Miller-McCune staff writer Melinda Burns was previously a senior writer for the Santa Barbara News-Press, covering immigration, urban planning, science, and the environment.

More From Melinda Burns

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

October 21 • 6:00 AM

Fruits and Vegetables Are About to Enter a Flavor Renaissance

Chefs are teaming up with plant breeders to revitalize bland produce with robust flavors and exotic beauty—qualities long neglected by industrial agriculture.


October 21 • 4:00 AM

She’s Cheating on Him, You Can Tell Just by Watching Them

New research suggests telltale signs of infidelity emerge even in a three- to five-minute video.


October 21 • 2:00 AM

Cheating Demographic Doom: Pittsburgh Exceptionalism and Japan’s Surprising Economic Resilience

Don’t judge a metro or a nation-state by its population numbers.


October 20 • 4:00 PM

The Bird Hat Craze That Sparked a Preservation Movement

How a fashion statement at the turn of the 19th century led to the creation of the first Audubon societies.


October 20 • 2:00 PM

The Risk of Getting Killed by the Police If You Are White, and If You Are Black

An analysis of killings by police shows outsize risk for young black males.


October 20 • 12:00 PM

Love and Hate in Israel and Palestine

Psychologists find that parties to a conflict think they’re motivated by love while their enemies are motivated by hate.


October 20 • 11:00 AM

My Dog Comes First: The Importance of Pets to Homeless Youth

Dogs and cats have both advantages and disadvantages for street-involved youth.


October 20 • 10:00 AM

Homophobia Is Not a Thing of the Past

Despite growing support for LGBT rights and recent decisions from the Supreme Court regarding the legality of same-sex marriage, the battle for acceptance has not yet been decided.


October 20 • 8:00 AM

Big Boobs Matter Most

Medical mnemonics are often scandalous and sexist, but they help the student to both remember important facts and cope with challenging new experiences.


October 20 • 6:00 AM

When Disease Becomes Political: The Likely Electoral Fallout From Ebola

Will voters blame President Obama—and punish Democrats in the upcoming mid-term elections—for a climate of fear?


October 20 • 4:00 AM

Coming Soon: The Anatomy of Ignorance


October 17 • 4:00 PM

What All Military Families Need to Know About High-Cost Lenders

Lessons from over a year on the beat.


October 17 • 2:00 PM

The Majority of Languages Do Not Have Gendered Pronouns

A world without “he.” Or “she.”


October 17 • 11:01 AM

How to Water a Farm in Sandy Ground

Physicists investigate how to grow food more efficiently in fine-grained soil.


October 17 • 10:00 AM

Can Science Fiction Spur Science Innovation?

Without proper funding, the answer might not even matter.


October 17 • 8:00 AM

Seattle, the Incredible Shrinking City

Seattle is leading the way in the micro-housing movement as an affordable alternative to high-cost city living.


October 17 • 6:00 AM

‘Voodoo Death’ and How the Mind Harms the Body

Can an intense belief that you’re about to die actually kill you? Researchers are learning more about “voodoo death” and how it isn’t limited to superstitious, foreign cultures.


October 17 • 4:00 AM

That Arts Degree Is Paying Off

A survey of people who have earned degrees in the arts find they are doing relatively well, although their education didn’t provide much guidance on managing a career.


October 16 • 4:00 PM

How (Some) Economists Are Like Doomsday Cult Members

Cognitive dissonance and clinging to paradigms even in the face of accumulated anomalous facts.


October 16 • 2:00 PM

The Latest—and Most Mysterious—Player in the Nasty Battle Over Net Neutrality

As the FCC considers how to regulate Internet providers, the telecom industry’s stealth campaign for hearts and minds encompasses everything from art installations to LOLcats.


October 16 • 12:00 PM

How Many Ads Is Too Many Ads?

The conundrum of online video advertising.


October 16 • 11:00 AM

Unlocking Consciousness

A study of vegetative patients closes in on the nature of consciousness.


October 16 • 10:00 AM

The False Promises of Higher Education

Danielle Henderson spent six years and $60,000 on college and beyond. The effects of that education? Not as advertised.


October 16 • 8:00 AM

Faster Justice, Closer to Home: The Power of Community Courts

Community courts across the country are fighting judicial backlog and lowering re-arrest rates.


October 16 • 6:00 AM

Killing Your Husband to Save Yourself

Without proper legal instruments, women with abusive partners are often forced to make a difficult choice: kill or be killed.


Follow us


Love and Hate in Israel and Palestine

Psychologists find that parties to a conflict think they're motivated by love while their enemies are motivated by hate.

How to Water a Farm in Sandy Ground

Physicists investigate how to grow food more efficiently in fine-grained soil.

Unlocking Consciousness

A study of vegetative patients closes in on the nature of consciousness.

Advice for Emergency Alert Systems: Don’t Cry Wolf

A survey finds college students don't always take alerts seriously.

Brain’s Reward Center Does More Than Manage Rewards

Nucleus accumbens tracks many different connections in the world, a new rat study suggests.

The Big One

One company, Amazon, controls 67 percent of the e-book market in the United States—down from 90 percent five years ago. September/October 2014 new-big-one-5

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.