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99 8 The Americas Argentina, Brazil, and Mexico Latin American countries exhibit some of the highest GINI indices in the world today. Developed by Corrado Gini, an Italian academic working in the early decades of the twentieth century, his index (or coefficient, which divides the index by 100) measures national inequalities. At one end, a GINI index of zero indicates that income levels are evenly distributed such that everyone has the same income, while a GINI index of 100 means that one person holds all of the money and resources. In recent years, globally, South Africa traditionally has had the highest recorded GINI index of any single country—65.0 (GINI coefficient of 0.65) in 2011, according to the World Bank [1]. Some fragile and oil-­rich African nations such as Equatorial Guinea may exceed even this level. Overall, however, Latin American countries have maintained the highest GINI indices. Spending time in any major Latin American city such as São Paulo or Rio de Janeiro in Brazil or in Mexico City, Tegucigalpa, Panama City, Guatemala City, makes it clear why. The differences between the “haves” and the “have-­ nots” are astounding. I do a fair bit of work in Latin America, especially Brazil, where we have been codeveloping our human hookworm and schistosomiasis vaccines. The economic differences are often jarring. For example, in Rio de Janeiro there are luxury hotels on Copacabana and Ipanema Beaches, and just a few miles away near FIOCRUZ (Fundação Oswaldo Cruz, the location of our scientific collaborators who work to develop new innovations for NTDs) are the favelas where devastating poverty rules the day. In Tegucigalpa or in Guatemala City, the wealthy are typically separated from the poor and live behind tall and impenetrable Hotez.indb 99 6/22/16 11:03 AM 100 Blue Marble Health fences topped by barbed wire. This trend of high GINI indices now extends beyond Latin America into Texas. For instance, my city of Houston’s GINI index also exceeds 50, as do several other Texas cities [2]. According to the Economist, Latin America’s income inequality increased steadily from 1980 to 2000 [3]. Overall , the region’s GINI coefficient remains incredibly high, at around 0.50, one of the highest for any major global or World Bank region. Such high GINI coefficients have not slowed Latin America’s economy. During the first decade of the 2000s its economic growth was impressive, averaging 5% annually between the years 2003 and 2012 [4]. It has since slowed to only 2.0–2.5% of its GDP [4]. However, that previous decade of economic growth helped to lift an estimated 70 million people in the region out of extreme poverty and allowed Latin America’s middle class to expand by an estimated 50% [4]. Just as in the rest of the “blue marble,” such robust economic growth in Latin America has left behind the region’s most impoverished people. Also according to the World Bank, of the more than 600 million people who live in the Latin American and Caribbean (LAC) region, 130 million remain “chronically poor” [4]. I have previously reported that approximately 50 million people in the LAC region live below the 2005–14 World Bank poverty figure of $1.25 per day, while 100 million live on less than $2 per day [5]. NTDs are pervasive among the LAC region’s “bottom 100 million” [5]. Shown in table 8.1 is a ranking of the leading NTDs by prevalence [6–9], led by the three major intestinal helminth infections and schistosomiasis, in Latin America has the greatest overall income inequality in the world and the highest GINI indices and coefficients. Table 8.1. The leading NTDs of the LAC region’s“bottom 100 million” NTD Number of people infected in LAC (in millions) Reference Ascariasis 86.0 [6] Trichuriasis 72.2 [6] Hookworm infection 30.3 [6] Chagas disease 5.7 [7] Schistosomiasis 1.5 [8] Malaria 0.4 (confirmed cases); 25 million people at high risk [9] Hotez.indb 100 6/22/16 11:03 AM The Americas 101 addition to more than five million people living with Chagas disease, according to WHO. Chagas disease (American trypanosomiasis caused by Trypanosoma cruzi) is a serious and debilitating heart infection transmitted by triatomine kissing bugs, as well as mother-­ to-­ child transmission. It is almost exclusively a disease of extreme poverty linked to poor-­quality housing where kissing bugs thrive, among other low socioeconomic and ecologic...


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