Impoverished countries are more vulnerable to diseases and natural disasters for several reasons: 1) Poverty forces people to live in hazardous areas with poor housing, sanitation and healthcare access, increasing exposure to diseases and the impacts of disasters. 2) Malnutrition and lack of access to clean water and healthcare weakens immune systems and the ability to manage diseases. 3) Following disasters, inadequate resources to address conditions in displacement camps can enable disease outbreaks, as occurred with cholera in Haiti.

1. Poverty, Disease and Disaster
Test Question: Why are impoverished countries more likely to have
higher casualties when a natural disaster hits? Are low income
countries more likely to see the spark of infectious diseases, and the
spread? Why or why not?

2. What is poverty?
• A basic needs approach examines poverty by how much money people have,
and also whether they have access to food, shelter, education, sanitation,
safe drinking water and health care.
• There are some countries (like Brazil) whose per capita income levels may
not be that low, but where pockets of the country do not have access to safe
drinking water and health care, for example.
• A capabilities approach, which was developed by Amartya Sen sets out that
poverty is not just inadequate incomes but low levels of capabilities and
opportunities.

3. Infectious diseases and poverty
• In examining the role of infectious diseases and poverty it is important to
differentiate between poverty at the individual or household level and
poverty at the state level, or poverty of low income countries.
• At the individual level, most of the global poor live in rural areas, are poorly
educated, employed in agricultural sector and are under the age of 18.
• But it is not just rural poor that are affected, but also those living in urban
slums.
• The WHO estimates that the diseases associated with poverty account for
45% of the disease burden in the poorest countries.
• Several studies have indicated that poverty is the key driver of the
tuberculosis pandemic, with incidence rates rising and falling in association
with measures of socioeconomic development and social protection

4. Malaria and the edge of forests
• People living on the edge of forests are also more likely to contract
other infectious diseases such as malaria because these areas are
popular habitats for mosquitoes
• Malaria occurs more frequently in forest workers in Thailand because
that is the preferred breeding site for mosquitoes

5. Education and diseases
• Education levels also affects the spread diseases and the spark.
• Education levels is certainly important in promoting better health outcomes. More
educated mothers tend to have fewer and healthier children.
• Education plays a vital role in preventing the spread of numerous infectious diseases,
such as HIV/AIDS, malaria, TB and many neglected tropical diseases.
• Education can help reduce vector borne diseases by encouraging people to remove
stagnant water which are insect breeding sites from near their homes.
• In a study in Ethiopia, mothers with low educational attainment were able to reduce
mortality rates among children under five years old when given information about
anti-malarial drugs.
• Educated parents were more likely to seek formal treatment for malaria when their
child develops symptoms. This serves to reduce the risk of progression of the
disease.
• Educated parents are also more likely to know what causes malaria to be
transmitted- whereas poorly educated individuals may believe myths that exposure
to the sun causes malaria.

6. • Education is also important in diagnosing and preventing TB, with studies
showing that low educational attainment is correlated with delayed
treatment and a failure to complete treatment.
• Traditional beliefs may espouse that TB is associated with witchcraft, which
prevents those that are afflicted with seeking and adhering to treatment
because they may believe that the disease in incurable.
• Rising maternal literacy rates is associated with better case notification
rates and early treatment sought out.
• Education is also important in stemming the spread of HIV.
• Lower levels of education are linked to higher rates of HIV infection.

7. Bushmeat trade
• Bushmeat plays an important role in local economies, human sustenance, nutrition,
international trade, culture
• While it has been an important dietary staple in many locations internationally for
generations, increased access to new and expanded hunting areas has been made
possible by logging campaigns and development of related roadways
• Several outbreaks of Ebola virus in Western Africa have been traced back to index
cases having butchered dead chimpanzees
• Cross species transmission of the simian immunodeficiency virus (SIV) from NHP to
humans is linked to bushmeat hunting and is widely believed to be the precursor to
the HIV pandemic
• Zoonotic disease connected to the bushmeat trade can be directly linked to three
primary human risk behaviors: (i) hunting (medium risk), (ii) butchering (high risk),
and (iii) consumption (low risk due to less contact with blood) of infected animals.
• Microbial transmission can occur during multiple points in the hunting and
butchering process.

8. Malnutrition and the management of diseases
• Malnutrition does not cause diseases to spark or spread but it impacts the
ability of infected people to manage diseases and recover.
• Poor nutritional status makes people more vulnerable to disease progression.
• Vitamin deficiencies such as vitamin A can lead to blindness, with 500,000
children becoming blind each year.
• Chronic malnutrition leads to reduced physical capacity and stunting.
• It has an impact on learning and affects future health and productivity rates
• Children who suffer from malnutrition are more likely to suffer illnesses, with
poor nutrition affecting child mortality rates of at least 50% of the 11 million
children under five who die each year.
• In fact every disease that children face is worsened severely by malnutrition
(WHO).

9. Malnutrition and diseases
• 1918 Flu was worse in LDCs than in HICs- due to malnutrition and co-
morbidities, poor access to medical care and higher rates of disease
transmission
• Roughly 870 million people suffer from chronic undernourishment,
almost all of whom live in developing countries, with Africa seeing a rise
in malnourished people.
• In India over 20% of the population is malnourished in spite of the fact
that India is the second biggest grower of rice and wheat.
• Nutritional status affects the progression from TB infection to disease—as
those with low body mass and food storages have been associated with
an increase in TB infection and mortality rates, particularly those lacking
in vitamin D, iron and zinc.
• Malnutrition is also associated with poor response to antimalarial drugs.

10. Pollution
• Poor households are also more susceptible to respiratory infections
because of greater exposure to burning biomass fuels in poorly ventilated
areas.
• Poor households are more likely to use animal dung, crop residues or
wood to cook their food and to heat their homes.
• According to the WHO, exposure to this type of biomass smoke increases
the risk of acute lower respiratory infections (ALRI) in childhood, such as
pneumonia---the single most important cause of death in children under
five.

11. Sanitation and water access
• Over 785 million people do not have access to clean water, while 2 billion people do
not have access to sanitation, such as flushed a toilet.
• Not having access to clean water not only uses up valuable time to collect and carry
the water, but also leads to the spread of diseases—and poor sanitation exacerbates
the severity of these diseases as well.
• Over 80% of the disease in developing countries is related to poor drinking water
and sanitation.
• Only about half of the population in sub-Saharan Africa has access to clean water.
• In rural parts of India, Indonesia, South Africa and Guatemala to name a few, the
level of access to running water is under 10%
• Inadequate sanitation and water access plays an important role in spreading
diarrhoeal diseases and other gastrointestinal infections
• Though diarrhoeal diseases are completely treatable through oral rehydration
therapy, they still claim 1.8 million lives each year.

12. • By not having access to clean water, this makes it more difficult to wash hands
frequently to prevent the spread of respiratory infections.
• In the case of the Ebola epidemic, those that didn’t have access to basic sanitation
in urban slums such as Monrovia are at far greater risk of being infected.
• Lack of access to clean water was associated with higher rates of respiratory
infections in Venezuela.
• Contaminated water in Nairobi slums with no piped water are ideal for the spread
of cholera and typhoid
• Schistosomiasis is transmitted through exposure to contaminated water
• Zika was more prevalent in neighbourhoods in Brazil that were less likely to be
connected to water source
• Rural areas without proper sanitation and flush toilets help to spread diseases as
well.
• The propagation of hookworm (and other soil transmitted helminths and
schostosomes) also depends on inadequate sanitation, such as the absence of a
latrine because it enables the accumulation of human faeces on soil.
• In rural parts of Cote d’Ivoire, poor children demonstrated higher infection rates of
hookworm than children from richer families.

13. Poor housing and crowded conditions
• The UN estimates that 863 million people, or one third of people in the developing world live in
urban slums.
• When social distancing is required, it is more impoverished people that are the least able to do so.
Crowding in low income households and neighbourhoods is a mechanism for exposure to different
diseases.
• For example, SARS was more likely to spread in poor areas of Hong Kong due to overcrowding and
poor infrastructure
• The same can be said of Ebola, which spread most rapidly through poor families living in crowded
conditions.
• TB is more likely to spread in crowded conditions (such as prisons, homeless centres and urban
slums) that are poorly ventilated because it spreads through airborne droplets.
• Malaria infection is also higher in overcrowded areas because high concentrations of carbon
dioxide and other chemicals are more likely to attract mosquitoes.
• Impoverished families that live in poorly constructed makeshift settlements with dirt floors, thatch
roofs and walks with cracks and holes are ideal for spreading many different diseases.
• The poor are more likely to become infected with Chagas disease, because the insect vectors
known as triatomines prefer to inhabit in wall cracks.
• People living in homes with dirt floors have an increased risk of infection for hookworm.
• People living in homes without proper screens, modern walks and protective coverings struggle to
prevent mosquitoes from entering, just as those who don’t own bed nets are unable to prevent
night time biting.

14. COVID and poverty
• Those in low SES groups are more likely to have unstable work conditions and
incomes, conditions exacerbated by the responses to COVID-19 and its aftermath.
• Such financial uncertainty disproportionately harms the mental health of those in
low SES groups and exacerbates their stress.
• Heightened stress is known to weaken the immune system, increasing susceptibility
to a range of diseases and the likelihood of health risk behaviours.
• Therefore, poverty may not only increase one's exposure to the virus, but also
reduce the immune system's ability to combat it
• People of low SES present to healthcare services at a more advanced stage of illness,
resulting in poorer health outcomes
• This will likely lead to poorer health outcomes from COVID-19 for economically
disadvantaged people.
• Access to health care is also determined by a person's ability to use health services
ʻwith ease, and having confidence that you will be treated with respectʼ.
• This can be hindered by language barriers, patients' attitudes towards healthcare
providers and the behaviour and attitudes of healthcare professionals towards
minority patients.

15. Poor working conditions
• Working conditions that affect certain occupations increase the risk of
contracting infectious diseases.
• Those that work in the health care profession represented a
disproportionately large share of total cases in the West African outbreak of
Ebola
• Mobile workers (construction, mining, trucking, agriculture, forestry, fishing
and shipping) and sex workers have had an increased risk of contracting HIV.
• Those that have high exposure to silica have a greater chance of being infected
with TB.
• Those that work in close contact with livestock and other animals also have an
altered rate of infection, and are the most at direct risk from zoonotic disease.
• Agricultural workers that must work during the rainy season have a greater
chance of contracting malaria since the greater availability of water for female
mosquitoes to breed in.

16. Health care and treatment
• More impoverished people also have less access to healthcare and
essential treatment.
• Most infectious diseases are completely treatable and preventable but
due to inadequate access to health care.
• It is estimated that 88% of child diarrhoeas, 91% of malaria and up to
100% of childhood illness, such as measles and tetanus, can be
prevented among children using existing treatments, which would save 3
million children a year.
• It is the poor that are more likely to not seek out modern medical care,
and delaying health care treatment can affect the prognosis for many
diseases such as TB.
• Poverty prevents those affected from purchasing the cheap oral
rehydration therapy sachets that could easily save lives.
• Richer families can also afford antehelminthic drugs to treat hookworm.

17. Who are the most vulnerable?
• Typically those who are the most vulnerable of contracting and dying from
diseases are women and children.
• Women are more likely to care for sick household members
• Women may also be less likely to eat if food is scarce making them more
vulnerable when they contract diseases.
• Women may lack education which puts them at greater risk of contracting
various diseases.
• Women are more likely to seek treatment, but this varies by whether or not
they are married or not.
• Married women in India for example, are less likely to receive and complete
treatment because they want to keep their illness a secret so that they are not
shunned.

18. Poverty and natural disasters
• The poor often have to live in more hazardous locations.
• Large landowners have driven out small farmers forcing peasants to migrate
to steep hillsides where agricultural practices caused soil erosion and
siltation of rivers.
• The rural poor have also been forced to adopt unsustainable practices of
agriculture (such as overusing the land) which make the land more prone to
disasters.
• In other cases, the rural poor are forced to live in unsafe physical areas.
• Some populations living on volcanic soil in the Philippines and Indonesia
support population densities of more than 1,000 people per square
kilometers

19. Poverty and natural disaster resilience
• Impoverished people are also forced to migrate to urban areas and lack
access to safe building sites.
• The poor may have few alternatives but to live in overcrowded slums on
steep hillsides, poorly constructed houses or in areas that are prone to
disasters
• The development in urban slopes increases the risk of flooding the lower
lying areas, where many of the poor may also reside
• For example, earthquakes killed 66,000 in Peru in 1970 and 23,000 in
Guatemala in 1976, disproportionately affected the poor who did not
have the means for self-protection and lived in flimsier houses on steep
slopes
• Not only does poverty and marginalization cause the poor to be more
likely to face a natural disaster but it also means that they are less
equipped to deal with natural disasters when they hit.

20. Earthquake and Haiti: a compound event
• Natural disasters can have a devastating impact on infectious diseases in
contexts of dire poverty.
• Insufficient resources were dedicated to rubble collection, and camps for the
displaced (10% of the population) were erected that had no electricity, running
water, or sewage systems.
• Such conditions paved the way for a cholera epidemic later that year
• An additional 8,000 people were killed at a rate of 50 deaths per day due to the
disease.
• Crime was also widespread, particularly violence against women and girls.
• By 2012, about a half a million Haitians remained homeless.
• This situation made it all the more difficult for Haiti to deal with Tropical Storm
Isaac in 2012, which killed 29 people, and Hurricane Sandy, also that year,
which killed 55 people.
• Another problem is that Haiti spends only 1.2% of its GDP on healthcare