Hookworm, a Disease of Extreme Poverty, Thrives in Alabama

Parasite in human blood

People testing positive for hookworm, an intestinal parasite that is only found in areas of extreme poverty, is thriving in the United States, the wealthiest country in the world. While hookworm, or Necator americanus, is a tropical disease that is often associated with the developing world of sub-Saharan Africa and Asia, it is currently rampant in Alabama.

Despite being the wealthiest country on the planet, the U.S. is home to some of the world’s greatest inequality. According to a just-released report, the U.S. tolerates poverty-related illnesses on the same level as the poorest countries in the world.

Hookworm infections affect 43- million people worldwide, causing iron deficiency and impaired mental development and stunting childhood development. but hookworm cannot just develop anywhere; for it to thrive, the environmental conditions have to be perfect.

Hookworm was rampant in the southern United States before improvements to sewage disposal systems and eradication programs. But because of continued poverty, poor sanitation, and other incidences of extreme poverty, hookworm has been thriving.


More than 33% of people sampled in a low-income area of Alabama tested positive for traces of hookworm, despite the gastrointestinal parasite having been thought to have been wiped out from the U.S. decades ago.

President Donald Trump has said he will “Make America Great Again” by cutting taxes, bringing jobs back to America, and fixing America’s crumbling infrastructure, but has said little or nothing about helping eradicate chronic poverty.

The study was conducted by the National School of Tropical Medicine at Baylor College in conjunction with the Alabama Center for Rural Enterprise, a nonprofit group that looks into the main causes of poverty.

The survey, which was conducted in Lowndes County, Alabama, an area with a long-history of inequity and racial discrimination, found that 34% tested positive for traces of Necator americanus.

The parasite enters the body through the skin, like the soles of bare feet, and attaches itself to the small intestine. Over months or years, hookworm causes iron deficiency, weight loss, anemia, and impaired mental function.

Hookworm was widespread in the southern U.S. in the earlier parts of the 20th century, but disappeared as overall public health improved. In fact, most health experts believed hookworm had been eradicated by the 1980s.

But this new study, the first of its kind in the modern era, proves otherwise. None of those that were part of the study had ever travelled outside the U.S. They didn’t need to travel outside of the country to get hookworm; the inadequate waste treatment is so bad it’s become a breeding ground.

Because of the growing inequity, it’s not going to get any better. The average income in Lowndes County, Alabama is just $18,046 per year. On top of that, one-third of the population lives below the official U.S. poverty line. As a result, the most basic waste disposal infrastructure is non-existent.

Case in point: 73% of residents said they had been exposed to raw sewage washing back into their homes due to faulty septic tanks or waste pipes that were overwhelmed during torrential rains.

Catherine Flowers, the founder of Alabama Center for Rural Enterprise, said hookworm is a 19th century disease that should have been addressed by now. She went on to say that billionaire philanthropists like Bill Gates fund water treatment around the world, but don’t do so in the U.S. because no one is willing to admit this level of poverty exists in the richest country in the world.

Unfortunately, President Trump’s infrastructure spending won’t help out areas like Lowndes County because there is no public infrastructure to begin with. It is estimated that 80% of the county is not covered by any municipal sewer system.

Despite the rampant poverty, families are expected to provide their own. But because of the dire poverty and huge costs to provide their own sewer system, it just won’t happen.


Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama,” The American Journal of Tropical Medicine and Hygiene, September 5, 2017.