One of the vicious cycles, or “poverty traps,” people in the developing world find themselves caught in is the mutually reinforcing relationship between illness and poverty. Chronic illness has a way of making sure the extremely poor stay extremely poor, and it can cause massive loss at both the individual and the national level of wealth.

Since 1997, HIV/AIDS has cut five years off the life-expectancy of sub-Saharan Africans, and a 2004 study found that a small-scale farming family in Kenya could expect a 57% drop in crop productivity if the male head of their household died. The burden of illness imposed by tsetse flies (vectors for trypanosomiasis, or “African Sleeping Sickness”) has historically slowed the adoption of animal husbandry practices, and therefore agricultural productivity, in the areas of Africa where they are most abundant. Entire developing nations could expect a 2% to 7% drop in GDP because of iron-deficient anemia in their citizens, according to a 2005 U.N. Millennium Project Report. In 2018, malaria by itself was capable of draining roughly $12 billion from Africa’s GDP.

Malnutrition Fuels the Poverty Trap

Extreme poverty also pushes individuals into the path of multiple illnesses, and the malnutrition that so often attends poverty enthusiastically helps this process along. Malaria, measles or acute respiratory infections kill about 1 million children per year. That is more than one every 30 seconds, and the death rate is much higher among malnourished children. It can significantly impair the immune system’s ability to fight infection, an especially severe burden for those living with chronic parasite infections, which often require immune repair of tissue damage caused by the parasites. Malnourishment can also stunt the growth of fetuses, and make them more vulnerable to neonatal death from sepsis and diarrhea.

Multiple Traps

One can easily grasp this particular trap – the circular progression from poverty to malnutrition to disease and back again. One seems to flow naturally from the other. Interrupting the process is not so intuitive, and unfortunately, it is not as simple as just giving people more food. Even when people start to receive adequate nutrition, they still must deal with some biological ironies. In the case of parasites, better nutrition benefits them as much as it does their hosts, and a better-fed community fosters parasite reproduction as much as it does immunity, the former possibly outpacing the latter. The symptoms of schistosomiasis, a disease of parasitized blood, present as runaway inflammation, an immune overreaction that actually thrives on a well-nourished body.  

The agricultural systems needed for better nourishment also present their own ironies, because they impose new infrastructure upon the natural environment, with repercussions that can restrain the disease-poverty cycle with one hand and unleash it with the other.

A good illustration of this is how agriculture changes the use of freshwater. The conversion of wetlands into orchards helped eradicate schistosomiasis in Japan, and the drainage of wetlands was an integral and successful component of malaria control in turn-of-the-century America. However, Egypt’s construction of the Aswan High Dam and irrigation network between 1960 and 1970 helped incubate a larger population of mosquitoes, mosquitoes capable of spreading lymphatic filariasis, an illness also known as human elephantiasis that disfigures those it infects by inhibiting the drainage of lymphatic fluid. A 1999 study showed Ethiopia experienced seven times as much malaria after the construction of dams and irrigation.

Multiple Solutions

After successfully reaching its Millennium Development Goal of cutting the number of people living in extreme poverty in half by 2015, the U.N. set its sights on achieving “sustainable development,” with significant implications for finally smashing the poverty trap. Sustainable development entails not only investing in agriculture and increasing access to food but also fostering a food infrastructure that both relieves micronutrient deficiencies (the most common variety of malnutrition) and provides the necessary infrastructure for education and sanitation. 

According to a 2019 paper published in the journal Nature Sustainability, there was a 37% difference in child mortality and a 20% difference in malnutrition between the richest and poorest among 43 developing countries that received safe water and sanitation. Some solutions can outsmart the poverty trap at its own game, creating cyclical, mutually reinforcing benefits. For instance, investment in education and health literacy can reduce the occurrence of neglected tropical diseases (NTDs), and directly investing in the control of NTDs at $3.50 per child can in effect give them an entire extra year of education.

Fortunately, there are several ways that the developed world can address the challenges associated with poverty and work toward sustainable development. By maintaining a strong commitment to sustainable development goals and keeping the complex issues faced by millions in mind, there is hope for a future where hunger, illness and poverty are not inextricably linked. This collective effort can help break the cycle of poverty and create global conditions that prevent its return.

– John Merino
Photo: Flickr