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Black Lives Matter: Health Disparities

Police aggression is not the only arena in which Whites and Blacks are treated differently. In environmental health, too, there are systematic and significant differences. Asthma, caused primarily by air pollution, is one of the most common chronic diseases among children. The mortality rate for African American children is 500% greater than Caucasian children. One in five Puerto Rican and Filipino children have asthma, and the overall cost to the U.S. economy was $19.7 billion in 2007 (EPA 2016). Lead likewise shows disparities by income and race, particularly for Black non-Hispanic children (EPA 2016). Poor housing contributes, and poor housing is higher in Cook County than elsewhere (County Rankings, 2016). Within the county, the West Side of Chicago, which is predominantly non-White (CityData, 2016), showed some of the highest levels of any region (Oyana et al., 2010). There may be no better example of health disparities than the environmental racism shown in examples like the Flint, Michigan water crisis. While there are some individual choices that can be made to avoid common environmental health hazards, the largest sources of such hazards are societal. Once the air has been polluted, it is very difficult for any citizen in a polluted area to mitigate their risk. If you live in a house painted with lead paint, with soil that has been contaminated for decades by emissions from leaded fuel, you can do a few things to protect your children – cover the soil, clean the dust in your house, and avoid anything that will disrupt the lead – but much of the exposure is out of your control, even though you had nothing to do with the lead being there. Reducing lead is often acknowledged an important environmental health goal, including in Healthy People 2020 (2016; Bennett et al., 2016).

It is worth saying that the fact that lead contamination continues to be a nightmare is so because paint and fuel companies vehemently insisted on the safety of lead even while knowing the contrary was true. Lead Wars documents the politics by which this was allowed to happen, as does the authors’ earlier book, Deceit and Denial, which was recommended to me by a Professor of Chemistry at Benedictine, Ed Ferroni. It is shocking to read about the National Lead and Sherwin-Williams discussing the dangers of lead paint to children among themselves in the 1920s, while maintaining a rigorous advertising campaign about safe and sanitary lead paint through the 1960s. All this came to light only because of lawsuits filed against the companies; otherwise, their duplicity may never have been known (Markowitz & Rosner, 2014, p. xii-xiii). There is a reason people do not trust corporate America; perhaps new technologies like GMO foods may prove not to be harmful, but given the guilty history of the chemical industry, one can hardly blame the public, often made unwitting guinea pigs, for having a skeptical attitude.

A quote from the more recent book, is, I think, completely illustrative of the premises of environmental health, environmental justice, and public health more generally, and is therefore worth quoting in full:

If the history of lead poisoning has taught us anything, it is that the worlds we as a society construct, or at least allow to be built in our name, to a large extent determine how we live and how we die. The social, economic, political, and physical environments humans create bring about specific diseases that are emblematic of these conditions. If poverty, for example, and great disparities of wealth result in those on the bottom of the social scale living in crowded conditions without access to pure water, adequate sanitation, or pure air, we can expect infectious and communicable diseases to predominate as they did in nineteenth-century American cities. If we systematically pollute our water and air, we can expect chronic diseases emblematic of the late twentieth century to predominate. (Markowitz & Rosner, 2014, p. xiv-xv)

Similar stories have played out with asbestos, tobacco, mercury, PCBs, and pesticides with terrible impacts on the health of all people, but particularly on those who are most vulnerable.

What causes health care disparities is a very complicated question, addressed by an entire field of study – Environmental Justice. But I would say that the answer ranges from out-and-out racism to economic forces based on externalized costs – costs that are put outside the economic calculus of the market: for instance, the cost of mentally handicapped children – which seem mostly to be borne by the least powerful and influential people in society. In reality, lead poisoning affects many people, but it does so disproportionately, allowing many people to selfishly live in denial that it will affect them.

Solutions

The solution to the lead problem is fairly simple: safely remove the lead. If Public Health as a discipline were able to solve these problems – if they had had the will, the money, and the political power to do something about racial disparities and mass poisonings, they would have by now. It seems to me that this is a result of two far larger problems: one, societal tolerance for the systematic poisoning of our population for profit; and two, racism.

Sadly, we are reminded that Public Health officials are not always the solution; sometimes they are the problem, as seen in the tragic case of the Flint poisoning. In brief, the manager running the city of Flint, rather than paying higher fees for clean water, switched the city over to water from the Flint River, which is highly polluted. It is also acidic, which caused the lead pipes in the town to corrode, releasing high levels of lead into drinking water. Children were harmed – it’s hard to say how many or to what degree. Time will tell, but there were roughly 9000 children in Flint, and no amount of lead is considered safe. What is worse is that even after citizens complained, state and local officials, including Public Health officials, claimed that the water was fine. As Marc Edwards, the civil engineer from Virginia Tech who helped lay bare the scandal, has said, “In Flint the agencies paid to protect these people weren’t solving the problem, they were the problem. What faculty person out there is going to take on their state, the Michigan Department of Environmental Quality, and the U.S. Environmental Protection Agency?… If an environmental injustice is occurring, someone in a government agency is not doing their job” (Kolowich, 2016). Edwards argues that public science is broken, that scientists often pursue their own interests, publications and career advancement, rather than the interests of those they are pledged to serve, particularly those who are powerless.

Primary Prevention

Primary Prevention is obviously superior to secondary or tertiary, in that it is aimed at preventing disease from ever occurring. Primary Prevention is essential in lead poisoning because once a child has been exposed, there is very little that can be done to reduce the risk or mitigate the damage. Those children in Flint are likely harmed for life to varying degrees. Markowitz and Rosner discuss how at the beginning of the lawsuits against the lead industry, and the discussion of remediation, in the 1990s, the aim was to spend $15 billion fixing the problem and ending the epidemic of lead poisoning among children. Instead, because of the pressure of landlords, industry, and others, that plan was abandoned for weak, partial, and ineffective measures that continued to allow millions of children to be poisoned (Markowitz & Rosner 2014, p. 19-20). That said, I often use lead levels as a success story to demonstrate what can be done when policy is changed and prevailing narratives challenged. It is terrible to have to offer a partial success as one of the greatest ones, but this graph counters a prevailing narrative, promoted by the industry and its allies, that poisoning our children – in the many ways we do – is inevitable, almost natural.

Lead levels

Figure 1. Percentage of children 1-5 years old in the U.S. population

with elevated blood lead levels (≥ 10 μg/dL) (Jones et al. 2009).

The problem with this graph is that while we have made progress, recent research has shown that there is no safe level of lead exposure for children, and the action level has been moved down to ≥ 5 µg/dL ((DHHS & CDC, 2011; Lanphear et al., 2005; Chiodo et al., 2007; Jusko et al., 2008; Jedrychowski et al., 2009). The problem with our society is that we are much more likely to tolerate damaging levels of lead in children who are brown, black, or economically deprived.

Opportunities and Barriers

As if we needed further reminder this week that Black Lives Matter. We need to confront the systematic racism that has made Flint possible. Racism has been institutionalized into all our major organizations and professions, and Public Health is no exception. That is the barrier. Changing a culture is not easy. But the opportunities are vast. The cost of IQ points lost to lead alone amount to $192-270 billion per birth cohort, not counting the personal cost of a lower IQ. The return on investment is such that for every dollar spent on lead abatement, $17-221 would be recompensed (Gould, 2009). I have been pleased to see that Health Disparities have been explicitly addressed in Benedictine’s MPH program; whether that is a result of our Benedictine values or national mandates, the change is to be lauded – at least as a start. Changing culture is not easy, but I do believe that education can be part of that. Recognizing and understanding injustice is the first step in working against it, and I hope that in the future we will all be part of remedying this grave injustice.

 

References

Bennett, D., Bellinger, D.C., Birnbaum, L.S., Bradman, A., Chen, A., Cory-Slechta, D.A…., Witherspoon, N.O. (2016). Project TENDR: Targeting environmental neuro-developmental risks. The TENDR consensus statement. Environ Health Perspect 124:A118–A122; http://dx.doi.org/10.1289/EHP358.

Chiodo, L.M., Covington, C., & Sokol, R.J. (2007). Blood lead levels and specific attention effects in young children. Neurotoxicology and Teratology 29 (5): 538-46.

CityData. (2016). Near West Side Chicago. Retrieved from http://www.city-data.com/neighborhood/Near-West-Side-Chicago-IL.html

County Health Rankings & Roadmaps. (2016). County health rankings & roadmaps. Robert Wood Johnson Foundation. Retrieved from http://www.countyhealthrankings.org/our-approach

Department of Health and Human Services (DHHS) & Centers for Disease Control and Prevention (CDC). (2011). Advisory committee on childhood lead poisoning prevention. Atlanta, Georgia. Retrieved from http://www.cdc.gov/nceh/lead/acclpp/meetings/minutes/acclpp_minutes_final2.pdf

Environmental Protection Agency (EPA). (2016). Children’s environmental health facts. Retrieved from https://www.epa.gov/children/childrens-environmental-health-facts

Gould, E. (2009). Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives 117(7):1162-1167.

Healthy People 2020. (2016). Healthy People 2020: Environmental Health. U.S. Department of Health and Human Services. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health/objectives

Jedrychowski W., Perera, F.P., & Jankowski, J. (2009). Very low prenatal exposure to lead and mental development of children in infancy and early childhood. Neuroepidemiology 32 (4): 270-78.

Jones, R.L., Homa, D.M., Meyer, P.A., Brody, J.F., Caldwell, K.L., Pirkle, J.L., & Brown, M.J. (2009). Trends in blood lead levels and blood lead testing among U.S. children aged 1 to 5 years, 1988-2004. Pediatrics 123 (3): e376-e385.

Jusko, T.A., Henderson, C. R., Lanphear, B.P., Cory-Slechta, D.A., Parsons, P.J., & Canfield, R.L. (2008). Blood lead concentrations < 10 µg/dL and child intelligence at 6 years of age. Environmental Health Perspectives 116 (2): 243-8.

Kolowich, S. (2016). The water next time: Professor who helped expose crisis in Flint says public science is broken. The Chronicle of Higher Education, February 2. Retrieved from http://chronicle.com/article/The-Water-Next-Time-Professor/235136

Lanphear, B.P., Hornung, R., Khoury, J., Yoton, K., Baghurst, P., Bellinger, D.C., … Roberts, R. (2005). Low-level environmental lead exposure and children’s intellectual function: An international pooled analysis. Environmental Health Perspectives 113 (7): 894-9.

Oyana, T.J., Margai, F.M. (2010). Spatial patterns and health disparities in pediatric lead exposure in Chicago: Characteristics and profiles of high-risk neighborhoods. Prof. Geogr; 62:46–65. doi: 10.1080/00330120903375894.

World Health Organization (WHO). (2014). 7 million premature deaths annually linked to air pollution. World Health Organization. Retrieved from http://www.who.int/mediacentre/news/releases/2014/air-pollution/en/

 

 

Organic Lawn Care: Midwest Grows Green

You, too, can have a beautiful organic lawn with handy tips from Midwest Grows Green:

MPAC Feet

#TakeAction in your own lawn

Build a lawn ready to last the summer with tips from our Natural Lawn Calendar:

  • Fertilize the 1st-15th of the month
  • Look for signs of weed, disease, or pest problems – address underlying soil  or turf health issues

Visit MPAC resources for more natural lawn tips.

#TakeAction in your community

In a unanimous vote this June, the Municipal Water Reclamation District (MWRD) of Greater Chicago passed a policy to reduce its herbicide use by 92 percent. MWRD Commissioner Frank Avila consulted with MPAC and MGG to eliminate synthetic herbicide use in turf landscapes, shrub beds, and paved areas. Read more about the collaboration here.

#TakeAction Midwest-wide

100 pledges…one hundred engaged natural lawn care activists now back your commitment to this MGG effort! Your overwhelming support these first three months helped us make headway to achieving 10 pesticide free parks by the end of 2016. For that we thank you and look forward to your continued support in recruiting 200 pledges!

Midwest_stacked-e1386625125966-300x186

Read more about caring for your lawn organically at http://midwestpesticideaction.org/

Mosquito Spraying

Clarke Environmental

When people read about Zika virus or West Nile, the first thing they want to do is solve the problem. Pesticides seem an easy way to do that. The problem is that while the benefit conveyed by spraying may be very visible for a small number of people, the risks are both invisible and very high. As public officials respond to complaints about mosquitoes, at least it seems they are doing something.

To be clear, Zika virus has not been acquired locally in the U.S., and the mosquitoes responsible are rarely found in the Midwest. It’s a no-brainer to larvicide, reduce mosquito breeding grounds, and take common-sense precautions like staying inside during peak mosquito times, wearing clothes, and applying lower-risk mosquito repellents. But the calculation whether or not to adulticide is a difficult one.

There are some great resources out there — the non-profits I admire most have been thinking seriously about this problem, which, IF Zika comes to the U.S., may be a sort of Sophie’s choice for women who are pregnant or intend to become pregnant. Would you rather have a child with Zika or a child who may develop autism, ADHD, or leukemia? How do you calculate those risks? How measure those risks in toto against celebrating a beautiful day outside in warm weather?

Here’s where I go to consider problems like this:

Environmental Working Group (EWG). http://www.ewg.org/research/ewgs-guide-bug-repellents/pregnant

Midwest Pesticide Action Center (MPAC). http://midwestpesticideaction.org/zika-and-panic-beware-the-scare/

Illinois Department of Health (IDPH). http://www.dph.illinois.gov/topics-services/diseases-and-conditions/zika 

Centers for Disease Control and Prevention (CDC). http://wwwnc.cdc.gov/travel/page/zika-travel-information

 

 

 

 

Fourteen Years

Katherine and JM.JPGKatherine died fourteen years ago today. An acquaintance once told me, in response to our story, that at least young children do not understand death. “They do when they are dying themselves,” I replied. At least Katherine did, as much as any of us ever do. Imagine having to face that kind of existential agony at age eight. As much as we hoped for more time for her, and as much as she struggled for every minute, I often wish she had died three weeks earlier, before her imminent death had become so clear to her, tormenting her with her own end, all the things she had left undone. She could have died at the very beginning of her final illness. Delirious with lack of sleep, I accidentally overdosed her on morphine, using the red-capped syringe to flush her port instead of the white. Immediately, she crumpled into herself and sunk into respiratory depression, her breathing labored and slow. We thought she would die. It was hours before I realized what had happened. The distraught young paramedics came and dosed her with an anti-narcotic. Riding in the ambulance, I was struck with how beautiful the sunrise was, how for everyone else on the road that early morning, it was just another day, while my world was ending. Carrying her into the hospital, she woke in my arms, after I thought I would never hear her voice again: “Mommy, where are we?” I comforted her, and the inquiry was mercifully short. She was her own little self again, her brain uninjured.

Where am I going with this? I scarcely know. But this respite she had was both all too brief and too torturously long. She would wake in the morning after a night of struggling for breath, near death, and sigh, “Mommy, I survived the night.” The morphine barely covered her bone pain. A fan blowing in her face helped her feel less the struggle to breathe. Great blue bruises accumulated as her circulation slowed and her platelets diminished. Her urine turned brown as her kidneys failed, and she lost the ability to swallow her medicine, however much she tried to comply. She mourned all she could not do on a beautiful June day and all she would never do again. She lamented all the years of life she would miss, which she would have enjoyed to the fullest, as she always did. She told me she loved me, in an ardent and anguished tone I will never forget. She had me record her last words to her brother and everyone else she loved. I suppose I hope to impress on you all that although deaths from childhood cancer rarely make headlines, although they seem somehow silent and inevitable, they are both horribly violent and completely avoidable. Every day we do not rein in the chemical industry’s business as usual, we are complicit in many more such deaths. And all the corporate profits and perfect lawns in the world cannot be worth my one darling Katherine.

Today, President Obama signed into law the Lautenberg Act, which puts some constraints on chemical production and use in the U.S. The Act is a start, but far from complete. And one can hardly expect those of us with children already dead to rejoice. But we can perhaps be soberly glad to think that with further regulation, maybe someday, no other parent will have to so needlessly bury a beloved child as a result of environmental chemicals.

To celebrate Katherine’s memory, please do something to remedy this grave injustice: read more about the Lautenberg Act on the EDF website, work to eliminate pesticides and other chemicals, and, most important, vote the environment so that we can pass more such life-saving legislation.

 

Notification Law — When Neighbors Spray

TruGreen-truck
ChemLawn: Ironic for new name and for featuring dogs, given link to canine lymphoma
If you are trying to protect yourself or your family from pesticides, it can be very frustrating when neighbors hire ChemLawn (ironically named TruGreen now), Green Drop, Green T, Scotts, or one of many different lawn chemical applicators. But you can at least get enough notification to close your windows, bring in your laundry, and keep your children and pets inside for the day.
Here is the protection offered homeowners:
(d) Prior notification of application to lawn. In the case of all lawns other than golf courses:
(1) Any neighbor whose property abuts or is adjacent to the property of a customer of an applicator for hire may receive prior notification of an application by contacting the applicator for hire and providing his name, address and telephone number.
(2) At least the day before a scheduled application, an applicator for hire shall provide notification to a person who has requested notification pursuant to paragraph (1) of this subsection (d), such notification to be made in writing, in person or by telephone, disclosing the date and approximate time of day of application.
(3) In the event that an applicator for hire is unable to provide prior notification to a neighbor whose property abuts or is adjacent to the property because of the absence or inaccessibility of the individual, at the time of application to a customer’s lawn, the applicator for hire shall leave a written notice at the residence of the person requesting notification, which shall provide the information specified in paragraph (2) of this subsection (d).
If your neighbors apply chemicals themselves, I encourage you to have a conversation with them and ask them to notify you if they intend to apply chemicals. Share information. They may never have thought about the health effects and may benefit from your resources. After all, who would think such a commonly available product could be lethal, both in the long and short term?

Pledge to Support Healthy Lawns

I cannot say enough good about Midwest Pesticide Action Center: not only do they campaign for healthy lawns and homes — they also provide top-notch resources for doing so. They are gathering grass-roots (pun intended) support for changing the culture about lawn chemicals: such poisons are not worth our children’s health — or our own. MPAC was  instrumental in helping switch the City of Warrenville and Benedictine University over to Healthy Lawns (minus the athletic fields), and they can help in your community too.

Sign the pledge at http://midwestpesticideaction.org/midwest-grows-green/community-engagement/take-the-pledge/

Here’s what they have to say about the pledge:

More and more, MPAC receives your concerns about reducing the use of potentially harmful gardening and lawn care chemicals in our lawns, parks, and other public places. We want to turn your concerns into action by creating a community of informed citizens ready to organize and advocate for more natural lawn care practices at home and Midwest-wide.

But we need your help! By taking this Midwest Grows Green (MGG) pledge, you join an online, engaged network of citizen activists prepared to eliminate synthetic chemical use on your own lawn and/or garden and at all locations where children, pets, and wildlife live and play. Will you join us?

Your commitment today gives you access to natural lawn care resources, advocacy support, and event updates from our monthly newsletter and adds your name to the larger MGG effort as we recruit more
pesticide-free parks, point-of-purchase retailers, and pledges.

Midwest_stacked-e1386625125966-300x186

Read more about why you should opt for a healthy lawn, how to maintain a healthy lawn, and the pledge at http://midwestpesticideaction.org/midwest-grows-green/community-engagement/take-the-pledge/

EWG’s Dirty Dozen: Do You Know What Produce Is Most Important to Eat Organic?

Every year, the Environmental Working Group tests dozens of different fruits and veggies to see which contain the most and the most hazardous pesticides; most test positive for more than one pesticide, a term that encompasses insecticides, herbicides, fungicides, rodenticides…you get the idea.

You may not feel you can find or afford all organic: this list allows you to strategize which ones are most important, at least for your children if you have them.

Here are the twelve worst culprits among conventional produce, with the worst first:

EWG’s 2016 Shopper’s Guide to Pesticides in Produce™

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#1 Worst: Strawberries

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#2 Worst: Apples

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#3 Worst: Nectarines

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#4 Worst: Peaches

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#5 Worst: Celery

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#6 Worst: Grapes

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#7 Worst: Cherries

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#8 Worst: Spinach

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#9 Worst: Tomatoes

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#10 Worst: Sweet bell peppers

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#11 Worst: Cherry tomatoes

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

#12 Worst: Cucumbers

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

Bonus: Hot Peppers

 

EWG's Dirty Dozen Plus and Clean Fifteen Lists

Bonus: Kale / Collard greens +

Read the full list for yourself at https://www.ewg.org/foodnews/list.php

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