By Bara Vaida
Socioeconomic factors such as poverty and living conditions play a role in shaping infection risk and disease outcomes.
Many times people in poverty live in crowded conditions, have limited access to quality health care, must work when they are sick, eat less nutritiously, get less sleep, face more stress and are more likely than others to abuse drugs and alcohol. All of these factors hinder immunity and increase susceptibility to infection and death.
In the U.S., infectious disease death rates have fallen about 19 percent over the past 25 years, but great disparities persist across the country. In poorer counties in areas like Alabama, Georgia, Louisiana, Mississippi and West Virginia, rates of death from infectious diseases like HIV/AIDS, hepatitis, and lower respiratory infections were higher in comparison to affluent counties.
And rates of patients diagnosed with hepatitis A, hepatitis C, Legionnaires’ disease, gonorrhea, chlamydia and syphilis have surged in U.S. cities over the past five years, according to Melinda Wenner Moyer’s May 2018 Scientific American story. Researchers agree the major driver of these rising infectious tides is the country’s growing income inequality, but it is being overlooked by most scientists and politicians, says Moyer’s article. Few researchers are looking at the socioeconomic impact on infection risk. Further, the Trump administration has proposed cutting funding for the Centers for Disease Control and Prevention (CDC), which is the leading U.S. agency on infectious disease prevention.
“We look more and more like the developing world, with very, very rich people and very, very poor people, and the very, very poor people are living in really abysmal situations,” Margot Bushel, a physician and scientist at the University of California, San Francisco, told Scientific American.
The opioid epidemic has certainly exacerbated rising infectious disease rates connected to social determinants. Infected needles, unprotected sex, homelessness, lack of access to medical care and other socioeconomic challenges are all associated with people who have physical addictions to drugs and opioids, and are factors in disease transmission.
For example, hepatitis A cases have been rising in communities where people have been diagnosed with a physical dependence on drugs, according to Dr. Jonathan Mermin, head of the CDC’s National Center for HIV/AIDS, viral hepatitis, STD and TB Prevention. The CDC has been doing what it can to get hepatitis A vaccines to at-risk people, but “these populations are hard to reach,” he told AHCJ members during an August 2018 webcast, because they are homeless or don’t want to seek medical care.
Government leaders are scrambling to respond to the opioid epidemic. At least eight states have declared states of emergencies, which has given them flexibility in developing strategies for prevention and treatment of infectious diseases. One strategy that has worked well in Alaska: syringe service programs. These programs allow people with dependence on drugs to obtain clean needles, according to Dr. Jay Butler, chief medical officer and director of public health with Alaska’s department of health and social services.
“There are advantages to being in a libertarian western state,” said Butler, in that there was little regulatory or political resistance to creating a needle exchange program. “The opioid crisis has allowed us to shine a light on … a public health best practice.”
For journalists looking for story ideas, look at the connections between socio economic issues, the opioid epidemic and infectious diseases.
A list of state health directors can be found here on the CDC website. Journalists can also look on this map to see which states and counties may be at most risk for an infectious disease outbreak related to the opioid epidemic.
“I think almost every community has been affected” by the epidemic, says Mermin. “You’ll be able to find people who have lost a loved one or experienced a hepatitis infection or HIV. Call your local health department. They’ll be able to tell you how to find physicians” who have been treating them.
For more resources to help journalists cover the essential topic of social determinants and infectious diseases, the AHCJ has compiled this tip sheet to help with resources and ideas.
Articles
The magazine goes deep into the issues of infectious disease outbreaks and social determinants. It’s a great primer on understanding the topic. “American Epidemic” – Scientific American (May 2018)
A report on the inequality connected to infectious disease deaths. “The stark disparities in how infectious diseases kill Americans,” Axios, (April 2018 )
Physicians who find themselves playing a new role as the opioid epidemic has expanded. “ID physicians define new role in opioid crisis,” Helio, (March 2018)
A story about the hepatitis A outbreak in San Diego. “In California, a housing crisis turned into a health crisis as hep A cases spread,” Center for Health Journalism, (February 2018)
How one hospital system identified people with socio economic disadvantages to provide more care. “The ‘frequent flier’ program that grounded a hospital’s soaring costs,” Politico, (December 2017)
How the hepatitis A outbreaks are overwhelming communities. “Hepatitis A is surging and cities don’t have the resources to stop it,” HuffPost, (November 2017 )
An explanation of one way hepatitis A has spread. “How a Lack of Public Restrooms Helped Spread a Deadly Hepatitis Outbreak,” Healthline, (September 2017)
How the opioid epidemic needs to be approached with a multi-pronged strategy and implementation. “We’re failing in the opioid crisis. A study shows a more serious approach that would save lives,” Vox. (August 2018)
Journal stories
A researcher analysis of inequality in infectious disease deaths. “Trends and Patterns of differences in Infectious Disease Mortality Among US Counties, 1980-2014,” Journal of the American Medical Association, (March 2018) (behind paywall but AHCJ members can access for free)
The nation’s top science advisory group took at look at the infectious disease implications of the opioid epidemic and recommendations: “Integrating Infectious Disease Considerations with Response to the Opioid Epidemic,” (March 2018)
Research report on how social determinants play a role in infectious diseases. “Infectious Disease, social determinants and the need for insectoral action,” Canada Communicable Disease Report, (February 2016)
Academic paper on the connection between social determinants and the spread of Zika. “The Social Determinants of Health Contextualized for the Zika Virus,” International Journal of Infectious Diseases, (December 2017)
How inequality played a role in the spread of the 1918 Spanish flu, which devastated the world 100 years ago. “Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic in 2018,” Proceedings in the National Academic of Sciences, (November 2016)
From AHCJ
Social Determinants Core Topic page
Infectious Diseases Core Topic page
“Social Determinants, Infectious Diseases and the Opioid Epidemic,” August 2018
Health Journalism 2018: “Housing as a prescription on the journey to well-being”
Health Journalism 2018: “Walking through history to truth,” – Health and the American Indian
Webcasts
“June 2018, Taking on the Opioid Crisis, Aligning Federal, State and Local Responses,” the Substance Abuse and Mental Health Services Administration highlights opioid response efforts that have been successful.
An infectious disease doctor explains some of the infectious diseases that are tied to the opioid epidemic. Infectious Diseases Impact of Opioid Epidemic: Facebook Live interview by the Infectious Diseases Society of America with Dr. Alysse Wurcel: May 2018
Experts
Jonathan Mermin, M.D., M.P.H., R.A.D.M. and assistant surgeon general, USPHS and head of the CDC’s National center for HIV/AIDS, viral hepatitis, STD and TB Prevention
Reached through CDC Media contact: Michael Williams, NCHHSTPMediaTeam@cdc.gov
Jay Butler, chief medical officer of the Alaska department of health and social services and past president of the Association of State Health and Territorial Officials; Jay.Butler@Alaska.gov
Margot Bushel, MD, professor of medicine, University of California, San Francisco, 415-206-8655, margot.kushel@ucsf.edu
Ruth Berkelman, MD, professor emeritus, Emory University, Rollins School of Public Health, 404-727-5409, rberkel@emory.edu
Jonathan Fielding, professor in residence, University of California, Los Angeles, Fielding School of Public Health, 310-206-1141, jfieldin@ucla.edu
David Harvey, executive director, National Coalition of STD Directors
Reached via media contact: Matthew Prior, prior@ncsddc.org, 202-715-7215
Data and mapping tools
The U.S. Centers for Disease Control and Prevention’s Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention in July 2018 added 11 new indicators on HIV and, for the first time, social determinants of health to its AtlasPlus, an online tool that gives users the ability to create customized tables, maps and charts using 15 years of CDC surveillance data on HIV, viral hepatitis, sexually transmitted diseases (STD’s) and tuberculosis (TB).
The social determinants of health includes five indicators: poverty, uninsured, less than a high school education and vacant housing nationally and by state and county; percentage of population living in rural areas nationally and by state; and county urbanization level.
The CDC developed a map of at-risk counties for infectious disease outbreaks because of the opioid epidemic.
