At the end of 2017, Philip Alston, the United Nation’s special rapporteur on extreme poverty and human rights toured the United States and Puerto Rico. His goal was to turn a global lens on our nation in order to assess the depth and breadth of poverty in America, especially extreme poverty.

Today few people are aware that we have as many as 19.4 million Americans who live at one-half the US poverty level and by some accounts more than a million U.S. families living below the World Bank poverty figure of $1.90 per day.

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The UN special rapporteur has many choices on where to look for extreme poverty, but as Michael Harrington first pointed out more than 50 years ago in his landmark book “The Other America,” this type of poverty is generally off the beaten track and it takes time to both find it and understand it.

In our case, we’ve been working to champion the plight of profoundly impoverished populations, especially African American populations, living in the Deep South. In Lowndes County, a rural county in Alabama’s “black belt” region we have called attention to rural towns without adequate wastewater treatment or any serious level of what anyone would consider sanitation. There is raw open sewage spewing from houses, with both adults and children regularly exposed to human waste.

Such conditions reminded one of us, an expert on parasitic and neglected tropical diseases who has worked extensively in poor countries, of conditions found across the developing world where these diseases flourish. Indeed our study just published in a tropical disease journal found that hookworm and other parasitic infections are still prevalent in Lowndes County. Almost a hundred years ago hookworm was identified as a stealth cause of poverty in Alabama due to its debilitating effects on productivity and child growth and intellectual development. It’s still there.

Sadly, Lowndes County is not unique. Quite the contrary — there are likely dozens if not hundreds of Lowndes Counties in Southern states where poverty mixes with degraded conditions to promote these long-forgotten diseases among forgotten people.

Making matters worse is climate change, which tends to disproportionately affect the poor and promotes tropical diseases due to warmer temperatures and shifting rainfall patterns. These illnesses include diseases transmitted by mosquitoes, such as dengue, Zika and West Nile virus infections, fleas that can transmit typhus, and triatomine kissing bugs that transmit Chagas disease. In all, today we estimate that as many as 12 million Americans live in poverty with a neglected tropical disease. These are not rare diseases — in fact they are extraordinarily common, it’s just that mostly affect the hidden poor.

A half-century ago Harrington’s “The Other America” inspired President Lyndon Johnson to launch a war on poverty. LBJ’s legacy is still with us today, but it needs a refresh and new approaches. Depending on the special rapporteur’s findings we may need a new war or assault, with a goal to lift our bottom 19 million out of extreme poverty. It’s been said before, “a civilization can be judged by the treatment of its minorities.” We need to fix extreme poverty in America.

Catherine Coleman Flowers is the founder of the Alabama Center for Rural Enterprise Community Development Corporation (ACRE).

Peter Hotez, MD, Ph.D., is professor of pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine.