Disease has maintained a relationship with poverty throughout the course of human history. Although our understanding of this relationship has changed with some of the major developments of the late nineteenth century and the early twentieth century, poverty continues to be “the world’s deadliest disease…and the greatest cause of suffering on earth”. Understanding poverty aids in understanding the varied patterns of epidemic diseases and how these patterns were triggered, reinforced, and comparable to privation.
Asiatic Cholera, previously confined to India and a few other Asian subcontinents, spread throughout the West in the nineteenth century due to mass industrial urbanization and imperialism. Poor hygiene and unsanitary conditions led to the contamination of food and water with vibrio cholerae, the causative agent of cholera. Animals living in close proximity, the improper disposal of excrement, and cesspools seeping into nearby soil all exacerbated the situation. The conflict between “contagionism” and “anticontagionism” paved the way for Koch’s ‘germ theory’ and the development of biomedicine.
René Villermé, a medical statistician, believed that poverty was the cause of disease. In Europe poverty was seen as a social, moral, and political problem, whereas in the continent of Asia it was largely cultural. Europeans and Americans associated cholera with ones social class and economic background. While it was true that the poor succumbed to the disease in greater numbers, this was mostly circumstantial, as the poor lived in the ‘disease-ridden’ parts of the city. The living conditions of the urban poor involved overcrowding, inadequate hygiene and nutrition, and a general lack of preventive care. René Villermé, Lemuel Shattuck, and Edwin Chadwick all shared a belief in statistics and the power of civilization to eradicate disease. They were proponents of the sanitation movement. In a sense, cholera helped launch the field of epidemiology, the cornerstone of public health.
Although it had always been a disease of the poor, tuberculosis and its association with poverty only became widely acknowledged in the latter half of the nineteenth century. In much the same way that urbanization had aided the transmission of cholera, it also facilitated the spread of tuberculosis and increased the likelihood of respiratory infections. The urban poor were trapped in a cyclical lifestyle full of “persistent…urban overcrowding combined with rapid international and intercontinental migration”.
The sanitation movement did not take aim at tuberculosis directly and yet a number of the measures taken coincided to ameliorate the complex etiological ideas surrounding consumption. Koch’s ‘germ theory’ went against most of what sanitationism addressed and provided a raison d’être for the sanatorium: to segregate the sick from the healthy. This eventually led to the development of a system of public ‘relief’ for the poor—the workhouse—where conditions discouraged applications from all but those in genuine need of assistance. The sick poor lived out isolated and lonely lives within the walls of these consumptive institutions.
There is also a notable correlation between the incidence of AIDS and tuberculosis, particularly in areas with a high percentage of urban poverty. HIV/AIDS is predominantly a “disease of the poor and socially outcast” in both poor nations and the developed world. In many African cities poverty has a significant affect on women. They are forced into dependent relationships with men that take advantage of the opportunity for concurrent sexual encounters. The virus spreads rapidly in such conditions and therefore puts women at a greater overall risk to contract the virus.
Although some social and economic conditions make the spread of HIV/AIDS more probable, the contemporary view is that they do not cause the disease. This break away from the biomedical model that previously shaped responses to societal issues challenged the cultural constructs coming out of the twentieth century. Poverty was no longer being seen as the cause of disease, as was the case with cholera (or even tuberculosis), but rather as a distant ally.
References
Echenberg, Myron J. Africa in the Time of Cholera: A History of Pandemics from 1815 To the Present, African studies. Cambridge: Cambridge University Press, 2011.1-13 & 15-44.
Hays, J. N. Cholera & Sanitation. The Burdens of Disease: Epidemics and Human Response in Western History. Rev. Ed. New Brunswick, N.J.: Rutgers University Press, 2009. 135-154.
Hays, J. N. Tuberculosis & Poverty. The Burdens of Disease: Epidemics and Human Response in Western History. Rev. Ed. New Brunswick, N.J.: Rutgers University Press, 2009. 155-178.
Hays, J. N. Disease & Power. The Burdens of Disease: Epidemics and Human Response In Western History. Rev. Ed. New Brunswick, N.J.: Rutgers University Press, 2009. 283-313.
Weiss, Holger. Dirty Water, People on the Move: Cholera Asiatica and the Shrinking of Time and Space during the nineteenth century. In Hamalainen, Pekka. When Disease Makes History: Epidemics and Great Historical Turning Points. Helsinki: Yliopistopaino, Helsinki University Press, 2006. 187-226.
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