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June 10, 1999
WEALTH AND HEALTH
The environmental movement is missing the boat on the biggest public health issue of our time. Thirty years of scientific research have established that the most powerful predictor of human disease is economic inequality, but the environmental movement, for the most part, is not paying attention to economic issues. Of course some traditional "tree huggers" have never spent much time worrying about human health at all. But even the environmental justice movement -- which definitely does care about people -- is not yet fully focused on the growing gap between rich and poor as the main predictor of human illness. Most environmentalists still view jobs and the economy as foreign territory, so most environmentalists are focused on something besides the main public health problem of our time: growing inequality of income, wealth and status.
As the NEW YORK TIMES reported June 1 in its weekly Science Section,
"Scientists have known for decades that poverty translates into higher rates of illness and mortality. But an explosion of research is demonstrating that social class -- as measured not just by income but also by education and other markers of relative status -- is one of the most powerful predictors of health, more powerful than genetics, exposure to carcinogens, even smoking.
"What matters is not simply whether a person is rich or poor, college educated or not. Rather, risk for a wide variety of illnesses, including cardiovascular disease, diabetes, arthritis, infant mortality, many infectious diseases and some types of cancer, varies with RELATIVE wealth or poverty: the higher the rung on the socioeconomic ladder, the lower the risk. [Emphasis in the original.]"[1]
It isn't the absolute level of well-being that matters so much as the relative level. Even among the well-to-do, those higher on the social scale are healthier. As the NEW YORK TIMES put it, current research is showing that a mid-level executive in a three-bedroom home in Scarsdale, N.Y. is more vulnerable to illness than his boss who lives in a 5-bedroom home a few blocks away.
No one is yet sure how all the components of this problem fit together. A sense of control of one's life is a key part of it. Stress is another. Social exclusion and residential segregation -- especially by race but also by class -- both have important negative impacts. A sense of opportunity, dignity, self-esteem, the respect of others -- all these are important for health. Social cohesion -- a sense of neighborliness -- also plays a role: people live longer in places where they believe they can trust their neighbors.
As Harvard economist Juliet Schor says, "The reasons may not turn out to be so very complicated. Humans are social. We judge our own situations very much in comparison to others around us. It is not surprising that people experience less stress, more peace of mind, and feel happier in an environment with more social cohesion and more equality."[2,pg.4]
If relative standing in the community is what matters most in protecting public health, then the modern world has been headed in the wrong direction for at least 20 years. Inequality has been increasing for 20 years, and not by accident. Most households in the U.S. have lower net worth than they did in 1983, and the wealthy few are far wealthier than they were in 1983. Between 1983 and 1995, the inflation-adjusted net worth of the top 1% of Americans swelled by 17% while the bottom 40% of households lost 80%.[2,pg.5] In other words, the gap between the rich and the rest of us has widened. It is this widening gap that gives rise to disease, research shows.
This problem is not restricted to the U.S., though the U.S. suffers from greater inequality than any other industrialized nation. The United Nations HUMAN DEVELOPMENT REPORT 1998 points out that in 100 countries, incomes today are lower in real terms than they were a decade ago.[3] And in many of these countries, inequality has grown as small elites have become fabulously wealthy. The HUMAN DEVELOPMENT REPORT does not say so, but these are some of the fruits of economic "liberalization" policies and "free trade" agreements.
Within the U.S., the growing gap between rich and poor has not occurred by accident. It is the result of public policies and private corporate practices intended to benefit those who own assets at the expense of those who earn wages.[2,pg.61] Here is a short (and incomplete) list:
** Shrinking wages. Despite some growth in wages in 1996 and 1997, hourly workers in 1998 still earned 6.2% less per hour (adjusted for inflation) than they did in 1973 when Richard Nixon was President.[2,pg.27]
** The minimum wage has become a poverty wage. At $5.15 per hour, the minimum wage today buys 19% less than it did in 1979, when it was worth $6.39 per hour, adjusted for inflation.[2,pg.27]
** The median income of young families with children was 33% lower in 1994 than it was in 1973.[2,pg.30]
** The average worker worked 148 more hours in 1996 (1868 hours) than in 1973 (1720 hours). That's equivalent to nearly 4 weeks additional work each year, to make ends meet.
** At a median weekly wage of $659, union jobs pay much better than non-union (with a median of $499). But union jobs have been destroyed by downsizing, free trade policies, and plain old union busting. As BUSINESS WEEK summed it up in 1994, "Over the past dozen years, in fact, U.S. industry has conducted one of the most successful anti-union wars ever, illegally firing thousands of workers for exercising their right to organize."[2,pg.32] Fewer than 14% of workers are union members now, down from 35% in 1955.
** For 20 years, companies have been withholding wages from workers and transferring that wealth to executives. In 1980, the average CEO in BUSINESS WEEK's annual survey made 42 times as much as a factory worker.[2,pg.32] By 1997, the average CEO was making 326 times as much as a factory worker.
** Pensions are slowly disappearing, and the quality of pension programs is rapidly declining. Only 47% of workers are covered by pension plans (down from 51% in 1979). Furthermore, there has been a shift away from "defined benefits" pensions to "defined contribution" plans. Under the old-style plans, a worker received a lifetime pension of a certain amount based on years worked and wages earned. The new-style plan takes a chunk of a worker's pay check (which may or may not be supplemented by a contribution from the employer) and invests it. If the investment does well, the worker has money for retirement; if not, tough luck. Defined contribution plans accounted for 42% of all pension plans in 1997, up from 13% in 1975. In addition, only 16% of low-wage workers are covered by pensions, vs. 73% among workers in the top fifth wage bracket, so pensions themselves contribute to inequality.
** The federal government subsidizes home ownership through a tax deduction for interest paid on mortgages for owner-occupied first and second homes. Unfortunately, this amounts to a subsidy for the well-off: the more you have to spend, the more your government subsidizes you. Tax subsidies for affluent homeowners have remained steady for 20 years while federal funding for low-income housing has been slashed 80%.[2,pg.38]
** Savings are a thing of the past. The U.S. personal savings rate has fallen from 8.6% in 1984 to 2.1% in 1997 and 0.5% in 1998. People are spending a larger portion of their incomes on health care, child care, housing, and college tuition. Even the cost of saving has risen as banks have steeply increased their service charges, especially on small accounts that don't meet the high minimums needed to avoid fees.
** The U.S. Conference of Mayors reports that requests for emergency food increased an average of 14% during the period 1997-1998. One out of five requests for food assistance went unmet. The AMERICAN JOURNAL OF PUBLIC HEALTH in 1998 reported that 10 million Americans -- including more than four million children -- do not have enough to eat;[4] a majority are members of families with at least one member working.
** All members of Congress enjoy publicly financed health care, but they refuse to extend these same benefits to their constituents. And the private sector is walking away: in 1985 nearly two thirds of all businesses with 100 or more employees paid the full cost of health care coverage. Today fewer than one-third still do.[2,pg.43]
** Increasingly a college education is the key to decent wages, but since 1989 tuition and fees have increased 94% -- three times as fast as inflation.[2,pg.47]
** Racism is a key factor in income inequality. It is hard for blacks to find work and when they do, they are paid less than whites for equal performance. The NEW YORK TIMES May 23 said "Booming Job Market Draws Young Black Men Into Fold," reporting that the "booming" economy has created a tight labor market, resulting in blacks getting good jobs. But deep in the story, you learn that unemployment among black youth has dropped from its high of 20% in the 1980s to 17% today -- still twice as high as among white youths.[5]
** The income gap between blacks and whites is reflected in a serious "wealth gap" as well. In 1995, the median black household had a net worth of $7,400 -- about 12% of the median wealth of white households ($61,000). Median black financial wealth (net worth minus home equity) was just $200 -- a mere 1% of the $18,000 median financial wealth of whites.
Hispanic households have even less than blacks. The median Hispanic household had a net worth of $5,000 in 1995, just 8% of the median net worth of white households. The median financial wealth of Hispanics in 1995 was zero.
** Housing discrimination explains a good deal of this inequality. According to a 1991 report on fair housing audits in 25 U.S. cities, published by the Department of Housing and Urban development, blacks encountered discrimination more than half of the time.[2,pg.56]
In the past 5 years, 193 studies have been published on various aspects of socioeconomic status and health, according to the NEW YORK TIMES.[1] The National Institutes of Health last year declared the relationship between social status, race and health to be one of its top priorities. The John T. and Catherine D. MacArthur Foundation has established a Network on Socioeconomic Status and Health.But to most environmentalists, the idea of pressing for a high-wage, "high road" economy -- to counter the present "low road" rush toward low-paying, part-time jobs without benefits -- still seems like a suggestion from another planet.
Luckily a coalition (called Sustainable America) has formed to advocate for all of the pieces we now know we need: a high-wage economy, clean production of needed goods and services, and a political democracy in which people can participate in the decisions that affect their lives. In sum, Sustainable America is taking on the whole ball of wax.[6] It's about time someone did.
--Peter Montague
DIOXIN AND PRECAUTION
Two years ago, in 1997, the International Agency for Research on Cancer (IARC) formally concluded that dioxin causes cancer in humans.[1] IARC is a division of the World Health Organization (WHO) and its recommendations carry considerable weight in the world of public health policy.
Dioxin is the name of a family of 219 toxic chemicals, many of them created as unwanted byproducts of numerous industrial processes: incineration of municipal solid waste, hazardous waste and medical waste; the smelting of metals; the manufacture of chlorine-bleached paper; and the production of many pesticides and other toxic chemicals. Basically, any time you have high temperatures and the presence of chlorine-containing chemicals, you have conditions that can spawn dioxins.
Over the years, many studies of laboratory animals have shown that dioxins can cause many different kinds of cancer. However, in reaching its 1997 conclusion, IARC relied on studies of humans, specifically, four studies of workers exposed to high levels of dioxin on the job. The four studies revealed a remarkably consistent effect from dioxin exposure: a 40% increased chance of dying from cancer. In all four studies, the effect was highly statistically significant.[2]
In three of the four studies, data for estimating dioxin exposures was available in 1997. Using the available exposure data, the authors of the three studies were able to observe a clear "dose response relationship" -- as the level of dioxin exposure increased, so did the chances of dying of cancer. Seeing a "dose response relationship" gives researchers more confidence that the relationship they have observed (in this case, between dioxin exposure and cancer) is real.
Now information about dioxin exposures among the fourth group of workers has become available, and a dose-response relationship can be seen in those workers as well.[3] The more dioxin they were exposed to on the job, the greater their chances of dying of cancer.
This fourth group was the largest of them all -- 5132 workers at 12 U.S. industrial plants where they were exposed to dioxin over many years. Researchers at the U.S. National Institute for Occupational Safety and Health (NIOSH) were able to find job histories for 69% of the 5132 workers and thus could categorize them into seven groups according to their dioxin exposures.
The new information appears in the May 5 issue of the JOURNAL OF THE NATIONAL CANCER INSTITUTE. In their report, the NIOSH researchers explain that they saw a 13% increased chance of dying of cancer among the 5132 workers, compared to an unexposed group. Among the highest two exposure groups, they observed a 60% increased chance of dying of cancer.
In sum, we now have four separate studies of groups of humans who have been exposed to dioxin and who are dying disproportionately from cancers. These studies provide support for many previous studies of laboratory animals showing that dioxin causes various cancers.
Does this close the book on dioxin and cancer? Unfortunately, it does not.
Every group of humans who have been exposed to high levels of dioxins has now been studied. There aren't any other groups to study. Therefore, the data that are available now are probably the only human data we will ever have. (Of course as time passes these same groups will be studied further, but the results are not likely to change dramatically.)
With today's data, it is still possible to reach conclusions that are 180 degrees out of synch with each other. In an editorial in the JOURNAL OF THE NATIONAL CANCER INSTITUTE May 5, Dr. Robert N. Hoover of the U.S. National Cancer Institute wrote, "My belief, based on the current weight of the evidence, is that TCDD [the most potent dioxin] should be considered a human carcinogen."[2] This is precisely what the World Health Organization concluded two years ago.
In contrast, when the British medical journal LANCET ran a news story reporting the latest dioxin findings from the JOURNAL OF THE NATIONAL CANCER INSTITUTE, they quoted Michael Kamrin, a toxicologist from Michigan State University (East Lansing, Mich. USA) who said the dioxin data is "unconvincing and epidemiologically weak... These data don't suggest to me that there's any health risk from dioxin [TCDD]. I didn't think so before, and I don't think so now," Kamrin told the LANCET.[4]
So the question is, how should ordinary people react to dioxin? When we learn that we and our children are breathing dioxins created by a medical waste incinerator, or a garbage incinerator, or a cement kiln burning hazardous waste, what should we think? Should we accept the opinion of Robert Hoover from the National Cancer Institute that dioxin is probably a cause of human cancers? Or should we accept the words of Michael Kamrin at Michigan State who says there isn't any health risk from dioxin? Experts can always disagree, but citizens must make choices in the best interests of themselves and their families.
It seems clear that science cannot solve this kind of dilemma. There has never been a chemical studied more thoroughly than dioxin. For the past decade the U.S. government has been conducting a detailed analysis of many hundreds of previous studies of the health effects of dioxins (in animals and humans). Furthermore, the government has spent millions of dollars conducting new studies of dioxin's effects on humans (for example, the NIOSH study, discussed above) and animals. In addition, the Chemical Manufacturers Association and the Chlorine Chemistry Council have spent substantial sums of money hiring their own brand of scientist to try to tilt the balance in the direction of "dioxin is no problem." (As you might imagine, there are huge sums of money riding on the outcome of the dioxin debate.)
For most chemicals, we can probably never expect to get data as good as the data we have now for dioxin. Given limited funds for study, and given that there are 70,000 chemicals now in use and 1000 new ones added each year, we cannot realistically expect anything like "thorough" data on the health effects of any particular toxic chemical.
Therefore, how should we, the public, react to dioxin or any other toxic chemical? There are two basic ways of approaching such a question -- risk assessment or precaution.
Risk assessment asks the question, How much damage are we willing to tolerate from dioxin exposure? Risk assessors usually answer this question by saying that it is "acceptable" to kill one in every million people exposed to dioxin. (Sometimes they give a different answer, saying it is OK to kill as many as one in every 10,000 people exposed to chemical A or chemical B, but usually their answer is that one-in-a-million is the acceptable kill ratio.)
Now let us remove our rose-colored glasses for just a moment and be blunt. You rarely find a risk assessor who will say so, but the one-in-a-million formula is, at base, a prescription for legalized murder. The dead person is selected at random and is killed anonymously. But it is still a premeditated, planned death. If "risk assessment science" improved to the point where the victim's identity were known, then everyone would agree that a murder had been committed.
Once the community of risk assessors has accepted that it is OK to kill one-in-a-million citizens by exposing them to dioxin (or some other toxicant du jour), then the mathematicians and toxicologists go to work and develop a formula that says "exactly this much dioxin can be emitted into the community, and no more, if we are to abide by the one-in-a-million limit of 'acceptable risk.'" Then it is up to the engineers to design a machine that will emit just the "acceptable" amount of dioxin or other toxicant and no more. And then the government regulators ratify and enforce the engineer's limit. That is the sum and substance of the "risk assessment" approach to controlling toxic exposures, from dioxin or from any other deadly agent.
A different way to view the problem is to ask, How can we avoid dioxin exposures and so avoid the possibility of killing people with dioxin? This is the approach embodied in the "principle of precautionary action." The precautionary principle says,
"When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context the proponent of an activity, rather than the public, should bear the burden of proof.
"The process of applying the Precautionary Principle must be open, informed and democratic and must include potentially affected parties. It must also involve an examination of a full range of alternatives, including no action."
A precautionary approach to dioxin would look at the available (sometimes conflicting) evidence about dioxin and ask, "If we think it is better to be safe than sorry, shouldn't we avoid dioxin exposures when we can?" And then the search would begin for alternative ways to avoid dioxin exposures. Shutting down incinerators -- or, better yet, not ever building incinerators -- would be one feasible approach. There are numerous alternatives to incineration, and a "better safe than sorry" strategy would examine all of them.
Reducing our use of chlorine-containing chemicals would be a second approach. There are few, if any, uses of chlorinated chemicals that are essential and irreplaceable. Alternatives are available.
In sum, a precautionary approach would not ask "How many dioxin deaths can we tolerate in our society?" -- instead, it would ask, "How can our society avoid making dioxin?"
The risk assessment approach, which has been the "official" approach in the U.S. for the past 25 years, excludes citizens for the most part because they don't have the knowledge to calculate the one-in-a-million kill ratio. Only the "risk experts" are able to do that. In that sense, the risk assessment approach is undemocratic and even anti-democratic. \tab But when it comes time to deciding whether an incinerator is the best way to handle the community's garbage, people can get involved. They can ask citizens in other communities how they are handling THEIR garbage. They can sponsor public discussions in which various groups (including waste companies) send representatives to tell how they would handle the community's wastes. People can ask about the sources of waste in their community and they can demand a "clean production" approach to those sources. (See REHW #650, #651.) Then people can discuss the pros and cons of what they have heard and can make up their own minds about what's best. Unlike risk assessment, the precautionary approach fosters citizen participation and promotes democracy.
--Peter Montague
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