Study Finds Poverty Spread Ebola

Partners In Health staff have long seen how poverty can make a person sick—how a crumbling house can increase the likelihood of contracting malaria, for example. Last month, a paper in PLOS Neglected Tropical Diseases quantified how poverty contributed to the Ebola epidemic.

Specifically, the study examined the role that poverty played in spreading the hemorrhagic fever throughout Monrovia, Liberia, in 2014. To do so, five colleagues at Yale University’s Center for Infectious Disease Modeling and Analysis began by establishing criteria to evaluate the wealth of neighborhoods in the capital. (Communities were categorized as relatively rich, for example, if a third of homes had access to latrines.)

They then compiled Ebola case information for more than 300 communities within the city. Lastly, they used statistical modeling to look at the infectious disease’s spread, from person to person, between February and December of 2014.

What did they find? Slums quickly became Ebola hotspots—that turned into hubs of disease. Ebola sufferers living in shanty towns infected 3.5 times as many people as those living in rich areas. And poor people were more likely to “export” the disease to rich neighborhoods.

The study focuses mostly on number crunching but does hint at why poor people passed the disease on more often and farther afield. And it has nothing to do with the people. Slums are, by definition, densely populated, lacking in sanitation and health care facilities, and places people must leave daily to find work—all conditions that increase the spread of an infectious disease such as Ebola.

The takeaway is clear, the authors say. Invest in medical care for Sinkor’s 12th Street, Peace Island, and other rundown neighborhoods in Monrovia. “Our findings suggest that targeting areas of extreme poverty would have the greatest impact,” they write. And don’t just build hospitals. “Focusing on sustainable development in urban slums and other communities of low and middle [income] could significantly reduce the risk of future infectious disease outbreaks.”

Or as we at PIH might say, "Poverty makes people sick; treat both."