Author: Steve Sartino

Policy Brief: Health implications of ARPA funding dedicated to on-site wastewater systems in the Black Belt area of Alabama

March 14, 2023 | Kimberly Randall, LHC Staff

A number of Alabama residents, particularly in the Black Belt area, are unable to connect to centralized water and sewage utilities and instead rely on on-site sanitation systems, or septic tanks. These systems are costly, particularly in comparison to the household income of the area, and often fail due to the unique geological structure of the region (He et al., 2011). Homeowners who are unable to afford a proper on-site sanitation system may resort to “straight piping” instead, dispensing raw sewage into nearby fields, ditches, or waterways (Loveless & Corcelli, 2015).

The Black Belt has a uniquely structured geologic profile that results in a rich, dark soil high in nitrates which gave the region its name. The unconfined aquifer, or layer of soil above the first layer of clay, is only a few feet deep and much more shallow than in other areas of the state. Traditional septic tanks are buried just below the ground level which results in the tanks potentially being buried in a layer of montmorillonite clay rather than soil.

This poses two issues. This type of clay is hydrophilic, meaning that any moisture leaving the system via drainage fields is not able to be naturally filtered the way soil composed of minerals and microorganisms is. Additionally, the clay expands and contracts in extreme temperatures found in Alabama which can cause the concrete septic tanks to crack and expose extreme amounts of waste into the groundwater, known as interaquifer leakage. Consequently, the area requires an engineered or “mounded” sanitation system that artificially creates a larger unconfined aquifer of sand and soil on a property, but the cost is upwards of 5x that of a traditional septic system.

Ineffective sanitation infrastructure poses a number of health and environmental risks. Common pathogens related to groundwater contamination include but are not limited to shigella, hepatitis A, norovirus, giardia, and salmonella (EPA, 2015). Additionally, parasites like hookworm have historically been present in the area due to poor sanitation (McKenna et al., 2017).

While many Alabama residents struggle to access adequate sanitation, the problem is especially severe in the Black Belt counties of Dallas, Perry, Sumter, and Wilcox. As some of the poorest areas in the state, the cost of an effective sanitation system is often unfeasible. However, under state law, it is the financial responsibility of the homeowner to install and maintain a state-permitted on-site sanitation system and risk fines, arrest, and a potential lien on their home for not doing so (Alabama Code § 11-68) It is estimated that tens of thousands of homes in the Black Belt area that have outdated, ineffective, or substandard on-site sanitation systems.

Currently, the Alabama Department of Environmental Management (ADEM) is the facilitator of all government funding for sanitation projects in the state. However, ADEM does not offer a mechanism to provide financial assistance for on-site systems to homeowners or non-municipal entities such as non-profit organizations.

On Tuesday, March 7th, Governor Ivey called for a special session of the Alabama legislature to distribute the remaining $1.06 billion in federal funding granted by the American Rescue Plan Act, a portion of which is expected to go toward sanitation infrastructure in the Black Belt. ARPA funds could be highlighted as a way to assist with on-site sanitation repairs via grants distributed through ADEM to begin tackling this problem.

To download this Policy Brief in PDF form, CLICK HERE.

Other facts of note:

  • According to one survey, 90% of land in the Black Belt is not suited for conventional on-site sanitation systems (He et al, 2011).
  • The average income in Wilcox county is $19,231 (US Census, 2021).
  • A survey conducted in Wilcox County showed that 90% of unsewered homes had an unpermitted sewage system, 60% of homes had a visible straight pipe, and 33% of homes had a buried straight pipe or other unpermitted sanitation systems (He et al, 2011).
  • Researchers estimate that upwards of 550,000 gallons of raw sewage are being put in the watershed each day due to inefficient sanitation (Walton, 2017).
  • One study estimated groundwater contamination from failing septic systems could affect up to 340,000 low-income people in rural Alabama, placing them at an elevated risk of disease (Wedgeworth & Brown, 2013).

References

EPA. (2015). Groundwater contamination Guide – US EPA. Retrieved March 10, 2023, from https://www.epa.gov/sites/default/files/2015-08/documents/mgwc-gwc1.pdf

He, J. et al., (2011). Assessing the Status of On-site Wastewater Treatment Systems in the Alabama Black Belt Soil Area. Environmental Engineering Sci, 28. 693-695.

Loveless, A., & Corcelli, L. (2015), Pipe Dreams: Advancing Sustainable Development in the United States, EPA BLOG, https://blog.epa.gov/blog/2015/03/pipe-dreams-advancing-sustainable-development-in-the-unitedstates/.

McKenna, M. L. et al., (2017). Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama. The American journal of tropical medicine and hygiene, 97(5), 1623–1628. https://doi.org/10.4269/ajtmh.17-0396

U.S. Census Bureau. (2022). Income and Poverty, July 1, 2022 (V2022) — Wilcox County, Alabama data table.

Walton, B. (2017). Diseases of poverty identified in Alabama County burdened by poor sanitation. Circle of Blue.

Wedgworth, J. C., & Brown, J., (2013). Limited Access to Safe Drinking Water and Sanitation in Alabama’s Black Belt: A Cross-Sectional Case Study. Water Quality, Exposure & Health, 5. 69-71.

Policy Watch: Alabama Bill Looks to Decrease Correctional Incentive Time in State Prison System

March 6, 2023 | Kimberly Randall, LHC Staff

As the 2023 Alabama Legislative Session begins on March 6 with Governor Ivey’s State of the State Address, dozens of bills have been pre-filed over the last few weeks. This year starts the first of a four-year term with new committees, new legislators, and new leadership. As a part of a five-part series, the Lister Hill Center for Health Policy has identified five pre-filed bills that could have substantial health implications if passed in 2023.

Inmates sitting on bunks wearing white jumpsuits

SB1 – Deputy Brad Johnson Act

Sponsored by: Sen. April Weaver (R-Brierfield)

This bill has also been pre-filed in the House of Representatives as HB-9 by Rep. Russell Bedsole (R-Montevallo)

Background

Under current Alabama law, § Section 14-9-41, individuals incarcerated within the Alabama Department of Corrections had “good behavior time” calculated by a specific equation. Referred to as correctional incentive time, inmates can have time reduced off of their sentences for serving portions of their time in various amounts depending on their classification, a ranking system determined by the length of time spent incarcerated and the deemed trustworthiness of each individual.

Proposed Legislation

The legislation, SB 1, would decrease the correctional incentive time for each classification of inmates.

Class 1 inmates (considered trustworthy and able to work without supervision) are eligible for a maximum of 75 days to be removed from their sentence per 30 days served. SB 1 would reduce this amount to 30 days.

Class 2 inmates (able to work under supervision) are eligible for a maximum of 40 days of correctional incentive time per 30 days served, which would be reduced to 15 days.

Class 3 inmates (special assignments) are eligible for a maximum of 20 days of correctional incentive time, which would be reduced to 5 days.

Additionally, SB1 doubles the length of time that inmates must spend in each category before advancing to the next class.

Impact

Alabama has been scrutinized by the Department of Justice and legal advocacy organizations for being unsanitary, overcrowded, and dangerous. The state has one of the highest incarcerations in the country, with a mortality rate of more than twice the national average. Alabama is home to the most dangerous prison in the United States, as determined by the number of violent and often fatal incidents at St. Clair Correctional Facility. While funding was diverted from the American Rescue Plan in 2022 to build new facilities, the Alabama Department of Corrections Commissioner, John Hamm, has declared that the new buildings will not have a higher capacity than the existing ones.

SB1 would increase the number of incarcerated persons in the state at any given time. Under the existing guidelines, an incarcerated person who was given a five-year sentence could be released after 28 months if maxing out the correctional incentive time. Under the proposed changes, the same person would be released no earlier than 36 months. Without proper procedures to increase capacity, medical access, and staffing, this increase in prison populations could have significant adverse health implications for incarcerated persons and prison staff.

Prison systems are hot spots for disease transmission and often have understaffed medical facilities. The Alabama Department of Corrections utilizes a co-pay system for incarcerated persons to use healthcare resources which are often 5-10x their daily wages. Additionally, the cost of medical treatment within the prison system is significantly higher than for unincarcerated persons, resulting in a higher percentage of undiagnosed and untreated diseases. It is also important to note that some disease transmission, such as SARS-COV-2, can impact the prison staff and inmates.

Next Steps

The Alabama Legislative Session officially begins on Wednesday, March 7. SB1 has been scheduled for a first reading that day, which will be sent to the committee for deliberation. Should it pass in committee, a second reading on the Senate floor will place the bill on the official Senate calendar. Then, a third reading will occur where the entire chamber will debate the bill.

If you want to make your voice heard on this or future legislation, click here to identify your elected officials, and check out this guide from the ACLU on how to write a letter to your legislators.

Stay Informed

Want to learn more about this bill and other issues impacting the Alabama prison system? Join the Lister Hill Center for Health Policy, the UAB Institute for Human Rights, and the Southern Poverty Law Center on Wednesday, March 22, at 4 PM at University Hall, Room 1008, for a special discussion on Criminal Justice Reform & Human Rights in Alabama. Registration can be found here.

Additionally, we recommend the following organizations for more information on criminal justice reform:

Student Reflections from APHA 2022

The mission of the Lister Hill Center for Health Policy (LHC) is to connect and support those seeking to improve health outcomes through policy. A key aim in achieving pursuing our mission is to empower students to affect policy change. We support students’ growth in public health policy and advocacy through our Health Policy Ambassadors program, internship opportunities, and resources available to all UAB students. We have also collaborated with the Sparkman Center for Global Health on the annual Global Health Case Competition, connected students with community partners, and hosted MPH internships. In 2022, thanks to the initiative of a group of four students, we supported four students in attending the American Public Health Association’s annual meeting in Boston, Massachusetts.

The American Public Health Association hosts its Annual Meeting and Expo (APHA) in late October or early November each year. This is an opportunity for over 12,000 public health professionals – clinical researchers, health officers, lawyers, academics, and so many more – to engage with and learn from one another. Hundreds of concurrent sessions over four days feature the latest developments on programs, policies, commentaries, interventions, and research in public health. Four students who had participated in LHC programs decided to submit two abstracts to the conference organizers. Both were accepted!

Four Exceptional Students

From left to right: Banks Stamp, Emma Kate Sellers, Katie Lovelady, and Sarah Van Winkle

Students who participated in last year’s Global Health Case Competition and Health Policy Ambassadors cohort submitted abstracts to APHA in the spring semester. These students include:

  • Katie Lovelady, an undergraduate Industrial Distribution major;
  • Emma Kate Sellers, who graduated in the fall with her MPH;
  • Banks Stamp, an Accelerated Bachelor’s/Master’s student pursuing an MPA; and
  • Sarah Van Winkle, an undergraduate Physics major.

The 2022 Global Health Case Competition tasked participants with addressing the health needs of Maasai elders in southwestern Kenya. The case was developed in close partnership with the Nashulai Maasai Conservancy, with the goal of generating innovative solutions to promote lung health, eye health, and cancer prevention. One group – comprised of Lovelady, Stamp, and Van Winkle – submitted their proposed intervention as an application to Clinton Global Initiative University, a program which supports college students in their commitment to change the world. Their proposal was accepted, and they have diligently worked with Conservancy leadership and UAB faculty to fine-tune their proposal for implementation. This team participated in the roundtable “Promoting Education and Awareness Across the Cancer Continuum.”

The Health Policy Ambassadors program pairs interdisciplinary teams of students with Birmingham-area community partners to identify and address policy issues. Sellers, Stamp, and Van Winkle participated in the 2021-2022 cohort on three separate teams and decided to share their experiences in the program at APHA. The objective of the presentation was to encourage other public health programs to adopt similar strategies to promote engagement in advocacy among public health professionals. This group presented in the “Student Training and Public Health Workforce Development” poster session. All four students were asked to reflect on their experience at APHA. General themes from these reflections are outlined below.

Project and Professional Development

When asked why they decided to go through with attending the conference, each noted the potential benefit to the projects they were presenting. The Conservancy group sought to learn from experts in cancer prevention and global health. “I knew I needed to learn from experts on how to successfully collaborate with international partners on a joint program,” recalled Van Winkle. “Because we were able to present to national global health leaders, our team was able to refine our plan and build a more successful program.” The Ambassadors group also sought to learn from public health experts engaged in advocacy, with an additional goal to encourage other academic public health programs to engage students with advocacy. All four students were determined to use the conference to improve their work.

All four students noted that their professional skills and networks developed in addition to their projects. Sellers had presented other conferences before, but due to the pandemic those opportunities were virtual. For her, this “first opportunity to present a poster in person was a really great opportunity for personal and professional growth.” Stamp described taking full advantage of the opportunity to “practice skills in networking, public speaking, and communicating academic research to subject-matter experts and the public.” Indeed, all four students identified networking as a key benefit to attending the conference. Lovelady added that connections she made with industry professionals have already proven beneficial to her!

A Sense of Learning and Community

APHA showcases the broad scope of public health. In addition to attending their own sessions, students found they were able to learn from presenters in other sessions with topics unrelated to their own expertise. Sellers recalled attending her peers’ roundtable session, noting that it became a highlight for her. “I have not learned much about cancer or done any research on the topic, but I learned so much from the presentations and was able to relate the content to migrant health,” said Sellers. “I learned about cancer screening within specific migrant communities in NYC, a cancer education pilot program used for migrant farm workers in Oregon, and cancer caused by H. Pylori which mainly affects immigrants from East Asia.”

As a Physics major, Van Winkle worried she might not find people with similar interests or sessions that aligned with her academic background. However, she this worry “was quickly washed away” by the interdisciplinary nature of public health. Van Winkle recalled attending the “Innovations in Global Health Technology” session, saying it “stoked my growing passion for leveraging my background in physics and medical technology in my future career to create healthcare technology for resource-limited environments.”

“I was not expecting everyone to be so open to connecting and meeting new people,” recalls Lovelady. “Overall, the sense of community among the attendees was great.” Reflecting on the School of Public Health Alumni Reception, Stamp appreciated the “respect and spirit” that alumni hold for our school. Each student attended networking sessions and the 150th anniversary celebration. Sellers, the only public health student in the group, noted that she “gained a sense of unity within the public health workforce and felt rejuvenated and hopeful about public health upon returning home from the conference.”

4/4 Would Recommend

All four students said that they would encourage their peers to submit abstracts to APHA in the future. As Stamp puts it, “This experience is perfect for those who are determined in their mission, passionate about social impact, and desire to be active change-makers in our world!” Tips from these students for future presenters include practicing and reviewing your presentation/project, planning a schedule beforehand, taking breaks throughout the conference, and being open to connect with anyone you run into. APHA was a great benefit to these students, and we hope to support others in the future.

Policy Watch: Alabama legislature authorizes enhanced lead regulations

September 6, 2022 | Anantha Korrapati, LHC Intern

Lead is a natural chemical commonly used in various products such as household paint (before 1978), gasoline (before 1995), and plumbing pipes and fixtures. However, it is a potent neurotoxin that harms people, especially children, and pregnant women. 

According to the EPA, lead can be absorbed into the body through inhalation or ingesting lead dust from paint coatings or contaminated drinking water. It then travels through the bloodstream to accumulate in the bones. Depending on the level of exposure, lead can adversely affect the nervous system, kidney function, immune system, reproductive and developmental systems, and cardiovascular system. It has been shown to cause brain damage and cognitive deficits in children, even at low exposure levels. Lead exposure also affects the oxygen-carrying capacity of the blood. Levels should be checked through blood tests since there are no apparent symptoms of elevated blood lead levels (BLL). In Alabama, a BLL of five micrograms per deciliter (µg/dL) or higher is considered elevated.

Lead dust can be caused by air pollution near ore and metals processing centers and piston-engine aircraft operating on leaded aviation fuel. The highest lead particulate matter is found in soil near lead smelters at about 50-400 parts per million. 

According to the EPA, there are two extensive lead smelting facilities in Alabama that are superfund sites–nationally contaminated sites with improperly managed hazardous waste that are under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), allowing the EPA to clean up contaminated sites and forces responsible parties to assist or reimburse them for cleanup services. 

The Interstate Lead Company, or ILCO, had a secondary lead smelter and lead battery recycling facility operating in Leeds, Alabama, from 1970 to 1992. It was named a superfund site in 1986 due to contaminated groundwater, sediment, soil, and surface water resulting from facility operations. The EPA, the Alabama Department of Environmental Management (ADEM), and the ILCO Site Remediation Group, the site’s potentially responsible parties (PRPs), have investigated site conditions. Site contamination does not currently threaten people living and working near the site. The other facility is the Sanders Lead Company in Troy, Alabama. The complete list of lead mines in Alabama can be found here.

Proposed Legislation

SB158, sponsored by Senator Bobby D. Singleton, is titled “Lead reduction, Alabama Lead Reduction Act, lead abatement and further regulation of lead hazard reductions” and aims to regulate lead hazard regulations further, revise the authority of the State Board of Health to conduct lead inspections, enforce the Alabama Lead Reduction Act of 1997, and provide criminal penalties for violation. 

It was signed into law in April 2022 by Governor Kay Ivey. 

The act will establish a program to educate owners on renovation, risk assessments by health officers, a state-accredited program for lead hazard training, enforcement of the Alabama Lead Reduction Act of 1997, and fines for violations. 

Many homes and public buildings designed before 1978 may have lead-based paint on surfaces or fixtures, and this act establishes abatement and renovation accreditation programs for both individuals and firms under “Safe State,” the state accreditation agency for lead hazard training through the University of Alabama. These programs are in accordance with Title IV of the Federal Toxic Substances Control Act. 

Abatement is defined as the removal of lead-based paint or contaminated dust, replacement of lead-painted surfaces or fixtures, and the removal or covering of lead-contaminated soil. 

Renovation is defined as fixing painted components and removing building components with weatherization projects and any interim controls that disturb painted surfaces during the conversion of a building.

The legislation also establishes risk assessments where “the State Health Officer may conduct investigations of general lead contamination problems or conditions in public buildings and upon request of the building owner of commercial buildings, or the request of the owner or occupant of residential buildings.”

The Alabama Lead Contractor Certification Program established by the Alabama Lead Reduction Act of 1997 consists of Lead Hazard Reduction Contractor Certification (Abatement) and Alabama Lead Renovation Contractor Certification. This new legislation defers this training to the “Safe State” program.

Violations of this legislation depend on the number of incidences and can apply to individuals and firms. The fines are as follows:

  • First offense: $250
  • Second offense: $500
  • Third offense: $2500 – $5000

Impact

According to a study done in Kent County, Michigan (where over 50% of respondents live in homes built pre-1978), a lead safety course for parents was successful in promoting education and empowerment. However, the researchers stated that “longer-term solutions require advocacy at community and policy levels and cannot be prevented by individual behavior,” such as lead-safe mopping or collecting dust from window sills. Therefore, the legislation in Alabama will hopefully provide lasting changes through the renovation and abatement programs. 

This legislation will improve air quality, both primary and secondary air standards stated below:

National Ambient Air Quality Standards: 0.15 micrograms lead per cubic meter of air

  • Primary: publichealth protection, including protecting the health of “sensitive” populations such as asthmatics, children, and the elderly
  • Secondary: public welfare protection, including protection against decreased visibility and damage to animals, crops, vegetation, and buildings

According to a cost-benefit analysis from 2009, “Each dollar invested in lead paint hazard control results in a return of $17–$221”. This analysis compared the baseline cost of implementing lead hazard control programs to the health care costs and social behavioral costs incurred by lead poisoning, specifically in children. 

Specifically, in Alabama, ValueofLeadPrevention.org estimates $1 billion worth of lifetime economic burden of childhood lead exposure–including costs of “reduced lifetime productivity; increased health care, education, and social assistance spending; and premature mortality.”

Below is a map of the estimated percentage of children with elevated BLLs: 

Source

More economical costs and benefits of lead hazard training can be found here with research done by the National Institute of Environmental Health Sciences. 

Next Steps

The Alabama Department of Public Health and UA are managing this legislation. 

UA SafeState now manages registration for Individual Accreditation and Firm Certification. Register Here.

Firms that seek to be certified to perform renovations must have certification from the Alabama Department of Public Health and at least one individual accredited by UA’s Safe State program.

Here are a few EPA guidelines for individual actions to reduce lead exposure and poisoning. 

  • Eat healthy foods with calcium, iron, and vitamin C. These foods may help keep lead from being digested. 
  • Regularly wash hands, toys, and horizontal surfaces with soapy water and disposable cleaning materials. 
  • Vacuum with a High-Efficiency Particulate Air (HEPA) filtered vacuum
  • Take shoes off before entering the home or living areas
  • Cover lead-exposed soil with fruitless plant materials
  • Hire certified lead professionals to assist with home renovations in pre-1978 housing
    • Homes built before 1978 are more likely to have lead-based paint. Performing home renovations may disturb this paint and be a source of lead exposure. Using lead-safe work practices is critical when renovating. For guidance on lead-safe renovations, please visit the EPA or hire a certified lead professional to do the work for you.

Policy Watch: Alabama Becomes First State to Enact Elder Abuse Registry

July 12, 2022 | Anantha Korrapati, LHC Student Intern & Kimberly Randall, LHC Program Manager

Montgomery, USA State capitol building in Alabama during sunny day with old historic architecture of government and many row of flags by dome

Background

Elder abuse is a prevalent issue in the United States and comes in various forms, such as physical harm, neglect or desertion, financial exploitation, and emotional abuse through verbal and non-verbal acts. According to the Alabama Department of Human Resources’ Adult Protective Services, over 9,000 reported adult abuse, neglect, and exploitation cases were reported in 2021.

Currently, the Alabama Code §13A, Chapter 6, Article 9 defines three degrees of elder abuse and elder financial exploitation:

The first degree of elder abuse and neglect occurs if someone intentionally abuses or neglects an elderly person resulting in serious physical injury, and the first degree of financial exploitation is if the value of the property taken from an elderly person exceeds $2,500. 

The second degree of elder abuse and neglect is defined by someone recklessly abusing or neglecting an elderly person resulting in serious physical injury, and the second degree of financial exploitation is if the value of the property is $500-$2,500. 

The third degree of elder abuse and neglect is defined by reckless neglect resulting in physical injury or emotional abuse, and third degree of financial exploitation is if the value of the property is up to $500.

Previous legislation, such as the APS Act of 1976, protected elderly and disabled adults by outlining the responsibilities of the Alabama Department of Human Resources, law enforcement authorities, agencies, caregivers, and individuals to report elder abuse cases, which has helped prevent over 1,700 cases in 2021.

In 2018, Shirley Holcombe was a victim of forgery by her caretaker, which inspired her daughter, Jo Holcombe, to campaign for the creation of a statewide elder abuse registry to improve protections for elders further and prevent future cases of abuse. 

Proposed Legislation

HB105, also known as “Shirley’s Law,” implemented the nation’s first elder abuse registry and was signed by Governor Kay Ivey on March 24, 2022, and became effective on June 1, 2022. 

Presented by Representative Victor Gaston and others, HB105 reads:

“To establish a registry for individuals convicted of certain crimes or found to have committed certain acts of abuse against certain individuals; to require certain care providers to query the registry for employees and prospective employees; to require the Department of Human Resources to adopt rules; to establish criminal penalties.”

In addition to requiring the Department of Human Resources to create a database, HB105 also requires all physicians, practitioners, and caregivers to file reports when they believe that any protected person has been subjected to physical abuse, neglect, exploitation, sexual abuse, or emotional abuse. Under HB105, oral reports are to be submitted immediately to the county Department of Human Resources with a supporting written report within seven days. If the report concerns a nursing home employee, it must be submitted to the Department of Public Health. HB105 establishes criminal penalties as well: “An individual required to make a report who knowingly fails to make a report shall be guilty of a Class C misdemeanor.”

Impact 

According to a study recently published by the Division of Clinical Epidemiology and Evaluative Sciences Research, financial abuse of older adults is the most common form of abuse, but is the least studied. The study found that certain older adults were more likely to be economically, medically, and sociodemographically vulnerable, such as African Americans, adults living below the federal poverty line, and adults who do not live with a partner. The study also found that adults with impaired instrumental activities of daily living (such as using the phone, managing transportation, prepping meals, housekeeping, etc.) are more likely to be victims of elder abuse. 

Forms of financial abuse can include: stolen/misappropriated money and property, forced or misled into surrendering rights or property, impersonation to obtain property or services, and lack of necessary assistance for household expenses from loved ones. 

Financial abuse is most likely to occur among family members, with the highest report being adult children and other relatives. Other common perpetrators include friends, neighbors, or paid home-care aides. 

According to the Journal of the American Society on Aging, “the lack of visibility of elder abuse as a serious national problem has been a long-standing barrier to action.” As the creator of the nation’s first statewide elder abuse registry, Alabama is taking strides to bring awareness to this problem to prevent future incidents. 

Creating and implementing a comprehensive database protects elders by lessening situations in which they might be victims of exploitation. 

Next Steps

If you suspect elder abuse and want to report it to the Alabama Department of Human Resources, use these instructions to fill out a report or email to aps@dhr.alabama.gov. You can also call the hotline at 1-800-458-7214. 

Stay Informed

Policy Review: Alabama’s Push Toward Electric Vehicles

March 1, 2022, | Anushree Gade, LHC Intern

Car plugged up to electricity

As a state, Alabama has been making a more pronounced effort to adopt sustainability initiatives. This may result from people becoming more knowledgeable about climate change and how sustainability directly plays into it.

Electric vehicles have been receiving a lot of attention in the previous years. There are many more fully electric vehicles and hybrid cars on the road in the past year compared to five years ago. For example, we probably see numerous Teslas while driving around in Birmingham these days compared to how many we saw just two years ago. Why is this significant? It is important to note that transportation accounts for 70% of petroleum consumption in the United States. Hybrid vehicles consume less fuel than vehicles that are dependent entirely on gasoline. Electric vehicles rely solely on electricity as the source of energy. Electric and hybrid vehicles are better alternatives to conventional cars as it helps us decrease our fuel consumption and decrease our ecological footprint.  

In this case, California serves as a model state for other states across the United States. California provides incentives to its residents to encourage them to purchase hybrid or electric vehicles. The state has a Clean Vehicle Rebate Program (CVRP) in which California residents who are buying hybrid or electric cars are given a rebate. This incentive encourages the residents to consider purchasing such vehicles to decrease the state’s contribution to air pollution and climate change. The state also provides grants to purchase electric buses to further their effort to increase the amount of zero-emission vehicles in the state. For more information on these incentives and other incentives for electric vehicles in California, visit this link.

The Alabama Department of Economic and Community Affairs has been attempting to encourage the public to learn about electric vehicles and their benefits through a marketing program called “Drive Electric Alabama.” This program aims to include TV, radio, and digital advertising to increase Alabama residents’ exposure to information about electric vehicles. They have also created a website where the public can learn more. Click this link to access the website! Furthermore, Alabama has an Electric Vehicle Supply Equipment (EVSE) Grant Program. This grant program provides funds to expand electric vehicle infrastructure. Alabama also offers grants to replace diesel vehicles with newer diesel vehicles or alternative fuel vehicles. Vehicles eligible for this include medium- and heavy-duty trucks, school buses, shuttle, transit buses, freight switchers, airport, and ground cargo handling equipment. The state has also been making an effort to increase the number of electric vehicle charging stations across the state. Lack of access to charging stations can serve as a con for those considering switching to electric cars. Increasing charging stations can further encourage residents to make the switch. 

Despite the push towards electric vehicles being a success in California, such vehicles are relatively new and in the works for most states. Alabama has been making this transition, though it may take more time and effort to do this more effectively. 

Furthermore, several different solar initiatives are in place for the residents of Alabama to encourage them to consider installing photovoltaic systems (solar panels) for the production of renewable energy. These initiatives include, but are not limited to: 

  • Tax Credit: If you install solar panels, your tax credit is 26% of the cost of the entire solar panel system.
  • Property Tax Abatement: the Alabama Tax Code provides property tax abatement for qualifying facilities that use renewable energy. 
  • Net Energy Metering helps people save some money on their electricity bills when they send electricity produced from their solar panels back to the grid. 

Policy Watch: The Impact of Eliminating Grocery Sales Tax

February 14, 2021 | Kimberly Randall, LHC Program Coordinator 

Photo Courtesy of Getty Images 

Background 

For almost two decades, Alabama policymakers have debated whether or not to remove the sales tax on groceries. Currently, sales tax on groceries accounts for nearly $500 million in state revenue from a 4% sales tax, earmarked for education spending. Additionally, in many cases, local taxes are added to the state tax, making the total grocery tax as high as 11% in some areas of the state. According to Alabama Arise, Alabama is one of three states in the nation with no tax breaks on groceries, and the 4% markup accounts for as much as two weeks’ worth of food for a family.

While Mississippi currently holds the highest grocery state sales tax rate in the nation, other surrounding states such as Georgia and Florida have eliminated sales tax on most groceries. Overall, 37 states have eliminated sales tax on groceries, while ten have a reduced sales tax. In addition to the sales tax rates, food costs are increasing overall. According to a report by KPMG, average consumers are seeing increases of up to 20% on prices at the grocery store, compared to 2019. 

Proposed Legislation 

Currently, two bills are being discussed to eliminate the state sales tax on groceries. House Bill 174, proposed by Representatives Holmes, Hanes, Meadows, Wadsworth, Fincher, Mooney, Wingo, Kitchens, Howard, Warren, Drummond, Paschal, Whorton, Sorrell, Wheeler, Brown (K) and Shaver, reads: 

“Under existing law, the state imposes sales or use taxes upon certain persons, firms, or corporations. Sales of certain items are taxed at a reduced rate. Sales of other items are exempt from the taxes. This bill would exempt sales of food from the sales and use taxes beginning September 1, 2022.” 

Meanwhile, House Bill 173, proposed by Representatives Holmes, Fincher, Wingo, Meadows, Paschal, and Mooney, also eliminates the sales tax on groceries but offers an alternative funding method by way of state income tax to make up the budget deficit earmarked for education. 

“This bill would exempt sales of food from state sales and use taxes beginning January 1, 2023. Under existing law, individual income taxpayers are allowed to deduct the amount of federal income taxes paid or accrued within the year. This bill would amend Amendment 225 to the Constitution of Alabama of 1901… [to] limit the amount of federal income taxes paid or accrued an individual income taxpayer can deduct to a maximum of $4,000 for individuals filing as single, head of household, and married filing separately and $8,000 for individuals filing as married filing jointly.” 

Impact

Reducing the amount of taxes for necessary purchases, such as groceries, has been shown to significantly impact the health of households falling below the poverty line. According to Zheng et al. (2021), states which impose income tax on groceries tend to see higher levels of food insecurity, which disproportionately affects lower-income households. In states with a sales tax rate of 4%, the probability of a household experiencing food insecurity rises 3% compared to states without a tax rate. 

Additionally, sales taxes on groceries correlate to higher rates of obesity. A recent study published in the Health Economics Review found that “Counties with grocery taxes have increased prevalence of obesity and diabetes [and] estimate the economic burden of increased obesity and diabetes rates resulting from grocery taxes to be $5.9 billion.” 

The main difference between the two bills comes from funding. HB174 allows the state sales tax to expire without a plan to replace the lost revenue for the education system. However, lawmakers have stated that the Education Trust Fund has seen an increase in recent years, and the ability to cut taxes overall could be beneficial for the state as a whole. HB173 creates a limit on the amount of federal income tax that individuals can write off on their state income tax filing, ultimately only increasing taxes on individuals falling in the top 5%.

According to an analysis from Alabama Arise, the income tax proposal would offer a tax cut to the majority of Alabamians. 

Next Steps  

The Alabama Legislative Session is currently underway and will continue for several months. Both bills are currently being discussed in committee and have not yet gone to a vote. If you want to make your voice heard on this or future legislation, click here to identify your elected officials. 

Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials. 

Stay Informed 

Want to know more? Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty, has officially endorsed HB173 due to the impact of removing the sales tax without jeopardizing the state’s education budget. 

 

A Conversation with Dr. Eri Saikawa

February 24, 2022

The Lister Hill Center for Health Policy recently hosted Dr. Eri Saikawa for a seminar on climate-smart agriculture and the impact of urban gardening on public health. Dr. Saikawa’s research includes evaluating the impact of fertilizer on air quality and how heavy metal toxicity in the soil of formerly red-lined neighborhoods has public health implications on the communities of Atlanta.

Q&A

When we’re talking about heavy metal toxicity and urban gardening from a policy perspective do you think it’s more important to focus on mitigation or prevention?  

I definitely think prevention. There is so much we can be doing to prevent exposure, and that’s why I think we need to be pushing for more urban testing so that we don’t put kids into unnecessary exposure. After the fact, it’s usually too late. So these lead exposures, as I understand, once you are exposed you are exposed. We really need to do a much better job to prevent that situation

Slag dumping in neighborhoods causes high levels of lead. Are there any local or federal bills to prevent the dumping of slag in residential areas? Are there any in progress and how can we support them if so? 

This is a very good question. So, the problem with the slag dumping is that it happened a long time ago before there was legislation to prevent it. We believe that this might have happened in the 60s or so, and at that time they were considered to be non-toxic materials. That’s why they use that as the fundamentals of buildings. What we are seeing is that the EPA is working to clean up [and reduce the metals in the soil]. They told me that sometimes they’ll dig eight feet down and they were still seeing slag, and so they decided that they cannot go any deeper.

In so many places, they dumped so, so much. Now they’re only digging up to a foot or two, and I think this is a very big problem as well. I think it is pretty prevalent in many different places, too, so how can we figure out the history. I just wonder if that’s because of the low-income neighborhood, we don’t have enough history like historical documentation on why was that area chosen [as a dumping site]. Because of that, we cannot tell from the existing documents that we could find.

How can you test lead levels in your backyard before planting a garden? If you find high lead levels, what do you do next, and how can you decrease those? 

In Georgia, what we started doing is called the Community Science Soil Shop. We have collection boxes in different parts of the greater Atlanta area [to drop off soil samples] and then we allow people to send in the soil samples to our lab. We have a video that shows how to collect soil samples, dry them, and then they can either ship them or drop them off. Then we would analyze them for free and then give them the results. These are just screening so it’s not the full testing because we’re not saving them but I think that’s a good way to know if that might be contaminated to look into it more.

But the second question is more important. What can you do once you know that it is contaminated? So I think this is also a problem on why people are not really willing to test. In the state of Georgia, if you find that there is lead in your soil then you have to disclose that if and when you want to sell your house. There have been several people that tell me that they found slag in their backyard, and when I asked them if we could go and take soil samples to figure out the lead levels they would say no because they want to make sure that their home value is not going to be impacted. So that’s a problem.

Another thing though is that cleaning up can be very expensive. So if you dig, that’s the best way, but it would cost a lot of money. We have community partners asking if we can use hyperaccumulator plants as a way to take up [some of the heavy metals] so we did some testing with sunflowers, peas, and Chinese cabbage. We saw quite good results from Chinese cabbage and peas but [the heavy metals] went to the edible parts. We did these experiments in the greenhouse, but we are worried about actually doing the experiment in the field in the case that people come and then start eating them and get exposed.

There is no good way in a cost-effective manner [to treat soil] and that is a problem. But you can do easy things [to prevent exposure] like washing hands, for example, and making sure if you have pets they wouldn’t be going into the garden and then coming back with their dirty feet everywhere in the home.

When it comes to climate change policy there is a lot of finger-pointing between industry and individual action. In your experience working with agriculture, which is more important, and what individual actions can we take that are going to make the biggest amount of difference? 

I get asked that question a lot, and I do think that we need to be pointing at the industry. Ninety percent of the emissions are potentially coming from a very small number of industries, and if they are not going to do anything then nothing is going to happen. I don’t want to say that individual actions are not important, but I do think that the companies that are really burning a lot of fossil fuel need to stop. Otherwise, even if we do everything we can, that’s not going to stop climate change.

That being said, the individual efforts to really voice concerns to push the government and also the industry to take action is important. We see that a lot from the youth movement, and I think they are the hope. They have shown how that’s possible and how that could work, so I think we need to do that more.

Does a yard contaminated with lead have impacts for children other than eating food grown there? 

The biggest impact that you would see is actually the kids eating the soil, either consciously or unconsciously. There are kids with certain behaviors or disorders that would really want to eat the soil, and that is the biggest worry. I think it can also be airborne, too. If you’re running around in those highly-contaminated areas, then you can breathe in the lead particles. It’s not just about eating the food that’s grown in those contaminated soils.

Learn More

Want to learn more about Dr. Saikawa’s work? Check out these recent publications.

Invited Perspective: Assessing the Contaminant Exposure Risks of Urban Gardening: Call for Updated Health Guidelines

The terrestrial biosphere as a net source of greenhouse gases to the atmosphere

Global soil nitrous oxide emissions since the preindustrial era estimated by an ensemble of terrestrial biosphere models: Magnitude, attribution, and uncertainty

The impact of cold weather on respiratory morbidity at Emory Healthcare in Atlanta

Keeping in Touch

Follow Dr. Saikawa on Twitter!

More information on the Atlanta-based soil contamination investigation can be found at https://atlsoilsafety.com/

Be sure to check out her podcast, AmpliFIRE, which aims to equip listeners to accelerate climate action by providing accessible information; amplifying diverse voices; and highlighting the intersections of environmental issues.

Policy Review: Climate Change Initiatives in the Deep South

March 14, 2022 | Anushree Gade, LHC Intern

Chimneys smoking
White smoke is pouring out of the chimneys of the power plant.

BACKGROUND

Last year in late October and early November, we saw many news articles pertaining to the Glasgow Climate Change Conference. Counties across the world are collaborating with one another to address the international crisis of Climate Change. At the Glasgow Climate Change Summit, 151 countries submitted climate plans for emission reduction in order to maintain their goal of preventing temperatures from rising more than 1.5 degrees Celsius. Furthermore, there was also an agreement to significantly reduce coal consumption as it serves as a major source of CO2 emissions. It is important to note that developing countries lack funds to adopt sustainable practices. Developed countries have agreed to financially aid developing countries.

INITIATIVES/POLICIES

It’s imperative to address climate change on an international level as it is a global crisis. However, what are we doing as a nation to be mindful of our contribution to this crisis? Recently, President Biden announced plans to reduce the United States’ greenhouse gas emissions by 50-52% by 2030. The United States is a major source of greenhouse gas emissions. In 2019, the United States emitted 6,558 million metric tons of greenhouse gases. Greenhouse gases contribute to global warming as they trap heat in the atmosphere and cause atmospheric temperatures to increase. Increasing greenhouse gas emissions has been a major cause of the observed global warming. Therefore, Biden’s plan to decrease greenhouse gas emissions comes with importance. Furthermore, the US has vehicle and aircraft emission standards set in order to ensure that greenhouse gas emissions are regulated. To learn more about these emission standards, click here. To learn more about greenhouse gases, click here. 

Did you know?

Health effects of Climate Change include, but are not limited to:

  • Heat-related illness
  • Respiratory illness (i.e. asthma)
  • Water-borne diseases
  • Noncommunicable diseases
  • Malnutrition

To learn more, visit this link. 

         You have probably heard about the Environmental Protection Agency’s (EPA) Clean Air Act. The Clean Air Act was first introduced in 1955, however, the act introduced in 1970 is the one that is most often referred to as the Clean Air Act and was one of the first policies that pertained to climate change. This act is one that “regulates air emissions from stationary and mobile sources.” The Act also sets deadlines for state and local governments to achieve the goals set forth by the Act. There are more components to the act that you can explore here.

         We have discussed initiatives and policies targeted at climate change on the national level, but what are some ways climate change is being addressed at the local level? One way in which this is being done is that local and state governments are adopting standards in alliance with national standards to address local power plants and vehicle emissions. Additionally, there are various organizations that are aiming to address climate change from the local level. A primary example of such an organization is the Greater-Birmingham Alliance to Stop Pollution (GASP). They are an organization based in our city. GASP came about in the late 1960s when there was resistance to the ideals set forth by the Clean Air Act. This organization advocates for clean air policies right here, in Birmingham. GASP played a significant role in exercising the Act in Birmingham. 

TAKING ACTION

The Lister Hill Center for Health Policy recently hosted a seminar with GASP discussing the Birmingham Green New Deal and how to get involved in local advocacy with climate change called Local Action: How the Urgency of Climate Change is Impacting Birmingham. GASP is a non-profit climate advocacy center dedicated to creating cleaner air for the city of Bimringham. A full recording of the event is available below. 

 

Policy Watch: Alabama Lawmakers Propose Mandated Mental Health Professionals in K-12 Schools

March 17, 2022 | Kimberly Randall, Lister Hill Center Program Coordinator 

Cutout of a head with puzzle pieces in brain

Image Courtesy of Getty Images

Background 

In 2009, the Institute of Medicine compiled a report that recommended local and state governments develop a system to increase access to resources for students for the prevention and treatment of mental, emotional, and behavioral disorders. A year later, the state of Alabama created the School-Based Mental Health Coalition, a subsidiary of the Alabama Department of Mental Health. The agency’s goal was to bridge the various government offices such as the Department of Education and Department of Public Health to ensure that students enrolled in public K-12 schooling had adequate access to adequate mental health intervention, treatment, and prevention services. 

Currently, there are 80 school systems statewide collaborating with just over a dozen mental health agencies to refer students for professional services. The program was expected to increase attendance, reduce the frequency of administrative corrections like suspensions, and integrate mental health practitioners into students’ lives. 

However, the program is not currently statewide, only accounting for 57% of school districts. While the state does offer some funding available for schools to partake in the program, often, the local districts are responsible for a portion of the cost, limiting the ability for poorer districts to join. 

Proposed Legislation 

Senate Bill 306, proposed by Sen. Rodger Smitherman (D-Birmingham), works to establish a minimum set of requirements for a certified mental health services coordinator and mandate that at least one position be required in all school districts within the state. The bill would go into effect with the 2023-2024 academic year. 

The coordinator must have one or more of the following qualifications: 

(1) Have a bachelor’s degree in social work. 

(2) Satisfy State Department of Education qualifications for a school counselor. 

(3) Satisfy State Department of Education qualifications for a school nurse. 

(4) Have professional mental health experience, or have been licensed in a mental health occupation including, but not limited to, licensure as a licensed professional counselor or marriage and family therapist.

(5) Other qualifications as determined by the Alabama Department of Mental Health and the State Department of Education.

Additionally, employees have one year after being hired to complete a certification program developed and implemented by the Alabama Department of Mental Health. 

The legislation also outlines an implementation plan to enact the bill, requiring each local board of education to complete a needs assessment report and a resource map for all public schools in their jurisdiction. These documents are intended to document the status of mental health for the entire school system and create a baseline on which to improve once the program is implemented. 

While the bill does not specify that school districts must join the School-Based Mental Health Coalition, there is substantial overlap between the legislation and the purpose of the SBMHC. 

Impact 

According to the World Health Organization, mental-health-related disabilities are a leading cause of mental health issues worldwide, with over ⅔ of patients receiving no or inadequate treatment for those conditions. Rates of depression have risen almost 50% in the last ten years, but access to mental health services has remained stagnant. Weare and Nind (2011) state that “childhood and adolescence provide key opportunities to develop the foundations for mental health and prevent mental health problems, and the school is a unique resource to help achieve this.” School-based services such as counselors and caseworkers have been shown to positively impact mental health prognosis in children and teens.

Multi-tiered systems of support (MTSS) are integral to providing proper support to students utilizing a school counselor, social worker, or psychologist. MTTS methods often utilize universal intervention as the primary mechanism for identifying at-risk students, primarily through widespread behavioral testing across the student body. A second tier, narrowed intervention, focuses on a select, smaller unit of students who may be at risk or suspected of behavioral disorders and includes increased monitoring and small-group counseling sessions. Lastly, the final stage of MTSS is an individualized plan of action which may consist of: 

“(a) conducting a functional behavior assessment and developing an individualized behavior plan; (b) direct student-level mental health services provided by a counselor, school psychologist, or school social worker; (c) additional coordinated mental health services with community agencies; or (d) possible identification for special education.” 

However, there can be a substantial delay in getting students access to necessary psychiatric and behavioral resources, negatively impacting mental health outcomes. A study completed by Guerra et al. (2019) found that the presence of a mental health services coordinator was vital to creating an environment that supports mental student health and learning. While there is no accessible data in the state of Alabama correlating improved health outcomes with mental health service coordinators, broad-scale investigations have shown a substantial impact on overall mental health outcomes across districts. The legislation would ensure that coordinators employed in every school district help streamline the processes to get students the help they need. 

Next Steps 

The Alabama Legislative Session is currently underway and will continue for several months. SB306 is presently being discussed in committee and has not yet gone to a vote. If you want to make your voice heard on this or future legislation, click here to identify your elected officials. 

Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials. 

Stay Informed 

Want to learn more? Several state agencies are dedicated to mental health resources in the state, such as the Alabama Department of Mental Health and its subsidiaries, the National Alliance on Mental Health, and the Youth Services Institute. 

Additionally, check out these previous publications that the Lister Hill Center has released about mental health services in Alabama: 

Policy Review: Analyzing Alabama’s Efforts to Improve Mental Health

Policy Review: Medicaid Expansion’s Impact on Mental Health

Policy Review: Student Mental Health at UAB