The health impact of hazardous waste sites on minority communities: implications for public health and environmental health professionals.

Hazardous waste production and disposal in the United States is a pressing environmental and public health concern. One issue related to this problem is the lack of published information about the health effect to humans from exposure to hazardous substances produced by commercial hazardous waste facilities and emanating from abandoned waste sites. Further, it is only recently that discussion has surfaced regarding the selective health risks faced by minority Americans who are more likely than nonminority populations to live in neighborhoods where these exposures might occur.

The public health concern about minorities exposed to hazardous substances is intensified by documentation of lower health status of minority Americans (which include African Americans, Hispanic Americans, Native Americans, Pacific Islanders and Asian Americans) (1, 2). African Americans and other economically disadvantaged groups are often concentrated in areas, such as urban settings, which may expose them to hazardous substances (3, 4). There is also evidence that populations living near hazardous waste sites are more likely to report increased levels of cancer, mortality, birth defects and other illnesses (5, 6, 7, 8).

Since the first studies regarding hazardous wastes and minority neighborhoods were published (4, 9), grassroots organizations have formed to address this concern (10, 11), and discussion has been focused primarily in the fields of sociology, political science, and planning and social policy (3, 11, 12, 13). Only recently have public health specialists become involved with this issue. The Agency for Toxic Substances and Disease Registry (ATSDR) is currently conducting public health assessments at hazardous waste sites, and information from these evaluations will continue to be forthcoming (14, 15). To date, however, there is little information in the public health/environmental health literature concerning the health impact of hazardous waste sites on minority populations, and the role of public health and environmental health specialists have in attending to this concern. Therefore, the purpose of this article is to alert the public health community and environmental health specialists to the specific health needs of minority groups who live near hazardous waste sties. This article provides background information about this issue, discusses remedial and grassroots efforts being conducted in the public and private sectors, and articulates the direction public health and environmental health specialists must take to initiate changes in public policy.

Waste sites located in minority communities

The earliest documented evidence that minority communities were more likely to be located near commercial hazardous waste facilities or abandoned hazardous waste sites appeared in 1983 when the U.S. General Accounting Office (GAO) analyzed the racial and socioeconomic status of communities located in the southeast region of the U.S. (4, 13, 16). The study revealed that African Americans composed the majority of the population in three of the four communities where the hazardous landfills were located. In all four communities, more than one-fourth of the population had incomes below the poverty level, and most of this population below the poverty level was African American (9).

The United Church of Christ (UCC) Commission for Racial Justice followed up the GAO report with a national study to determine the relationship between ethnic groups and the location of hazardous waste sites (4). One aspect of the study analyzed demographic patterns associated with commercial hazardous waste facilities, and another section described demographic patterns associated with uncontrolled (abandoned) toxic waste sites. With regard to the first part of the study, the Commission found that race was the most significant variable associated with the location of commercial hazardous waste facilities. In communities with two or more commercial hazardous waste facilities or any of the nation's five largest landfills, the average percentage of minorities in the population was more than three times that of communities without such facilities. The second aspect of the study revealed that three out of five of the largest hazardous waste landfills in the U.S. were located in predominantly African American or Hispanic communities. The report concluded that, "it is virtually impossible for this disproportionate distribution to occur by chance, and that underlying factors relating to race...play a role in the location of commercial hazardous waste facilities." (16)

Later investigations have pointed to the unequal racial distribution of populations living near hazardous waste sites and/or radioactive waste deposits (7, 12, 16). For example, "the fifth largest landfill in the U.S. is located in Kettleman City, California, where the population is made up of 78% Hispanics" (17). Already playing host to a hazardous waste landfill, Kettleman City residents recently opposed the proposed siting of a hazardous waste incinerator (17).

Public health concerns

Although in 1982 attention was drawn to the relationship between hazardous waste and race, public health concerns around the indiscriminate disposal of hazardous chemicals came to the forefront of the media in 1978, when residents in a Love Canal, New York neighborhood complained of illness believed to be linked to chemical wastes that had been buried there years before (18, 19). Health authorities and environmental agency officials now regard Love Canal as the "tip of the iceberg" in alerting society to the widespread nature of health problems that may surface from past hazardous waste disposal practices (19).

More recent reports detail the increased risk of disease and disability for all populations living in proximity to hazardous waste sites, with the following examples:

* Memphis, Tennessee has more uncontrolled hazardous waste sites (173 in 1987) than any other city in the U.S. Local politicians are concerned about statistics that show a disproportionate increase in the incidence of cancer and chronic respiratory illness in non-white Tennesseans, as well as reports of neurological disorders (6).

* An industrial dumpsite in Lake Charles, Louisiana was closed in 1984 due to contaminated groundwater. Residents, who ingested the water and were exposed to windblown chemical fumes from the dumpsite, have reported eye irritation, constant nosebleeds, nausea and cramps (5).

* More than 150,000 residents in a Southeast Chicago housing project live near 50 active or closed commercial hazardous waste landfills and 103 abandoned toxic waste sites. This largely African American and Hispanic population has levels of cancer and infant mortality higher than is expected, according to national statistics (20).

* Individuals exposed to hazardous substances (when compared to control groups) may experience elevated levels of health concern, depression, anxiety and generalized psychopathology (21).

* A study (7) conducted by the Navajo Nation found that children growing up in uranium mining areas such as Grants Uranium Belt, New Mexico, were developing ovarian and testicular cancers at rates 15 times higher than the national average. A public health advisory was issued in November 1991 by ATSDR, acknowledging that there was an "imminent public health threat" to the Navajo people living in the area (7).

* Lead contamination at Superfund sites is of particular concern because of the hazardous lead poses for children. ATSDR is reviewing 13 sites where public health assessments have indicated that the exposure to lead may warrant further public health action (22).

* A case-control study of households residing near a thorium waste disposal site found a higher prevalent of birth defects and liver disease among the exposed groups when compared to the unexposed groups (8).

The public health concern for African Americans and other minority residents living near hazardous waste sites is serious because, in this situation, environmental factors are superimposed on populations already experiencing a health care crisis. The U.S. Public Health Service's 1990 report, Health Status of the Disadvantaged, documents that U.S. minorities continue to lag behind nonminorities on a number of demographic and health status indicators. Specifically, minority males have a shorter life expectancy than nonminority males; the infant mortality rate for minority babies is double that for white babies; death rates among minorities are higher at all age levels than for whites; and African Americans and the economically disadvantaged are more likely than others to lose work days due to illness or disability (2). The Centers for Disease Control recently released a report concerning lead levels that endanger millions of preschool children, particularly poor and minority children (23). In addition, the Office of Minority Health Resource Center reported in 1984 that Hispanics have three times the risk of developing diabetes as non-Hispanic whites; and, for those under the age of 35, heart disease mortality for Native Americans is approximately twice as high as for all other Americans (1).

Further, there is clear documentation that African Americans, other minority groups, and lower-income populations are often concentrated in areas in which they may be exposed to hazardous substances in the workplace and in their neighborhoods (24, 25). Examples of these exposures include urban industrial communities with elevated air and water contamination, or rural areas with exposure to farm pesticides. Unfortunately, few physicians may recognize that physical illnesses their patients have are caused by, or related to, hazardous substances. Physical symptoms often go untreated because the complaints are regarded as psychosomatic (12).

Initiatives

Given the increased concern by the general public, and particularly by people living near waste sites, "naivete |has been~ replaced by a sense of distrust of how American industries were handling hazardous substances and skepticism about the efficacy of the public sector to regulate them" (20). Grassroots coalitions and networks, educational programs, the legal system, and government agencies are all involved in assessing the health impact of hazardous waste in minority communities.

Grassroots

During the 1980s thousands of citizens organized into community groups to force closure of hazardous waste sites, to halt the siting of new hazardous waste facilities in their communities, and to seek legal settlement for citizens' illnesses. One coalition, the Mothers of East Los Angeles, successfully halted the installation of a hazardous waste incinerator despite reassurance by "experts" that the emissions were "acceptable risks" and would not cause congenital defects or cancer in the nearby residents (11, 26). Another coalition formed by Native Americans and African Americans prevented the siting of a commercial low level radioactive waste incinerator in Robeson County, North Carolina (26).

In the 1980s grassroots organizations were joined by mainstream environmental groups. This alliance was important because prior to this, mainstream groups narrowly viewed environmental issues as those focused on preserving nature, and urban problems were seen as public health issues. For example, in 1988 the national Sierra Club joined with the National Toxics Coalition to co-sponsor the Southern Environmental Assembly. The Assembly resulted in the formation of the Louisiana Toxics Project which organized a march in "cancer alley", the corridor between New Orleans and Baton Rouge, to halt the siting of additional incinerators and landfills (26). The Southwest Organizing Project in Albuquerque, New Mexico was a joint effort by several organizations to target residents adversely affected by sawmill emissions (27).

Native American groups have also coalesced to block siting of landfills and incineration plants on their reservations. The first Protecting Mother Earth Conference, held in 1990 and funded by Greenpeace and the Seventh Generation Fund, resulted in the formation of an international network and clearinghouse between Canada and the United States. The second Protecting Mother Earth Conference in 1991 included workshops on organizing skills, fund raising, legal assistance, research, media skills, and evaluation of environmental impact assessments. As a result of these conferences and collaboration with mainstream environmental groups, more Native Americans are serving in an administrative capacity in these organizations.

Other coalitions, such as Indigenous Women of North America and Women of Color of North America, discussed the health impact of hazardous waste at the 1991 World Women's Congress. As a result of this international convention, the topic of hazardous waste and minority communities was placed on the agenda of the 1992 Earth Summit sponsored by the United Nations Conference on Environment and Development (28).

Government

The UCC report included recommendations for educational initiatives, reform, and further research at the federal, state and local levels (4). One recommendation requested that the Department of Health and Human Services conduct epidemiological studies in minority communities to examine the relationship between exposure to hazardous wastes and the occurrence of particular illnesses (26). A second recommendation called for the ATSDR to perform health assessments of residents living near hazardous waste sites even if the site was not included on the National Priorities List (NPL) (26).

Additionally, since 1989 ATSDR has been directing the Minority Health Initiative to address the health impact of hazardous waste on minority communities (14). The Initiative focuses on four areas: demographics, health perspectives, health education and health communication (14). The demographics sub-project uses census data and maps, topographic maps, and Geographic Information System files to evaluate National Priority List sites and identify potentially impacted minority communities. The health perspectives subproject is studying increased risk from hazardous substances related to health factors, lifestyle factors, disease states, and psychosocial factors. The compilation of a data file by the health education and communication sub-projects will enable state and local public health agencies to use this information about health risks to coordinate communication efforts with religious groups, health care providers, schools and homes, and to local, city and state officials (14).

Education

Universities have been encouraged to: 1) develop curricula that integrates minority environmental health concerns with broader socioeconomic, political and economic issues that impact the environment; and 2) recruit and retain minority students in environmental fields (26, 29). Universities are also participating in research about hazardous waste and the impact on communities. This topic was featured at the 1990 Michigan Conference on Race and the Incidence of Environmental Hazards where numerous participants reviewed environmental risk from a socioeconomic perspective. The review pointed out "significantly disproportionate health impacts on minorities due to higher rates of exposure to pollution" (16).

Legal decisions

Plaintiffs have successfully blocked the construction of hazardous waste facilities which were to be built near schools and homes (11), and have also received compensatory settlements in cases where it was proven that hazardous emissions caused ill health (11, 30). Community groups are increasingly using the legal system as they are joined by mainstream environmental groups which offer funding and legal expertise.

Implications for public health and environmental health professionals

Without question, public health structures need to anticipate and respond to environmental health challenges of the future. Within the next decade, additional research will provide a better understanding of the relationship between exposure and adverse health outcomes. In the meantime, however, it is important to recognize that public awareness and perceptions toward hazardous waste production and disposal have changed. In a sense, the increased awareness of the possible health concerns associated with exposure to hazardous substances has made solving the hazardous waste problem a public policy imperative (18). A new form of environmentalism centered around the hazardous waste disposal issue has taken root in minority communities throughout the U.S. Proponents of this powerful grassroots movement are challenging compensatory schemes that were successful in the past, and insisting that the hazards of both old practices and new technologies be thoroughly assessed for potential health and environmental effects. It behooves the public health community to take a close look at strategies that have worked for this movement. In addition, significant work to investigate environmental racism has been initiated by the EPA, through the formation of the Environmental Equity Workgroup, and the recent (1992) publication of the Workgroup's findings and recommendations regarding this issue (31, 32).

Public health and environmental health professionals have the resources and expertise to lead the way with the development of policy and social change that reflects a new set of public values around the issues of social justice, preventive health care, and waste reduction. Suggested strategies for these professionals include (24, 26, 29, 31, 33, 34, 35, 36, 37, 38):

* Involvement with private and governmental organizations that: 1) link minority and nonminority groups on issues that cut across geographic boundaries and political spheres; 2) provide communication networks to foster information clearinghouses, community leadership and social networking; 3) promote the use of collaborative and cooperative models for problem-solving and dispute resolution; and 4) raise concerns about environmental equity issues.

* Recruit minority professionals in environmental and occupational health, environmental law, public health and health planning. Minority professionals rising through the management ranks of government and industry may force the scientific and public health communities to be "more hospitable to and nurturing of its ethnic minority members" (33). In addition, public health/environmental health academic curricula must include minority health and sociopolitical issues as well as coursework in advocacy and conflict management.

* Participate in health assessments, epidemiologic studies and programs in risk communication that are tailored to the political, economic and cultural situations of the at-risk communities. This includes validating the health concerns of communities even in the absence of definitive cause and effect data. Communities are making decisions about dealing with the presence of hazardous materials in their neighborhoods whether or not they have what government agencies feel is concrete data.

* Become active participants in and outspoken leaders for pollution prevention through waste reduction. Pollution prevention seeks to reduce or eliminate the production of all wastes from every place where they are created in industry, commercial establishments, homes and institutions--a radical departure from our present practices.

With the mounting empirical evidence that minority and low income communities are disproportionately burdened with hazardous waste sites and facilities in their neighborhoods, the authors agree with Bullard that "past discriminatory waste siting practices should not guide future policy decisions" (24). Although existing scientific evidence cannot conclusively link socioeconomic and ethnic variables to environmentally induced disease, it is postulated that health risks are likely to occur with increasing exposure to hazardous substances (39).

In spite of the lack of scientific evidence, ample anecdotal evidence exists to prompt immediate response by a coalition of health professionals who cross-cut the areas of research, program implementation, management and assessment. "It is the poor and minority communities who are paying a high price in terms of their health" (24). Federal, state and local public health agencies must place this issue squarely on their agenda. Public health and environmental health professionals cannot merely be advocates for health aspects of environmental issues, but must have "direct operational involvement" (40) in policy formation that identifies, assesses, controls and prevents community environmental problems that may be disproportionately hazardous to minority groups.

References

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Anna K. Harding, R.S., Ph.D., Department of Public Health, 309 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406.