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California’s Central Valley is arguably the most productive agricultural region in the world. Despite making up only 1% of all farmland in the United States, it produces 250 different crops that make up a quarter of all food consumed in the U.S., including close to half of all fruit, nuts, and table foods. The map included below shows the variety and intensity of this kind of cultivation. This level of agricultural production has been made possible by the dominance of industrial agriculture interests at all levels of government, resulting in one of the most physically altered landscapes in the world. These alterations focused in large part on water, the biggest limiting factor for industrial agriculture in a region technically classified as a desert. Over the course of the 20th century, the largest body of freshwater west of the Mississippi–Tulare Lake–was drained to make more land available, the Central Valley Project and State Water Project built thousands of miles of canals and tens of dams to control the supply of water for irrigation, and massive groundwater aquifers were pumped nearly dry during drought years. These transformations were accomplished through the utilization of rhetoric that emphasizes the centrality of the farmer identity to the American political imaginary (despite the massive distance between Californian industrial agriculture and the Jeffersonian agrarian ideal) and the unique importance of providing the nation’s food. This kind of exceptionalism has characterized agriculture across the United States since its inception and has repeatedly produced other forms of social injustice (e.g., the exclusion of agricultural laborers from U.S. labor protections) that compound the hazardous effects of its environmental injustices.

Source

Vo, Katie, Taranjot Bhari and Margaret Tebbe. 2023. Industrial Agriculture in California's Central Valley. In 4S Paraconference X EiJ: Building a Global Record, curated by Misria Shaik Ali, Kim Fortun, Phillip Baum and Prerna Srigyan. Annual Meeting of the Society of Social Studies of Science. Honolulu, Hawai'i, Nov 8-11.

California’s Central Valley is arguably the most productive agricultural region in the world. Despite making up only 1% of all farmland in the United States, it produces 250 different crops that make up a quarter of all food consumed in the U.S., including close to half of all fruit, nuts, and table foods. The map included below shows the variety and intensity of this kind of cultivation. This level of agricultural production has been made possible by the dominance of industrial agriculture interests at all levels of government, resulting in one of the most physically altered landscapes in the world. These alterations focused in large part on water, the biggest limiting factor for industrial agriculture in a region technically classified as a desert. Over the course of the 20th century, the largest body of freshwater west of the Mississippi–Tulare Lake–was drained to make more land available, the Central Valley Project and State Water Project built thousands of miles of canals and tens of dams to control the supply of water for irrigation, and massive groundwater aquifers were pumped nearly dry during drought years. These transformations were accomplished through the utilization of rhetoric that emphasizes the centrality of the farmer identity to the American political imaginary (despite the massive distance between Californian industrial agriculture and the Jeffersonian agrarian ideal) and the unique importance of providing the nation’s food. This kind of exceptionalism has characterized agriculture across the United States since its inception and has repeatedly produced other forms of social injustice (e.g., the exclusion of agricultural laborers from U.S. labor protections) that compound the hazardous effects of its environmental injustices.

Vo, Katie, Taranjot Bhari and Margaret Tebbe. 2023. "Industrial Agriculture in California's Central Valley." In 4S Paraconference X EiJ: Building a Global Record, curated by Misria Shaik Ali, Kim Fortun, Phillip Baum and Prerna Srigyan. Annual Meeting of the Society of Social Studies of Science. Honolulu, Hawai'i, Nov 8-11.

Ochsner Health is a 501(c)3 not-for-profit organization and one of the US’s largest non-university academic medical centers.  It encompasses 46 hospitals and more than 370 health and urgent care centers. There are more than 38,000 team members and over 4,700 physicians employed or affiliated with Oschner. 

Ochsner. N.d. “About Ochsner.” https://www.ochsner.org/about-ochsner. Accessed March 1, 2024. 

Xavier University of Louisiana -  Oschner and Xavier’s partnership has been centered around establishing a joint College of Medicine, to “create a strong physician pipeline that addresses longstanding inequities within the nation’s health care system and builds the health care workforce of the future” (Xavier University 2023). Xavier and Oschner have partnered since the early 1980s, when Oschner began offering clinical training sites for Xavier pharmacy students. Today, Ochsner and Xavier have established a master data sharing and use agreement that provides Xavier faculty with access to Oschner Health’s electronic medical record data. The program has hired four data scientists to provide data analytic services to Xavier faculty. They have also worked together to launch Oschner’s health equity data and quality improvement strategy. Advocacy emerging from this partnership has focused on the expansion of services covered by Medicaid to include tobacco cessation, as well as increasing access to evidence-based maternal health technology. 

“Xavier University of Louisiana and Ochsner Health Partner to Create College of Medicine and Pursue Health, Educational Equity - Xavier University of Louisiana.” n.d. Accessed February 27, 2024. https://www.xula.edu/news/2023/01/xavier-university-of-louisiana-and-ochsner-health-partner-to-create-college-of-medicine-and-pursue-health-educational-equity.html.

Ochsner. 2023. “Ochsner Health-Community Benefit Report.” https://issuu.com/ochsnerweb/docs/communitybenefitreport_8x10.5_final. 

Chevron - Oschner’s partnership with Chevron is centered around a smoking cessation and education program that was launched in 2021. In 2023, Chevron opted to continue the partnership for a third consecutive year through a $50,000 donation. The program is offered in the following parishes: Jefferson, St. Tammany, East Baton Rouge, West Baton Rouge, Ascension, St. Charles, Terrebonne, and Lafourche.  In a press release for Oschner, cigarette smoking was described as “the leading cause of preventable deaths and diseases in the nation” (Oschner 2023). The release refers to America’s Health Rankings data that indicates smoking as one of the top 20 factors shaping poor health in Louisiana. This program is part of Oschner’s broader Healthy State initiative. Chevron funding also supports initiatives to encourage low-dose CT scans (to detect and diagnose lung cancer), teach high school students about the risks of smoking, and teach people to recognize and treat the stressors that lead to smoking.

Oschner. 2023. “Ochsner Health and Chevron Partner for a Third Consecutive Year to Offer Smoking Cessation and Education Program.” n.d. Online Newsroom. Accessed February 28, 2024. https://news.ochsner.org/news-releases/ochsner-health-and-chevron-partner-for-a-third-consecutive-year-to-offer-smoking-cessation-and-education-program.

 The Healthy State by 2030 initiative emerged in 2020. The goal of the initiative is to improve access to healthcare in Louisiana through community engagement and by partnering with organizations across different sectors (healthcare, business, religion, education, government, and education). The program also includes a focus on collecting, analyzing, and sharing health data. The program’s priorities are to reduce smoking cessation (with 214,000 fewer residents smoking by 2030); improve access to care for cancer and other chronic conditions like diabetes and high blood pressure through screenings (aiming for 100,000 fewer residents with chronic conditions by 2030); reduce obesity rates (with 182,000 “more physically active adults” by 2030); reduce rates of food insecurity (helping 72,000 more households gain access to healthy food); improve per-capita income levels (by $4,838); and improve access to high-speed internet (with 86,000 more homes having access). 

 This initiative is focused on improving health by improving “the conditions in which we are born, live, and work,” in the words of Dr. Eboni Price-Haywood, the medical director of the Healthy State 2030 Initiative and the Oschner Xavier Institute for Health Equity and Research. However, the projects that have been highlighted under this initiative seem to largely consist of expanding Oschners’ service delivery footprint. Ochsner’s expansion has been welcomed by communities that have long struggled to access care, but this form of intervention is limited in addressing broader structural drivers of health. 

One of the largest investments of Health States has revolved around the opening of five new health centers (in Baton Rouge, Lafayette, Monroe, and Shreveport). The health centers are framed as addressing health equity because they are “strategically located in areas of the state with high instances of chronic conditions, low birth weights, infant mortality, and early adult mortality” (Mcelfresh np, 2022). In addition to healthcare services, the centers offer resources for smoking cessation, diabetes management, and “social issues” that include transportation and food insecurity. Each center has an advisory council that includes patients, elected officials, businesspeople, and community members. 

In 2023, Oschner’s executive leadership announced their commitment to the Global Health Network (GHEN) Zero Health Gaps Pledge.  This initiative falls under the UN Sustainable Development Goals and has been described as a part of Healthy State.  

Ochsner Health. N.d. "Healthy State." https://www.ochsner.org/healthystate. 

Oschner Health. N.d. “Ochsner Health Pledges Zero Health Gaps for World Health Day.” Accessed February 28, 2024. https://www.newswise.com/articles/ochsner-health-pledges-zero-health-gaps-for-world-health-day.

McElfresh, Amanda. 2022. “Ochsner’s Healthy State 2030 Uses Community-First Approach to Improve Life for Louisianans.” NOLA.Com. August 7, 2022. https://www.nola.com/sponsored/cox_business/ochsner-s-healthy-state-2030-uses-community-first-approach-to-improve-life-for-louisianans/article_cfb1a366-1345-11ed-bfdf-33daaec76946.html.

Louisiana Clinical Data Research Network (LACDRN) is a collaborative project between the Louisiana Public Health Institute (LPHI), Pennington Biomedical Research Center, Tulane University, and Ochsner Health System. The network provides warehouses of clinical data available to clinical and health systems researchers: “representing a state and region that has unique health challenges related to disparities, natural disasters, high prevalence of chronic diseases, and some rare conditions, LACDRN is an important resource for clinical and health system research that will advance evidence-based diagnosis, treatment, disease management, and healthcare delivery” (Kurshid et al. 2014, 612).

Khurshid, Anjum, Elizabeth Nauman, Tom Carton, and Ron Horswell. 2014. “Louisiana Clinical Data Research Network: Establishing an Infrastructure for Efficient Conduct of Clinical Research.” Journal of the American Medical Informatics Association : JAMIA 21 (4): 612–14. https://doi.org/10.1136/amiajnl-2014-002740.

Ochsner is using a digital platform developed by Unite US to expand and improve community health throughout Louisiana, in partnership with CVS Health and Humana. The platform is used by insurance companies’ care managers and provider teams to coordinate social services for patients. The Louisiana Unite US more than doubled following the outbreak of COVID-19 (Unite US, 2020).

Unite US. “CVS Health, Humana, Ochsner Health, and Unite Us Join Forces.” 2020. Uniteus.Com. November 18, 2020. https://uniteus.com/press/unite-louisiana-healthcare/.

As a tax-exempt hospital, Ochsner produces publicly accessible community health assessments as a requirement of the Patient Protection and Affordable Care Act (PPACA). As a statewide network, Ochsner has conducted health assessments for Shreveport, Lafayette, Monroe, New Orleans, Kenner, Baton Rouge, St. Mary, St. Anne, Northshore, Houma, Kaplan, Crowley, and Breaux Bridge, as well as Bay St. Louis in Mississippi. 

Ochsner’s proprietary Diversity, Equity and Inclusion (DE&I) Dashboard launched in 2022. The dashboard does not appear to be public however and there is very little available information about this tool. Ochsner's 2022-2023 impact report describes the tool as follows:  “In 2022, Ochsner’s proprietary Diversity, Equity and Inclusion (DE&I) Dashboard launched, informing delivery model innovations and enabling clinicians to identify populations with gaps in care and outcomes. The dashboard includes patient experience and care metrics, with data sortable by sociodemographic groups like race, location, and insurance type. Through the dashboard, we could see that 36% of Ochsner Health Network patients with hypertension are Black or African American, and of those, 80% have their hypertension controlled. In comparison, 86% of white patients with hypertension have it controlled. This data was in turn used to inform strategies to close gaps in care and improve outcomes”  (Ochsner 2022-2023 Impact Report, n.p.). 

Ochsner Health Network. “2022 – 2023 Impact Report, Accelerating Value-Based Care.” Accessed March 2nd 2024.  https://www.ochsner.org/impact-report/. 

Ochsner’s  Enterprise Data Warehouse (EDW) stores clinical data collected over more than 20 years, includes data captured through EPIC/Clarity and claims data.

According to Philip M. Oravetz, MD, MPH, MBA, chief population health officer at Ochsner Health, Oschner is in the process of developing an electronic health record that includes demographic and SDOH data collected at the point of care, and then integrated into artificial intelligence (AI) and predictive modeling (Caffrey and Klein 2022). 

Caffrey, Mary, and Hayden Klein. 2022. “How Ochsner, Xavier Are Working Together to Make Louisiana a Healthy State,” December 2022, 10 (December). https://www.ajmc.com/view/how-ochsner-xavier-are-working-together-to-make-louisiana-a-healthy-state.

Oschner was founded on January 2, 1942, in New Orleans by Alton Oschner, an American surgeon and medical researcher. Before founding Oschner, he worked at Tulane University and organized a surgical teaching program at New Orleans Charity Hospital. Oschner Medical Center, formerly known as the Oschner Clinic, was the first to document the connection between cancer and cigarette use. This work mobilized Oschner to expose the hazards of tobacco and pioneer the war against smoking. 

Blum, Alan. 1999. “Alton Ochsner, MD, 1896-1981 Anti-Smoking Pioneer.” The Ochsner Journal 1 (3): 102–5.

Ochsner’s mission statement is to “We Serve, Heal, Lead, Educate and Innovate” (Ochsner n.d.).

Their vision is to inspire “Healthier Lives and Stronger Communities” (Ochsner n.d.)

Ochsner. N.d. “Mission, Vision, Values.” https://www.ochsner.org/values. 

“...Toxic Wastes and Race at Twenty (Bullard et al., 2007) revealed that communities of colour and poor communities were still being used as dumping grounds for all kinds of toxic contaminants. The authors discovered evidence that the clustering of environmental hazards, in addition to single sources of pollution, presented significant threats to communities of colour. Furthermore, the research showed that polluting industries frequently singled out communities of colour in siting decisions, countering the “minority move-in hypothesis”: the claim that people of colour voluntarily move into contaminated communities rather than being targeted in situ by dirty industries.” (122)

“Bullard (1990) has highlighted the problem of “Black Love Canals” throughout the United States, where issues of environmental injustice are deeply connected with environ- mental racism. For example, Bullard highlights the case of toxic DDT water contamination in the African American community of Triana, Alabama. In 1978, in the midst of the national media attention focused on Love Canal, residents in Triana raised complaints over ill-health effects and contaminated fish and waterfowl. Lawsuits in Triana against the Olin Corporation continued throughout the 1980s. Although the case is noted within environ- mental justice histories (see Taylor, 2014), it is not widely recognized or commemorated.” (126)

“Underpinning the slow, structural violence (see Galtung, 1969; Davies, 2019) of unequal and unjust toxic exposures is the problem of “expendability” … Pellow (2018) proposes that indispensability is a key pillar of critical environmental justice studies (alongside intersectionality, scale, and state power). This idea builds on the work of critical race and ethnic studies scholar John Marquez (2014) on “racial expendability” to argue that, within a white-dominated society, people of colour are typically viewed as expendable.” (127)

“National and international media headlines followed the Flint water crisis story as it unfolded, but, after the initial shock, Flint faded from media attention. It shifted from being a spectacular disaster to a case of slow violence. This paral- lels the dynamics of public memory surrounding many toxic disasters, struggles, and legacies.” (128)