In the American South, an Inequity of Diseases

In Alabama, climate change and poor infrastructure provide hospitable conditions for diseases typically found in the developing world.

Eight years later, on a stifling hot spring morning, the 58-year-old Flowers, who also works on race and poverty initiatives at the Equal Justice Initiative and is an avid environmental justice activist, drove through Lowndes on the famous 54-mile highway between Selma and Montgomery that Martin Luther King Jr. and hundreds of others marched in 1965. “This road is supposed to represent equality in the United States,” she said. “But here, there’s one of the most glaring forms of inequality in the U.S.”

For decades, this poor, rural county has lacked basic wastewater infrastructure. With climate change driving warmer temperatures and heavier rains, flooding is more common, and the standing water and raw sewage attracts mosquitoes and other tropical disease vectors. Flowers has witnessed these conditions since her childhood — she grew up in the area — and long suspected they were a problem. But earlier this year, her suspicions were confirmed: researchers from the National School of Tropical Medicine at Baylor College of Medicine in Houston, Texas, found tropical parasites in Lowndes County that are typically found in developing countries.

“This is the frontline community for environmental injustice, already suffering from climate change and having health issues exacerbated by it,” Flowers said. “We’re starting to see the possibility of tropical illnesses in places that didn’t have them before. And we don’t have infrastructure in place to address it, nor are our medical personnel being trained to find it.”

Flowers pointed out dozens of homes that dump raw sewage in their yards because they can’t afford individual septic systems. Many of these families participated in the Baylor College of Medicine study.

Flowers has a commanding presence and contagious laugh, and she never meets a stranger — especially in Lowndes County. She was born in Birmingham, but her family moved to Lowndes in the 1960s, at the height of the Civil Rights Movement — when it was called “Bloody Lowndes” for the excessive police violence against black residents. The family used an outhouse for years before her parents installed an onsite septic system. But the dark, rich Alabama soil, perfect for agriculture, retains water, so the systems overflow in hard rains.

Also in the early 1990s, a University of Alabama study on a small clinic in neighboring Wilcox County revealed that a third of children under age 10 had intestinal helminths, parasites linked to poor sanitation and contaminated soil. By the time Flowers was bitten by those mosquitoes in 2009, she had a feeling the effects of climate change were making conditions in rural Alabama worse. Three years later, she read an op-ed on tropical diseases as the new plague of poverty in The New York Times, written by Peter Hotez, a pediatrician and dean of the National School of Tropical Medicine at Baylor. It sounded all-too familiar. “I held onto that article, kept going back to it,” she said. Three months later, she emailed Hotez and told him about Lowndes.

Hotez is one of the world’s leading experts on neglected tropical diseases, and helped found the National School of Tropical Medicine six years ago. He said these types of neglected diseases, which most people associate with developing nations, impact 12 million people living in poverty in the U.S. already, and more are at risk. Most are on the Gulf Coast in Texas and in the Southeast. Poverty is the overriding determinant, but other key factors include hot and wet conditions, climate change, migration, and increasing numbers of vector species. “These diseases are not on anybody’s radar,” Hotez said. “They’re occurring in flyover country, among the poor, in neighborhoods that go unseen.”

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