Introduction

Children, whose father died from chronic kidney disease, collect leaves to wrap food to sell in their community near Chichigalpa, Nicaragua. Anna Barry-Jester

Pledging $1.7 million to combat a mysterious kidney disease killing agricultural laborers by the thousands, health ministers from across the Americas passed a resolution last week formally recognizing the disease as a serious threat to public health.

For more than two years, the International Consortium of Investigative Journalists has examined how a rare type of chronic kidney disease is afflicting agricultural workers along Central America’s Pacific Coast, as well as in Sri Lanka and India. A recent study estimated that the ailment has killed more than 20,000 people in Central America alone, but scientists have yet to definitively uncover the cause of the parallel epidemics.

Last week’s declaration from the Directing Council of the Pan American Health Organization (PAHO) called on member states to conduct research and surveillance of the disease, and to strengthen their occupational and environmental health programs. It designated several Central American groups, including governments and NGOs, to collaborate.

The policy marks a significant turnaround for PAHO, which in 2011 rejected a proposal by El Salvador to recognize chronic kidney disease in agricultural workers as a distinct new form of illness and designate it as a top public health priority. At the time, the United States played a key role in blocking the resolution because it did not fit the U.S.’s agenda and U.S. delegates were unaware of the ailment’s severity.

El Salvador has since led a campaign by Central American nations demanding greater attention to the disease, and contended that agrochemicals are the primary culprit. Today, chronic kidney disease is the leading cause of hospital deaths in El Salvador, the PAHO resolution said.

Dr. Carlos Orantes, director of El Salvador’s national research and treatment programs for the disease, compared the growing recognition of CKD’s severity to the emergence of HIV/AIDS in the 1980s. “I see this as similar to what happened with AIDS,” Orantes said. “The science advanced together with political advocacy. People with chronic kidney disease of non-traditional causes are people who are not recognized, who are excluded from our public health systems.”