From cholera outbreaks to pandemics : the role of poverty and inequality

Cholera and other diarrheal diseases are the second leading cause of death among the poor globally. The tragedy of this statistic is that it need not be the case. Unlike many afflictions, the impact of cholera can be greatly reduced, if not eliminated, through the provision of clean water services. This begs the question of why such provision is absent in much of the world. It is our contention that the provision of clean water services is an increasing function of both a country's level of income and income equality. We test these hypotheses by analyzing 1,032 annual observations arising from 55 relatively poor countries between the years 1980 and 2002. In the primary part of the analysis, we find that providing clean water is, as predicted, an increasing function of income and equality. Following this, and consistent with the existing epidemiological research on cholera, we find that both the numbers of cases and deaths resulting from a given cholera outbreak are strongly and negatively related to the provision of clean water.