social and economic impacts of cholera

Cambridge A‑Level Geography 9696 – Cholera: Social and Economic Impacts

1. Overview of Cholera

Cholera is an acute diarrhoeal disease caused by the bacterium Vibrio cholerae. Infection occurs when people ingest water or food contaminated with the bacterium. Rapid fluid loss can lead to severe dehydration and death within hours if untreated. The disease is preventable through safe water, adequate sanitation and timely treatment.

2. How Cholera Spreads

• Contaminated drinking water – the principal transmission route.
• Contaminated food – especially raw produce washed with unsafe water.
• Poor sanitation – open defecation and inadequate sewage allow faecal‑oral transmission.
• Population movement – refugees, migrants and tourists can carry the pathogen to new areas.
• Political‑institutional drivers – weak governance, conflict, and limited health‑system capacity hinder surveillance and response.
• Economic determinants – low GDP per capita and low health‑care expenditure reduce access to clean water and treatment.

3. Global Patterns of Cholera

Cholera remains concentrated in low‑ and middle‑income countries where water‑sanitation infrastructure is weak. Hotspots align with major river basins, flood‑prone coastal zones and densely populated informal settlements.

Mini‑map description (for exam revision): World maps of cholera typically highlight the Ganges‑Brahmaputra, Nile, Mekong and Congo basins, as well as low‑lying coastal districts of Haiti, Yemen and parts of the Caribbean. The pattern mirrors the distribution of low‑income and lower‑middle‑income economies, illustrating the “scale” key concept (local water source → national outbreak → global concern).

4. Change Over Time – Timeline of Major Drivers (2010‑2024)

• 2010‑2011: Haiti earthquake destroys water infrastructure; cholera introduced by UN peacekeepers → >800 000 cases in the following decade.
• 2015‑2016: El Niño‑related floods in East Africa and Yemen trigger spikes in cases; conflict limits humanitarian access.
• 2017‑2019: Rapid urbanisation in South Asia creates new informal settlements; incidence rises despite national vaccination programmes.
• 2020‑2022: COVID‑19 pandemic diverts health resources; however, increased hand‑washing campaigns inadvertently reduce cholera transmission in some regions.
• 2023‑2024: Climate‑change‑driven extreme weather (heavy rains in Bangladesh, drought in the Sahel) leads to renewed outbreaks; GTFCC “Roadmap to 2030” begins pilot implementation in 12 high‑risk countries.

5. Social Impacts

1. Health‑related mortality and morbidity – high case‑fatality in children <5 yr, the elderly and malnourished.
2. Disruption of daily life – school closures, cancellation of public events, movement restrictions, and reduced attendance at health facilities for other conditions.
3. Stigma and fear – affected communities may be ostracised; fear can undermine trust in health services.
4. Impact on vulnerable groups – slum dwellers, remote rural villages, internally displaced persons (IDPs) and refugees experience the greatest burden because of limited water, sanitation and health‑care access.

6. Economic Impacts

Costs are split into direct (health‑care) and indirect (productivity, infrastructure, long‑term macro‑economic) categories.

7. Vulnerability & Equity (Diversity & Inclusion)

• Age: Children <5 yr have the highest case‑fatality ratio (up to 5 %).
• Gender: Women often collect water, increasing exposure; pregnant women are at higher risk of severe dehydration.
• Socio‑economic status: Poverty limits access to safe water, sanitation facilities and timely treatment.
• Migrant & refugee status: Over‑crowded camps lack adequate WASH services, amplifying transmission.
• Ethnicity & marginalisation: Indigenous or minority groups may be excluded from national health programmes.

8. Governance, Policy and International Frameworks

• World Health Organization (WHO) – Global Task Force on Cholera Control (GTFCC) and the “Ending Cholera: A Global Roadmap to 2030”.
• United Nations Sustainable Development Goal 6 – “Clean water and sanitation”.
• International Health Regulations (IHR) – mandatory reporting of cholera outbreaks.
• National cholera preparedness plans (e.g., Yemen’s Ministry of Public Health & Population; Haiti’s Ministry of Public Health and Population).
• Major donors and programmes: UNICEF, World Bank, Gavi, and NGOs delivering WASH and health‑education interventions.

9. Case Studies

9.1 Yemen (2016‑2020)

• Scale: >2.5 million suspected cases; >5 000 deaths (≈ 70 % under five years).
• Social impact: Prolonged school closures; heightened community fear and stigma; increased gender‑based violence as women travelled longer distances for safe water.
• Economic impact: Approx. US$150 million diverted from other health services; agricultural output in flood‑prone districts fell ~12 % due to contaminated irrigation water.
• Governance challenges: Ongoing conflict restricted humanitarian access, hampering water‑treatment, surveillance and vaccination.
• Key lesson: Integrated WASH‑health response (mobile chlorination units + ORS distribution) reduced case‑fatality from 2.5 % to 1.2 % within two years.

9.2 Haiti (2010‑2019) – Caribbean Low‑Income Context

• Trigger: Earthquake damaged water infrastructure; heavy rains caused widespread contamination.
• Scale: ≈ 820 000 cases and 9 800 deaths reported (2010‑2019).
• Social impact: >1 million people displaced; women faced increased risk of gender‑based violence while fetching water.
• Economic impact: Tourism revenues fell by an estimated US$45 million (2010‑2012); emergency WASH spending exceeded US$200 million.
• Management success: Rapid deployment of oral‑rehydration kits (ORKs) together with Community‑Led Total Sanitation (CLTS) cut case‑fatality from 2.5 % to <1 % within two years.

10. Mitigation and Management Strategies

1. Hard measures (infrastructure)
   • Chlorination of municipal water supplies – immediate pathogen reduction.
   • Construction of durable latrines and sewage networks.
   • Installation of low‑cost filtration (e.g., ceramic filters, biosand filters).
2. Soft measures (behavioural & policy)
   • Health education – hand‑washing, safe food handling, proper storage of water.
   • Community‑Led Total Sanitation (CLTS) – promotes local ownership of latrine construction.
   • Oral‑Rehydration Solutions (ORS) and Oral‑Rehydration Kits (ORKs) – life‑saving treatment at household level.
   • Cash transfers or food aid to households that lose income during an outbreak.
3. Rapid response mechanisms
   • Early‑warning surveillance (community health workers, mobile reporting).
   • Case isolation and targeted distribution of ORS/IV fluids.
   • Emergency water treatment teams (chlorination trucks, portable filtration).

Evaluation of Management Strategies (linked to AO2 & AO3)

Evaluation criteria used by the GTFCC and national planners:

• Effectiveness: Reduction in incidence and case‑fatality.
• Equity: Extent to which the most vulnerable groups are reached.
• Sustainability: Long‑term maintenance, community ownership and environmental impact.
• Cost‑effectiveness: Cost per case averted or per life saved.

11. Suggested Diagram for Revision