Diseases of poverty

The prevalence of unfavorable environmental and social factors that contribute to disease are highest among individuals living in poverty. These communities are at a higher risk of adverse health outcomes, particularly with infectious diseases and noncommunicable diseases. Physical activity Physical activity is a protective factor against chronic conditions such as type 2 diabetes, high blood pressure, and coronary heart disease. Lack of physical activity is related to socioeconomic status, with a higher prevalence of sedentary lifestyles among less affluent groups. There are several factors which contribute to the barriers of exercise among these groups. Within low-income communities in the US, there is reduced access to environments that promote physical activity including parks, recreational facilities, and gyms. Only about one in five homes in low-income areas have parks within a half-mile distance, and about the same number have a fitness or recreation center within that distance. Expanded availability of local environments enabling exercise is associated with an increase in physical activity and a decrease in individuals with an overweight status. Children from low-income families are more likely to engage in sedentary, indoor activities due to challenges in obtaining adult supervision of outdoor play and parental concern for noise complaints. Mental health Mental health is "a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity". Poverty has a profound effect on a person's mental health. According to Alyssa Brown of the Washington D.C. Gallup, 31% of people living in poverty have reported at some point been diagnosed with depression compared with 15.8% of those not in poverty. There is evidence that low income or loss of income are associated with worsening mental health while wealth and gain of income are linked with improvements in mental health. Furthermore, individuals living in poverty are disproportionally exposed to air pollution, temperature extremes, and violence, which all negatively impact mental health. These factors can induce chronic stress, which result in high cortisol levels. Excess cortisol is associated with unfavorable health outcomes, such as hypertension, diabetes, osteoporosis, and increased risk of infections. It is uncertain whether poverty induces depression or depression causes poverty. What is certain is that the two are closely linked. A reason for this link could be due to the lack of support groups such as community centers. Isolation plays an integral role in depression. Results from a cohort study of approximately 2,000 older adults aged 65 years and older from the New Haven Established Populations for the Epidemiological Study of the Elderly found that social engagement was associated with lower depression scores after adjustment for various demographic characteristics, physical activity and functional status. According to UNICEF, 3,000 children die every day, worldwide due to contaminated drinking water and poor sanitation. Although the Millennium Development Goal (MDG) of halving the number of people who did not have access to clean water by 2015 was reached five years ahead of schedule in 2010, there are still 783 million people who rely on unimproved water sources. There have been efforts to improve water quality using new technology, which allows water to be disinfected immediately upon collection and during the storage process. Clean water is necessary for cooking, cleaning, and laundry because many people come into contact with disease-causing pathogens through their food, or while bathing or washing. Though access to water has improved for some, it continues to be especially difficult for women and children as they bear most of the burden for accessing water and supplying it to their households. In India, Sub-Saharan Africa, and parts of Latin America, women are required to travel long distances in order to access a clean water source and then bring some water home. This has a significant impact on girls' educational attainment. An ongoing issue of contaminated water in the United States has been taking place in Flint, Michigan since 2014. The issue of lead-contaminated water began after the source of drinking water was changed from Lake Huron to the Flint River, resulting in corrosion of supply pipes and lead leaching into the city's water supply. Exposure to lead has serious health complications in developing fetuses, children, and adults. Children are particularly vulnerable to low levels of lead, and can display behavioral changes, hearing problems, and other neurologic consequences as a result of lead ingestion. Air pollution Studies show that there is an association between low socioeconomic status and exposure to higher concentrations of air pollution. This relationship is especially apparent in North America, New Zealand, Asia, and Africa. Exposure to environmental toxins, like ambient particulate matter (or air pollution), has been linked to the development of diseases like cancer, immune system impairment, and reproductive dysfunction. According to the World Health Organization, 2.4 billion people are exposed to household air pollution through the use of open fire cooking and inefficient stoves. This resulted in 3.2 million deaths per year in 2020 and countless cases of stroke, heart disease, and lung cancer. Education Education is affected by poverty, which is known as the income achievement gap. This gap shows that children living in poverty or have lower-income are less likely to have the cognitive development and early literacy levels of those who do not. The amount of income affects the amount of extra money a family has to spend on additional educational programs; including summer camps and out of school assistance. In addition to finances, environmental toxins, including lead and stress and lack of nutritious food can diminish cognitive development. The failure to achieve higher levels of education attributes to the cycle of poverty which can continue for generations in the same family and even in the community. These individuals are more likely to engage in behaviors that worsen health, such as smoke, have an unhealthy diet, and are less likely to exercise. Poor sanitation can lead to diarrheal disease and malnutrition, which can result in serious illness. These inequalities in access result in open defecation and improperly treated wastewater that is used for food production. Countries where open defecation is seen have higher levels of poverty, adverse health outcomes, and death in children due to diarrheal disease. Malnutrition, the immune system, and infectious diseases operate in a cyclical manner: infectious diseases have deleterious effects on nutritional status, and nutritional deficiencies can lower the strength of the immune system which affects the body's ability to resist infections. Increased mother-to-child transmission is related to specific deficiencies in micro-nutrients such as vitamin A. Further, anemia, a decrease in the number of red blood cells, increases viral shedding in the birth canal, which also increases risk of mother-to-child transmission. Without these vital nutrients, the body lacks the defense mechanisms to resist infections. Food insecurity refers to the lack of access to quality food for a healthy lifestyle. Poor housing conditions Families living in poverty often struggle not only with housing problems, but neighborhood safety and affordability problems as well. Avoiding neighborhood safety problems often means staying home which reduces opportunity for exercise outside the home which exacerbates health issues due to lack of exercise. Staying in the home can mean exposure to lead, mold and rodents within that home that can lead to an increased risk of illness due to these inadequate housing issues. The population below the poverty line lacks access due to higher retail price and unavailability of the medicines. The higher cost can be due to the higher manufacturing price or due to local or regional tax and Value Added Tax. There is a significant disparity in the research conducted in the health sector. It is claimed that only 10% of the health research conducted globally focuses on 90% disease burden. However, diseases such as cancer, cardiovascular diseases etc. that traditionally were associated with the wealthier community are now becoming more prevalent in the poor communities as well. Hence, the research conducted now is relevant to poor population. Without these interventions, poverty-related diseases will continue to disproportionately impact low-income populations. Cycle of poverty The cycle of poverty is the process through which families already in poverty are likely to remain in those circumstances unless there is an intervention of some kind. This cycle of poverty has an impact on the types of diseases that are experienced by these individuals, and will often be passed down through generations. Mental illnesses are particularly important when discussing the cycle of poverty, because these mental illnesses prevent individuals from obtaining gainful employment. The stressful experience of living in poverty can also exacerbate mental illnesses. By experiencing the same stressful situations for decades, individuals become more susceptible to diseases like cardiovascular disease, obesity, diabetes, and mental illnesses including schizophrenia and bipolar disorder. Health disparities contribute significantly to the cycle of poverty. Chronic conditions such as diabetes and hypertension reduce an individual's ability to work, further deepening economic hardship. Studies have shown that children in low-income families are at greater risk of malnutrition, which can lead to long-term cognitive and physical health issues. Addressing these health disparities requires policies that integrate healthcare, education, and economic support systems ==Infectious diseases==

Together, diseases of poverty kill approximately 14 million people annually. At the global level, the three primary PRDs are tuberculosis, AIDS/HIV and malaria. Developing countries account for 95% of the global AIDS prevalence and 98% of active tuberculosis infections. Furthermore, 90% of malaria deaths occur in African countries. Together, these three diseases account for 10% of global mortality. Expanding healthcare interventions to address both infectious and non-communicable diseases can provide a more comprehensive approach to reducing the global disease burden. Treatable childhood diseases are another set which have disproportionately higher rates in poor countries despite the availability of cures for decades. These include measles, pertussis and polio. The largest three PRDs—AIDS, malaria, and tuberculosis—account for 18% of diseases in poor countries. Three other diseases, measles, pneumonia, and diarrheal diseases, are also closely associated with poverty, and are often included with AIDS, malaria, and tuberculosis in broader definitions and discussions of diseases of poverty. Neglected diseases Based upon the spread of research in cures for diseases, certain diseases are identified and referred to as "neglected diseases". These include the following diseases: These diseases have been identified by the Centers for Disease Control and Prevention, as priorities for public health action based on the number of people infected, the severity of the illnesses, and the ability to prevent and treat them. Trichomoniasis Trichomoniasis is the most common sexually transmitted infection affecting more than 200 million people worldwide. It is especially prevalent among young, poor and African American women. This infection is also common in poor communities in Sub-Saharan Africa and impoverished parts of Asia. This neglected infection is one of special concern because it is associated with a heightened risk for contracting HIV and pre-term deliveries. In addition, availability of cures and recent advances in medicine have led to only three diseases being considered neglected diseases, namely, African trypanosomiasis, Chagas disease and Leishmaniasis. Each year, about one million children under the age of five die from malaria. Children who are poor, have mothers with little to no education, and live in rural areas are more susceptible to malaria and more likely to die from it. Malaria is directly related to the spread of HIV in sub-Saharan Africa. It increases viral load seven to ten times, which increases the chances of transmission of HIV through sexual intercourse from a patient with malaria to an uninfected partner. After the first pregnancy, HIV can also decrease the immunity to malaria. This contributes to the increase of the vulnerability to HIV and higher mortality from HIV, especially for women and infants. HIV and malaria interact in a cyclical manner—being infected with malaria increases susceptibility to HIV infection, and HIV infections increase malarial episodes. The co-existence of HIV and malaria infections helps spread both diseases, particularly in Sub-Saharan Africa. Malaria vaccines are an area of intensive research. Intestinal parasites Intestinal parasites are extremely prevalent in tropical areas. At the same time, chronic worm infections can cause immune activation that increases susceptibility of HIV infection and vulnerability to HIV replication once infected. Schistosomiasis Schistosomiasis (bilharzia) is a parasitic disease caused by the parasitic flatworm trematodes. Moreover, more than 80 percent of the 200 million people worldwide who have schistosomiasis live in sub-Saharan Africa. Infections often occur in contaminated water where freshwater snails release larval forms of the parasite. After penetrating the skin and eventually traveling to the intestines or the urinary tract, the parasite lays eggs and infects those organs. Along with malaria, schistosomiasis is one of the most important parasitic co-factors aiding in HIV transmission. Epidemiological data shows schistosome-endemic areas coincide with areas of high HIV prevalence, suggesting that parasitic infections such as schistosomiasis increase risk of HIV transmission. Tuberculosis Tuberculosis is the leading cause of death around the world for an infectious disease. This disease is especially prevalent in sub-Saharan Africa, and the Latin American and Caribbean region. While the tuberculosis rate is decreasing in the rest of the world, it is increasing by rate of 6 percent per year in Sub-Saharan Africa. It is the leading cause of death for people with HIV in Africa. Tuberculosis (TB) is closely related to lifestyles of poverty, overcrowded conditions, alcoholism, stress, drug addiction and malnutrition. This disease spreads quickly among people who are undernourished. HIV infection and TB are also closely tied. Being infected with HIV increases the rate of activation of latent TB infections, and having TB, increases the rate of HIV replication, therefore accelerating the progression of AIDS. Primary modes of HIV transmission in sub-Saharan Africa are sexual intercourse, mother-to-child transmission (vertical transmission), and through HIV-infected blood. Since rate of HIV transmission via heterosexual intercourse is so low, it is insufficient to cause AIDS disparities between countries. Many of the countries in Sub-Saharan Africa are ravaged with poverty and many people live on less than one United States dollar a day. The poverty in these countries gives rise to many other factors that explain the high prevalence of AIDS. The poorest people in most African countries are malnourished, lack of access to clean water, and have improper sanitation. Because of a lack of clean water many people are plagued by intestinal parasites that significantly increase their chances of contracting HIV due to compromised immune system. Malaria, a disease still rampant in Africa also increases the risk of contracting HIV. These parasitic diseases, affect the body's immune response to HIV, making people more susceptible to contracting the disease once exposed. Genital schistosomiasis, also prevalent in the topical areas of Sub-Saharan Africa and many countries worldwide, produces genital lesions and attract CD4 cells to the genital region which promotes HIV infection. All these factors contribute to the high rate of HIV in Sub-Saharan Africa. Many of the factors seen in Africa are also present in Latin America and the Caribbean and contribute to the high rates of infections seen in those regions. In the United States, poverty is a contributing factor to HIV infections. There is also a large racial disparity, with African Americans having a significantly higher rate of infection than their white counterparts. == Noncommunicable diseases ==

Noncommunicable diseases (NCDs) such as cardiovascular disease, chronic respiratory diseases, cancer, and diabetes place a significant and growing burden of disease in low and middle income countries (LMICs), where they have shifted from being perceived as "diseases of affluence" to key drivers of poverty cycles due to limited access and preventive care. NCDs cause 43 million deaths each year (2021 data), which account for 75% of all non-pandemic-related deaths globally, of which 73% (32 million) are in LMICs. Of the 18 million premature NCD deaths under age 70 annually, 82% occur in LMICs, disproportionately affecting vulnerable populations and impeding poverty reduction through rising household healthcare costs. Chronic diseases and poverty Poverty also significantly contributes to chronic diseases, including diabetes, cardiovascular disease, and mental illness. A study by Johns Hopkins Public Health highlights that people living in poverty have a heightened risk of developing non-communicable diseases (NCDs) due to inadequate access to nutritious food, preventive medical care, and healthcare services. Poor dietary habits, increased stress, and environmental factors such as air pollution further exacerbate these health risks. Addressing these chronic illnesses is critical to understanding the full impact of poverty on health. Respiratory diseases More than 300 million people worldwide have asthma. The rate of asthma increases as countries become more urbanized and in many parts of the world those who develop asthma do not have access to medication and medical care. Within the United States, African Americans and Latinos are four times more likely to have severe asthma than whites. The disease is closely tied to poverty and poor living conditions. Asthma is also prevalent in children in low income countries. Homes with roaches and mice, as well as mold and mildew put children at risk for developing asthma as well as exposure to cigarette smoke. Mortality rates for African American children due to asthma are also far higher than that of other racial groups. For African Americans, the rate of visits to the emergency room is 330 percent higher than their white counterparts. The hospitalization rate is 220 percent higher and the death rate is 190 percent higher. Among Hispanics, Puerto Ricans are disporpotionatly affected by asthma with a disease rate that is 113 percent higher than non-Hispanic Whites and 50 percent higher than non-Hispanic Blacks. Asthma continues to have an adverse effects on the health of the poor and school attendance rates among poor children. 10.5 million days of school are missed each year due to asthma. Both low income and low education were predictors of coronary heart disease, a subset of cardiovascular disease. Of those admitted to hospital in the United States for heart failure, women and African Americans were more likely to reside in lower income neighborhoods. In the developing world, there is a 10 fold increase in cardiac events in the black and urban populations. Cancer While cancer affects all populations, certain populations are disproportionally affected by the disease due to differences in risk factor exposures. People living in poverty are at an increased risk of cancer incidence and mortality, with annual death rates being 12% higher in countries living in poverty. Globally, two out of three cancer deaths are attributed to lifestyle and behaviors such as smoking, poor diet, physical inactivity, and insufficient cancer screenings. Individuals living in LMIC have greater exposure to these risk factors in the setting of reduced access to health care services. Inadequate access to health care presents a major barrier as individuals are less likely to receive regular cancer screenings resulting in a late-stage diagnosis, which is associated with worse health outcomes. People living in poverty have also higher levels of chronic stress, which also increases an individual's risk of cancer due to inflammatory changes. Higher obesity rates tend to be observed in LMICs and it has been believed that lower socioeconomic statuses (SES) leads to higher obesity rates because individuals living in poverty are limited in their abilities to engage in healthy exercising and dieting practices. In the United States, there tends to be higher obesity rates in lower SES neighborhoods, which are called food deserts. A food desert lacks supermarkets that offer healthy and fresh food options and instead have highly processed foods. Because of the limited access to healthy foods, it follows that individuals who live farther away from supermarkets tend to have higher rates of obesity. Besides food access, individuals living in poverty may also be limited in their healthcare access, leading to later diagnosis and management of chronic conditions like obesity. Conversely, chronic conditions such as obesity can also increase rates of poverty via increased healthcare expenditures, wage loss during peak productive years, and missed schooling. These points underscore the positive effect poverty alleviation has on improving health outcomes as it concerns obesity and other chronic NCDs. In spite of this data, pervasive attitudes remain that individual behavior, not SES, is responsible for obesity. These attitudes stigmatize individuals with obesity, which further hampers public health interventions to reduce obesity rates and accelerates health disparities along SES lines. This stigma extends to other NCDs, including mental health conditions, where societal biases delay treatment and exacerbate isolation in low-resource settings. Social and economic determinants of health Poverty related diseases are not just biological but are deeply influenced by social and economic conditions. According to the Centers for Disease Control and Prevention (CDC), factors such as income security, stable housing, education, and employment opportunities play a critical role in determining health outcomes. Individuals in poverty often live in environments with higher exposure to pollutants, limited access to fresh food, and higher stress levels, all of which contribute to poor health. Socioeconomic disparities persist even in high income areas. For example, 2025 surveillance in France revealed persistent TB hotspots in low SES urban areas of metropolitan regions, with area-level variables like unemployment and housing instability associated with 1.5 to 2 times higher notification rates illustrating how poverty amplifies both communicable and non-communicable disease risks through shared structural drivers. Healthcare access and policy solutions Access to healthcare remains a crucial determinant of health outcomes for individuals in poverty. Research demonstrates that healthcare system improvements in low- and middle-income countries (LMICs) can significantly reduce the burden of poverty-related diseases. However, many impoverished communities continue to face barriers such as high medical costs, lack of healthcare infrastructure, and limited insurance coverage. Implementing policies that prioritize equitable healthcare access, such as universal health coverage and community health programs, can help mitigate these disparities. To address NCD inequities, governments should invest in user-centered health systems, including affordable interventions for behavioral risk factors, e.g. tobacco control, and early detection as recommended by global frameworks like the WHO's 2025 equity report. == Other health complications ==

Maternal health Obstetric fistula or vaginal fistula is a medical condition in which a fistula (hole) develops between either the rectum and vagina (see rectovaginal fistula) or between the bladder and vagina (see vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available. It is considered a disease of poverty because of its tendency to occur women in poor countries who do not have health resources comparable to developed nations. Dental decay Dental decay or dental caries is the gradual destruction of tooth enamel. Poverty is a significant determinant for oral health. Dental caries is one of the most common chronic diseases worldwide. In the United States it is the most common chronic disease of childhood. Risk factors for dental caries includes living in poverty, poor education, low socioeconomic status, being part of an ethnic minority group, having a developmental disability, recent immigrants and people infected with HIV/AIDS. In Peru, poverty was found to be positively correlated with dental caries among children. According to a report by U.S. health surveillance, tooth decay peaks earlier in life and is more severe in children with families living below the poverty line. Because the mouth is a gateway to the respiratory and digestive tracts, oral health has a significant impact on other health outcomes. Gum disease has been linked to diseases such as cardiovascular disease. ==Societal consequences==

Diseases of poverty reflect the dynamic relationship between poverty and poor health; while such diseases result directly from poverty, they also perpetuate and deepen impoverishment by sapping personal and national health and financial resources. For example, malaria decreases GDP growth by up to 1.3% in some developing nations, and by killing tens of millions in sub-Saharan Africa, AIDS alone threatens "the economies, social structures, and political stability of entire societies". For women Women and children are often put at a high risk of being infected by schistosomiasis, which in turn puts them at a higher risk of acquiring HIV. Women also have a higher risk of HIV transmission through the use of medical equipment such as needles. This increased risk of contracting HIV through non-sexual means has social consequences for women as well. Over half of the husbands of HIV-positive women in Africa tested HIV-negative. When HIV-positive women reveal their HIV status to their HIV-negative husbands, they are often accused of infidelity and face violence and abandonment from their family and community. This is crucial in parts of Africa where farming is the primary occupation and obtaining food is dependent on the agricultural outcome. Without adequate food production, malnutrition becomes more prevalent. Children are often collateral damage in the AIDS crisis. As dependents, they can be burdened by the illness and eventual death of one or both parents due to HIV/AIDS. Studies have shown that orphaned children are more likely to display physical symptoms of malnutrition than children whose parents are both alive. ==Public policy proposals==

There are a number of proposals for reducing the diseases of poverty and eliminating health disparities within and between countries. The World Health Organization proposes closing the gaps by acting on social determinants. Their first recommendation is to improve daily living conditions. This area involves improving the lives of women and girls so that their children are born in healthy environments and placing an emphasis on early childhood health. Their second recommendation is to tackle the inequitable distribution of money, power and resources. This would involve building stronger public sectors and changing the way in which society is organized. Their third recommendation is to measure and understand the problem and assess the impact of action. This would involve training policy makers and healthcare practitioners to recognize problems and form policy solutions. has proposed an approach termed Health in All Policies. Health inequalities are shaped by many powerful forces and social, political, and economic determinants. Governments have a responsibility to ensure that their people are able to live healthy lives and have equitable access to achieving a reasonable state of good health. Policies that governments craft and implement in all sectors have a significant and ongoing impact on public health, health equity, and the lives of their citizens. Increases in technology, medical innovation, and living conditions have led to the disappearance of diseases and other factors contributing to poor health. However, there are many diseases of poverty that still persist in developed and developing countries. Tackling these health inequalities and diseases of poverty requires a willingness to engage the whole government in health. The Helsinki Statement lays out a framework of action for countries and calls on governments to make a commitment to building health equity within their country. Health in All Policies (HiAP) is an approach to public policies across all sectors of government that takes into account the health implications of all government and policy decisions to improve health equity across all populations residing within the borders of a country. This concept is built upon principles in line with the Universal Declaration of Human Rights, The United Nations Millennium Development Declaration, and principles of good governance: ==See also==