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.”
“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.