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 collective action of clean water services. This begs the question of why such collective action is absent in much of the world. To address this, we first develop a theoretical model which indicates that the required collective action is an increasing function of both a country’s level of income and income equality. We test these predictions by analyzing 1,032 annual observations arising from 17 relatively poor countries between the years 1980 and 2002. The countries come from the Americas, Africa, and Asia. In the first part of the analysis, we find that the collective action of providing clean water is, as predicted, an increasing function of income and equality. Following this, we find that both the numbers of cases and deaths resulting from a given cholera outbreak are strongly and negatively related to the collective action.