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
by Ed Pilkington in Lowndes County, Alabama
Children playing feet away from open pools of raw sewage; drinking water pumped beside cracked pipes of untreated waste; human faeces flushed back into kitchen sinks and bathtubs whenever the rains come; people testing positive for hookworm, an intestinal parasite that thrives on extreme poverty.
These are the findings of a new study into endemic tropical diseases, not in places usually associated with them in the developing world of sub-Saharan Africa and Asia, but in a corner of the richest nation on earth: Alabama.
Scientists in Houston, Texas, have lifted the lid on one of America’s darkest and deepest secrets: that hidden beneath fabulous wealth, the US tolerates poverty-related illness at levels comparable to the world’s poorest countries. More than one in three people sampled in a poor area of Alabama tested positive for traces of hookworm, a gastrointestinal parasite that was thought to have been eradicated from the US decades ago.
The long-awaited findings, revealed by the Guardian for the first time, are a wake-up call for the world’s only superpower as it grapples with growing inequality. Donald Trump has promised to “Make America Great Again” and tackle the nation’s crumbling infrastructure, but he has said very little about enduring chronic poverty, particularly in the southern states.
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. In a survey of people living in Lowndes County, an area with a long history of racial discrimination and inequality, it found that 34% tested positive for genetic traces of Necator americanus.
The parasite, better known as hookworm, enters the body through the skin, usually through the soles of bare feet, and travels around the body until it attaches itself to the small intestine where it proceeds to suck the blood of its host. Over months or years it causes iron deficiency and anemia, weight loss, tiredness and impaired mental function, especially in children, helping to trap them into the poverty in which the disease flourishes.
Hookworm was rampant in the deep south of the US in the earlier 20th century, sapping the energy and educational achievements of both white and black kids and helping to create the stereotype of the lazy and lethargic southern redneck. As public health improved, most experts assumed it had disappeared altogether by the 1980s.
But the new study reveals that hookworm not only survives in communities of Americans lacking even basic sanitation, but does so on a breathtaking scale. None of the people included in the research had travelled outside the US, yet parasite exposure was found to be prevalent, as was shockingly inadequate waste treatment.
The peer-reviewed research paper, published in the American Journal of Tropical Medicine and Hygiene, focuses on Lowndes County, Alabama – the home state of the US attorney general, Jeff Sessions, and a landmark region in the history of the nation’s civil rights movement. “Bloody Lowndes”, the area was called in reference to the violent reaction of white residents towards attempts to undo racial segregation in the 1950s.
It was through this county that Martin Luther King led marchers from Selma to Montgomery in 1965 in search of voting rights for black citizens, More than half a century later, King’s dream of what he called the “dignity of equality” remains elusive for many of the 11,000 residents of Lowndes County, 74% of whom are African American.
Raw sewage is carried through a PVC pipe to be dumped only a few yards away from a nearby home. Photograph: Bob Miller for the Guardian
The average income is just $18,046 (£13,850) a year, and almost a third of the population live below the official US poverty line. The most elementary waste disposal infrastructure is often non-existent.
Some 73% of residents included in the Baylor survey reported that they had been exposed to raw sewage washing back into their homes as a result of faulty septic tanks or waste pipes becoming overwhelmed in torrential rains.
The Baylor study was inspired by Catherine Flowers, ACRE’s founder, who encouraged the Houston scientists to carry out the review after she became concerned about the health consequences of having so many open sewers in her home county. “Hookworm is a 19th-century disease that should by now have been addressed, yet we are still struggling with it in the United States in the 21st century,” she said.
“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.”
Flowers took the Guardian on a tour of Lowndes County to witness the conditions in which hookworm continues to proliferate. One stop was at a group of mobile homes outside Fort Deposit that graphically illustrated the crisis.
An eight-year-old child was sitting on the stoop of one of the trailers. Below him a white pipe ran from his house, across the yard just a few feet away from a basketball hoop, and into a copse of pine and sweet gum trees.
The pipe was cracked in several places and stopped just inside the copse, barely 30ft from the house, dripping ooze into a viscous pool the color of oil. Directly above the sewage pool, a separate narrow-gauge pipe ran up to the house, which turned out to be the main channel carrying drinking water to the residents.
The open sewer was festooned with mosquitoes, and a long cordon of ants could be seen trailing along the waste pipe from the house. At the end of the pool nearest the house the treacly fluid was glistening in the dappled sunlight – a closer look revealed that it was actually moving, its human effluence heaving and churning with thousands of worms.
Long read. Full story below.
Hookworm, a disease of extreme poverty, is thriving in the US south. Why?
by Ed Pilkington in Lowndes County, Alabama
Children playing feet away from open pools of raw sewage; drinking water pumped beside cracked pipes of untreated waste; human faeces flushed back into kitchen sinks and bathtubs whenever the rains come; people testing positive for hookworm, an intestinal parasite that thrives on extreme poverty.
These are the findings of a new study into endemic tropical diseases, not in places usually associated with them in the developing world of sub-Saharan Africa and Asia, but in a corner of the richest nation on earth: Alabama.
Scientists in Houston, Texas, have lifted the lid on one of America’s darkest and deepest secrets: that hidden beneath fabulous wealth, the US tolerates poverty-related illness at levels comparable to the world’s poorest countries. More than one in three people sampled in a poor area of Alabama tested positive for traces of hookworm, a gastrointestinal parasite that was thought to have been eradicated from the US decades ago.
The long-awaited findings, revealed by the Guardian for the first time, are a wake-up call for the world’s only superpower as it grapples with growing inequality. Donald Trump has promised to “Make America Great Again” and tackle the nation’s crumbling infrastructure, but he has said very little about enduring chronic poverty, particularly in the southern states.
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. In a survey of people living in Lowndes County, an area with a long history of racial discrimination and inequality, it found that 34% tested positive for genetic traces of Necator americanus.
The parasite, better known as hookworm, enters the body through the skin, usually through the soles of bare feet, and travels around the body until it attaches itself to the small intestine where it proceeds to suck the blood of its host. Over months or years it causes iron deficiency and anemia, weight loss, tiredness and impaired mental function, especially in children, helping to trap them into the poverty in which the disease flourishes.
Hookworm was rampant in the deep south of the US in the earlier 20th century, sapping the energy and educational achievements of both white and black kids and helping to create the stereotype of the lazy and lethargic southern redneck. As public health improved, most experts assumed it had disappeared altogether by the 1980s.
But the new study reveals that hookworm not only survives in communities of Americans lacking even basic sanitation, but does so on a breathtaking scale. None of the people included in the research had travelled outside the US, yet parasite exposure was found to be prevalent, as was shockingly inadequate waste treatment.
The peer-reviewed research paper, published in the American Journal of Tropical Medicine and Hygiene, focuses on Lowndes County, Alabama – the home state of the US attorney general, Jeff Sessions, and a landmark region in the history of the nation’s civil rights movement. “Bloody Lowndes”, the area was called in reference to the violent reaction of white residents towards attempts to undo racial segregation in the 1950s.
It was through this county that Martin Luther King led marchers from Selma to Montgomery in 1965 in search of voting rights for black citizens, More than half a century later, King’s dream of what he called the “dignity of equality” remains elusive for many of the 11,000 residents of Lowndes County, 74% of whom are African American.
Raw sewage is carried through a PVC pipe to be dumped only a few yards away from a nearby home. Photograph: Bob Miller for the Guardian
The average income is just $18,046 (£13,850) a year, and almost a third of the population live below the official US poverty line. The most elementary waste disposal infrastructure is often non-existent.
Some 73% of residents included in the Baylor survey reported that they had been exposed to raw sewage washing back into their homes as a result of faulty septic tanks or waste pipes becoming overwhelmed in torrential rains.
Ruby Dee Rudolph, 66, noticed her septic tank was slowly sinking unevenly into the ground
The Baylor study was inspired by Catherine Flowers, ACRE’s founder, who encouraged the Houston scientists to carry out the review after she became concerned about the health consequences of having so many open sewers in her home county. “Hookworm is a 19th-century disease that should by now have been addressed, yet we are still struggling with it in the United States in the 21st century,” she said.
“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.”
Flowers took the Guardian on a tour of Lowndes County to witness the conditions in which hookworm continues to proliferate. One stop was at a group of mobile homes outside Fort Deposit that graphically illustrated the crisis.
An eight-year-old child was sitting on the stoop of one of the trailers. Below him a white pipe ran from his house, across the yard just a few feet away from a basketball hoop, and into a copse of pine and sweet gum trees.
The pipe was cracked in several places and stopped just inside the copse, barely 30ft from the house, dripping ooze into a viscous pool the color of oil. Directly above the sewage pool, a separate narrow-gauge pipe ran up to the house, which turned out to be the main channel carrying drinking water to the residents.
The open sewer was festooned with mosquitoes, and a long cordon of ants could be seen trailing along the waste pipe from the house. At the end of the pool nearest the house the treacly fluid was glistening in the dappled sunlight – a closer look revealed that it was actually moving, its human effluence heaving and churning with thousands of worms.
Long read. Full story below.
Hookworm, a disease of extreme poverty, is thriving in the US south. Why?