PMC:7100305 / 36362-39889 JSONTXT

{"project":"2_test","denotations":[{"id":"32226719-27070380-45162411","span":{"begin":323,"end":327},"obj":"27070380"},{"id":"32226719-27224278-45162412","span":{"begin":645,"end":649},"obj":"27224278"},{"id":"32226719-27224278-45162413","span":{"begin":819,"end":823},"obj":"27224278"},{"id":"32226719-25343493-45162414","span":{"begin":1006,"end":1010},"obj":"25343493"},{"id":"32226719-27389614-45162415","span":{"begin":1021,"end":1025},"obj":"27389614"},{"id":"32226719-27185252-45162416","span":{"begin":1064,"end":1068},"obj":"27185252"},{"id":"32226719-26903474-45162417","span":{"begin":1187,"end":1191},"obj":"26903474"},{"id":"32226719-21896362-45162418","span":{"begin":1718,"end":1722},"obj":"21896362"},{"id":"32226719-21896362-45162419","span":{"begin":2210,"end":2214},"obj":"21896362"},{"id":"32226719-27060396-45162420","span":{"begin":2601,"end":2605},"obj":"27060396"},{"id":"T61810","span":{"begin":323,"end":327},"obj":"27070380"},{"id":"T3823","span":{"begin":645,"end":649},"obj":"27224278"},{"id":"T32813","span":{"begin":819,"end":823},"obj":"27224278"},{"id":"T50860","span":{"begin":1006,"end":1010},"obj":"25343493"},{"id":"T88548","span":{"begin":1021,"end":1025},"obj":"27389614"},{"id":"T20693","span":{"begin":1064,"end":1068},"obj":"27185252"},{"id":"T9940","span":{"begin":1187,"end":1191},"obj":"26903474"},{"id":"T45124","span":{"begin":1718,"end":1722},"obj":"21896362"},{"id":"T19436","span":{"begin":2210,"end":2214},"obj":"21896362"},{"id":"T50987","span":{"begin":2601,"end":2605},"obj":"27060396"}],"text":"The Socioeconomic Distribution of Disease\nA case-specific review of the literature has demonstrated the influence of power and privilege on the experience of an epidemic. In the case of Zika in Brazil, the communities most vulnerable to the virus are those with insufficient resources and infrastructure (Plourde and Bloch 2016). Consequently, Zika has been socially distributed to exacerbate conditions of poverty. However, the voices of these most affected people are drowned out by more powerful and prestigious groups. This is seen in the comparison that Lotufo (2016) makes between the politics of HIV/AIDS and the politics of Zika (Lotufo 2016). HIV/AIDS research in Brazil procured greater funding because those affected tended to be very notable Brazilians with more dominant social and politics voices (Lotufo 2016). The same pattern was reported in relationship to the Ebola outbreak in Liberia, where weak public health infrastructure aggravated Liberian experiences of Ebola (Burkle and Burkle 2015; McNamara 2016; Maras and Miranda 2016; Scott et al. 2016), while interventions targeted cultural practices, ultimately disempowering the economically disadvantaged (Garbuglia 2016).\nThis review found that infectious disease outbreaks disproportionately affect the poor, specifically communities with poor physical infrastructure and limited access to quality public health services. The link between income and politics of epidemics has been discussed in the social science literature, where poverty is perceived to be the greatest risk factor. For example, Farmer (1996) argued that disease outbreaks, e.g., Ebola systematically affecting poor people and are tied to regional trade networks (Alsan et al. 2011). Building on this literature, Marcella (2011) uses the term structural violence to highlight the institutional biases, inequalities, and economic policies that emanate from global centers of power and privilege, which tend to marginalize poor people during outbreaks (Leach et al. 2010). These linkages highlight social and economic inequalities (within communities, societies and countries), which are complex and often ignored by the medical (and political) communities (Alsan et al. 2011; Leach et al. 2010).\nIndeed, some of the narratives criticized the (epidemiological) evidence, which tends to overlook the role of poverty in the facilitation of disease spread. For instance, focusing on pregnancy in the case of Zika in Brazil was criticized for overlooking the conditions of poverty that might also/instead be responsible for the spike in cases of microcephaly (Diniz 2016). Furthermore, responding to Ebola in Liberia with developmental aid that is not designed for contexts with insufficient infrastructure was criticized again for overlooking the role of poverty (Nunes 2016). This limited focus on the role of poverty in the peer-reviewed medical literature calls into question the politics of the research process itself. For example, what institutions are funding the research and what are the interests of the stakeholders in the research process? Who gets funding to conduct the research? What are the advantages of overlooking poverty for those producing the evidence? By disregarding the role of poverty and income inequality, epidemic responses will remain insufficient, and may, instead worsen the situation of poor populations (Mykhalovskiy and Weir 2005). Perhaps poverty remains unaddressed in epidemic responses as its origins in a neoliberalist society feel too deep to uproot."}