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WHAT (& WHAT FOR): Lead is a metal often found in pipes, and in old paint (before it was banned in paint in the late 1970s). Before 1996, lead also found in vehicle fuel resulting in  soil contamination in many communities from both paint dust and vehicle pollution. 

HEALTH IMPACT: Lead is a neurotoxin and is known to have no safe blood lead level in children. 

Has been linked to:

1. Brain swelling, anemia, seizures, renal failure, reduced IQ, and ADHD

2. Damages brain development in children

3. Connected to behavioral problems like aggression and bullying, and internalizing problems such as depression and anxiety 

LOCAL IMPACT: Recent research in Santa Ana has shown that there is a disproportionately impact of solid lead contamination crisis on lower income, people of color communities. 

POSSIBLE RESPONSES: There are many ways to respond to lead contamination:

1. Providing special health care for children with high blood lead levels, and investigating possible sources of lead exposure in homes, daycares and school, playground, etc.

2. Implement strict housing policies where landlord and city housing officials are required to have lead inspections of homes for lead paint hazards (especially in low income, people of color communities)

3. Requiring a minimum reduction standard for lead paint in older homes 

4. Requiring blood lead level test as part of the routine check up for children (extremely important for children in low-income housing)

This supplementary legal document describes recommendations for storm- and waste-water management improvements for the Formosa petrochemical plant in Calhoun County, Texas. The text is a fairly standard drainage assessment. The author describes non-trivial discharge of pollutants out of the plant’s outfalls, which drain into local waters, and the inability of the plant’s systems to prevent flooding from even small storms. For some context on this, it is pretty standard to design a stormwater system to be able to drain the 100-year storm (that is, the storm with a 1% or less chance of occurring in any given year). Formosa’s Texas plant demonstrated the inability to convey even the 2-year storm.

Emphases are mine:

“Problem areas were identified based on the results from the outfall drainage studies provided by Formosa. Thus, all the results in the OPCC rely on those studies, uncertainities associated with those studies, and the assumptions made for those studies, some of which may or may not be appropriate as I pointed out in Supplement #2 [Page 4]” (3)

“The proposed improvements assume that the conveyance capacity of the problem areas is increased 100%, which would be able to handle twice as much flow that it currently does. The results from the Drainage Study are not conclusive as to what storm event Formosa’s system currently is capable of conveying. The report does mention that the system is not capable of conveying the 2-year storm, and “sometimes” not even the 1-year storm event.” (3)

“A 45% contingency is applied to the OPCC due to the uncertainties associated with underground utilities, likelihood of existence of low road crossings and need to replace those, groundwater impacts, other unknowns, and additional costs associated with engineering, etc. 45% is reasonable and in line with industry practices in my experience, especially given the large amount of unknown information available.” (4) 

“My opinion from my July 9, 2018 report that “there have been and are still pellets and/or plastic materials discharges above trace amounts through Outfall 001” is further supported by the deposition testimony of Lisa Vitale, as representative for Freese & Nichols, Inc, that she and her colleagues have seen floating white pellets or small plastic pieces in Lavaca Bay and in the area near outfall 001 as part of her work on the receiving water monitoring program for Formosa’s TPDES permit...Ms. Vitale also testified that she told John Hyak of Formosa about these sightings as well as has sent him water samples with the pellets about five or six times, including at least one time prior to 2010. This, along with the June 2010 EPA Report I cited in my July Report, demonstrates to me that Formosa was aware of problems related to discharges of plastics from its facility since at least in 2010.” (6)

The 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.

The 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.

The 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.

“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)

Data 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.

Emergency 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.

The 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.