widespread. Lack of food, shelter, security and social protection make people more vulnerable to infections, while affected populations are often unable to obtain even the most basic means of prevention and care. Poverty creates conditions that favour the spread of infectious diseases and pre - vents affected populations from obtaining adequate access to prevention and care. Ul - timately, these diseases – infectious diseases of poverty (see Box 1.1) – disproportionately affect people living in poor or marginalized communities. Social, economic and biologi - cal factors interact to drive a vicious cycle of poverty and disease from which, for many people, there is “no escape”. As stated in the report of the Commission on Social Deter - minants of Health ( 6): “Poverty is not only lack of income. The implication, both of the social gradient in health and the poor health of the poorest of the poor, is that health in - equity is caused by the unequal distribution of income, goods, and services and of the consequent chance of leading a flourishing life. This … is not in any sense a ‘natural’ phe - nomenon. ” Infectious diseases have shaped societies, driven conflict and spawned the marginalization of infected individuals and communities throughout history. Today they are significant agents in the appalling poverty afflicting so much of the world. 12 3 Why research infectious diseases of poverty? Why research infectious diseases of poverty? 13 Chapter 1 Global Report for Research on Infectious Diseases of Poverty 1 Infectious diseases. http://www.who.int/topics/ infectious_diseases/en/, accessed 13 February 2012. Box 1.1. Infectious diseases of poverty Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi. The diseases can be spread, directly or indirectly, from one person to another1 . “Infectious diseases of poverty” is an umbrella term used to describe a number of diseases which are known to be more prevalent among poorer populations, rather than a definitive group of diseases. It is an overarching concept, recognizing the need to focus on the poor and vulnerable, who have less power to intervene. Many such diseases are also considered “neglected tropical diseases”, as defined by WHO (see list below). Infectious diseases of poverty are not restricted to low and middle-income countries, but manifest in poor populations globally. Apart from TB, malaria and HIV/AIDS, many other infectious diseases have not been high on the global agenda. However, an increasing number of organizations and partnerships are now engaged in their control. Main neglected tropical diseases (6) as identified by WHO are listed below: • dengue • rabies • trachoma • Buruli ulcer • endemic treponematoses (including yaws) • leprosy • chagas disease (American trypanosomiasis) • human African trypanosomiasis (sleeping sickness) • leishmaniasis • cysticercosis • dracunculiasis (Guinea-worm disease) • echinococcosis • foodborne trematode infections • lymphatic filariasis (elephantiasis) • onchocerciasis (river blindness) • schistosomiasis (bilharziasis) • soil-transmitted helminthiases (intestinal parasitic worms) Infectious diseases do not respect socioeconomic status. Biologically, we are all at risk – but the risk is not evenly distributed. People already living in social and economic deprivation have a greater exposure to the risk factors for disease, and the economic consequences of living with chronic infectious conditions are often more serious. Investment in controlling the spread of infectious and parasitic diseases will have a powerful impact on global human, social and economic development. Infectious disease – the true burden on communities For the working poor, the economic impact of infectious diseases can be catastrophic. Not only are infectious diseases causally linked to conditions of poverty; they can actually make people poor. For example, a study in Orissa, India showed that people with chronic lymphatic filariasis lost 68 working days per year and that their families spent more on treatment than the average government per capita expenditure on health (21). Thus, families that experience such a disease not only have death to fear but also the cost of illness