1. Human health at Risk: The Case of Cholera in Peru
Ross Edgeworth
Disaster & Development Centre

2. PERU
The Impact of Cholera

4. Peru at a Glance 60% of population (7 million) live in poverty
14% liv60% of population (7 million) live in poverty
14% live in extreme poverty
Urban population 71%
10% without adequate water or sanitation
Lima, 7 million serviced by water supply designed for 230,000
Existing supplies overstretched leading to sewage contamination

5. Cholera in Peru Reported January 1991 12,000 cases by mid-February
Spread to neighbouring countries by March
End of 1991: 400,000 cases, 4,000 deaths

7. Cause and Susceptibility
Cause…? Disputed, most likely transported from China
Original source of outbreak: most polluted town in Peru
Rapid population growth– exceeding infrastructure capacity
External influence? Structural adjustment: Poverty increased 11%, access to drinking water declined from 72% - 24%,
Govt expenditure on public health fell 0.23% GDP – 0.04%, Govt expenditure on disease prevention fell $77 million - $2 million

8. Cause and Susceptibility
Sewage is released
directly beneath
houses, which are
often on stilts
Tidal flow (twice per
day) corresponds with toilet flushing
People play, wash…

9. Cause and Susceptibility
Global climatic changes responsible?
Cholera bacteria lives in the environment
El Niño current warmer in 1991, more vibrios in aquatic environment which infect people who drink water or eat fish or shellfish feeding on the vibrios

10. Consequences of the Epidemic
Global dimensions – fishing industry (56,000)
Ill fated Health Minister (pun intended)
Border closures
Tourist Industry lost $150 million (1991)
Shrimp exports declined $270 million
Overall loses at $770 million
For countries already struggling to provide basic public health outbreak further undermined capacity of governments to address underlying causes of epidemic in long term