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CHILDREN
CHILDREN’S ENVIRONMENTAL HEALTH
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CHILDREN The Unwitting Target of Environmental Injustices Dorothy L. Powell, RN, EdD, and Victor Stewart, RN, BSN
The term environmental justice was coined in the early 1990s to denote the application of fair strategies and processes in the resolution of inequality related to environmental contamination. Fair treatment means that no group of people should bear a disproportionate share of negative environmental consequences resulting from industrial, municipal, and commercial operations or the execution of federal, state, local, and tribal programs and policies.21, s2 According to Children’s Defense Fund data, more than 21% of America’s children lived in poverty during the 1990s. Although 16% of non-Hispanic white children live in poverty, 41.5% of black and 41% of Hispanic children live in poverty, placing them at more than double the risks for exposure to toxic substances. Poor families and families of color are more likely to live in communities where there are higher levels of exposure to toxic substances. Low-income and minority parents and their children are more likely to live near heavily polluting industries, hazardous waste dumping sites, and incinerators. They live in substandard or old housing with friable asbestos, deteriorating lead paint, poor indoor air quality, contaminated yard soil, and adjacent to roadways where hazardous substances are tran~ported.~~, so Similarly, poor people are more likely to consume seafood caught in polluted streams and lakes where fishing and swimming are banned. As a result, these communities bear a disproportionate share of the air, water, and waste contamination problems of the United Statesz1 Findings from a US Government Accounting Office studys4document that minorities inhabit 75% of communities with a hazardous waste facility. A disproportionate number of identified Superfund sites (discussed subsequently) in the United States are located in poor and minority communitie~.~~, 54 The presence of a Superfund site, according to the US Environmental Protection Agency
From the College of Pharmacy, Nursing, and Allied Health Sciences, Howard University, Washington, District of Columbia (DLP, VS)
PEDIATRIC CLINICS OF NORTH AMERICA VOLUME 48 * NUMBER 5 * OCTOBER 2001
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(EPA),= is a surrogate measure for potential exposure to the contaminants found at that site. Children who play around such sites, including in or near posted areas, are at increased risk for exposure. When one segment of society bears a greater burden of risk for contact with toxic substances, evidence of inequality is apparent. The purposes of this article are several: (1) to summarize the context of environmental contamination and the environmental justice movement, (2) to analyze studies and propositions demonstrating the unwitting victimization of children in decisions made regarding the disposal of toxic substances and hazardous waste, (3) to review environmental justice legislation and the relation of child protection laws to environmental justice, and (4)to explore a variety of child and family advocacy strategies that promote equality and environmental justice. HISTORY OF ENVIRONMENTAL CONTAMINATION: CREATING A CONTEXT FOR ENVIRONMENTAL JUSTICE
Every industrialized country has the continuing challenge of how to dispose of trash and waste products. Historically, the remedy was to bum it, bury it, or dump it with little consideration of the potential implications for future generations. The ”Chemical Revolution” of the 1940s ushered in the production of potentially toxic and radioactive substances, including munitions associated with World War I1 and the Cold War. These substances pose potential threats to health and well-being for decades and centuries to come. Workers in the defense and other industries and the communities neighboring manufacturing facilities were exposed to highly radioactive substances, their byproducts, and the chemical waste discharged into the air, soil, and water systems bordering plants and reservations where these items were produced. The Chemical Revolution also led to the manufacture of ”miracle drugs,” more effective solvents, adhesives, dyes, paints, and wood preservatives,2O many of which now are known to have highly toxic effects. Industrialization led to an era of mass production, packaging, and the creation of disposable containers; glass; paper products; and, ultimately, plastics. The use of fertilizers and pesticides, such as DDT, to enhance plant growth had, paradoxically, the unfortunate effect of polluting the environment and placing farm workers who labored in the fields at risk. America became a ”throwaway” society and created trash in huge quantities. The open burning of trash piles and later the use of incinerators, waste dumps, and landfills grew in relation to the growing consumption of disposable products by the American people. During the 1950s and 1960s, there were few, if any, controls on standards for emission into the environment. The burning of hazardous and nonhazardous waste created unknown risks to the people who lived within reach of fumes and particulates as they dissipated in the atmosphere. Automobile tires, for instance, became a major source of noxious fumes and toxins when disposed of by buming. Growing awareness of the effects of chemical releases into the environment during the 1960s ushered in what Freeze calls the “Age of Awakening.” Carson13 sounded the alarm in 1962, making the public aware of the potential adverse health effects of pesticides and DDT residues in soils, plants, birds, fish, animals, and the body fat of humans. Toxic waste from the defense industry and chemical plants was found buried in landfills, in canisters dumped in ditches and caverns, and in groundwater and streams used for fishing and recreation.8,*3*30,35 Second-
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ary uses of waste materials, such as in pest and dust control, created acute illnesses,3O but the long-term health effects had not been realized yet. The insidious leaching of decomposing buried substances and their migration into the food chain had not yet revealed their effects on health. Concern about the ozone level, global warming, the destruction of wildlife, water pollution, and other environmental ills became increasingly apparent during the 1970s. The "Age of Awareness and Action"20followed and resulted in passage of federal and state laws and regulations designed to safeguard the environment for future generations. By the early 1990s, environmental concerns had become the focus of concern on the US agenda and buoyed voluntary organizations, such as the Sierra Club, the Wildlife Federation, and the Wilderness Society. The EPA was established in 1970 with a mission to "abate and control pollution systematically, by proper integration of a variety of research, monitoring, standard setting and enforcement activities including state and local govemments, private and public groups, individuals, and educational institution^."^^ Federal standards to protect water and air, control toxic substances, and manage hazardous and solid waste were enacted. In 1980, the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), also known as Superfund, was passed. Superfund sites are hazardous waste sites designated by the EPA as a threat to human health and include leaking underground storage tanks and inactive hazardous waste sites (e.g., municipal dumps and contaminated factories), mines, and rnills.l6 Superfund sites placed on the National Priority Lists (NPLs) are the most serious and hazardous and targeted for longterm US action. The Agency for Toxic Substances and Disease Registry (ATSDR) was founded in 1980 as a part of Superfund legislation. Its mission is "to prevent or mitigate adverse human health effects and diminished quality of life resulting from exposure to hazardous substances in the en~ironment."~~ Under CERCLA, persons, businesses, corporations, or other parties responsible for the hazardous waste could be found liable and required to clean up the Superfund site. US dollars were appropriated to augment cleanup of contaminated sites or to relocate communities impacted by the contaminants where necessary. As an example, more than 1000 households at a cost of $30 million were evacuated from Love Canal, a subdivision in Niagara, New York when 100,000 drums of chemical waste, including dioxin, from a chemical and plastics corporation contaminated the soil and leaked into basements, causing multiple health problems.*O Inequality in Environmental Contamination and Remediation
More than 1327 Superfund sites were identified by 1992 (www.boma.org\ suprissa.htm), with a disproportionate number located in poor or minority communities.48,54 Despite US government efforts to clean up contamination, impose strict standards on emissions from industrial sites, and enact safeguards to protect the public in the siting of industrial and waste treatment facilities, the net effect has not been equitable across racial and socioeconomic classes. Poor and minority communities experience a disproportionate burden from environmental contamination than do more affluent and nonminority communities (R. Levine et al, unpublished observations, 1997).9-11,21, 49, 51, 58 Low-income and minority groups are more likely than are affluent and nonminority groups to live near landfills, incinerators, hazardous waste treatment facilities, and NPL sitesz3* 27, 42, and to eat contaminated fish.51Similarly, @
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75% of Southern waste dumps are more likely to be located in black communities.26,”Three of the largest hazardous waste landfills, containing more than 40% of the total US permitted commercial capacity, remain in two black communities, supporting the notion that ”waste tends to flow toward communities with weak response capacity.”25Kellyz9reported that, even when income is controlled, race continues to be a significant factor in the siting of waste facilities, particularly hazardous and nuclear facilities. Middle-class communities of color tend to have more waste facilities than do poor, white communities. Race is the most significant variable associated with the location of hazardous waste sites. This phenomenon has been described as environmental discrimination or environmental rucisrn9~lo, and substantiates that past environmental practices, policies, and decisions were unfair. W e i n t r a ~ bnotes ~ ~ that environmental racism is ”the intentional siting of hazardous waste sites, landfills, incinerators, and polluting industries in communities inhabited mainly by African Americans, Hispanics, Native Americans, Asians, migrant farm workers, and the working poor.” Although discrimination is often a challenge to prove, it is clear that lowincome and disadvantaged communities and populations are exposed and vulnerable to hazardous substances to a greater degree than is the population as a Vulnerability is a factor associated with powerlessness. Minority communities are perceived as powerless. Communities known as passive, lacking political power, not well informed, unorganized, and with “an eager and docile work force”l0,57 are the most likely targets for environmental contamination and abuse and the least likely to receive remediation once dangers to the community are noted. Consistent with these findings, HeimanZ5suggests that politics, demographic shifts, corruption, economics, permitting fraud, discrimination, and weak community response capacity are at the root of decisions to site hazardous facilities in poor and minority areas. Also, instances of falsified laboratory findings have been reported questioning the designation of some sites as uncontaminated (www.mapcruzin.com). impact of Environmental Injustices on Children
Children are often the unwitting victims of environmental injustices, and poor and minority children, just as their parents, are affected disproportionately. An estimated 2.75 million to 3.85 million children (25%) live within 1 mile of a NPL hazardous waste site, and black and Hispanic children are over-represented in these c ~ m m u n i t i e sThe . ~ ~ short-term and long-term effects of environmental contamination and exposure among children have the potential to impact future generations and even markedly change society. Schettler et a14 examined the contributions of toxic chemicals to neurodevelopment, learning, and behavioral disabilities in children. A series of environmental chemicals found in the home, schools, and industrial sites acting singularly or in a synergistic or potentiating manner may contribute to an epidemic of developmental, learning, and behavioral disabilities among children who are at greatest risk for exposure. An estimated 5% to 10% of school-age children have learning disabilities33*34 and an estimated 52% of children are in special education (or approximately 2.25 million children have learning disabilities).” US Department of Education data for 1998 to 1999 show that overall minority participation in special education by 6- to 21-year-old people is comparable with their distribution by ethnic groups in the general population; however, 20.2% of blacks in this age group are in special education programs compared with 14.8% in the
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general p0pulation.3~Black students were over-represented in 10 of 13 disability categories and were present in the categories for mental retardation and developmental delay more than twice their US population e~tirnates.~~ Stone and a s ley47 further document that twice as many special education students as nonspecial education students are likely to drop out of school and that 60% of adolescents in treatment for substance abuse have undetected special education needs.%Young people with a history of special education have a 62% chance of unempl~yment'~; a 52% chance of being in the juvenile justice system2;and, if female, a 50% chance of becoming pregnant within 5 years after high schoo1.5 Lastly, an estimated 42% of adults in correctional institutions were eligible for special There are a host of chemical substances linked with poor neurologic performance and learning. In fact, nearly 75% of the top 20 chemicals on the Toxic Release Inventory (EnvironmentalDefense Fund, 1996) are neurotoxic. Annually, nearly 0.45 billion kg (1billion Ib) of these chemicals are released to the environment and subject to inhalation or ingestion. Some of the more common neurotoxic substances related to learning and behavioral disabilities are lead; mercury; organophosphate pesticides; dioxin; polychlorinated biphenyls (PCBs); nicotine; and solvents used in paints, glue, and cleaning solutions. The prevalence of exposure to lead and dioxin or PCBs in low-income and minority communities is illustrious of the disproportionate impact of hazardous substances on the health of ~hildren.5~ Lead
The risk for lead exposure among children is a subject that has been researched considerably. The EPA53documents that race and poverty correlate with the likelihood of a child having elevated levels of lead in the blood. Children in families with incomes below the poverty line have a greater risk for elevated levels of lead in their blood, and black children are more likely to have higher than normal blood lead levels than are non-Hispanic white children or Hispanic children. Eight percent of low-income children become lead poisoned annually compared with 1.9% of middle-income and 1%of high-income children.'" l5 Despite these disparities, acute lead poisoning necessitating aggressive medical intervention represents only a small proportion of childhood lead exposure. The subtle and long-term effects of regular and insidious intake of lead are a much more pervasive and enduring problem, particularly in communities where exposure is most common. Exposure, particularly in preschool children, is associated with IQ deficits and developmental delays and can be linked with industrial exhaust, car repair shops, traffic c0ngestion,2~and lead-contaminated household Using the Child Behavior Checklist, Needleman et a138and Burns et all2 concluded an association between lifetime low-level lead exposure and increased risk for antisocial and delinquent behaviors among children. Moreover, lead is associated consistently with lower scores on neurologic tests, failure in high school, and reading disabiliv; however, on balance, Bellingel.6, questioned the strength of such associations in the absence of experimental designs. Dioxins and Polychlorinated Biphenyls
Dioxins and PCBs are particularly threatening to infants and small children. These two classes of chemicals are linked to IQ deficits, hyperactivity, and attention-deficit disorders. Dioxins are an unintentional byproduct of industrial
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processes, including the incineration of municipal and medical waste, copper smelting, hazardous waste incineration, and chlorine-based pulp paper bleaching.53PCBs were produced intentionally for many years and used as lubricants, coatings, and insulating materials in electric transformers. Industrial exhaust emitted PCBs and dioxin to the atmosphere where they could travel thousands of miles and settle on water, soil, and vegetation consumed as food by livestock.44 Although the manufacture of PCBs was banned in most countries in the 1970s and 1980s, DeVoogt and Brinkmadsa report that approximately two thirds of the PCBs produced have not yet been released into the environment. Even in the United States, which outlawed their production in the 1970s, the disposal of the chemical in old electric transformers, spent oil in landfills, and hazardous waste sites where leakage is possible, will continue to pose a threat to organisms for centuries to come. Regulated release of these products into streams and waterways also constitutes long-term threats to higher-order animalsM Dioxins and PCBs are stable compounds, bioaccumulate, and are highly toxic. They accumulate in fatty tissue of animals, particularly those near the top of the food chain, such as cows (beef), pigs (pork), fish, and humans. In humans, these compounds can be found in breast milk and then are passed to nursing infants. The primary source of PCBs in pregnant and nursing mothers is contaminated fish. Even if fish is not consumed during pregnancy, PCBs stored in human fat remain toxic for years.28In older children and adults, fish consumption, especially the more fatty varieties, constitutes the major exposure mechanism.l, 40 Although prenatal exposure to PCBs has been found to be related to long-term deficits in a child's intellectual development and short-term memory,2" ** postnatal exposure through breast milk has a lesser neurologic impact. The impact of PCBs on the neurologic development of children is of even greater concern among the poor and minorities. Socioeconomic status is related inversely to fish consumption. Poorer people and minorities tend to consume fish from local waters on a regular basis and are more likely to eat fish from waters with posted fish There is a direct relationship between the amount of fish consumed and the level of detectable PCB in cord blood of infants?" Whether lead or PCBs and dioxin, the data substantiate that poor and minorities are exposed to these highly toxic substances to a greater extent than more affluent residents. It is also clear that these toxic substances are related to lower IQs, memory loss, agitation, and other neurologic syndromes. It also is documented extensively that tests scores of minorities, inner-city residents, and poor persons tend to fall below those of white children and those living in higher-income communities.'" These findings support the likelihood of inequitable management and control of hazardous substances that place some segments of the population at greater risk for exposure than others. These findings raise questions about the relationship between environment and health status of certain populations: Is there a relationship between disproportionate environmental exposure among poor and minority children and disparities in health status? Is there a relationship between environmental exposure to certain toxic substances and violence or performance in school? Is the US response to the real or potential presence of environmental toxins more aggressive in more affluent neighborhoods than in poor and minority neighborhoods? Although evidence suggests that there are relationships between environmental exposure and health and behavioral status, the translation of these
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findings into policy and prevention or remediation actions is less apparent. For example, only 1%of US dollars spent on lead is directed toward eliminating or reducing its presence from poor and minority communities, where the exposure potential is high.37Are environmental inequalities deliberately or inadvertently practiced among vulnerable and less powerful communities?
LEGISLATION AND POLICIES AFFECTING ENVIRONMENTAL JUSTICE AND CHILDREN
In an effort to address evidence of racism and inequality in environmental decision making and the disproportionate burden of contamination in communities of color, environmental justice became a part of US jargon in the early 1990s. The phrase denotes the application of fair strategies and processes in the resolution of inequality related to environmental contamination. Fair treatment means that no group of people should bear a disproportionate share of negative environmental consequences resulting from industrial, municipal, and commercial operations or the execution of federal, state, local, and tribal programs and To monitor and address issues of discriminatory environmental practices, the EPA Office on Environmental Equity was established in 1991, followed by the Office of Environmental Justice in 1992. In 1994, the National Environmental Justice Advisory Council was founded to provide independent advice, consultation, and recommendations to the administrator of the EPA on environmental issues. In 1991, the first National People of Color Environmental Leadership Summit was held and affirmed through principles and strategies that environmental justice must ensure that all people should have an opportunity to live in a healthy environment and are entitled to breathe clean air, drink clean water, and consume uncontaminated foods (Washington, DC,October 24-27, 1991). The US response to actual and potential environmental injustices did not emerge voluntarily but was preceded by a grassroots movement nestled within the Civil Rights movement of the late 1960s. A series of protests and displays of civil disobedience were staged to demonstrate public outrage at the consequences or unintended consequences of environmental decisions or prevailing practices that placed people of color at significant risk. In 1967, students at predominately black Texas Southern University in Houston demonstrated following the drowning of an 8-year-old girl in a garbage dump, where she played at a site unprotected by a fence or warning signs. In 1968, Martin Luther King, Jr. led a campaign for better working conditions for largely black garbage workers in Memphis, Tennessee. The handling of undifferentiated waste placed these workers at heightened risk for exposure to toxic substances. The most widely recognized protest against a deliberate action of injustice occurred in 1982 in Warren County, North Carolina!* The State ordered 32,000 cubic yards of soil contaminated with highly toxic PCBs targeted for burial in the Afton community of Warren County, which was 84% black and one of the poorest counties in the state. Despite hundreds of demonstrators, an admittedly less than suitable water table, and broad national attention, the state prevailed in the creation of this egregious landfill.*0, National studies confirmed such unfair practices in the siting of landfill^.^*,^ By the early 1990s, legislation began to be passed that was relevant to or specific to environmental justice.
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Environmental Justice Legislation
National efforts evolved to address the growing awareness that hazardous chemicals and wastes were putting some communities at substantial risk for exposure and related health problems. Several significant laws were passed and were aimed at preventing or eradicating prior discrimination. The landmark Superfund legislation of 1986, also known as the Emergency Planning and Community Right-to-Know Act, was passed to give communities access to information on environmental hazards that exist in their communities. The legislation directs state and local authorities to develop and promote emergencypreparedness programs based on information from reports about these hazards (EnvironmentalJustice: Legislation in the States, September, 1994). Other legislation introduced in the 1990s focused specifically on racial inequities; the Environmental Justice Act of 1993, the Environmental Equal Rights Act of 1993, and the Environmental Health Equity Act of 1994 were passed. Environmental Justice Act
The Environmental Justice Act of 1993 directs the EPA to publish a list, in rank order, of the total weight of toxic chemicals released in each county or other geographic unit in the most recent 5-year period for which there are available data. The act requires that potential health affects be identified and that remedies be legislated (www.nativenet.uthscsa.edu/archive/nl/9311/ 0125.html). Environmental Equal Rights Act
The Environmental Equal Rights Act of 1993 (HR 1924) gives "citizens of a state the right to petition to prevent the siting and construction of proposed polluting facilities scheduled to be placed in 'environmentally disadvantaged communities" (Jewish Council for Public Affairs, 1994-95).3" For the purposes of this act, environmentally disadvantaged communities are defined as communities that already have a similar facility located within 2 miles of a proposed facility and have a specific demographic m i x of minority and low-income residents. Environmental Health Equity Act
The Environmental Health Equity Act of 1994 (HR 1925) mandates data collection by the EPA on race, income, gender, ethnic origin, and education level in communities adjacent to toxic sites (JCPA, 1994-95). Executive Order 12898
Perhaps the most sweeping policy against environmental injustices in minority communities was enacted through an executive order. Executive Order 12898,19Federal Actions to Address Environmental Justice in Minority Populations, was signed into law by President Clinton in 1994. It mandated that federal agencies make environmental justice part of their mission by identifymg and addressing disproportionately high and adverse human health or environmental health effects of their programs, policies, and activities with minority populations. Also, the order required that meaningful opportunities be provided for the involvement of communities in the development of, compliance with, and
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enforcement of federal laws, regulations, and policies pertaining to human health and the environment regardless of race, color, national origin, or income. Although this executive order is not directed specifically toward children, the breadth of the order certainly offers measures to protect and defend children within the context of the family and community; however, in 1997, a parallel executive order, 13045; was enacted to provide for child safety risks in matters of actual and potential environmental hazards among low-income and minority children. The Centers for Disease Control and Prevention and ATSDR are also in the forefront in advocating and promoting improvement in the quality of the environment for the protection of children. In 1996, ATSDR sponsored the Child Health Initiative to address the vulnerability of children to toxic substances emitted from hazardous waste sites and promote positive child health practices. This initiative focuses on developing child-specific components within existing programs and planning new projects that incorporate child health issues.15 COMMUNITY EMPOWERMENT STRATEGIES
Most of the environmental justice legislation includes a provision that requires community participation in decision making regarding environmental siting and provisions for communities to be inv01ved.l~The level of community participation in relation to environmental legislation is dependent on community awareness, sophistication, sense of power, economic base, organizational skills, and access to knowledge. Community affiliations and networks are, likewise, crucial indicators of its performance when threatened by an environmental issue. These affiliations are useful predictors of the success of its self-efficacy for right, fair, and proper response to immediate and long-term implications of environmental decision making. The resources of poor and minority communities are often lacking when these communities are faced with contrary intentions of “big businesses” and developers to site a potentially dangerous facility. Poor and minority communities, which tend to be more educationally disadvantaged, are less likely than are more affluent communities to know and understand the laws and regulations, have access to environmental data, and use such data in seeking remedies to environmental hazards. These communities are also less likely to be aware of the implications of certain environmental toxins and their long-term impact on the health of populations for generations to come. Such communities are also less likely to respond to environmental concerns arising out of instances of noncompliance by some industrial sites to maintain compliance with emission standards or proposed siting of plants with the potential to pollute. Fear of reprisal, the need for employment, and economic stability are often priorities over the threat to health. Cultural habits and the vestiges of a subservient mentality, particularly in southern states:’ contribute to a sense of powerlessness and inactivity in the face of real environmental concerns. Community empowerment through education, organizing, and partnering are mechanisms for increasing community awareness, activism, and self-advocacy. Lassiter31 describes the value of affinity groups in communities as fundamental structural networks for communication, consensus building, and cooperation around issues of mutual concern. Affinity groups may include aggregates as complex as parent-teacher associations and church membership groups or as simple as families, a grouping of friends, or a group of women who consistently and regularly do laundry together at the neighborhood laundromat. Self-advo-
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cacy can begin through ”story telling” and determining that multiple persons share common concerns and frustrations. These early informal efforts at problem identification are where advocacy stops or is crystallized into a need for action. The ability to move from problem identification to advocacy, power, and influence is related to community resources and community development. US guidelines inherent within policies, such as Executive Order 12898,19 address the requirement for community development and community participation in decision making regarding environmental matters. Community de~elopment~l is a model for community change and encourages a high level of citizen participation in health concerns. It is a process of collaboration with community members to assess collective needs and desires for healthful change and to address these priority needs through problem solving, use of local talent, resource development, and management. It is not the role of health care professionals or other outsiders to resolve the problems on behalf of the community but rather to enhance the capacity of the community by promoting the development of local skills and knowledge to protect or restore the community’s health. Partnering with the community offers a potentially effective model for empowering communities. Building capacity within communities may include community organizing, program development, and supporting protests. Community Organizing
Community organizing involves bringing together cross-sections of community residents and building coalitions for strategic problem solving. In coalition building, citizen groups, professional groups, and other key stakeholders and supporters partner around common interests and concerns. Citizen participation and partnerships are essential for community growth and development and for response to real and potential threats. Communities with fewer resources and weaker linkages with dominant and more powerful communities are vulnerable to exploitations.3l. 55, 56 Strengthening the knowledge base and self-advocacy strategies, coalescing disparate formal and informal groups, and broadening the economic and political power bases enable communities to address and respond to actual and potential circumstances of environmental injustices. Health care professionals are in a position to facilitate strengthening communities and building coalitions based on existing relationships with community members and potential networks with resources and power. To assist communities in addressing injustice issues, health care professionals need basic principles, knowledge, and skills fundamental to working with communities, including community development and community empowerment. Program Development
Program development involves organizing and instituting educational programs in response to identified community need. Responding to community needs by offering programs in health awareness, health promotion, and health education is of considerable value in empowering communities to address issues of environmental injustice or potential injustice. Developing and providing educational programs for citizens to make them aware of potential toxic emissions from manufacturing plants situated in their communities and the relationship of the toxins to health and disease are helpful and beneficial empowerment strategies.
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Protest
Protest, historically, has facilitated many major societal changes and, as such, is an effective class-advocacy strategy. Environmental justice is rooted in the Civil Rights movement and peaceful protest. Successful protests are well planned; involve coalitions; attract media attention; and have an impact on the operations, productivity, or economics of the targeted organization. Civil demonstrations must be organized and executed in accordance with local laws that govern the right of US citizens to protest. Because protest is an adversarial strategy that makes a statement about one position against another prevailing set of principles or practices, caution must be exercised to act in ways to ensure the safety of protesters and property. Health care professionals can play meaningful roles in protests, such as providing assistance in organizing, being expert speakers at rallies, and providing supportive health care services. Child Health Advocacy Strategies
In addition to local and grassroots advocacy, there are a number of national and regional groups that advocate on behalf of children and environmental threats. Some of the organizations are environment specific, and others embrace children’s health within the context of their broader purposes. Their efforts increase public awareness, influence national policy, and promote research. Most of these organizations address the disparities in health among poor and minority children. Several of the more visible organizations include the following. Children’s Environmental Health Network
The Children’s Environmental Health Network is a US multidisciplinary project whose mission is to promote a health environment and protect fetuses and children from environmental health threats. The goals are to promote the development of child-focused US policy, to stimulate prevention-oriented research, to educate educators and others on prevention strategies, and to elevate public awareness of environmental health hazards to children. Information is available through their Web site (http:/ /www.cehn.org). Children’s Defense Fund
The Children’s Defense Fund is a nonprofit, private organization that advocates for children who are disabled, poor, and minority. They are concerned with the well-being of children and focus on prevention of problems that affect them. The organization also channels information about federal and state legislation that affects children to parents. They hope to empower the youth to tackle issues such as environmental justice and crises that arise that affect communities across the United States (www.chi1drensdefense.org). American Lung Association
The American Lung Association (ALA), the oldest voluntary organization in the United States, includes a major focus on childhood asthma, tobacco smoke, and environmental health as parts of its mission. The ALA’s National Asthma Educational Program provides awareness and understanding of asthma across the United States. Its Open Airways Program is an elementary school
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initiative to teach children with asthma to understand and manage their health. The ALA also played a major role in tobacco control laws for children and has developed antismoking education materials for schools. They implemented the Radon Public Information Project and supported the Indoor Air Quality Act, which reduces indoor pollution in offices, public buildings, and homes. The ALA supports public awareness activities and advocacy and provides information on what people can do to prevent lung disease (www.lungusa.org). The West Harlem Environmental Action
The West Harlem Environmental Action (WE ACT) is a nonprofit organization working to improve environmental quality and to secure environmental justice in predominately black and Latino communities. WE ACT advances its mission through research, public education, advocacy, mobilization, litigation, legislative affairs, and sustainable economic deve10pment.l~They produce fact sheets on lead, asthma, and indoor air pollution for black and Latino communities (www.weact.org). SUMMARY
Children have little control over where they live, what they eat, the financial circumstances of their families, or the developmental activities and behaviors that make them vulnerable to environmental contaminants. Minority and poor families disproportionately live in communities with landfills, hazardous waste facilities, incinerators, industrial plants, and old housing with poor indoor air quality and lead-based paint. Residents of these communities are also more likely than are more affluent communities to consume fish on a regular basis from local waters, many of which have banned fishing. Consequently, these children and their families are exposed more frequently than are children in other communities to potentially dangerous chemicals that can affect health. Data indicate that poor and minority children have higher rates of asthma, elevated blood lead levels, learning disabilities, and hyperactivity than do nonminority and more affluent children. When a group of people is exposed unfairly and inequitably to toxins in their communities, workplaces; and schools, a phenomenon called environmental discrimination or environmental racism exists. Environmental justice is a US governmental remedy that requires the application of fair strategies and processes in the resolution of inequality related to environmental contamination. The US response resulted in the establishment of offices of Environmental Justice within the EPA and ATSDR and passage of important legislation and policies, such as the Community Planning and Right-to-Know Act of 1986, Executive Order 12898 (Federal Actions to Address Environmental Justice in Minority Populations), and Executive Order 13045, a parallel order to protect low-income and minority children from actual and potential environmental hazards. Communities and advocacy groups play an important role in promoting healthier environments for children. Frequently, low-income and minority communities are perceived as less powerful, less organized, and ill equipped to defend against actual and potential sources of environmental contamination. Health care professionals are in a strategic position to assist with community development, organizing, and empowerment through educational programming, networking, and supporting other activities that bring attention to the plight of environmentally vulnerable communities.
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References 1. Abramowicz D A Aerobic and anaerobic PCB biodegradation in the environment. Environ Health Perspect 103:97-99,1995 2. Achenback TM, Edelbrock C S The classification of child psychology: A review and analysis of empirical efforts. Psycho1 Bull 85:12751301,1978 3. Agency for Toxic Substances and Disease Registry: Child Health Initiative: Presidential Executive Order 13045.Protection of Children from Environmental Health Risks and Safety Risks [announcement; online]. Washington, DC, William J. Clinton, April 21, 1997.Available: http:/ /www.atsdr.cdc.gov/child/press497.html[March 3, 2001] 4. Barton H: Legislation in the States. Butler B (ed): Center for Policy Alternatives (September 1994; online). Available: http://es.epa.gov/program/iniative/justice/ejstate.htm1 [February 21,20011 5. Baumgaertel A, Copeland L, Wolraich M L Attention deficit hyperactivity disorder. In Wolraich ML (ed): Disorders of Development and Learning, ed 2. St. Louis, Mosby, 1996,p 428 6. Bellinger DC:Effect modification in epidemiologic studies of low-level neurotoxicant exposure and health outcomes. Neurotoxicol Teratol22133-140, 1999 7. Bellinger DC: Interpreting the literature on lead and child development The neglected role of experimental system. Neurotoxicol Teratol 17201-212, 1995 8. Brown MH: Laying Waste: The Poisoning of Americans by Toxic Chemicals. New York, Pantheon, 1979,pp 173-180 9. Bullard RD: Confronting Environmental Racism: Voices from the Grassroots. Boston, South End Press, 1993 10. Bullard RD: Dumping in Dixie: Race, Class, and Environmental Quality. Boulder, CO, Westview Press, 1990 11. Bullard RD: Unequal Protection: Environmental Justice and Communities of Color. San Francisco, Sierra Club Book, 1994 12. Burns PA, Baghurst MG, Sawyer MG, et al: Lifetime low-level exposure to environmental lead and children’s emotional and behavioral development at ages 11-13.Am J Epidemiol 149:740-749,1999 13. Carson R Silent Spring. Boston, Houghton Mifflin, 1962 14. Children’s Environmental Health Network Chronology of Children’s Environmental Health [online]. Available: http://www.cehn.org/cehn/Chronology.html [February 28, 20011 15. Children’s Environmental Health Network Resource Guide on Children’s Environmental Health [online]. Emeryville, CA, CEHN, 1999. Available: http://www.cehn.org/ cehn/resourceguide/rghome.html [February 28,20011 16. Chiras D D Environmental science: Action for a sustainable future. Redwood City, CA, Benjamin/Cummings Publishing, 1994 17. Coyle J: Foreword. In Slikken W, Chang LW (eds): Handbook of Developmental Neurotoxicology. San Diego, Academic Press, 1998 18. Cummins, Hilliard: Factors associated with the provision of special education to students with disabilities in inner cities [online]. Available: http:/ /www.ed.gov/
pubs/OSEP96AnlRpt/execum.html 18a. De Voogt P, Brinkman VAT: Production, properties, and usage of polychlorinated biphenyls. In Kimbrough RD, Jensen A (eds): Halogenated Biphenyls, TeThenyls, Naphthalenes, Dibenzodioxins, and Related Products. Amsterdam, Elsevier, 1989, pp 3-46 19. Executive Order No. 12898, 59 C.F.R. 7629 (February 16, 1994). Federal Register 59,1994 20. Freeze RA: The environmental pendulum: A quest for the truth about toxic chemicals, human health, and environmental protection. Berkeley, CA, University of California Press, 2000, pp 1-47 21. Gaylord C: Environmental equity and empowerment. In Patriots: Black History, commemorative ed. Silver Spring, MD, 1993 22. Gladen BC, Walter J R Effects of perinatal polychlorinated biphenyls and dichlorodiphenyl dichloroethene on later development. J Pediatr 11958-63,1997 23. Goldman BA, Fitton L: Toxic waste and race revisited: An update of the 1987 report
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of racial and socioeconomic characteristics of communities with hazardous waste sites. Washington, DC, Center for Policy Alternatives, National Center for the Advancement of Colored People, and United Church of Christ Commission on Racial Justice, 1993 24. Hansen C, Butler R, Procopovich E, et a1 Blood lead levels in children of Cordoba City. Medicina (B fires) 59:167-170, 1999 25. Heiman MK. Race, waste, and class: New perspectives on environmental justice [online]. Carlisle, PA, Environmental Studies, James Center, Dickerson College, 2000. Available: http:/ /www.penweb.org/er/rc.html 26. Heitgerd J, Burg J, Strickland H A geographic information systems approach to estimating and assessing national priority lists site demographics: Racial and Hispanic origin composition. Int J Occup Med Toxicol 95:343-363, 1995 27. Hirschhorn J S Two Superfund environmental justice case studies [online]. Wheaton, MD, Hirschhom & Associates, 2000. Available: http:/ /www.igc.org/envjustice/hirsch hom.htm1 28. Jacobson JL, Jacobson SW, Humphrey HEB: Effects of in utero exposure to polychlorinated biphenyls and related contaminants on cognitive functioning in young children. J Pediatr 116:38-45, 1990 29. Kelly M. The history of Chester [online]. 2000. Available: http://www.penweb.org/ chester.html 30. LaGrega M, Buckingham PL, Evans JC: Hazardous waste management. New York, McGraw-Hill, 1962, p 5 31. Lassiter PG: Community perspectives as related to community organizations, empowerment, partnering and education. In Howard University Division of Nursing, Environmental Health and Nursing: The Mississippi Delta Project. A Modular Curriculum. Atlanta, US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry, 1999 32. Lyon G R Preface. In Lyon GR, Krasnegor NA (eds): Attention, Memory and Executive Function. Baltimore, Paul H. Brooks, 1996 33. Mann CC. Behavioral genetics in transition. Science 264:1686-1689, 1994 34. Mash EJ, Terdal LG: Assessment of child and family disturbance: A behavioral-system approach. In Mash EM, Terdal LG (eds): Assessment of Childhood Disorders, ed 3. New York, Guilford Press, 1997, p 3 35. Mowery M, Redmond T: Not in our backyard: The people and events that shaped American’s modem environmental movement. New York, William Marrow & Co., 1993, pp 39-43 36. National Council for Jewish Affairs: Jewish security and the bill of rights [online]. 2000. Available: http: / / www.jewishpublicaffairs.org /publications /JPP-94-95-securityenvironment.html 36a. National Jewish Community Relations Advisory Council Joint Program Plan 19941995; Energy and Environment Jewish Council for Public Affairs [online]. Available: http: / /www.jewishpublicaffairs.org/publications / JPP-94-95-security-environmental .htnd 37. Needleman HL: Lead exposure and antisocial behavior: A neglected effect. In Children’s Environmental Health Research, Practice Prevention Policy [conference report]. Children’s Environmental Health Network/Public Policy Instikte, Washington, DC, 1997 38. Needleman HL, Riess JA, Tobin MJ, et al: Bone lead levels and delinquent behavior. JAMA 275:363-369,1996 39. Office of Special Populations: Race of students with disabilities [online]. 2001. In 22nd Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Available: www.ed.gov/offices/OSERS/OSEP 40. Paustenbach DJ, Wenning RJ, Lau V Recent developments on the hazards posed by 2, 3, 7, 8 tedd in soil Implications for setting risk-based cleanup levels at residential and industrial sites. J Toxicol Environ Health 37103-150, 1991 [cited in ATSDR Tox. Profile for Dioxin, 19971 41. Pope AM, Synder MA, Mood LA. Nursing, Health, and Environment: Strengthening
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the Relationships to Improve the Public‘s Health. Washington, DC, National Academy Press, 1995 42. Powell D L Environmental justice. In Howard University Division of Nursing, Environmental Health and Nursing, The Mississippi Delta Project, A Modular Curriculum. Atlanta, US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry, 1999 43. Russell D: Environmental racism: Minority communities and their battle against toxic. Amicus Journal 11:22-32, 1989 44. Schettler T, Stein J, Reich F, et al: In Harm’s Way: Toxic Threats to Child Development. Cambridge, MA, Greater Boston Physicians for Sound Responsibility, 2000 45. Sexton K, Zimmerman R The emerging role of environmental justice in decision making. In Sexton K, Marcus AA, Easter W, et a1 (eds): Better Environmental Decision: Strategies for Governments, Businesses and Communities. Washington, DC, Island Press, 1998, pp 419443 46. Sterling DA, Roegner KC, Lewis RD, et al: Evaluation of four sampling methods for determining exposure of children to lead-contaminated household dust. Environ Res 81:130-141, 1999 47. Stone WL, Ousley OY Pervasive developmental disorders: Autism. In Disorders of Development and Learning, ed 2. St. Louis, Mosby, 1996, p 432 48. United Church of Christ for Racial Justice: Toxic waste and race in the United States: A national study of racial and socio-economic characteristics of communities with hazardous waste sites. Am J Public Health 87:731, 1987 49. US Department of Justice: Guidance concerning environmental justice [online]. Washington, DC, USDOJ, 2000. Available: http:/ /www.usdoj.gov. /enrd/ejguide.html 50. US Environmental Protection Agency: America‘s Children and the Environment: A first View of Available Measures. Washimton, DC, USEPA, 2000 51. US Environmental Protection Agency: Environmental Equity: Reducing Risk for All Communities. Washington, DC, USEPA, Office of Policy, Planning and Evaluation, 1992 52. US Environmental Protection Agency: Environmental Health Threats to Children. Washington, DC, USEPA, 1996 53. US Environmental Protection Agency: Estimating Exposure to Dioxin-like Compounds, vol2: Properties, Sources, Occurrence and Background Exposure. Publication # EPA/600/6-881005cb. Washington, DC, USEPA, Office of Research Development, 2000 54. US Government Accounting Office: Hazardous and Nonhazardous Waste: Demographics of People Living Near Waste Facilities. Washngton, DC, USGAO, 1995 55. VonBertalanffy L: Problems of Life: An Evaluation of Modem Biological and Scientific Thought. New York, Harper, 1952 56. Warren RL: The Community in America, ed 2. Chicago, Rand McNally, 1963 57. Weintraub I: Fighting environmental racism: A selected annotated bibliography [online]. Piscataway, NJ, Library of Science and Medicine, Rutgers University, 2000. Available: http: / /egj.lib.uniaho.edu/egjOl/weinOl.html 58. Wigley DC, Shrader-Frechette K: Environmental racism and biased methods of risk assessment [online]. Available: http:/ /www.fplc.edu/RISK/vol7/winter/wigley.html 59. Yung-Cheng JC, et al: Cognitive development of Yu-Cheng (‘Oil Disease’) children prenatally exposed to heat-degraded PCBs. JAMA 268:3213-3218, 1992 Address reprint requests to Dorothy L. Powell, RN, EdD College of Pharmacy, Nursing, and Allied Health Sciences Howard University Annex I 501 Bryant Street, N W Washington, DC 20059
0031-3955/01 $15.00
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CHILDREN The Unwitting Target of Environmental Injustices Dorothy L. Powell, RN, EdD, and Victor Stewart, RN, BSN
The term environmental justice was coined in the early 1990s to denote the application of fair strategies and processes in the resolution of inequality related to environmental contamination. Fair treatment means that no group of people should bear a disproportionate share of negative environmental consequences resulting from industrial, municipal, and commercial operations or the execution of federal, state, local, and tribal programs and policies.21, s2 According to Children’s Defense Fund data, more than 21% of America’s children lived in poverty during the 1990s. Although 16% of non-Hispanic white children live in poverty, 41.5% of black and 41% of Hispanic children live in poverty, placing them at more than double the risks for exposure to toxic substances. Poor families and families of color are more likely to live in communities where there are higher levels of exposure to toxic substances. Low-income and minority parents and their children are more likely to live near heavily polluting industries, hazardous waste dumping sites, and incinerators. They live in substandard or old housing with friable asbestos, deteriorating lead paint, poor indoor air quality, contaminated yard soil, and adjacent to roadways where hazardous substances are tran~ported.~~, so Similarly, poor people are more likely to consume seafood caught in polluted streams and lakes where fishing and swimming are banned. As a result, these communities bear a disproportionate share of the air, water, and waste contamination problems of the United Statesz1 Findings from a US Government Accounting Office studys4document that minorities inhabit 75% of communities with a hazardous waste facility. A disproportionate number of identified Superfund sites (discussed subsequently) in the United States are located in poor and minority communitie~.~~, 54 The presence of a Superfund site, according to the US Environmental Protection Agency
From the College of Pharmacy, Nursing, and Allied Health Sciences, Howard University, Washington, District of Columbia (DLP, VS)
PEDIATRIC CLINICS OF NORTH AMERICA VOLUME 48 * NUMBER 5 * OCTOBER 2001
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(EPA),= is a surrogate measure for potential exposure to the contaminants found at that site. Children who play around such sites, including in or near posted areas, are at increased risk for exposure. When one segment of society bears a greater burden of risk for contact with toxic substances, evidence of inequality is apparent. The purposes of this article are several: (1) to summarize the context of environmental contamination and the environmental justice movement, (2) to analyze studies and propositions demonstrating the unwitting victimization of children in decisions made regarding the disposal of toxic substances and hazardous waste, (3) to review environmental justice legislation and the relation of child protection laws to environmental justice, and (4)to explore a variety of child and family advocacy strategies that promote equality and environmental justice. HISTORY OF ENVIRONMENTAL CONTAMINATION: CREATING A CONTEXT FOR ENVIRONMENTAL JUSTICE
Every industrialized country has the continuing challenge of how to dispose of trash and waste products. Historically, the remedy was to bum it, bury it, or dump it with little consideration of the potential implications for future generations. The ”Chemical Revolution” of the 1940s ushered in the production of potentially toxic and radioactive substances, including munitions associated with World War I1 and the Cold War. These substances pose potential threats to health and well-being for decades and centuries to come. Workers in the defense and other industries and the communities neighboring manufacturing facilities were exposed to highly radioactive substances, their byproducts, and the chemical waste discharged into the air, soil, and water systems bordering plants and reservations where these items were produced. The Chemical Revolution also led to the manufacture of ”miracle drugs,” more effective solvents, adhesives, dyes, paints, and wood preservatives,2O many of which now are known to have highly toxic effects. Industrialization led to an era of mass production, packaging, and the creation of disposable containers; glass; paper products; and, ultimately, plastics. The use of fertilizers and pesticides, such as DDT, to enhance plant growth had, paradoxically, the unfortunate effect of polluting the environment and placing farm workers who labored in the fields at risk. America became a ”throwaway” society and created trash in huge quantities. The open burning of trash piles and later the use of incinerators, waste dumps, and landfills grew in relation to the growing consumption of disposable products by the American people. During the 1950s and 1960s, there were few, if any, controls on standards for emission into the environment. The burning of hazardous and nonhazardous waste created unknown risks to the people who lived within reach of fumes and particulates as they dissipated in the atmosphere. Automobile tires, for instance, became a major source of noxious fumes and toxins when disposed of by buming. Growing awareness of the effects of chemical releases into the environment during the 1960s ushered in what Freeze calls the “Age of Awakening.” Carson13 sounded the alarm in 1962, making the public aware of the potential adverse health effects of pesticides and DDT residues in soils, plants, birds, fish, animals, and the body fat of humans. Toxic waste from the defense industry and chemical plants was found buried in landfills, in canisters dumped in ditches and caverns, and in groundwater and streams used for fishing and recreation.8,*3*30,35 Second-
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ary uses of waste materials, such as in pest and dust control, created acute illnesses,3O but the long-term health effects had not been realized yet. The insidious leaching of decomposing buried substances and their migration into the food chain had not yet revealed their effects on health. Concern about the ozone level, global warming, the destruction of wildlife, water pollution, and other environmental ills became increasingly apparent during the 1970s. The "Age of Awareness and Action"20followed and resulted in passage of federal and state laws and regulations designed to safeguard the environment for future generations. By the early 1990s, environmental concerns had become the focus of concern on the US agenda and buoyed voluntary organizations, such as the Sierra Club, the Wildlife Federation, and the Wilderness Society. The EPA was established in 1970 with a mission to "abate and control pollution systematically, by proper integration of a variety of research, monitoring, standard setting and enforcement activities including state and local govemments, private and public groups, individuals, and educational institution^."^^ Federal standards to protect water and air, control toxic substances, and manage hazardous and solid waste were enacted. In 1980, the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), also known as Superfund, was passed. Superfund sites are hazardous waste sites designated by the EPA as a threat to human health and include leaking underground storage tanks and inactive hazardous waste sites (e.g., municipal dumps and contaminated factories), mines, and rnills.l6 Superfund sites placed on the National Priority Lists (NPLs) are the most serious and hazardous and targeted for longterm US action. The Agency for Toxic Substances and Disease Registry (ATSDR) was founded in 1980 as a part of Superfund legislation. Its mission is "to prevent or mitigate adverse human health effects and diminished quality of life resulting from exposure to hazardous substances in the en~ironment."~~ Under CERCLA, persons, businesses, corporations, or other parties responsible for the hazardous waste could be found liable and required to clean up the Superfund site. US dollars were appropriated to augment cleanup of contaminated sites or to relocate communities impacted by the contaminants where necessary. As an example, more than 1000 households at a cost of $30 million were evacuated from Love Canal, a subdivision in Niagara, New York when 100,000 drums of chemical waste, including dioxin, from a chemical and plastics corporation contaminated the soil and leaked into basements, causing multiple health problems.*O Inequality in Environmental Contamination and Remediation
More than 1327 Superfund sites were identified by 1992 (www.boma.org\ suprissa.htm), with a disproportionate number located in poor or minority communities.48,54 Despite US government efforts to clean up contamination, impose strict standards on emissions from industrial sites, and enact safeguards to protect the public in the siting of industrial and waste treatment facilities, the net effect has not been equitable across racial and socioeconomic classes. Poor and minority communities experience a disproportionate burden from environmental contamination than do more affluent and nonminority communities (R. Levine et al, unpublished observations, 1997).9-11,21, 49, 51, 58 Low-income and minority groups are more likely than are affluent and nonminority groups to live near landfills, incinerators, hazardous waste treatment facilities, and NPL sitesz3* 27, 42, and to eat contaminated fish.51Similarly, @
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75% of Southern waste dumps are more likely to be located in black communities.26,”Three of the largest hazardous waste landfills, containing more than 40% of the total US permitted commercial capacity, remain in two black communities, supporting the notion that ”waste tends to flow toward communities with weak response capacity.”25Kellyz9reported that, even when income is controlled, race continues to be a significant factor in the siting of waste facilities, particularly hazardous and nuclear facilities. Middle-class communities of color tend to have more waste facilities than do poor, white communities. Race is the most significant variable associated with the location of hazardous waste sites. This phenomenon has been described as environmental discrimination or environmental rucisrn9~lo, and substantiates that past environmental practices, policies, and decisions were unfair. W e i n t r a ~ bnotes ~ ~ that environmental racism is ”the intentional siting of hazardous waste sites, landfills, incinerators, and polluting industries in communities inhabited mainly by African Americans, Hispanics, Native Americans, Asians, migrant farm workers, and the working poor.” Although discrimination is often a challenge to prove, it is clear that lowincome and disadvantaged communities and populations are exposed and vulnerable to hazardous substances to a greater degree than is the population as a Vulnerability is a factor associated with powerlessness. Minority communities are perceived as powerless. Communities known as passive, lacking political power, not well informed, unorganized, and with “an eager and docile work force”l0,57 are the most likely targets for environmental contamination and abuse and the least likely to receive remediation once dangers to the community are noted. Consistent with these findings, HeimanZ5suggests that politics, demographic shifts, corruption, economics, permitting fraud, discrimination, and weak community response capacity are at the root of decisions to site hazardous facilities in poor and minority areas. Also, instances of falsified laboratory findings have been reported questioning the designation of some sites as uncontaminated (www.mapcruzin.com). impact of Environmental Injustices on Children
Children are often the unwitting victims of environmental injustices, and poor and minority children, just as their parents, are affected disproportionately. An estimated 2.75 million to 3.85 million children (25%) live within 1 mile of a NPL hazardous waste site, and black and Hispanic children are over-represented in these c ~ m m u n i t i e sThe . ~ ~ short-term and long-term effects of environmental contamination and exposure among children have the potential to impact future generations and even markedly change society. Schettler et a14 examined the contributions of toxic chemicals to neurodevelopment, learning, and behavioral disabilities in children. A series of environmental chemicals found in the home, schools, and industrial sites acting singularly or in a synergistic or potentiating manner may contribute to an epidemic of developmental, learning, and behavioral disabilities among children who are at greatest risk for exposure. An estimated 5% to 10% of school-age children have learning disabilities33*34 and an estimated 52% of children are in special education (or approximately 2.25 million children have learning disabilities).” US Department of Education data for 1998 to 1999 show that overall minority participation in special education by 6- to 21-year-old people is comparable with their distribution by ethnic groups in the general population; however, 20.2% of blacks in this age group are in special education programs compared with 14.8% in the
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general p0pulation.3~Black students were over-represented in 10 of 13 disability categories and were present in the categories for mental retardation and developmental delay more than twice their US population e~tirnates.~~ Stone and a s ley47 further document that twice as many special education students as nonspecial education students are likely to drop out of school and that 60% of adolescents in treatment for substance abuse have undetected special education needs.%Young people with a history of special education have a 62% chance of unempl~yment'~; a 52% chance of being in the juvenile justice system2;and, if female, a 50% chance of becoming pregnant within 5 years after high schoo1.5 Lastly, an estimated 42% of adults in correctional institutions were eligible for special There are a host of chemical substances linked with poor neurologic performance and learning. In fact, nearly 75% of the top 20 chemicals on the Toxic Release Inventory (EnvironmentalDefense Fund, 1996) are neurotoxic. Annually, nearly 0.45 billion kg (1billion Ib) of these chemicals are released to the environment and subject to inhalation or ingestion. Some of the more common neurotoxic substances related to learning and behavioral disabilities are lead; mercury; organophosphate pesticides; dioxin; polychlorinated biphenyls (PCBs); nicotine; and solvents used in paints, glue, and cleaning solutions. The prevalence of exposure to lead and dioxin or PCBs in low-income and minority communities is illustrious of the disproportionate impact of hazardous substances on the health of ~hildren.5~ Lead
The risk for lead exposure among children is a subject that has been researched considerably. The EPA53documents that race and poverty correlate with the likelihood of a child having elevated levels of lead in the blood. Children in families with incomes below the poverty line have a greater risk for elevated levels of lead in their blood, and black children are more likely to have higher than normal blood lead levels than are non-Hispanic white children or Hispanic children. Eight percent of low-income children become lead poisoned annually compared with 1.9% of middle-income and 1%of high-income children.'" l5 Despite these disparities, acute lead poisoning necessitating aggressive medical intervention represents only a small proportion of childhood lead exposure. The subtle and long-term effects of regular and insidious intake of lead are a much more pervasive and enduring problem, particularly in communities where exposure is most common. Exposure, particularly in preschool children, is associated with IQ deficits and developmental delays and can be linked with industrial exhaust, car repair shops, traffic c0ngestion,2~and lead-contaminated household Using the Child Behavior Checklist, Needleman et a138and Burns et all2 concluded an association between lifetime low-level lead exposure and increased risk for antisocial and delinquent behaviors among children. Moreover, lead is associated consistently with lower scores on neurologic tests, failure in high school, and reading disabiliv; however, on balance, Bellingel.6, questioned the strength of such associations in the absence of experimental designs. Dioxins and Polychlorinated Biphenyls
Dioxins and PCBs are particularly threatening to infants and small children. These two classes of chemicals are linked to IQ deficits, hyperactivity, and attention-deficit disorders. Dioxins are an unintentional byproduct of industrial
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processes, including the incineration of municipal and medical waste, copper smelting, hazardous waste incineration, and chlorine-based pulp paper bleaching.53PCBs were produced intentionally for many years and used as lubricants, coatings, and insulating materials in electric transformers. Industrial exhaust emitted PCBs and dioxin to the atmosphere where they could travel thousands of miles and settle on water, soil, and vegetation consumed as food by livestock.44 Although the manufacture of PCBs was banned in most countries in the 1970s and 1980s, DeVoogt and Brinkmadsa report that approximately two thirds of the PCBs produced have not yet been released into the environment. Even in the United States, which outlawed their production in the 1970s, the disposal of the chemical in old electric transformers, spent oil in landfills, and hazardous waste sites where leakage is possible, will continue to pose a threat to organisms for centuries to come. Regulated release of these products into streams and waterways also constitutes long-term threats to higher-order animalsM Dioxins and PCBs are stable compounds, bioaccumulate, and are highly toxic. They accumulate in fatty tissue of animals, particularly those near the top of the food chain, such as cows (beef), pigs (pork), fish, and humans. In humans, these compounds can be found in breast milk and then are passed to nursing infants. The primary source of PCBs in pregnant and nursing mothers is contaminated fish. Even if fish is not consumed during pregnancy, PCBs stored in human fat remain toxic for years.28In older children and adults, fish consumption, especially the more fatty varieties, constitutes the major exposure mechanism.l, 40 Although prenatal exposure to PCBs has been found to be related to long-term deficits in a child's intellectual development and short-term memory,2" ** postnatal exposure through breast milk has a lesser neurologic impact. The impact of PCBs on the neurologic development of children is of even greater concern among the poor and minorities. Socioeconomic status is related inversely to fish consumption. Poorer people and minorities tend to consume fish from local waters on a regular basis and are more likely to eat fish from waters with posted fish There is a direct relationship between the amount of fish consumed and the level of detectable PCB in cord blood of infants?" Whether lead or PCBs and dioxin, the data substantiate that poor and minorities are exposed to these highly toxic substances to a greater extent than more affluent residents. It is also clear that these toxic substances are related to lower IQs, memory loss, agitation, and other neurologic syndromes. It also is documented extensively that tests scores of minorities, inner-city residents, and poor persons tend to fall below those of white children and those living in higher-income communities.'" These findings support the likelihood of inequitable management and control of hazardous substances that place some segments of the population at greater risk for exposure than others. These findings raise questions about the relationship between environment and health status of certain populations: Is there a relationship between disproportionate environmental exposure among poor and minority children and disparities in health status? Is there a relationship between environmental exposure to certain toxic substances and violence or performance in school? Is the US response to the real or potential presence of environmental toxins more aggressive in more affluent neighborhoods than in poor and minority neighborhoods? Although evidence suggests that there are relationships between environmental exposure and health and behavioral status, the translation of these
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findings into policy and prevention or remediation actions is less apparent. For example, only 1%of US dollars spent on lead is directed toward eliminating or reducing its presence from poor and minority communities, where the exposure potential is high.37Are environmental inequalities deliberately or inadvertently practiced among vulnerable and less powerful communities?
LEGISLATION AND POLICIES AFFECTING ENVIRONMENTAL JUSTICE AND CHILDREN
In an effort to address evidence of racism and inequality in environmental decision making and the disproportionate burden of contamination in communities of color, environmental justice became a part of US jargon in the early 1990s. The phrase denotes the application of fair strategies and processes in the resolution of inequality related to environmental contamination. Fair treatment means that no group of people should bear a disproportionate share of negative environmental consequences resulting from industrial, municipal, and commercial operations or the execution of federal, state, local, and tribal programs and To monitor and address issues of discriminatory environmental practices, the EPA Office on Environmental Equity was established in 1991, followed by the Office of Environmental Justice in 1992. In 1994, the National Environmental Justice Advisory Council was founded to provide independent advice, consultation, and recommendations to the administrator of the EPA on environmental issues. In 1991, the first National People of Color Environmental Leadership Summit was held and affirmed through principles and strategies that environmental justice must ensure that all people should have an opportunity to live in a healthy environment and are entitled to breathe clean air, drink clean water, and consume uncontaminated foods (Washington, DC,October 24-27, 1991). The US response to actual and potential environmental injustices did not emerge voluntarily but was preceded by a grassroots movement nestled within the Civil Rights movement of the late 1960s. A series of protests and displays of civil disobedience were staged to demonstrate public outrage at the consequences or unintended consequences of environmental decisions or prevailing practices that placed people of color at significant risk. In 1967, students at predominately black Texas Southern University in Houston demonstrated following the drowning of an 8-year-old girl in a garbage dump, where she played at a site unprotected by a fence or warning signs. In 1968, Martin Luther King, Jr. led a campaign for better working conditions for largely black garbage workers in Memphis, Tennessee. The handling of undifferentiated waste placed these workers at heightened risk for exposure to toxic substances. The most widely recognized protest against a deliberate action of injustice occurred in 1982 in Warren County, North Carolina!* The State ordered 32,000 cubic yards of soil contaminated with highly toxic PCBs targeted for burial in the Afton community of Warren County, which was 84% black and one of the poorest counties in the state. Despite hundreds of demonstrators, an admittedly less than suitable water table, and broad national attention, the state prevailed in the creation of this egregious landfill.*0, National studies confirmed such unfair practices in the siting of landfill^.^*,^ By the early 1990s, legislation began to be passed that was relevant to or specific to environmental justice.
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Environmental Justice Legislation
National efforts evolved to address the growing awareness that hazardous chemicals and wastes were putting some communities at substantial risk for exposure and related health problems. Several significant laws were passed and were aimed at preventing or eradicating prior discrimination. The landmark Superfund legislation of 1986, also known as the Emergency Planning and Community Right-to-Know Act, was passed to give communities access to information on environmental hazards that exist in their communities. The legislation directs state and local authorities to develop and promote emergencypreparedness programs based on information from reports about these hazards (EnvironmentalJustice: Legislation in the States, September, 1994). Other legislation introduced in the 1990s focused specifically on racial inequities; the Environmental Justice Act of 1993, the Environmental Equal Rights Act of 1993, and the Environmental Health Equity Act of 1994 were passed. Environmental Justice Act
The Environmental Justice Act of 1993 directs the EPA to publish a list, in rank order, of the total weight of toxic chemicals released in each county or other geographic unit in the most recent 5-year period for which there are available data. The act requires that potential health affects be identified and that remedies be legislated (www.nativenet.uthscsa.edu/archive/nl/9311/ 0125.html). Environmental Equal Rights Act
The Environmental Equal Rights Act of 1993 (HR 1924) gives "citizens of a state the right to petition to prevent the siting and construction of proposed polluting facilities scheduled to be placed in 'environmentally disadvantaged communities" (Jewish Council for Public Affairs, 1994-95).3" For the purposes of this act, environmentally disadvantaged communities are defined as communities that already have a similar facility located within 2 miles of a proposed facility and have a specific demographic m i x of minority and low-income residents. Environmental Health Equity Act
The Environmental Health Equity Act of 1994 (HR 1925) mandates data collection by the EPA on race, income, gender, ethnic origin, and education level in communities adjacent to toxic sites (JCPA, 1994-95). Executive Order 12898
Perhaps the most sweeping policy against environmental injustices in minority communities was enacted through an executive order. Executive Order 12898,19Federal Actions to Address Environmental Justice in Minority Populations, was signed into law by President Clinton in 1994. It mandated that federal agencies make environmental justice part of their mission by identifymg and addressing disproportionately high and adverse human health or environmental health effects of their programs, policies, and activities with minority populations. Also, the order required that meaningful opportunities be provided for the involvement of communities in the development of, compliance with, and
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enforcement of federal laws, regulations, and policies pertaining to human health and the environment regardless of race, color, national origin, or income. Although this executive order is not directed specifically toward children, the breadth of the order certainly offers measures to protect and defend children within the context of the family and community; however, in 1997, a parallel executive order, 13045; was enacted to provide for child safety risks in matters of actual and potential environmental hazards among low-income and minority children. The Centers for Disease Control and Prevention and ATSDR are also in the forefront in advocating and promoting improvement in the quality of the environment for the protection of children. In 1996, ATSDR sponsored the Child Health Initiative to address the vulnerability of children to toxic substances emitted from hazardous waste sites and promote positive child health practices. This initiative focuses on developing child-specific components within existing programs and planning new projects that incorporate child health issues.15 COMMUNITY EMPOWERMENT STRATEGIES
Most of the environmental justice legislation includes a provision that requires community participation in decision making regarding environmental siting and provisions for communities to be inv01ved.l~The level of community participation in relation to environmental legislation is dependent on community awareness, sophistication, sense of power, economic base, organizational skills, and access to knowledge. Community affiliations and networks are, likewise, crucial indicators of its performance when threatened by an environmental issue. These affiliations are useful predictors of the success of its self-efficacy for right, fair, and proper response to immediate and long-term implications of environmental decision making. The resources of poor and minority communities are often lacking when these communities are faced with contrary intentions of “big businesses” and developers to site a potentially dangerous facility. Poor and minority communities, which tend to be more educationally disadvantaged, are less likely than are more affluent communities to know and understand the laws and regulations, have access to environmental data, and use such data in seeking remedies to environmental hazards. These communities are also less likely to be aware of the implications of certain environmental toxins and their long-term impact on the health of populations for generations to come. Such communities are also less likely to respond to environmental concerns arising out of instances of noncompliance by some industrial sites to maintain compliance with emission standards or proposed siting of plants with the potential to pollute. Fear of reprisal, the need for employment, and economic stability are often priorities over the threat to health. Cultural habits and the vestiges of a subservient mentality, particularly in southern states:’ contribute to a sense of powerlessness and inactivity in the face of real environmental concerns. Community empowerment through education, organizing, and partnering are mechanisms for increasing community awareness, activism, and self-advocacy. Lassiter31 describes the value of affinity groups in communities as fundamental structural networks for communication, consensus building, and cooperation around issues of mutual concern. Affinity groups may include aggregates as complex as parent-teacher associations and church membership groups or as simple as families, a grouping of friends, or a group of women who consistently and regularly do laundry together at the neighborhood laundromat. Self-advo-
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cacy can begin through ”story telling” and determining that multiple persons share common concerns and frustrations. These early informal efforts at problem identification are where advocacy stops or is crystallized into a need for action. The ability to move from problem identification to advocacy, power, and influence is related to community resources and community development. US guidelines inherent within policies, such as Executive Order 12898,19 address the requirement for community development and community participation in decision making regarding environmental matters. Community de~elopment~l is a model for community change and encourages a high level of citizen participation in health concerns. It is a process of collaboration with community members to assess collective needs and desires for healthful change and to address these priority needs through problem solving, use of local talent, resource development, and management. It is not the role of health care professionals or other outsiders to resolve the problems on behalf of the community but rather to enhance the capacity of the community by promoting the development of local skills and knowledge to protect or restore the community’s health. Partnering with the community offers a potentially effective model for empowering communities. Building capacity within communities may include community organizing, program development, and supporting protests. Community Organizing
Community organizing involves bringing together cross-sections of community residents and building coalitions for strategic problem solving. In coalition building, citizen groups, professional groups, and other key stakeholders and supporters partner around common interests and concerns. Citizen participation and partnerships are essential for community growth and development and for response to real and potential threats. Communities with fewer resources and weaker linkages with dominant and more powerful communities are vulnerable to exploitations.3l. 55, 56 Strengthening the knowledge base and self-advocacy strategies, coalescing disparate formal and informal groups, and broadening the economic and political power bases enable communities to address and respond to actual and potential circumstances of environmental injustices. Health care professionals are in a position to facilitate strengthening communities and building coalitions based on existing relationships with community members and potential networks with resources and power. To assist communities in addressing injustice issues, health care professionals need basic principles, knowledge, and skills fundamental to working with communities, including community development and community empowerment. Program Development
Program development involves organizing and instituting educational programs in response to identified community need. Responding to community needs by offering programs in health awareness, health promotion, and health education is of considerable value in empowering communities to address issues of environmental injustice or potential injustice. Developing and providing educational programs for citizens to make them aware of potential toxic emissions from manufacturing plants situated in their communities and the relationship of the toxins to health and disease are helpful and beneficial empowerment strategies.
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Protest
Protest, historically, has facilitated many major societal changes and, as such, is an effective class-advocacy strategy. Environmental justice is rooted in the Civil Rights movement and peaceful protest. Successful protests are well planned; involve coalitions; attract media attention; and have an impact on the operations, productivity, or economics of the targeted organization. Civil demonstrations must be organized and executed in accordance with local laws that govern the right of US citizens to protest. Because protest is an adversarial strategy that makes a statement about one position against another prevailing set of principles or practices, caution must be exercised to act in ways to ensure the safety of protesters and property. Health care professionals can play meaningful roles in protests, such as providing assistance in organizing, being expert speakers at rallies, and providing supportive health care services. Child Health Advocacy Strategies
In addition to local and grassroots advocacy, there are a number of national and regional groups that advocate on behalf of children and environmental threats. Some of the organizations are environment specific, and others embrace children’s health within the context of their broader purposes. Their efforts increase public awareness, influence national policy, and promote research. Most of these organizations address the disparities in health among poor and minority children. Several of the more visible organizations include the following. Children’s Environmental Health Network
The Children’s Environmental Health Network is a US multidisciplinary project whose mission is to promote a health environment and protect fetuses and children from environmental health threats. The goals are to promote the development of child-focused US policy, to stimulate prevention-oriented research, to educate educators and others on prevention strategies, and to elevate public awareness of environmental health hazards to children. Information is available through their Web site (http:/ /www.cehn.org). Children’s Defense Fund
The Children’s Defense Fund is a nonprofit, private organization that advocates for children who are disabled, poor, and minority. They are concerned with the well-being of children and focus on prevention of problems that affect them. The organization also channels information about federal and state legislation that affects children to parents. They hope to empower the youth to tackle issues such as environmental justice and crises that arise that affect communities across the United States (www.chi1drensdefense.org). American Lung Association
The American Lung Association (ALA), the oldest voluntary organization in the United States, includes a major focus on childhood asthma, tobacco smoke, and environmental health as parts of its mission. The ALA’s National Asthma Educational Program provides awareness and understanding of asthma across the United States. Its Open Airways Program is an elementary school
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initiative to teach children with asthma to understand and manage their health. The ALA also played a major role in tobacco control laws for children and has developed antismoking education materials for schools. They implemented the Radon Public Information Project and supported the Indoor Air Quality Act, which reduces indoor pollution in offices, public buildings, and homes. The ALA supports public awareness activities and advocacy and provides information on what people can do to prevent lung disease (www.lungusa.org). The West Harlem Environmental Action
The West Harlem Environmental Action (WE ACT) is a nonprofit organization working to improve environmental quality and to secure environmental justice in predominately black and Latino communities. WE ACT advances its mission through research, public education, advocacy, mobilization, litigation, legislative affairs, and sustainable economic deve10pment.l~They produce fact sheets on lead, asthma, and indoor air pollution for black and Latino communities (www.weact.org). SUMMARY
Children have little control over where they live, what they eat, the financial circumstances of their families, or the developmental activities and behaviors that make them vulnerable to environmental contaminants. Minority and poor families disproportionately live in communities with landfills, hazardous waste facilities, incinerators, industrial plants, and old housing with poor indoor air quality and lead-based paint. Residents of these communities are also more likely than are more affluent communities to consume fish on a regular basis from local waters, many of which have banned fishing. Consequently, these children and their families are exposed more frequently than are children in other communities to potentially dangerous chemicals that can affect health. Data indicate that poor and minority children have higher rates of asthma, elevated blood lead levels, learning disabilities, and hyperactivity than do nonminority and more affluent children. When a group of people is exposed unfairly and inequitably to toxins in their communities, workplaces; and schools, a phenomenon called environmental discrimination or environmental racism exists. Environmental justice is a US governmental remedy that requires the application of fair strategies and processes in the resolution of inequality related to environmental contamination. The US response resulted in the establishment of offices of Environmental Justice within the EPA and ATSDR and passage of important legislation and policies, such as the Community Planning and Right-to-Know Act of 1986, Executive Order 12898 (Federal Actions to Address Environmental Justice in Minority Populations), and Executive Order 13045, a parallel order to protect low-income and minority children from actual and potential environmental hazards. Communities and advocacy groups play an important role in promoting healthier environments for children. Frequently, low-income and minority communities are perceived as less powerful, less organized, and ill equipped to defend against actual and potential sources of environmental contamination. Health care professionals are in a strategic position to assist with community development, organizing, and empowerment through educational programming, networking, and supporting other activities that bring attention to the plight of environmentally vulnerable communities.
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