Human health at Risk: The Case of Cholera in Peru Ross Edgeworth Disaster & Development Centre

PERU The Impact of Cholera

Peru at a Glance 60% of population (7 million) live in poverty 14% liv60% of population (7 million) live in poverty 14% live in extreme poverty Urban population 71% 10% without adequate water or sanitation Lima, 7 million serviced by water supply designed for 230,000 Existing supplies overstretched leading to sewage contamination

Cholera in Peru Reported January 1991 12,000 cases by mid-February Spread to neighbouring countries by March End of 1991: 400,000 cases, 4,000 deaths

Cause and Susceptibility Cause…? Disputed, most likely transported from China Original source of outbreak: most polluted town in Peru Rapid population growth– exceeding infrastructure capacity External influence? Structural adjustment: Poverty increased 11%, access to drinking water declined from 72% - 24%, Govt expenditure on public health fell 0.23% GDP – 0.04%, Govt expenditure on disease prevention fell $77 million - $2 million

Cause and Susceptibility Sewage is released directly beneath houses, which are often on stilts Tidal flow (twice per day) corresponds with toilet flushing People play, wash…

Cause and Susceptibility Global climatic changes responsible? Cholera bacteria lives in the environment El Niño current warmer in 1991, more vibrios in aquatic environment which infect people who drink water or eat fish or shellfish feeding on the vibrios

Consequences of the Epidemic Global dimensions – fishing industry (56,000) Ill fated Health Minister (pun intended) Border closures Tourist Industry lost $150 million (1991) Shrimp exports declined $270 million Overall loses at $770 million For countries already struggling to provide basic public health outbreak further undermined capacity of governments to address underlying causes of epidemic in long term