In 1854 in London, there was an outbreak of a disease that was fairly common in the world at the time. The name of the disease was Cholera. Cholera is a disease (that still exists) caused by a bacteria called Vibrio Cholerae.

This disease is spread by drinking water that is contaminated by the bacterium and the bacterium is passed by the fecal-oral route ( yeah gross) from dumping sewage into the water source that you then drink from.

It gives you a severe diarrhea that leaves you dehydrated and was a major cause of death as cities grew all over the world.

The normal distribution of this disease (as you would figure) is in those areas around a river that is contaminated with sewage. London (being on the Thames River) at that time was having it’s fair share of problems with that. The thing is, they didn’t KNOW about Vibrio Cholera. This was before the confirmation of the Germ Theory so they didn’t know what caused Cholera.

There were many throries. From “miasmas” or clouds of invisible toxic gasses, to sinfulness and being a bad person.

The idea was that the wealthier you were, it meant that you were a good person and that you were somehow protected from getting the disease. Similarly, the holier you were, or the higher station you were, prevented you from getting it. What was happening in London at the time however, was baffling to the physicians of the time.

It didn’t matter what station in life or how much money you had or even if you had the best doctors, people were still getting it. Not by the river but smack in the middle of the city.

A controversial doctor by the name of John Snow had a suspicion that there was more to it than that.

What he did was to plot the known cases of Cholera on a map with the names and addresses of the victims. By doing this, he found that every sngle infection had a common point, a water pump on Broad Street in Central London.

In the mid 1800’s there was no routine indoor plumbing and water had to be obtained from pumps that drew their water from the local water source or resevoir. Either the family drew water from this pump or the servants for the family did, and it was this pump that was the common denominator.

There was no “boiling the water” as there was no reason that anyone would want to do that. No one knew about bacteria or parasites, or even viruses.

Dr. Snow figured that something had to be in the water or on the pump that caused the disease.

In a very controversial move, he caused that pump to be put off limits.

He then followed it up by plotting the illness once that pump was shut down. Finding the cases almost stopped, he went on to investigate just what the heck was in that water that caused the disease and became a great researcher into “anti-sepsis” and cleanliness in the field of anesthesiology (as it was practiced at the time).

Cool Story Bro…

So what does this have to do with anything?

What Dr. Snow did was essentially invent the field of epidemiology which is the study of how diseases spread. Lately, with Covid, we’ve all been exposed to a little bit of that, and we are smart enough to know about bacteria and viruses and the like. However, the major diseases that have been around before Covid, and will be around long after, have a similar pattern but with a twist.

They aren’t caused by a bacteria or virus, but by a lifestyle.

When people died of bacterial infection, sepsis, “childbirth”, viral infections like measles, mumps, rubella, polio, and yes even the flu, there was no need to worry about “lifestyle” diseases.

Even when Type I Diabetes (juvenile or insulin requiring) was first described as a disease and subsequently treated (NOT CURED), people died young and the lifespan of the average human was very short.

What is a major problem that is correlated with lifestyle are the diseases that are considered chronic and non-infectious: smoking, substance abuse, Diabetes Type II, Coronary heart Disease, and obesity.

Eventually we’ll get to all of them, but today I want to make the correlation between obesity and relative poverty.

Now Come The Inequities

Now true poverty leads to many self perpetuating issues and we will discuss these in the future, but I want to bring in the subject of obesity in children leading to Diabetes in youg adults. This has been found to be directly related (by the method that Dr. Snow invented) with what is I like to think about as second world poverty in our own country.

For example: A family makes just enough (in whatever community that may be in) to provide food for their children. This food however, is as inexpensive as can be, as the family does not have extra to pay for the more expensive food items. We have all experienced that the least expensive food items are the high carb, high fat, high sugar items that are usually “generic” when found in a supermarket. This keeps the family fed and happy. It does not keep them healthy though, salads and fresh fruits and vegetables are not cheap, so families in these types of situations avoid them when they can. [as an aside, in Dr. Snow’s times an apple or an orange was considered such a treat that it was given as a christmas gift]

This same family may live a fair distance from a supermarket and live in a “Food Desert” (an area that has little access to healthy food), in which there may be many convenience stores (of the 7-11, gas station, or bodega variety) or fast food restaurants with their one dollar chicken nugget deals.

This same family may not have a car or only one car that the principle breadwinner needs for work, so the family will have access to a supermarket infrequently using the car or they would have to use public transportation.

Public transportation is usually very poor in areas where this income level family lives, so it is easier (and cheaper) to shop at the local bodega or 7-11 – yes, this really happens. So the cheapest and most convenient thing is what gets bought.

Now, in these areas (growing up as a hispanic NYC kid in the 70’s we thought of them as “those places”, but now living in a suburb, what are food deserts to a poor family are just “drive through” neighborhoods to me), there are usually schools that are considered “Bad Schools” whose kids don’t usually graduate and whose budgets are small compared to wealthier neighborhoods. These schools don’t usually have any afterschool activities, so (as in my case as a kid-until I joined the Cub Scouts), those kids are kept indoors, away from the “bad kids”. In my case, it was reading encyclopedias borrowed from the library, today it is video games. These bookish kids don’t do any exercise, get fat, and tend to develop pre-diabetes and diabetes at an early age since they don’t get healthy food, develop habits of eating unhealthy food, and don’t get much exercise.

The only other alternative in some neighborhoods is joining a gang.

I know of many Moms locally who make their kids study and exercise at home and sign early waivers for their kids to join the military, to get them away from the gangs. A much safer plan and considered a win for the family who now has more money to spend on the others and that child is now considered safe.

So… Inequities?

This correlation is strong. “second world” poverty in the US is a preventable source of Diabetes in children which leads to Diabetes in adults which then leads to Heart Disease, frequent illness and a strain on the medical system. So ensuring things like good Public Transportation, and incentives for supermarkets to locate in areas most needed, can inexpensively decrease the amount of heart disease in the working poor, thus decreasing the strain on the medical system (such as it is).

But What About Covid?

Things are opening up, that’s good.

The virus is NOT GONE, there is NO MAGIC CURE.

You are NOT Immune.

In New York, the cases are down as are the deaths, this means we have plenty of room in our ICUs so you can do dumb stuff and get infected. We are used to face-timing family of dying patients now. So, go ahead, we have this down. You’ll still be running the risk of death or chronic disability as a “Chronic Lung Patient”, but hell, it’s YOUR choice.

In other parts of the country (outside the Northeast), your numbers are going up. You may end up sick without facilities to care for you, but it IS YOUR CHOICE.

Please: wash your hands, don’t touch your face, social distance, and wear the masks.

Please love each other, we are all we have.

Remember that everyone is of value, but we need to see that too many people of color have been discriminated against and mercilessly abused by a system in which (amazingly) most of its members don’t even realize that it is doing it. So at this time it is important that we recognize and fight for the recognition that Black Lives Matter.