What this goes to...is a sanitation issue. Suburban towns and cities go and pay for real sanitation works. What you have in Alabama is a large collection of rural communities (unincorporated places) which either run a poorly maintained system, or simply runs to a septic tank in ‘bad’ shape (leaking). So you end up with hookworm in poor communities.
You can blame economic conditions where jobs are marginally paying anything....to county commissions that refuse to do their job and order inspections on property....onto towns which don’t have a tax base to build a system.
I will add....you have the case in Birmingham from 20 years ago where they went and spent tons of money that they didn’t have...building a system that required massive loans, which was big enough to handle three or four times the population of the city. Their effort basically bankrupted the city/county. A lot of people are fearful of repeating the Birmingham episode.
Thanks for the info.