I got an 8 out of 10 on the Health Equity quiz. The statistic I was most surprised by was that Latino immigrants have better health than your average Americans. It almost seemed counter-intuitive to me as one of the previous questions asked what the strongest indicator of health was, with the answer being the status of wealth. Recent Latino immigrants are generally more financially disenfranchised ergo I didn’t choose this group for that question. Evidently, this phenomenon is known as the ‘Hispanic Paradox’.
As you can tell from the title for the post, the video I watched was named ‘Collateral Damage’. This video focused on the Marshall Islands and the high rates of TB (among other infectious illnesses) prevalent there. In fact, within the last sixty years, the TB rate is 23 times that of the United States. In 1944, the US took the Marshall Islands from the Japanese which resulted in many changes that no one expected. To make way for nuclear testing on one island and a military base on another, the US moved the inhabitants of those islands on to another — initiating the overcrowding prevalent on those islands that the inhabitants were moved to.
Between 1946 and 1958, around 67 nuclear devices were detonated on or around the northern-most Marshall Islands. The video paralleled this to Hiroshima, stating that it was around 1.7 Hiroshima shots every day for 12 years. The largest explosion, named ‘Bravo’, amounted to “1,000 Hiroshima’s”. There was a miscalculation which resulted in radioactive fallout on two close-by and inhabited islands.
In 1951, US authorities resettled the inhabitants on one of the islands elsewhere to make way for that military base. The island with the military base on it only houses Americans with the exception of a few Marshallese contractors. Because the presence of a military base does provide some job opportunities, more of the Marshallese have moved to the new island — resulting in more overcrowding. The Marshallese employees that work on that island have to take a ferry back and forth. Although it is only a 30 minute ferry ride between the two islands, there is a stark divide in terms of health equity between them. Additionally, residents of the Marshall Islands have the worst of both worlds wrt health — they face both developing country illnesses like TB and malnutrition as well as diseases prevalent in Western countries like heart disease and high blood pressure.
The rising over-crowding population of the resettled island has had a direct impact on the high TB rates prevalent in the Marshall Islands. Eradicating TB from the Marshall Islands will have to be more intensive than just ensuring patients are adhering to the strict drug regimen. It will take improving the living conditions (no more over-crowding) and improving nutrition (so that the immune systems will be strong enough to fight TB).
The non-genetic factors that explain the high rates of TB in the Marshall Islands are poverty, over-crowding, and malnutrition. Additionally, another non-genetic factor is US’s involvement in creating the over-crowding as well as their use of one of the islands as a nuclear testing site.