PLOS NTDs Editor-in-Chief, Peter Hotez, highlights the continuing disproportionate burden of neglected diseases and incarceration among African Americans.

In the United States of America, a higher percentage of African Americans live in poverty than any other racial/ethnic subgroup. According to the U.S. Census Bureau, 27.4% of blacks lived below the poverty line in 2010, compared to 9.9% non-Hispanic whites, while 38.4% of black children (almost five million children) lived in poverty compared to 12.4% of non-Hispanic white children [1]. A high percentage of Hispanics (26.6%) and their children (35%) also live below the poverty line [1].

One of the more compelling reasons for this huge disparity among poverty levels was stated recently by Michelle Alexander, a law school professor at Ohio State University. In her landmark book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness (The New Press), she makes a convincing case that the Jim Crow order that existed in this country prior to the 1960’s Civil Rights movement never really disappeared but instead was reincarnated in the form of incarcerating a generation of young African American men [2]. As Alexander states in her book, the 30-year-old “War on Drugs” has expanded the U.S. penal population almost 10-fold –from 300,000 to 2 million. Today the U.S has the largest number of prisoners anywhere in the world – even more than China or Iran [2]. Most of those are jailed for convictions of non-violent crime related to drug possession, and in some states black men are 20-50 times more likely to see prison time than white men [2]. In Washington, D.C., three of four black men have or are at risk of serving time in prison [2].

To me, one of her most startling assertions is that the U.S. now sends a higher percentage of its black population to prison than South Africa did during the apartheid era [2].

Upon leaving prison, black men cannot escape the stigma of a felony conviction. They are often unable to find employment and support their families. They are also denied the right to vote. Alexander asserts that this current situation has little to do with protecting the public welfare but everything to do with preserving a status quo of a racial caste system in America.

This disturbing data undoubtedly account for a significant amount of maternal and child poverty among African Americans in the U.S. Five years ago, I proposed a second possible underlying factor, namely high rates of neglected tropical diseases (NTDs) among the poor, especially in the American South [3]. NTDs are chronic infections often lasting for years that both occur in the setting of poverty and can actually cause poverty by making people too sick to go to work and causing developmental delays in childhood. My research published in a PLOS Neglected Tropical Diseases article entitled, “Neglected infections of poverty in the United States of America”, identified a (previously hidden) burden of NTDs among the poor in the U.S. and mostly among people of color [3]. The leading NTDs among African Americans include toxocariasis, a parasitic cause of asthma and epilepsy; trichomoniasis, a sexually-transmitted parasitic infection, congenital cytomegalovirus (CMV) infection that results in severe mental disabilities and deafness, congenital syphilis, and possibly dengue [3]. I estimated that the number of cases of these NTDs among African-Americans exceeds 4 million at any given time [3]. These are not rare diseases! Among Hispanics, a second group of NTDs includes Chagas disease and cysticercosis [3]. I recommended a series of measures to combat NTDs in the U.S. including programs of active surveillance, disease transmission studies and research and development efforts to produce new drugs, diagnostics, and vaccines [3].

This summer will mark five years since the original publication of the PLOS article. Over this time period, I am afraid to say not very much has happened at the state or federal levels. Given our success in highlighting NTDs in developing countries so far it is profoundly disappointing to me that I have not achieved similar success in highlighting the impact of NTDs among the poor and disenfranchised in my own country. Even a modest piece of legislation with no funding entitled the Neglected Infections of Impoverished Americans Act has basically gone nowhere in the U.S. Congress.

Beginning in 2012 I began trying to resurrect interest in NTDs among people of color in the U.S. by writing high profile op-ed pieces in The New York Times, BMJ, and PLOS NTDs [4-6]. CNN’s Soledad O’Brien was amazing in giving air time to the issue. These activities followed on the heels of my relocation to Houston, Texas, to establish a new National School of Tropical Medicine at Baylor College of Medicine [7], which has as a focus NTDs in the Americas, including those in Texas where the largest concentration of these diseases probably occurs.

Later this spring, the second edition of my book, Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and their Impact on Global Health and Development (ASM Press) will be published and will include updated chapters on NTDs in the U.S. I’m hopeful the book together with a new foreword by Soledad O’Brien might help to re-energize interest in the problems of disease and poverty everywhere, but I am equally eager to see if it might finally call attention to the poor, underserved, and people of color in the USA.

Literature Cited

1. http://www.npc.umich.edu/poverty/, accessed March 23, 2013.

2. Alexander M. 2012. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. The New Press 312 p; pp 6-7.

3. Hotez PJ. 2008. Neglected infections of poverty in the United States of America. PLOS Negl Trop Dis 2: e256. http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000256, accessed March 24, 2013.

4. Hotez PJ. 2012. Fighting neglected tropical diseases in the southern United States. BMJ 345: e6112. http://bakerinstitute.org/publications/HPF-pub-HotezBMJ-091312.pdf, accessed March 24, 2013.

5. Hotez PJ. 2012. Tropical diseases: the new plague of poverty. The New York Times , August 18, 2012. http://www.nytimes.com/2012/08/19/opinion/sunday/tropical-diseases-the-new-plague-of-poverty.html?_r=0, accessed March 24, 2013.

6. Hotez PJ, Bottazzi ME, Dumonteil E, Valenzuela JG, Kamhawi S, Ortega J, Rosales SP, Cravioto MB, Tapia-Conyer R. 2012. Texas and Mexico: sharing a legacy of poverty and neglected tropical diseases. PLOS Negl Trop Dis 6: e1497. http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0001497, accessed March 24, 2013.

7. http://www.bcm.edu/tropicalmedicine/, accessed March 24, 2013.