Sherri White-Williamson collects a water sample in Sampson County NC (March 2021)
rwitterIn response to multiple concerns about water quality expressed by residents, EJCAN launched a water quality testing initiative with university-based collaborators from UNC Chapel Hill and Appalachian State University. Threats to water include but are not limited to industrialized agriculture. Industrialized hog feces contain pathogens, heavy metals, and antibiotic-resistant bacteria that growers store in large, open pit lagoons (Grant 1999; Wing et al. 2008; Blanchette 2019; Christenson et al. 2022). When operators spray the waste onto nearby fields, they also release air and waterborne contaminants. Scholars have linked airborne emissions from industrial hog operations to respiratory dysfunction, mood disorders, compromised immune function, anemia, kidney disease, tuberculosis, and low birth weight (Wing et al. 2000; Kravchenko et al. 2018; Guidry et al. 2018). Moreover, the odor is noxious, causing nausea, embarrassment, disorientation, and social loss in cultural continuity as people cease culturally meaningful practices like gardening, going for walks, or gathering outside to share food (Herring 2014; Blanchette 2019). The impacts to water include contamination, harmful algal blooms, fish kills, and eutrophication in rivers and estuaries, especially when hurricanes flood the inner coastal plains with industrialized animal waste (Wing et al. 2000; Wing et al. 2008; NCCN 2021; Emanuel 2018; Christenson et al. 2022). Access to water infrastructure in Sampson County is highly uneven, and residents have been advocating for improved access for more than a decade.
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erin_tuttleThe authors are Paul E. Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. All of the authors are involved with the nonprofit organization Partners in Health in some capacity, with experience working with rural or poverty stricken areas. Paul E Farmer, the primary author of the article is a medical doctor also working for the United Nations who has published many other articles on similar topics.
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erin_tuttleThe main argument is that susceptibility to certain diseases is not only determined by biology but also social conditions, leading to a disproportionate disease rate among the poor, and minority groups without access to medical services. The author shows that addressing these social conditions leads to a decrease in disease when combining treatment and prevention plans.
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erin_tuttleThe argument is supported through a combination of historical information including rates of AIDS in the early 1990’s and a study done in Baltimore in an effort to reduce AIDS rates in African Americans, who were more likely to be in poverty, by addressing monetary barriers to heath care. Two more recent cases are also used to support the main argument, implementing a method created by the Partners in Health to prevent transmission and provide AIDS care in rural Haiti and rural Rwanda. Throughout the article references were made to the current medical professional’s dilemma, where they are in a position to see the social inequalities contributing to disease rates but not trained to report or change common social contributing factors. This makes the article more relatable to the reader that may have experience in the medical field which elps to support the argument.
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erin_tuttle“Pioneers of modern public health during the nineteenth century, such as Rudolph Virchow, understood that epidemic disease and dismal life expectancies were tightly linked to social conditions [55,56].” (Farmer 5)
“…large-scale social forces—racism, gender inequality, poverty, political violence and war, and sometimes the very policies that address them—often determine who falls ill and who has access to care.” (Farmer 1)
“In an attempt to address these ethnic disparities in care, researchers and clinicians in Baltimore reported how racism and poverty— forms of structural violence, though they did not use these specific terms—were embodied [33,34] as excess mortality among African Americans without insurance.” (Farmer 2)
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erin_tuttleData collected from a study done in Baltimore in the 1990’s, including statistics and observations is used to support the main argument. The methods used in Haiti and Rwanda as well as the results from implementing those methods are also used as examples for the claim that social conditions greatly impact disease susceptibility.
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erin_tuttleEmergency response is addressed in terms of both long term response and future emergency prevention. The method used by the PIH in both Haiti and Rwanda were implemented in response to high rates of disease in those places, showing that an emergency can occur gradually and the response may require creating a permanent system. Prevention is also discussed as a portion of emergency response, that it is important not only to deal with emergencies as they occur but also to identify the causes and change the system to prevent the same emergency in the future.
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erin_tuttleThe article has primarily been referenced in later works by Paul E. Farmer who has written several other papers and articles on both the medical state of Haiti and Rwanda as well as structural violence in many capacities. The article was initially published in 2006 and has since been published in journals, books, as well as open online collections for use by the sts community.
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erin_tuttleThe bibliography shows references to several papers by many of the same authors, showing it was produced as a continuation of previous ideas but showing new information learned through the PIH’s activities in Haiti and Rwanda. The bibliography also shows many references from the early to mid 1990’s showing similar thoughts to initial research done in Baltimore and other places with high rates of AIDS.