“This is the inconvenient truth nobody in America wants to talk about."

September 13, 2017 12:41 PM

"In America, the world’s richest country, hookworm, a parasitic disease found in areas of extreme poverty, is rampant, the first study of its kind in modern times shows." (SLGuardian)

"The study, the first of its kind in modern times, was carried out by the National School of Tropical Medicine at Baylor College of Medicine in conjunction with Alabama Center for Rural Enterprise (ACRE), a non-profit group seeking to address the root causes of poverty." The study was reported in the American Journal of Tropical Medicine and Hygiene.

Says Catherine Flowers, founder of the Alabama Center for Rural Enterprise (ACRE) “Our billionaire philanthropists like Bill Gates fund water treatment around the world, but they don’t fund it here in the US because no one acknowledges that this level of poverty exists in the richest nation in the world.”

Hookworm, previously.

Hookworm, previouslyer.

Hookworm, even yet still more previouslyer.

posted by cooker girl (16 comments total)

These people are afflicted by a "19th-century disease" because we never allowed them to come into the 20th, much less the 21st.
posted by emjaybee at 12:55 PM on September 13, 2017 [12 favorites]

(Considering the previouslies) I wonder what the asthma levels are in the area.
posted by dances_with_sneetches at 1:09 PM on September 13, 2017 [1 favorite]

This is good to read, but I am confused by a lot of language in the articles.
I grew up in the American South, and I never once heard that hookworm wasn't a thing to worry about. I was always taught about why going barefoot was something not to be done in many places, and why you always washed your feet before coming inside if you had been. Dogs getting hookworm is one of those things you dread, as it can kill them. I wasn't even aware people considered hookworms "extinct" in the US? Maybe this is part of the disconnect, but I did grow up in a major city here in the south, yet I knew about hookworms and other such things as a danger, and knew the reasons why they were a problem still throughout (lack of infrastructure development, septic tanks failing, sewage overflow into creeks, etc.).
posted by strixus at 1:40 PM on September 13, 2017 [12 favorites]

If kids are playing outside in a rural area with dogs and cats and chickens around, I'd guess that asthma rates are already lower than for city kids. Too many septic tanks in too small an area is a problem even in pretty wealthy areas. Lots of rural people can't drink their well water with out boiling first.
posted by Bee'sWing at 2:01 PM on September 13, 2017

I didn't grow up in the South, but spent time there as a teenager, enough to know that hookworm was considered a real issue. It wasn't treated as "rampant epidemic" material, but it was known to be one of those problems that could afflict a person (or dog), and that it took real medical attention to fix, not over-the-counter measures.

I had no idea that there were medical professionals who thought it was gone.
posted by ErisLordFreedom at 2:02 PM on September 13, 2017 [4 favorites]

Not having RTFA yet, I can attest to the fact that we are finding FAR more hookworm and other intestinal parasites (along with tick-borne illnesses) in dogs these days. My unscientific guess about this is some combination of people not having/wishing to expend the finances to care for a pet properly, or reading crap like "Dogs Naturally" and not wanting to address proper parasite control because "it's poison" (yes, if you're a parasitic worm, not if you're a freaking mammal), and dogs being transported all over the goram country by retail rescues from areas with significant parasite issues without any diagnosis or treatment being performed.

I am sure that TFA probably talks about other reasons, but we are definitely seeing more of it in companion animals it seems to me.
posted by biscotti at 2:34 PM on September 13, 2017 [4 favorites]

no one acknowledges that this level of poverty exists in the richest nation in the world.

Two thoughts: no one (not quite true, but forgiven) acknowledges it because disease = health care = who can afford it and who can't. We can see poverty on the streets of every city ever day. I live in a city in which the expense of living is 160% of the national average; it's surrounded by a county in which over 10,000 people are homeless and in a state in which 45% of K-12 students live below the poverty line. But mere numbers are an inhuman metric.

Second: 'richest nation in the world'. I keep seeing that phrase, like it's a mantra we feel we need to repeat. Assume it once was true. Is it still true? Where can I scrutinize the books? Yes (for one example) there may be $50-100+ trillion in valuation in all of America's homes. How much of that is real (liquid) asset, and how much has to be paid off in funds that have yet to be created? Subtract from that the -real- national debt (good luck on that number) and what's left?

Ain't that rich?
posted by Twang at 3:55 PM on September 13, 2017 [7 favorites]

The fact that this is a thing in the South made me wonder about climate change and hookworms, and sure enough...
posted by clawsoon at 4:14 PM on September 13, 2017 [3 favorites]

It's only a matter of time before malaria has a return engagement.
posted by Bee'sWing at 4:16 PM on September 13, 2017

As for how much I've went barefoot in my life, most of it lived in the South but also various and sundry hiking excursions (AT to South American cloud forest to YNP) where I may or may not be barefoot for miles at a time, I'm surprised I haven't had any medical complications other than the occasional laceration or stubbed toe.

Note that I am not saying that I disbelieve the articles findings or premise in the least, I just can't help but see it more as an expose on poverty instead of a shoes sort of thing... I mean, I'm sure shoes play a role and help but damn, basic sanitation access is, as it should, be the focus here.

Final takeaway, I'm not surprised, I'm really not.
posted by RolandOfEld at 4:54 PM on September 13, 2017

Another unspoken issue is that the veterinary profession seems to fully believe that two (maybe three if you're persistent) dewormings with the right RX for their canine patients is sufficient. In my experience, that protocol in no way treats for hookworm eggs that have become encysted, especially outside of the intestinal tract which seems to be the case in canines more often than thought.
posted by vers at 4:56 PM on September 13, 2017 [2 favorites]

These people are afflicted by a "19th-century disease" because we never allowed them to come into the 20th, much less the 21st.

I remember a longread from a few years ago that sort of offhandedly mentioned that when Bobby Kennedy went to visit the poorest areas of the Mississippi Delta he found children with bellies distended from malnutrition. That little detail has never left me though I can't recall what the rest of the article was about. Consequently, I find myself saddened but unsurprised by this article.
posted by xyzzy at 5:06 PM on September 13, 2017 [3 favorites]

Hell with malaria; I have a colleague working on leishmaniasis coming up north through Texas, and we're projected to get some pleasant returns of old friends like dengue as climate change takes hold, too. The US is in for a nasty shock with infectious disease if it doesn't step up its game and do things like, oh, consistently fund its damn CDC.

We only wiped out malaria in the country last time with the use of copious DDT. I am not looking forward to what we'll do (or the inevitable ethics fights over it, if it involves genetically modified drivers designed to crash mosquito populations) if we need to do it again.

We need to care about these people. There's a hell of potential being wasted here, and these are the people who suffer hardest when the left abandons the South as a place for activism and help. How much would it cost, on a national level, to provide grants for people to have a goddamn place to shit without it washing back into their yard? And how much would that save us, not just in human quality of life and potential, but people who aren't then sick and who can provide for themselves and their families that much better?
posted by sciatrix at 5:14 PM on September 13, 2017 [18 favorites]

Anecdotally, my mother's people are from rural Mississippi. I'm talking 45 minutes of driving on dirt roads before we even came within 10 miles of my Papaw's farm rural. I spent a damn good amount of my childhood down South and never once did anyone ever tell me (or my cousins) to put my shoes on outside or wash my feet when I came inside. Then again, my family wasn't living anywhere near open sewage, for many reasons, one of the most relevant being we aren't black.
posted by cooker girl at 6:50 PM on September 13, 2017 [2 favorites]

Two things come to mind:

Several years ago, a bus went by that had an advertisement I can never forget. The ad guaranteed they could "remove any tooth for only $99." Such is the state of dental care in the US, people will stand in line for hours for free or low-cost clinics.

Secondly, a recent move by Anaheim to remove portable toilets from homeless camps, which is going to have dire consequences.

To paraphrase William Gibson, "The health crisis is already here, it's just not evenly distributed."
posted by fifteen schnitzengruben is my limit at 7:18 PM on September 13, 2017 [10 favorites]

As they note, it was a very small study and the overall prevalence is likely to be different. But it's a really good reminder of how many communities we have now that are economically and socially marginalized in ways that ensure the persistence and spread of diseases like TB, parasites, and so on. It should not be a surprise that if you make people live like they are in a developing country, you are going to get some of the same health outcomes.

Fairly recently there was either an FPP or a link in a comment about the sanitary latrines built throughout rural America by the WPA. We've had many successful public health interventions in the past, but it seems like these days there is no willingness to invest.
posted by Dip Flash at 6:05 AM on September 14, 2017 [1 favorite]