Intestinal infections are a significant health concern for impoverished Black communities with outdated sewage systems. These infections spread through contaminated soil and water and are among the most common diseases worldwide. Up to 50 percent of people around the world are infected with Helicobacter pylori, bacteria that live in the stomach and can cause ulcers and cancer. Additionally, approximately one-quarter of the global population is infected with soil-transmitted helminths, intestinal parasitic worms that can cause serious health problems. Limited access to medical care and inadequate sanitation systems contribute to systemic health inequities, especially among communities of color. Intestinal infections have historically been prevalent in parts of the US where high poverty rates and environmental factors favor infection spread.

The Rural Embodiment and Community Health Study

The Rural Embodiment and Community Health Study, launched in 2019, aimed to measure current infection rates and determine which living conditions contribute to infection risk. Though national infection rates remain unclear due to the absence of large-scale studies, the study found that 38 percent of children sampled in a predominantly Black Mississippi Delta community had intestinal parasitic infections. Moreover, 80 percent of those children exhibited high levels of intestinal inflammation, much higher than those observed in other populations, which may lead to several poor health outcomes, including impaired intestinal ability to absorb nutrients and stunted growth. Recent analyses from 2022 focused on adults living in the Mississippi Delta and Southwestern Illinois, two areas that experience regular flooding. Among those adults, 73 percent displayed elevated intestinal inflammation, while 45 percent were infected with H. pylori, the bacteria that can cause ulcers and cancer. These results demonstrate widespread intestinal infections and inflammation at all ages in these low-income, mostly Black communities.

Impact of Intestinal Infections on Black Communities

Long-lasting intestinal infections and associated inflammation can lead to nutritional deficiencies, restricted growth, reduced educational attainment, decreased work productivity, and increased risk for serious diseases later in life, including certain cancers. One of the most widely publicized recent research studies investigating intestinal infections focused on the health effects of poverty and crumbling sanitation infrastructure in Lowndes County, Alabama, a region characterized by a history of racial segregation and inequity. Researchers found that more than one in three people tested in Lowndes County were infected with hookworm, an intestinal worm spread through sewage exposure that lives in soil and infects people by burrowing into bare feet. In a landmark May 2023 court ruling, the Biden administration found that Alabama’s public health department had discriminated against Black residents by denying access to adequate sanitation systems and imposed fines for resulting sewage issues.

The recent court decision in Alabama represents an important step toward increased national recognition of the role intestinal infections play in perpetuating racial health inequities. Increased awareness will ideally result in improved access to testing and treatment in affected communities. But more work is needed to assess the full extent of these infections across the US. Vulnerable individuals are often reinfected, as these pathogens continue to spread through the environment. Structural changes are needed to break the cycle of infection and poor health. Current federal investment in community infrastructure, including water quality, is encouraging but does not go far enough. Ultimately, a concentrated nationwide effort to update and maintain sanitation systems is the best way to finally halt infection transmission and support health equity across the US.


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