New Orleans    Spoiler alert.  There is not a happy ending to this story without wide scale change in inequality.  Turns out that not only is the wealth and income gap destroying our democracy and much of the social fabric of our lives and communities, but it is also breeding infectious diseases that leap past the boundaries of even the fattest wallets.  If you ever want to read a real horror story of our times, go past the front pages of the daily papers and steel yourself for a deep dive in harsh reality and abject fear, which I found in Scientific American in a recent article entitled “American Epidemic” by Melinda Wenner Moyer.

Admittedly, I couldn’t resist the article because I’ve been on a regular route through Detroit every few months recently, and that’s where Moyer begins her piece at the Tumaini Center, a crisis support center there for the homeless, where people literally live in chairs, not only lacking real shelter, but denied even a bed.  The center becomes the setting for the battle against a hepatitis A epidemic that has been the largest since a vaccine was introduced in 1995.

The heart of the problem becomes clear in the piece quickly as Moyer writes,

There are many causes for these rising infectious tides, but researchers agree that a major driver is the country’s ever worsening income inequality…The number of households earning less than $15,000 a year grew by 37% between 2000 and 2016…In poor areas where almost half the people live below federal poverty levels, populations doubled during this period.  People on these bottom rungs of society’s ladder live in crowded, often unclean conditions, have limited health care, must work when sick, have poor nutrition, experience debilitating stress, and are more likely than others to abuse drugs and alcohol – all known infection risk factors.

Got the picture?

Furthermore, you can run, but you can’t hide.  Urban spaces are increasingly crowded.  Public transportation puts people together.  Only the superrich can live in a bubble, and anyone who has flown on a plane in recent years knows how easily one can pick up a bug and carry it around the world.

Walking across the street to avoid the homeless won’t protect you either.  Eating in public also exposes many to infectious epidemics.  Moyer points out that,

The working poor in urban areas are also uniquely positioned to spread infectious diseases because of job conditions.  More than one million low-income Americans work as food preparers, which pays an average of $13,200 a year.  Many of these workers go in even when they are ill.  In a 2015 study, researchers at state health departments interviewed 426 restaurant managers around the country and reported that many of the restaurants’ policies regarding working while ill violated the US Food and Drug Administration recommendations.

Add the fact that older and crowded buildings can create SARS types of infections based on design and architectural flaws and just plain lack of maintenance, and the list goes on and on.

There’s no way to miss the message.  Inequality is a public health catastrophe that could kill us all, rich and poor, big and small.