Depression-era malaria control in the South.

Abstract

RACIAL HEALTH DISPARITIES are commonly expressed in terms of health indicators such as infant mortality or life expectancy, or by differences in the incidence of diseases such as tuberculosis or HIV/AIDS. However, racial health disparities have also been manifested in regional patterns of disease distribution. Malaria, notably, was once widespread throughout the United States, but by the early 20th century it was concentrated in the poorer areas of the rural South, where many African Americans were living in crumbling, windowless shacks. In her recent work on the history of malaria in the United States, Margaret Humphreys traces the changing prevalence of malaria, the likely reasons for its persistence in the South, and its eventual decline even there.1 Malaria was a disease of poverty. It was especially associated with the growing of cotton, which required intensive cultivation, with many laborers living close together in the rich “bottom lands” where the anopheles mosquito also bred. Malariologist Marshall Barber commented that high endemic malaria required “a permanent reservoir of infection such as is furnished by a considerable body of people lacking proper housing, proper food, and adequate medical treatment.”2(p2544) Public health department budgets in the South were threadbare and could afford to supply little in the way of insecticides or quinine. Although some progress was made in the early decades of the 20th century and malaria rates began to decline, the Great Depression of the 1930s erased all such gains. Malaria rates peaked from 1932 to 1936 as people, discouraged by urban unemployment and living under conditions of increasingly desperate poverty, moved back to the countryside to eke out a bare subsistence from the land. The New Deal brought some relief in the shape of the Federal Emergency Relief Administration (FERA) and the Works Progress Administration (WPA), which soon had thousands of laborers digging ditches and draining swampland. The most important and effective of the programs, Humphreys argues, was the Tennessee Valley Authority (TVA), in which teams of medical malariologists, sanitary engineers, and entomologists worked together to control malaria. In the period before World War II, the TVA funded more malaria research than any other institution in the country.1 This image (from about 1935) shows a malaria team from the TVA visiting a sharecropper’s home to eliminate possible mosquito breeding places. Thanks at least in part to these intensive control efforts, malaria had essentially disappeared from the southern states by the early 1940s.