Steve Sartino – Page 5 – Lister Hill Center for Health Policy

Unintended Consequences: COVID-19 Policy

May 8, 2020 | Sean McMahon and Sara Harper, LHC Staff

The COVID-19 pandemic seems to have launched us into the great unknown. It’s hard to predict what will change in the world outside the safety of our homes. While news outlets are operating a constant stream of pandemic-related updates, there are other changes going on that don’t make as many headlines. Even in normal times, every policy change leads to unintended consequences, side-effects of the change that are not in line with the goal of the policy. Stay-home orders have certainly slowed the spread of SARS-CoV-2 (the novel coronavirus which causes COVID-19), but what else have those orders done? We’ve rounded up some of the news of the last two months that may be side-effects of staying at home.

Excess Deaths

Using data from previous years, the CDC uses statistical modeling to calculate “expected deaths” across the country on a weekly basis. “Excess deaths” is the difference between observed deaths and the expected number. Of course, with over 75,000 COVID-19 deaths in the United States, we would expect roughly that same number in excess deaths. However, in several cities and states the number of excess deaths is larger than their COVID-19 deaths. Death certificates are often submitted without a cause of death with the intention of later completion, so the particular causes can’t be teased out just yet. These deaths stem from a number of possible factors: people may be avoiding healthcare facilities, foregoing medical treatment; people are struggling financially, possibly unable to afford necessities; food insecurity is on the rise. We won’t know exactly what is causing the excess deaths until we have more complete data from death certificates.

Primary Health

On the other end of the healthcare spectrum, a survey of 2,000 primary care physicians reported that approximately 20% predict they will be forced to close within the coming weeks. Privately owned primary care clinics typically operate as small businesses, which have taken a massive blow during the COVID-19 pandemic. Patients aren’t engaging with primary care as we quarantine within our homes, and in consequence, we may see a surge in preventable illnesses in the coming months. Of course, with fewer patients, fewer primary care offices have the resources to remain open. When we emerge from this crisis some families will be left without a primary care physician. Primary care losses can impact treatment access for other deadly diseases like routinely screened cancers, as most treatment referrals come through primary care physicians. Already, lockdowns have resulted in an 86-94% drop in routine cancer screenings and a 60% decrease in chemotherapy attendance.

Mental Health

“Are we required to wear masks or not? Are we still seeing 3,000+ deaths a day? All my hometown Facebook friends are posting conspiracy theories. Working from home is not as great as I thought it would be.”

Uncertainty can be hard to deal with. Things are changing so quickly that it’s difficult to keep track of what’s going on. Overall, it seems that mental health and our support systems are taking a hit around the world. Isolation can be a trigger for suicidal ideation, panic attacks, depression, and several other concerns. US alcohol sales spiked at the beginning of the crisis, and “problem drinking” is on the rise in the United Kingdom. Our support systems are also on the rocks. Drug users across Europe cannot access their opioid substitutes and other treatment services. With support groups held online with virtual platforms, participation and accountability may be lower as well. A lack of readily available support services coupled with an economic downturn has led to an increase in deaths from drugs, alcohol and suicide; or what researchers call “deaths of despair”.

Economics

Image of Lucy’s Coffee & Tea. Image from the shop’s Facebook page

Of course, ordering businesses to close has dealt a major blow to the economy. To mitigate this, Congress passed the CARES Act in late March. This $2 trillion stimulus has proven too little, too late in some cases. As of the writing of this blog post, 33.5 million people have filed for unemployment as a result of the pandemic. Over 7 million small businesses are at risk of permanently closing their doors. Several small businesses across the country have already been forced into this. Much to our dismay, Lucy’s Coffee & Tea has shut its doors for good. While some community favorites are forced out of business, other companies find themselves in a position to turn a profit by raising prices on everyday items. Texas Attorney General Ken Paxton, along with a group of individuals in California, has filed a lawsuit against the country’s largest egg producer for price gouging in the midst of a pandemic.

Environment

Not every unintended consequence of stay-home orders has been detrimental. Air quality in the world’s major cities has improved since the lockdowns started. Some cities have seen particulate matter 2.5 (PM 2.5) levels decrease by 60%. This drastic change has increased breathability and visibility in normally crowded cities; quite noticeably in New Delhi. These PM 2.5 declines are beneficial to the environment and human health in general. Lower levels of air pollution also could help fight the novel coronavirus, according to a study from Harvard that found increased susceptibility to COVID-19 in those who have been chronically exposed to high levels of PM 2.5. Air quality will continue to change as countries reopen their economies, hopefully with an increased awareness of sustainability. The National Oceanic and Atmospheric Administration is set to conduct its own studies on the environmental effects of stay-home orders.

New Delihi’s India Gate war memorial on 17 October 2019 and on 8 April 2020. Photograph: Anushree Fadnavis/Adnan Abidi/Reuters

More Speculations:

Re-opening strategies put communities of color at greater risk

Some domestic violence aid organizations are worried about a drop in reports, a sentiment echoed by the UN Secretary-General.

Some people may be grappling with a “Quarantine 15,” as physical activity decreases and calorie intake increases.

Experts predict a rise in tuberculosis cases as a result of lockdowns’ impact on treatment and mitigation efforts.

The State of Menstruation

May 20, 2020, | Sara Harper, LHC Student Assistant

Humor me, if you will, and think back to the first time you learned about periods. As I was entering the dreaded “tween” years, my mother pulled me aside for yet another “big girl talk,” conversations about impending physical and social changes in my life. I didn’t learn much about my period that day. However, I did gain a sense that it was not something I should openly talk about. I learned I should hide my period because even the idea of menstruation could make others uncomfortable. Queue many years of figuring out the best way to grab a tampon or pad and get to the bathroom without suspicion…

Even as an adult, this needless taboo is still deeply ingrained in me. In honor of the upcoming Menstrual Hygiene Day, I have decided to write this blog to coax myself and readers out of our comfort zone and examine how shame, culture, and money can influence menstrual hygiene around the world.

Barriers in the US Education System

Beyond parent-child conversations, learning about menstruation can happen in biology or sex-ed courses taught in some schools. However, only 29 states in the US require sex education in public schools. Each school decides the degree to which they choose to teach sex-ed and only 13 states mandate the information to be medically accurate. Therefore, if an institution believes menstrual education is unnecessary, entire cohorts of students graduate without comprehensive knowledge on an essential part of sex education. Without proper education, some youth may only be able to refer to their peer’s anecdotes about their menstrual experiences. Others refer to the internet for answers or even struggle in silence for months before asking for help managing their menstrual hygiene.

Image credit: University of Southern California Department of Nursing

Economic Barriers

Mandatory sex education remains a challenge to achieve in every country, but inequities in education and hygiene access can lead to higher rates of “period poverty” in some populations. Period poverty is a concept that includes lack of access to both menstrual hygiene products and educational support for those who menstruate, which can lead to social and economic consequences. Even in countries that have adequate menstrual hygiene supplies, cost can be a barrier to proper menstrual hygiene. In the US, 35 states place a tax on period products because they are not considered to be a necessary expense. Additionally, neither SNAP nor WIC cover these products, leaving some to resort to using absorbent materials like toilet paper or even clothing.

Culture of Shame

Starting the conversation about menstrual hygiene has become a public health initiative around the world, most notably in low- and middle-income countries where there is the greatest opportunity for positive growth. Researchers note a “culture of silence” in Uganda around the idea of discussing menstruation and an overall lack of support services in schools and families in Kenya. East and Southern African taboos restrict girls from touching water, cooking, attending religious ceremonies, or participating in community-wide events while they are menstruating. Some Nepali communities still practice the custom of sending girls to live alone in unheated, unprotected Chhaupadi huts, far away from the rest of society. This custom is by far the most isolated and dangerous measure I have come across while researching, sometimes even leading to the death of the menstruating woman. These taboos perpetuate a culture of shame and misinformation that negatively impact the health of those who menstruate as well as the children who rely on them. Maintaining an open and bilateral conversation about menstruation can diminish the mysticism and shame that clouds the opportunity for necessary education.

Girls’ club members discuss menstrual hygiene at school in Sheno, Ethiopia. Several schools in the region launched clubs like this one as a way to tackle the problem of girls dropping out because of shame and discomfort around the topic of menstruation. The goal is to replace silence and misconceptions with open discussion and information. © UNICEF/UN064418/Tadesse

Gender Achievement

Keeping girls in school is one of the most effective ways to promote positive growth within a country. Educated women have the ability to find jobs and create their own stream of income, making them less dependent on male counterparts. Women with primary education typically have fewer children and are able to increase their family’s quality of life. However, many pubescent girls in Sub-Saharan Africa find themselves missing school due to their lack of menstrual hygiene education and resources, further widening the gender achievement gap. In extreme cases, some girls will participate in transactional sex to obtain money to buy sanitary towels so that they can continue to attend school. Schools that provide adequate menstrual support are giving their students the dignity and autonomy to manage their own menstrual hygiene and avoid unnecessary absenteeism.

Positive Steps

Non-governmental organizations around the world are working to make inequities due to menstrual hygiene a thing of the past. The organization behind Menstrual Health Day (May 28) raises awareness through sale and donation of menstruation bracelets. These bracelets can be used as period trackers to help young people stay aware of where they are in their cycle in the absence of other tracking resources. Wearing the bracelet signifies that you are refusing the stigma around periods and standing in support of improving menstrual health across the globe. Grassroots groups have seen improvements just by creating girl’s clubs that provide a safe space for youth to voice their questions and concerns without fear of being shamed. Some schools have found success in simply switching girls’ uniforms to darker colors in order to prevent possible staining. Improving menstrual hygiene can help achieve up to six of the Sustainable Development Goals and increase the overall quality of life for those of us who menstruate. These successes prove that menstrual health equity is possible with the correct supportive measures in place.

Reflections on Jury Duty and Civic Obligations

September 26, 2019 | Dr. Suzanne Judd, LHC Director

A few weeks ago, I had that wonderful American privilege of being selected for jury duty to the 10th Judicial Circuit Court of Jefferson County, Alabama. I say “wonderful” tongue-in-cheek since, like most of the people I was chatting with in the Jury Assembly Room, I had no desire to be there. Parking was a nightmare. They simply don’t have enough spots for the 400 jurors that were summoned to downtown Birmingham for the shot at being selected to sit on a jury. This was my second time in three months coming on a Monday morning to wait to see if I would be selected for a jury. Three months prior, I was dismissed because I had not lived in Jefferson County continuously for a year due to a six-month commitment in France. The disqualification didn’t make sense to me. Luckily, I was back 90 days later to try again. And this time, it was even better because Law & Order was on the television to keep me entertained while waiting. No lie!

Before jury selection began, we sat through a 30-minute explanation of what a great honor it is to be selected as a juror. The judge described how unique we are as Americans to be allowed to serve as jurors. In most countries, citizens do not decide the fate of other citizens. He described the jury selection process in Alabama, which is basically tied to being a registered voter. Really? Given all we know about voter suppression in Alabama, one can only assume the same factors affect the juror selection process. This was a fact that was tough for this former Michigander to digest since Michigan uses driver’s license lists to generate juror pools.

As I sat looking around the room, I wondered why I can’t, as a voter, be randomly selected to sit down with lawmakers for a week to express ways to improve society rather than sitting here waiting to be selected for a jury. My registering to vote enables me to sit on a jury to decide another human’s fate but does not provide me with the random chance to meet with the people for whom I voted? Honestly, I would rather sit down with one of my elected officials for one week. Nevertheless, I suppose jury service is important even if that means sitting and waiting.

Since I spent hours waiting, I began to meditate on the process for influencing elected officials to create and implement policies. At times it can seem like citizens don’t have much input. We can call, write, or email our representatives but that always seems so impersonal. Layers of bureaucracy obscure the tangible results of those efforts. If we want to occupy the same space as a candidate, there are town halls and debates but often those feel staged, lacking a real human connection between you and the candidate or elected official.

So where does that leave the average American who wants to be more involved? Advocacy is one of the key tools to ensure the laws our elected officials pass and the ways in which they spend our collective money are more representative of what we want as a people. Beyond simply contacting elected officials, an individual can advocate for their opinion by signing petitions, funding advocacy groups, and constantly pursuing information to stay educated about a variety of topics that face society. Advocating can lead to policies that mold society into something that is more reflective of what the majority of people would like to see.

On the upside, jury duty begrudgingly provided me with needed time and space away from the daily grind to think my own role in influencing laws and policies. I also began to wonder what was on the mind of others. So, in the absence of a random lottery system that grants me access to my elected officials, here are some areas of health policy that seem quite timely:

What are you doing? Let us know; we would love to hear from you.

AL Public Service Commission Hearing for Solar Reform

December 2, 2019 by Sara Harper, LHC Student Intern

Thursday, November 21, I attended the Alabama Public Service Commission’s public rate hearing on Alabama Power’s fee on solar producers. Alabama Power charges solar users who are plugged into the “grid” $5 per kW of energy they produce. The idea behind the fee is to cover the costs of solar-users who draw supplementary power from the grid during non-productive hours. However, the fees erase most savings that solar producers would be getting from switching to renewables and make recovering the cost of installation difficult. GASP, represented by the Southern Environmental Law Center, and Energy Alabama requested the hearing, testifying that the stand-by fee is unnecessary, discriminatory, and has impeded upon Alabama’s solar progress for years.

The inside of the courtroom was representative of the greater issue we were there to discuss. People of all ages and races filed in until the space became standing room only. Supporters of the cause sported a sticker reading “Let it Shine” emblazoned with a bright yellow sun. Once the stickers were passed out to those willing, it was easy to discern there was a greater majority of “pro” than “against”. Advocates of all demographics exemplified that Alabama Power’s monopoly is a bipartisan issue that concerns all of Alabama’s residents.

On the other hand, the current public service commission seems entirely partisan, all three of its members being part of the Republican Party, and was moderated by an agitated Administrative Law Judge John Garner. Alabama power was represented by one lawyer and Team Leader of Regulatory Costing, Natalie Dean. The whole scene conveyed that Alabama Power was not intimidated by their challengers and the legislators were annoyed to be pulled into work so early in the morning (the hearing was scheduled at 9AM to deter public engagement).

Alabama Power, backed by the Public Service Commission, continues to force Alabamians to pay some of the highest solar rates in the US. Throughout the course of the day it was easy to tell that the Public Service Commission was not interested in the minutia of the hearing: one example of this being Judge Garner and Commission chair Chip Beeker exchanging phones and giggling to themselves on the stand while the SELC was cross examining Natalie Dean. A blatant example of misuse of power was displayed when Judge Garner disrupted a testimony to order the bailiff to remove anyone filming the hearing from the courtroom. Several audience members, all adorned with sunshine stickers, were removed from the courtroom; most notably Kari Powell, who has run for a Public Service Commission seat in the past. This removal was unconstitutional and those several who were removed were prepared to show the bailiff the exact legislation that defended the legality of their recording. The recordings were an attempt to make the “public” hearing accessible and keep Alabama Power and the Public Service Commission accountable for what was discussed, despite the two entities being involved in controversial a smear campaign a few years prior.

An official decision on the fees was not made on the 21st. Both parties have until December 20th to submit their final orders and a decision will be made after that. The odds seem stacked against the Alabama advocates for solar energy; however, an appeal of the case could be sent to the United States Supreme Court.

Built Environment Symposium Re-Cap: Four Perspectives

November 21, 2019 | LHC Team

Each Fall and Spring semester we focus in on a public health topic to encourage policy action among our stakeholders. We call this our Semester Spotlight. This Fall was our first semester rolling out this program; we decided to start with the Built Environment. As our city continues to grow and re-develop, we hope to spark conversations about how the environment we build affects the public’s health.

This semester, we hosted a number of seminars centered on this issue, and decided to top it all off with the Built Environment Symposium – a six-hour meeting highlighting some the work being done both nationwide and here at home. We started the day with Dr. Natalie Colabianchi from the University of Michigan; she spoke about her research on the built environment’s impact on physical activity. Then we moved across the hall for a coffee break, which featured five community partners working on improving the man-made environment. Our Lightning Talks Expo featured six brief presentations about different programs and initiatives both around UAB and elsewhere. After the Expo, Ryan Gravel delivered the keynote presentation based on his book, Where We Want to Live. Gravel is known for developing the initial concept for the Atlanta Beltline, a project that repurposed unused and abandoned rail lines that circled the city of Atlanta into a thriving and heavily used loop of trails and parks around the city. After Gravel’s talk we had a time for networking in which attendees were encouraged to ask any of the presenters more questions about research, policy, and interventions.

We had a full day of learning, inspiration, and networking. Below are the perspectives from the whole team!

Sara Harper, Student Intern

My experience at the symposium as a student was a little different from others’ because I had to balance my time between the event and my classes. During the morning coffee break I manned the Symposium hosts table and provided guests with information about the Lister Hill Center as well as our co-hosts. I was able to tell guests more about the LHC, including our lunch seminars and Semester Spotlights. In addition, an organization I’m active with, We Envision Alabamian Renewable Energy (WEARE), participated in the tabling event. It was a beneficial experience to be able to easily network and share the projects we have been working on.

The part of the symposium I found the most impactful was being surrounded by a group of like-minded individuals, all in differing levels of the professional and academic world. Every person who attended the event was there because they care about improving and learning about the built environment. The Symposium fostered a creative space for myself and other attendees to discuss our own experiences with research, work, and advocacy. The Built Environment Symposium left me in a productive mood, energized by the atmosphere we were able to create.

Sean McMahon, Outreach Coordinator

I am incredibly proud of our work this semester, especially the Built Environment Symposium. We began planning this event in May, an entire six months before the event itself. Without the input of our co-sponsors (Institute for Human Rights, Environmental Health Sciences, UAB Transportation & Sustainability) we wouldn’t have even known where to start. We also couldn’t have gotten the word out to such a broad audience without the help of the Freshwater Land Trust.

What I was the most impressed with last Tuesday was the conversations. One of our major goals for this Symposium was to get people talking to each other about ways to collaborate and come together. Not only were people from different groups doing just that, they were speaking up and asking important questions. I’m so happy that we were able to bring together a hundred people from diverse backgrounds and get them to speak to one another about an issue that’s so important. Also, I’m excited to see what else we can do as a Center in the future!

Ariann Nassel, Director of Geospatial Data Visualization

As the newest member of the Lister Hill Center for Health Policy team, I was looking forward to the inaugural Semester Spotlight event. I was happy to learn that the topic for this year’s symposium was the Built Environment. I have been involved in a number of projects looking into the effects of the built environment on both individual and public health during my tenure in the UAB Center for the Study of Community Health. As someone new to the Center, I was thrilled with the robust turnout and the range of backgrounds and interests of those who attended the event as well as the insightful feedback during the Q&A at the end of the symposium.

I was impressed by the insightful views that the Symposium’s two main speakers, Ryan Gravel and Dr. Colabianchi brought to the table regarding the interaction between health, place, and most notably the built environment within which each of us interacts daily. Lastly, as a person who designs maps on a daily basis, I was thrilled to see that in addition to the engaging and map-filled presentations of the two main speakers, each of the six Lightening Talk presentations featured maps that helped concisely visualize and highlight how location and our built environment impacts our Birmingham community and surrounding environs. The event facilitated the interaction of city, academic, and community partners in a way that encouraged engagement and creative brainstorming that will help move forward the discussion of how thoughtful and collaborative planning can reshape the environment we live and share.

Suzanne Judd, Director

The Built Environment Symposium provided many different views from those of a city employee, to an academic, to a non-profit, to a community member. From an academic perspective, Natalie Colabianchi challenged the room to consider how changing parks may change the way they are used and Jeff Walker, Chair on Criminal Justice at UAB, encouraged the audience to think of maps as more than just a way to display data. Both provided data that was incredibly complex but valuable for city planners.

The room was full of energy all day with many people hoping to see more thought given to intentional city change. This made Grace Graszer’s presentation incredibly relevant. Understanding the way Atlanta is providing loans to developers that work with the community to maintain local character is a novel way to consider changing neighborhoods. Policies such as this one may help Birmingham to maintain affordable housing. Ryan Gravel left the audience with many things to think about in terms of how people are displaced and what it means to move from concentrated poverty to dispersed poverty. These are complex societal issues that will need to be thoroughly evaluated and require a solution that brings together many of the diverse partners that were at the symposium. The symposium provided more questions than answers but started a conversation that will hopefully continue at UAB and Birmingham for years to come.

We want to thank everyone who joined us for the Symposium! We hope you enjoyed your time with us and you learned a thing or two. Sign up for our monthly newsletter to keep tabs on future events with the Lister Hill Center!

Are there Dental Access Issues in Alabama?

November 4, 2019 | Conan Davis, DMD MPH

Do we have any issues to be concerned about regarding access to dental care in Alabama? Everyone has a dentist who can see them on short notice if they need, right? Wrong.

If you live in Birmingham or in one of the larger cities in Alabama, you might not have a problem being seen on short notice – particularly if you have dental insurance or out of pocket cash for treatment, but if you live in smaller towns or rural areas in our state, you might not be so lucky.

Alabama currently has only one county without a dentist: Greene County. However, about 80 percent of all the dentists practicing in Alabama practice in the 13 most urban counties. The other 20 percent practice in the 54 non-urban counties of Alabama; many of these smaller counties only have between one and three dentists. This translates to about one dentist for every 1800 people in the urban areas, versus one dentist for every 4100 people in the non-urban areas – a big difference.

This is the subject of a paper Dr. Stuart Lockwood and I are developing and hope to publish with the Lister Hill Center for Health Policy in the next few months. Dr. Lockwood and I are both former State Dental Directors with the Alabama Department of Public Health. We both have examined the teeth of thousands of children in Alabama to assess the state of dental decay and to make referrals to local dentists. We have seen many with excellent dental care and many without any need for treatment. However, we have also seen the evidence of neglected dental needs in many children. An even larger concern we have seen is the lack of access afforded to low-income adults with no dental insurance and no public dental coverage in Alabama. We will cover that connected subject perhaps in another post.

Dr. Lockwood and I have been engaged in studying the underlying issues for our widening gap between urban and non-urban areas concerning dental care access for many years. We developed a partnership between UAB School of Dentistry and the Alabama Dental Association to develop a strategy to correct the disparities we found in the more rural areas of the state.

Through this partnership, we wrote and were awarded a grant to do several things in this area. One was to take the available data on dental practices in Alabama and with the help of the UAB School of Public Health develop a GIS map detailing where all dentists’ practices are located in Alabama. The grant also allowed for rotation experiences in rural areas for dental students as a way to allow them to see dental practice life in these areas. We also provided significant financial awards to a few graduating dentists who agreed to practice in a rural area and also agreed to see a certain percentage of Medicaid patients for a specified number of years. Graduating dental students can have very significant school debt, and this was designed to assist them with that debt and help them establish a practice. The grants were planned to help “plant” dental offices in nine rural areas needing a dentist. Nine such practices came about through this grant program and they have successfully continued in those areas to this day.

I’ve worked with Dr. Lockwood and the state dental association on language presented to the state legislature and the Governor’s office for consideration of a similar state-based financial incentive program for new dentists willing to locate in a rural area. We hoped this would also encourage young dentists to choose a smaller town or rural area in which to practice. While all our legislators were favorable to the concept, funding has not been significant just yet. We continue pursuing this possibility.

Another issue regarding distribution of dentists involves the current ages of dentists in the rural areas. We will discuss these findings in some detail in our upcoming paper.

So – to answer the question, “Is it easy to find a dentist to see you on short notice anywhere in Alabama?” – no. However, many of us are engaged about this concern and working towards positive solutions for all Alabamians. We hope to be able to answer my question in the affirmative in the near future!

Conan Davis recently retired from his position as Assistant Dean for Community Collaborations and Public Health at the UAB School of Dentistry. He continues to research the inequities in access to dental care across Alabama.

Environmental Justice: Lois Gibbs

October 24, 2019 | Sean McMahon, LHC Outreach Coordinator and Sara Harper, LHC Student Intern

A few weeks ago the Lister Hill Center for Health Policy co-sponsored a visit from Lois Gibbs, often called the Mother of the Superfund. She guest-lectured in a few classes and met with community members in Birmingham. We had the wonderful opportunity to sit down and chat with Ms. Gibbs over lunch at Lucy’s. We were able to get to know her a bit more and hear about her 40 years of Environmental Justice (EJ) work.

If you missed her, you can listen to the podcast she recorded with the Office of Public Health Practice. You can view Ms. Gibbs’s lecture here.

Conveying Environmental Justice Concepts through Storytelling

We found out very quickly that Lois Gibbs is a woman of many great stories – stories of triumph, direct action, community, and even stories of failure.

Relocating Together or Breaking Apart

Although the abandoned coalmines beneath the town of Centralia, Pennsylvania caught fire in 1962, residents weren’t relocated until 1983. When sinkholes opened in the town and released dangerous levels of carbon monoxide, an act of Congress provided the funding to relocate. Gibbs told us that when the community was relocated, the citizens of Centralia stayed together and each family moved into the same sort of house they lived in prior to the incidents. According to Gibbs, “On one hand, [environmental justice communities] are very excited to get moved out because they needed to get moved out for their health.” But being forced to move from the neighborhood you call home is hard. She continued, “On the other hand they are scared to death, and they really feel that they aren’t going to be able to cope… When they relocate, they lose [a sense of togetherness and community]. They go into a strange neighborhood. They don’t know anybody… It’s really unsettling and I would say that [of the two], the unsettling part is the strongest factor.” While the idea of relocating a community together is favorable, this process played out differently for a generations-old African American community in Pensacola, FL. The EPA proposed moving the entire community together and providing each family with the same amenities they had before their forced relocation. The community loved this idea, but when a lawyer from the Office of Civil Rights called and accused the agency of racism (alleging that the agency was keeping them together to prevent integration into the white communities), they threw out the idea and conducted business as usual, separating the community during the relocation.

Direct Action

During our lunch, Gibbs recounted the exciting story of what she calls an “Environmental Justice SWAT Team” in a town called Wheatfield. The SWAT team would come in the night to fill pipelines with cement, ultimately halting a development project altogether. She purposefully never found out who the perpetrators were, so that she could remain honest when telling the local authorities that she didn’t know. This direct action prevented the development of a polluted area into a neighborhood. Disclaimer: this might not always be the best course of action, but this is what worked in Wheatfield.

Power

Most importantly, she told us stories about empowerment. When a governor wanted to use on EJ community for a PR stunt for his re-election campaign, the community reversed the narrative by asking him: “What can you do for us first?” The organizers would ask the governor to visit them and see the pollution for himself, to which he would respond with an offer for a thirty-minute visit during work hours. Community influence prevailed, and the governor went for a two-hour visit in the evening so that the community members could really meet with him and discuss potential solutions. Time and time again, real change happens when the communities seize their intrinsic power and leverage policymakers. Gibbs continued recounting stories of power as we moved on to different subjects.

Community Organizing: Best Practices

Lois Gibbs founded the Center for Health, Environment, and Justice (CHEJ) in 1981 after her successes in Love Canal, NY to provide guidance to other struggling EJ communities as they fight their own battles. Since then she has served as the principle community organizer of the CHEJ and has aided communities in organizing and pursuing justice. With four decades of experience, she shared with us a few of her rules for engaging with EJ communities.

The 10-90-10 Rule

Often, experts will go into a community and list out what the obvious needs are; they’ve been in EJ communities before and they think they know exactly what it is the community needs. However, this doesn’t always work. Gibbs told us, “every statement you make needs to be in the form of a question as opposed to telling people what they should be thinking.” She explained to us what we’re calling the 10-90-10 rule: community organizing is “10% talking, 90% listening, and 10% flipping what’s been said by asking another question to help them dig deeper.” She said she finds it helpful to start with something as simple as “What do you guys want?” She says, “you’re really trying to create a conversation about what is right, what is wrong, and how you’re going to move forward, and how does it fit into your culture?”

She described a time when the women of a South Carolina community said that if they were to protest it would upset the unspoken community norms and they would be ostracized from their social circles. With a few prompts from Lois they decided to stage a “Save the Earth Parade” instead of a protest because that is what felt the most compatible with their community’s culture/norms. Instead of prescribing what the women should do and being upset with their rejection of the protest, Gibbs asked why and then the women came up with the parade themselves.

Set goals and plan to achieve them

Gibbs reminded us that concrete goals are important before embarking on an EJ journey, “I always advise [communities] to set their goals and always put those goals in front of the room at their next meeting[s]… If somebody says ‘Let’s go do this,’ [they’ll be asked] ‘How’s that going to get us there?’” After setting goals, a community can form a strategic plan by asking questions like, “Who can give you what you want? Who can relocate you? Who has the ability and the authority to do it? How is that person or that agency vulnerable and how do you make them do it?” One group she spoke with recently wanted to have the President visit them to see the pollution for himself; after asking who had a viable contact to make that happen, the group decided to find someone else.

Don’t settle for being an after-thought

Gibbs stressed the importance of refusing to compromise with powerful people at the expense of your community. It may be tempting to have that PR moment with your representative, but never forget “you have the power… [Policy makers] work for you, by the way.” She notes that it is hard to say no to people in power when they give you a nod, “but don’t take the potato chip when you can have the whole potato field.” Utilize your community’s power by refusing to be on stage with them until they agree to do whatever it is you’re asking them to do. If they’re asking you to engage with them for their own image, they’ve given you the power to influence that image.

Say thank you

Most importantly, she said that recognizing people’s hard work is imperative to getting them to repeat the behavior. She reminded us of the carrot-and-stick analogy. “Recognizing people for even the tiniest thing that they do,” makes them, “more eager to do it and turn out, and they’re proud of their work and they have a sense of respect and pride in delivering it.” When she was organizing the Love Canal Homeowners Association, Gibbs would reward her “street captains” with recognition and small drug store trinkets, which she said fostered pride and ownership among the group.

Sacrifice Zones: A Policy to Rewrite the Story

The CHEJ is currently drafting and vetting a policy to improve ambient air quality by allowing communities classified by the EPA as EJ communities to apply for a “Sacrifice Zone” designation – a name coined from the notion that these communities are already sacrificed for the sake of industry. Communities would opt into the program by a majority, which takes the decision out of the hands of the state or county. This policy is about mitigating the effects of that sacrifice, specifically as it relates to air pollution. Here’s a break-down:

To qualify, the community has to fit the criteria for an EJ community, and the cancer risk has to be in the 70^th percentile as compared with the rest of the state.
Upon approval, a four-mile radius is drawn around the polluting industry (or industries). This is the same geographic area covered by EPA superfund sites.
Within that four-mile radius, no industry development can happen – meaning no new industries, new permits, permit renewals, or expansion – until air contaminants have gone down 30 percent. This forces the industries to work together to reduce their emissions – none of them can progress unless they all collectively improve.
Real-time monitors would be placed at polluting facilities that would be accessible to the community in order to increase accountability and transparency of the program.
During this time, health professionals in the area would receive a briefing on the magnitude of chemical releases, the possible effects it can have, and how to recognize those effects in patients. A community wellness van would also be provided to each Sacrifice Zone to assist with primary care and educate the public about exposure symptomology.
Fines on the polluting industries within the Sacrifice Zone would pay for all this, incentivizing local and state governments to fine negligent companies.

CHEJ will vet the program with an EJ community in Houston, Texas this December, with hopes of a second pilot in Mobile, Alabama this coming January. Once vetted with community stakeholders, the policy will eventually be proposed as a federal bill for Congressional review, superseding individual state approval.

“If I was Mayor”

We asked Ms. Gibbs what she would do as Mayor of Birmingham to address the Environmental Injustice that burdens the city. She stressed the importance of economic development as a way to make positive change. In a country where everyone is worried about employment and having their needs met, Environmental Justice must focus on transitioning away from dirty industry by providing jobs in industries that do not emit heavy pollutants. An example Lois gave of this was a community in North Carolina that was repeatedly pressured to accept an incinerator or a landfill in the county, but instead opened a regional recycling facility thanks to grassroots-level pushback. This was an example of a community tackling the incoming waste stream in a way that they could generate profit from it instead of suffer from it. She also emphasized the importance of meeting with our neighborhoods, assessing their needs together with residents, and creating a plan of action that is both inclusive and feasible.

We closed out our conversation by asking what gives Lois Gibbs hope in a constant uphill battle. She said she has hope for the future of Environmental Justice as it is garnering more public attention this election season. It is becoming a national topic thanks to a boost from climate activists and has been addressed by multiple presidential candidates. As we parted ways she praised the community of North Birmingham, “They’re becoming stronger, so that’s the good news!” We look forward to meeting Ms. Gibbs again, and we’ll keep you posted on the Sacrifice Zone legislation!

Ag-Gag: Big Agriculture fighting back

October 11, 2019 | Sara Harper, LHC Student Intern

Three years ago, I got obsessed with where meat comes from. Kip Anderson’s exposé Cowspiracy had come out a few years prior and, while sensationalized, it gave me a passion for something that enveloped environment, policy, and justice. Since then, I’ve written several academic pieces on the factory farming industry and adjusted my purchasing habits away from supporting industrialized farms. Do I sound like PETA yet? Throughout my research I’ve consistently addressed the issue from a human and environmental health point of view, with animal rights being a positive outcome of the latter. My reasoning for this is to steer my point away from sensationalizing the animal cruelty involved, in favor of a health-based approach to this problematic industry.

Quick background: Factory farming, or intensive livestock farming, is a sector of the agriculture industry that relies on overcrowding animals and assembly-line style production in order to maximize meat output. These facilities have large negative impacts on the surrounding environment including: Water source contamination, greenhouse gas production, and deforestation, and so many other issues.

Okay now you’re caught up. These things are bad, right? So, who’s fighting the good fight? Well…

In the past two decades, “Big Ag” has proposed laws in states across the country that criminalize the efforts of whistleblowers in the industry. These laws have been coined “Ag-Gags” because, by nature, they silence those who intend to call out the harm done by intensive livestock farms. Alabama passed their own Ag-Gag bill in 2002, which makes it a felony offense to obtain access to a property “by false pretenses” and to possess records obtained by deception. This law was directly related to an increase in environmental advocates performing undercover investigations on factory farms under the pretense of employment.

So why is this important? The agricultural industry in America is a high grossing source of income and production but is, by all accounts, necessary. However, powerful, money intensive industries like factory farming have little government oversight when it comes to their environmental health impacts. These production facilities are known to under-report incidents like waste spills and romanticize the idea of their farms to consumers. In this industry, whistle blowers in the media and advocacy groups are the only people holding these companies accountable for their actions. Ag-Gag bills seek to make it virtually impossible to report on factory farms in order to reduce the amount of incriminating information leaking out of their facilities.

I know what you’re thinking… “What can I do?” As consumers, it’s up to us to consume responsibly. Using your purchasing power to opt for humanely farmed meat shows that you do not condone the actions of this negligent polluting industry. All in all, the future for defeating Ag-Gags looks bright. As of June 2019, 3 states have declared Ag-Gag policies unconstitutional, ruling that the laws infringe upon freedom of speech and freedom of the press. Seventeen other states have blocked such bills from ever being passed.

Suicide Prevention

September 11, 2019 | Sean McMahon, LHC Outreach Coordinator

September is National Suicide Prevention Month, and specifically this week is National Suicide Prevention Week. A friend of mine recently died by suicide, and since then I’ve been diving into national statistics and prevention strategies.

A month ago, I was at my desk, stumped about what to share on the Lister Hill Center’s Facebook page. This is always an involved process. I’d like to share the new Healthcare Triage video each week, but that would be redundant. I’d like to make another post about Medicaid policy changes, but I’d already made a few. Still deciding, I logged on and the first this I saw was a post from a former pastor of mine, someone my family has kept in touch with for nearly two decades.

Normally, when I log into Facebook to interact as the Lister Hill Center, I quickly navigate away from the home page so that I don’t bring my personal life to my work desk. However, when you see the words “my oldest son has passed away,” your heart jumps a bit and you have to take a moment to investigate. Almost immediately I received a text from my sister to tell me the news. She was with the family. She was with them shortly after they were told that their son had taken his own life.

After a week of going through the motions, I went to be with my family and friends. We had an informal memorial; a funeral wasn’t possible just yet. After another week of going through the motions, I went back for the formal funeral service. Just two months prior, I was taking a policy advocacy course at Johns Hopkins University, crafting a mock proposal (similar to UAB’s annual Global Health Case Competition) for an advocacy plan to decrease suicide rates in India. And now I’m dealing with the very real occurrence of suicide happening within my circle of friends.

Nationwide, a staggering 47,173 people died by suicide in 2017. After adjusting for age, that’s a mortality rate of 14 per 100,000 population. If that doesn’t sound like much to you, just remember that intentional self-harm was the 10^th leading cause of death that year. Alabama’s rate (16.2) is higher than the national average.

Several policy interventions have proven useful in preventing suicide: restricting the means (tighter gun control, regulating certain medications, etc.); integrating mental health with primary care; and enhancing mental health services in general. Someday we’ll find the perfect combination of policies to keep the suicide rate down, but until then there are things we can all do at the individual level to prevent suicides.

If you’re having thoughts of suicide, please take the time to call the National Suicide Prevention Hotline at 1-(800)-273-8255. To learn more about how the Lifeline operates, join this webinar on September 18.

If you want to get involved with prevention efforts, you can volunteer with the Crisis Center right here in Birmingham.

If someone reaches out to you about having suicidal thoughts, listen to them and help guide them towards seeking help. Don’t tell them everything will be fine, and don’t promise to keep it a secret. This fact sheet from the Alabama Department of Public Health has more information about how to help.