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Science without conscience is the soul’s perdition.
–FRANÇOIS RABELAIS, PANTAGRUEL
AFT Health Care is committed to advancing equity and promoting well-being. As we strive to publish the highest quality research and ideas for cultivating individuals’ and communities’ health, one of our core areas of focus will be uncovering and dismantling systemic racism. In this article, Harriet A. Washington addresses environmental racism; discussing the Flint water crisis, she includes a direct quote that uses the N-word in full. The question of how to handle such language is a difficult one: we respect Washington’s choice as an African American scholar to convey the full horror of the racist act, and we are also concerned about how it may affect our Black readers. After consulting with colleagues, we concluded that in this case, confronting the harsh reality of racism is part of the way forward. Please help us reflect on our practices by sharing your thoughts on this specific question, or on our broader efforts to reckon with racial injustice, by emailing us at hc@aft.org.
–Editors
The Swiss firm Syngenta, which manufactures atrazine, launched a campaign to discredit Hayes’s work. It even had representatives appear at academic conferences where Hayes spoke; those representatives spread vitriolic personal criticisms, organized opposition to his presentations, and accused him of fabricating data. Internal Syngenta documents released as part of a 2014 class-action lawsuit reveal that Syngenta also conspired to convince journals to retract his work and investigate his private life.5 (An unabashed Hayes was not above responding testily—sometimes in acerbic rap couplets.6)
This is certainly a disquieting image of industry scientists at work, but the disrespect and drama veil a tendency that should worry us more: a scientific penchant for manipulating statistical dangers out of existence.
After Hayes first reported to EcoRisk scientists the hormonal devastation wrought by atrazine, he says they suggested statistical maneuvers that “made the effects appear to vanish.”7 And although the United States Environmental Protection Agency (EPA) determined that such “low” levels of atrazine exposure pose no hazard to human health, the EPA’s sources are questionable. Fewer than 1 in 5 papers that the EPA uses to support its decision making are peer reviewed; worse, 1 of every 2 are generated by scientists who have a financial stake in the research outcome.8
These distortions are important. We have known since 2009 that 33 million Americans drink water tainted by atrazine, and epidemiological studies link prenatal atrazine exposure with birth defects, premature birth, and low birth weight—even at extremely low concentrations.9
Scientists often proceed as if very low exposures and doses are innocuous, tacitly assuming that a threshold exists beneath which an exposure is benign. But this is not a given. Some chemicals are indeed harmless at very low doses. Not so in other cases: persistent exposure to low levels of some near-ubiquitous poisons causes more cumulative harm than discrete large doses of others.10 Still other substances, like lead, have no safe level of exposure.11
Many countries, such as those of the European Union, are more suspicious of industrial chemicals even at low doses. They require that the safety of industrial chemicals be determined before they go into uses that can affect humans, an illustration of what’s known as the precautionary principle. But we Americans do not follow the precautionary principle. We require relatively little safety testing before use, so we typically learn of environmental health hazards only after people are exposed to them.
Greater vigilance and testing in accordance with the precautionary principle help explain why atrazine is banned in Europe12 but the EPA has approved approximately 200 atrazine-containing products in the United States.13 US corporations often cite the additional expense of premarket testing that would be required to follow the precautionary principle, but they tend to downplay the importance of saving the expense of bans, cleanups, and lawsuits—to say nothing of the lives, health, and intellect of millions of Americans poisoned each year.
For industries accused of poisoning the populace, doubt has served as a useful foil against the expense of regulation and restitution.14 This corporate skepticism is most often articulated as a scientific question, to wit, “Is there really incontrovertible evidence that atrazine in drinking water (or lead in interior paint or mercury in oceans) is a hazard demanding eradication?”
Incontrovertible is a tricky word—any scientific finding can be questioned—but there really is overwhelming evidence that the myriad toxicants being pumped into our environment and our bodies constitute hazards that demand eradication. As surely as radiation exposure after Chernobyl caused cancers and premature deaths, constant exposure to environmental poisons acts as invisible “background radiation” that blinds us to the presence of the subtle but profound harms it generates in affected neighborhoods.
Imaginary Thresholds and Very Real Harms
“Socioeconomic” Is a Semantic Shroud
Despite a wealth of data documenting that there are far greater concentrations of lead, PCBs, other industrial chemicals, and air pollution in communities of color, semantics shroud this powerful causal connection. Far too many American scientists, reporters, and elected officials tend to overlook or downplay the role of racial bias—past and present—in creating residential areas where environmental toxicity is concentrated in sacrifice zones populated by people of color.
The popular news media and many peer-reviewed medical journals have long referred to areas assailed by industrial chemicals, lead, mercury, arsenic, hydrocarbons, and particulate matter as “low-income” and “socioeconomically depressed” neighborhoods. Until 2016, even the principally African American and Hispanic lead-poisoning victims of Flint, Michigan, were described as socioeconomically disadvantaged, “poor,” or lower class. Only after crusading pediatrician Mona Hanna-Attisha decried the targeting15 was the racial nature of the hazard more broadly acknowledged in news media.
Referring to the risks as “socioeconomic” is a semantic mischaracterization that muddies the picture. A more accurate description of the problem would pinpoint the primary cause: environmental racism. Data from recent publications make it clear that although poverty puts one at higher-than-normal risk for living across the street from a gas-belching bus depot, near a Superfund waste-disposal site, or in a fence-line community that abuts an industrial park, race is a much greater risk factor. For example, a 2014 report determined that middle-class African Americans earning $50,000 to $60,000 are more likely to live in heavily polluted environments than are profoundly poor white people with mean incomes of $10,000.16
Mythology and Toxicology
The “socioeconomic” nature of concentrated environmental assaults is not the only mischaracterization of risks that has long been refuted by the data. Scientific assessment of environmental harms is far from objective. It is clouded by unsubstantiated beliefs about the nature of industrial chemicals and by frank conflicts of interest that often serve the interests of industry rather than health.
Nationally, approximately 60,000 industrial chemicals commonly used in the United States have never been tested for their effects on humans. In our country, safety tests are undertaken only when a chemical is suspected to be harmful. But even then, definitive findings are elusive, and it sometimes takes years or even decades of expensive research for them to emerge. Meanwhile, the standard of proof demanded by the industries that use and disseminate these chemicals is sometimes so high that masses of people suffer the chemicals’ effects in the time it takes to sufficiently prove their harmfulness.
All too often, industry scientists and leaders already have evidence that their chemicals are harmful—but they hide it. For example, scientists working for the lead industry were deployed to dissuade municipalities from banning lead-lined water plumbing and were allowed to set their own exposure “standards” for use, knowingly employing standards that allowed widespread exposure to lead in homes and workplaces. The lead industry similarly denied the toxicity of automobile emissions from leaded gas (which uses tetraethyl lead as an “anti-knock” additive), although internal industry documents revealed that they had recognized its fiendishly toxic nature from the beginning of their research in the 1920s.17 Once lead’s toxicity proved undeniable, the industry maintained that low levels of exposure were not problematic. Although the Centers for Disease Control and Prevention (CDC) now states that there is no safe level of exposure to lead, it had changed from flagging children with 10 micrograms per deciliter of lead in their blood as a “level of concern” to calling for “case management” among children with 5 micrograms per deciliter.18 Just a few years ago, the Environmental Defense Fund estimated that thousands of children are still being poisoned (at a cost of $50 billion per year to the nation) because lead abatement has never been completed.19
Whether we call them mythologies, unsupported assumptions, assessments biased by industry’s pecuniary interests, or simply habits of thought, these distortions keep us from properly analyzing and understanding the risk of environmental exposures. Which exposures are most harmful, what types of harm they do, and who is at highest risk—these are often distorted by such myopia. And in recent years, the situation has grown more dire.
Since Donald Trump appointed Scott Pruitt, a lobbyist who described himself as a “leading advocate against the EPA’s activist agenda,”20 as his first chief of the EPA, the agency has consistently diminished protections that sought to limit exposure to environmental toxicity. In 2019, the EPA ended unannounced inspections of industry sites21 and relaxed Obama-era regulations that required coal-fired power plants to reduce their carbon emissions or close, thereby maintaining those plants as key sources of mercury pollution.22 As we saw with the atrazine example, the EPA’s decision-making process is questionable at best—it eschews the precautionary principle and relies heavily on industry-sponsored, non-peer-reviewed research.
Against this backdrop—disregard for the precautionary principle and for the communities of color bearing most of the burden—we face two enormous challenges: the immediate threat to people of color from the novel coronavirus and the longstanding threat to these populations from exposure to toxicants.
Coronavirus, in Color
Speculation about why this is indicts the usual suspects. It’s often noted that African Americans are less likely than white people to have a personal physician or health insurance and so must rely on emergency departments that are not the optimal sites for preventive care. Less frequently noted is that hospital closings in many neighborhoods of color have escalated, leaving whole communities without medical options.
It’s also the case that people of color are least likely to have the option of working from home or practicing social distancing, either in the workplace or while using the mass transit upon which most depend: only 16.2 percent of Hispanic workers and 19.7 percent of African Americans can work remotely.24 As epidemiologist Linda Goler Blount, president and CEO of the Black Women’s Health Imperative, has noted, “20 or 25 percent of Blacks and Latinos have to get on a bus, get on a train and go someplace to work on a job where they are in front of people.”25 Even at home, social distancing is difficult: biased credit and mortgaging practices (such as redlining) make it less likely that a person of color will own his own house. This consigns him to apartment life, which also militates against social distancing when one must share corridors, elevators, and crowded living spaces.
Among those fortunate enough to have some personal protective gear, the mandatory wearing of masks presents health hazards for African American men who have been hounded by police and ejected from stores by security guards who claim to have taken the masks for potential criminal attire—when police officers aren’t preferentially assaulting people of color for not wearing masks in public. Some private citizens have also exploited health concerns to assault people of color, ostensibly for failing to observe social distancing.26 We first saw this in the spate of verbal and violent attacks on people of Asian descent who were blamed for what President Trump—the person who not long ago decried immigration from “shithole countries”27—chose to call the “Chinese virus.”28 Shouted slurs and threats escalated quickly to knife attacks.29 These attacks spread to members of other ethnic groups, including Janie Marshall, an 86-year-old African American woman with dementia who was killed by another patient in a Brooklyn hospital emergency department for “failing to observe social distancing” when she felt faint and reached for an IV pole to steady herself.30
Xenophobia escalating in accord with people’s fear of infection is far from a new phenomenon: we saw it in violence around the 2014 Ebola outbreak. More ominously, denouncing one’s enemies as agents of pathogenic disease figured prominently in propaganda of the Third Reich in the 1930s and in the Rwandan and Bosnian genocides in the 1990s. It is high time that we recognize, anticipate, and seek to neutralize this tendency when we contend with an emerging disease, especially one with a putative foreign origin.
Environmental Risk and Coronavirus
We must also recognize the environmental roots of heightened coronavirus susceptibility. It is true that ethnic minority groups suffer elevated rates of respiratory disorders, certain cancers, kidney disorders, asthma, immunosuppression (including from cancer treatment and organ transplant maintenance), and other contested conditions, such as obesity, that may raise susceptibility to COVID-19.31
But it is also true that known risk factors are caused and exacerbated by the environmental exposures that preferentially assail people of color. Air pollution’s particulate matter creates a legion of respiratory ailments.32 Cancers whose therapy generates immunosuppression are too often caused by the witches’ brew of benzene, pesticides, PCBs, and other carcinogens to which people of color are disproportionately exposed. Thus, many of the oft-cited risks may be proximate triggers of coronavirus infection, but living with the background radiation of a poison-laced environment is the ultimate risk factor.33
Unfortunately, a message we’ve heard many times before has come to dominate discussions of the high COVID-19 rates among African Americans and other people of color: blame the victim. Hard on the heels of the news that African Americans were suffering and dying disproportionately, a Manhattan Republican Party leader tweeted, “Is it about race or obesity? It would seem that obese people fair [sic] worse. Also males as well as people who smoke and drink alcohol.”34
Specifying smoking and drinking invokes personal responsibility, which is important in many health arenas but meaningless when discussing risk factors that are beyond an individual’s control, such as underlying health conditions, proximity to environmental toxicity, and an inability to practice social distancing and still keep one’s job. Obesity—tacitly obesity in African Americans, as in the tweet—is often bandied about as a risk factor, but many question this because attacking those with a high BMI is a form of socially acceptable discrimination. It is true that obese people with COVID-19 are more likely to be hospitalized, some analysts acknowledge, but this is because of policies that establish obesity as a criterion for hospitalization, not because the obese present with a more dire clinical picture.35 Blaming obesity may be the result of prejudice against the overweight, as happened when it was held to be a risk factor in the H1N1 “swine flu” epidemic. A 2016 meta-analysis of studies on H1N1 and weight shows no increased risk of death from swine flu for people with BMIs of 25 and above. However, smaller-bodied H1N1 patients were more likely to receive early antiviral treatment, making bias, not weight, the true risk factor for people with obesity.36
Unfortunately, a long history of blaming people of color for their environmentally mediated illness precedes this stigmatization. When gross poisoning became impossible to ignore, the lead industry worked to deflect blame onto victims. The Lead Industry Association blamed “ineducable” Black and Puerto Rican parents for making lead poisoning a “problem of slum dwellings.”37 In Baltimore, public health workers “taught” homemakers to clean using Spic and Span, to move cribs away from surfaces with peeling paint,38 and to “assume the responsibility for their children and for watching that they did not eat abnormally” (ignoring that lead’s appeal for children is that it tastes sweet).39 Maryland’s state secretary of the Department of Housing and Community Development, Kenneth C. Holt, claimed that mothers could be intentionally causing their children’s lead poisoning by placing lead fishing weights in their mouths.40 It would be comforting to believe that such a shocking and unsupported accusation would not be made today, but Holt stated this in 2015. All too similarly, just a few years ago Flint official Phil Stairs attributed Flint’s lead-poisoned water crisis to “fucking niggers who don’t pay their bills.”41
Although immediate healthcare and policy actions are needed to reduce the devastation of COVID-19, we must also confront the manifestations of racism, from the legacy of enslavement to environmental racism, that make the disproportionate impact of the pandemic yet another example of injustice and inequity. Exposing the harm being done to our children—and demanding change—is the only way forward.
The Exquisite Vulnerability of the Young
Ignoring “infinitesimal” doses of heavy metals, industrial chemicals, and even air pollution validates industry’s message that low concentrations are too small to do harm. The result? These prime causes of sickness and death in the young are often overlooked.
As industry scientists and executives know, the very young are often the most vulnerable. In utero mercury exposure at a concentration of 100 ppb significantly increases learning deficits, but an adult exposed to this concentration will suffer no discernible effect. Prolonged consumption of tap water with 20 parts per million (ppm) of nitrates can kill an infant but have no effect on an adult. And children exposed to radiation have a much higher incidence of cancers than do adults exposed to the same levels.
Children also suffer exposures that are larger, relatively speaking, than those of adults. Children drink more water relative to their size than do adults; their relative lung volume is also greater, causing them to inhale proportionally more air with greater exposure to air pollution. Babies’ principal means of exploring the unfamiliar world is to put objects in their mouths, and even noxious tastes won’t deter them. When they become toddlers, their exposure to industrial chemicals and heavy metals escalates as they begin to move about independently, mouthing contaminated objects.
Moreover, an exclusive focus on quantity hides a key element of children’s vulnerability to toxicants. Paracelsus famously declared that the dose makes the poison, as illustrated by the 2007 death of a California woman who drank two gallons of water in three hours to win a radio contest.42 But today, we know that Paracelsus was only half right; sometimes, as Philippe Grandjean, professor of environmental health at Harvard’s T.H. Chan School of Public Health, has pointed out, the “timing makes the poison.”43 This is especially true for fetuses and for children in the first two years of life.
Subtle environmental injuries such as endocrine disruption, cognitive deficits, and reproductive failures often emanate from exposures at the wrong times. For example, at many key junctures during fetal development, even a vanishingly small toxic exposure can wield a devastating effect, although the same exposure a day earlier or an hour later might have no effect at all.
Approximately 83 percent of the brain’s development takes place within the last three months of pregnancy and the first two years of life. The seemingly indolent child devotes 86 percent of her metabolic energy to constructing a breathtakingly complex brain by directing events that include neurogenesis, neuronal differentiation, and myelination.
A child who must contend with noxious environmental exposure while devoting most of her energy to constructing a well-functioning brain finds that the brain cannot do both. Brain development will suffer, resulting in malformed or even missing structures and connections. These could manifest as profound birth defects or reveal themselves more subtly later in the form of missed developmental milestones, cognitive disorders, or behavior problems—or sometimes they are misdiagnosed as psychiatric conditions such as conduct disorder.
Fetal Death in Flint
With regard to lead poisoning in Flint, I doubt that any one aspect of the tragedy can be singled out as the worst. But the silence in the wake of hundreds of dead fetuses is certainly a candidate.
In 2017, health economists found that 218 to 276 more children should have been born in Flint between 2013 and 2015, and that these “missing children” succumbed to fetal death and miscarriages caused by waterborne lead exposure resulting from the city’s temporary switch to a new water source.44 Even more shocking, the count of missing babies is significantly underestimated because the investigation included only hospital fetal deaths—not miscarriages that occurred before 20 weeks’ gestation.
The water purity change was restricted to a specific period, allowing clear comparisons of Flint’s fertility and fetal health rates before and after the switch, when fetuses were exposed to tainted water in utero for at least one trimester. Because Flint was the only city in the area that switched its water supply, studies could also meaningfully compare data with surrounding cities. No other Michigan cities recorded such a drop in fertility.
What’s truly troubling is that this same tragedy occurred in Washington, DC, several years earlier. During 2007 and 2008, when the city endured its own lead crisis, lead-driven fetal deaths rose as much as 42 percent. Could not the fetal deaths in Flint have been anticipated and protections enacted for pregnant women? Or better yet, could not this danger dissuade the government from subjecting people to exposures that sicken adults and prove lethal to hundreds of fetuses?
Racial Silences
The affected child’s race matters too. Banishing lead poisoning among white children, who are less likely to live in crumbling urban housing or in fence-line communities, is a success story. (Though there are alarming pockets of hazard that demand a vigorous public health response; for example, in 2017 the Environmental Defense Fund found that 27 percent of baby foods sampled—and 100 percent of sampled baby food carrots and sweet potatoes—had detectable levels of lead.45) But the scourge of lead poisoning rages among African American and Hispanic children. Nearly all of the at least 37,500 Baltimore children who suffered lead poisoning between 2003 and 2015, for example, were African American.
University of Minnesota researchers determined that 69 percent of Hispanic children, 68 percent of Asian American children, and 61 percent of African American children live in areas that exceed EPA ozone standards, compared with only 51 percent of white children. People of color breathe 38 percent more polluted air than white people and are exposed to 46 percent more nitrogen oxide than white people.
Especially troubling from an environmental health standpoint is the silence on environmental hazards that reigns during prenatal counseling of women of color. One doctor explained that she knows of the greater hazards but failed to broach the subject with her patients of color. Although Dr. Naomi Stotland of San Francisco General Hospital knows that her low-income patients on California’s Medicaid program are probably at higher risk of toxic exposures, she told Scientific American that she didn’t discuss environmental health with them for a long time. Why? “The social circumstances are so burdensome. Some colleagues think the patients are already worried about paying rent, getting deported, or their partner being incarcerated.”46
Central to this problem is the limited exploration of environmental hazards in medical education, even for future obstetricians and gynecologists.47 Healthcare professionals would better serve their patients by asking more questions related to living conditions (including pollutants in the community) and sharing more information about minimizing exposure to hazards, especially in prenatal counseling. But truly addressing the issue—and confronting the devastation of environmental racism—will have to involve the whole research community.
Absence of Evidence Is Not Evidence of Absence
The myopia that haunts research into environmental racism was revealed to me as I prepared to discuss the hazards of subsistence fishing among African Americans and other minority groups. Growing up in several Eastern seaboard towns and upstate New York, and occasionally traveling to the Midwest, I saw urban anglers everywhere. My own father and his inner-city friends made frequent excursions into the country, where they fished and hunted to supplement their families’ diets. They even pooled funds to buy a boat together.
But for urban anglers’ families, and especially for pregnant women and new mothers, subsistence fishing presents dangers to their children’s brains, chiefly by exposing them to PCBs and mercury. We know that “as PCBs work their way up the food chain [from smaller fish like smelt to lake trout and ultimately to herrings and the gulls that feed on them], their concentrations in tissue can be magnified up to 25 million times.”48 Mercury also increases. I wanted people to understand that they should choose smaller fish rather than larger ones because mercury becomes concentrated in predators higher up the food chain, and that they should choose species of fish that harbored lower amounts of mercury. I knew many people were lulled into a false sense of security when they were told that the waterways near them had only elemental mercury. What many people do not know is that common bacteria such as salmonella can transform elemental mercury into the much more dangerous organic mercury.
But when I broached the subject to a Johns Hopkins University toxicologist, she denied that it was an issue. African Americans didn’t engage in subsistence fishing, she said, and so were in no danger. When I protested that I had seen it often, she countered: “Where are the data? There’s nothing in the national literature: if it’s not written there, it doesn’t exist.”
She was right that there were no recent national data documenting subsistence fishing by African Americans; however I thought she was wrong to deny it existed. But without national data, how could I make this case? I called Robert Bullard, father of the environmental justice movement, who went straight to the heart of the matter, declaring, “Absence of evidence is not evidence of absence.”
I decided to address the issue, although I knew it could be dismissed as anecdotal. But fortunately, just weeks before my deadline, a comprehensive national report presented data showing that African Americans practiced subsistence fishing at a very high rate.49 The report’s preface decried the fact that the phenomenon had been ignored for so long, and this experience impressed upon me that we cannot find patterns, trends, and data for which we are not looking. Absence of evidence can cause us to overlook important addressable public health challenges, reinforcing health risks that we choose not to see.
Accurate information in the form of data and analysis is key to solving the health problems confronting all of us, from COVID-19 to lead poisoning, atrazine, and more. But we also need historical and ethical lenses that allow us to recognize and properly understand when we have turned a blind eye to disaster by shrouding racial harms and blaming the victims. Most of all, we need to resist allowing the pursuit of that mythical entity “pure science” to trump the compassion that is an essential element of public health work.
Perhaps Dr. Irving Selikoff said it best: “Never forget that the numbers in your tables are human destinies, although the tears have been washed away.”50
Harriet A. Washington is a science writer, editor, and ethicist. She has been the Shearing Fellow at the University of Nevada’s Black Mountain Institute, a research fellow in Medical Ethics at Harvard Medical School, a senior research scholar at the National Center for Bioethics at Tuskegee University, and a visiting scholar at DePaul University College of Law. She has held fellowships at the Harvard T.H. Chan School of Public Health and Stanford University. She is the author of A Terrible Thing to Waste: Environmental Racism and Its Assault on the American Mind, Medical Apartheid, several other books, and numerous articles.
Endnotes
1. D. Slater, “The Frog of War,” Mother Jones, February 2012, www.motherjones.com/environment/2012/02/tyrone-hayes-atrazine-syngenta-….
2. “The Frog Scientist,” What’s Happening (blog), Dennison University, February 24, 2014,
3. T. Hayes, “Endocrine Disruption, Environmental Justice, and The Ivory Tower,” March 2018, TEDxBerkeley, https://www.youtube.com/watch?v=Hu0IXMTFY9Q.
4. “The Frog Scientist,” What’s Happening, 3.
5. C. Howard, “Pest Control: Syngenta’s Secret Campaign to Discredit Atrazine’s Critics,” 100 Reporters, June 17, 2013.
6. H. Nolan, “World’s Greatest Angry Scientist…,” Gawker (blog), August 23, 2010.
7. Slater, “The Frog of War.”
8. Slater, “The Frog of War.”
9. Slater, “The Frog of War”; C. Duhigg, “Debating How Much Weed Killer Is Safe in Your Water Glass,” New York Times, August 22, 2009; P.D. Winchester, J. Huskins, and J. Ying, “Agrichemicals in Surface Water and Birth Defects in the United States,” Acta Pædiatrica 98, no. 4 (2009): 664–69; and E.C. Marquez and K.S. Schaffer with G. Aldern and K. VanderMolen, Kids on the Frontline: How Pesticides Are Undermining the Health of Children (Oakland, CA: Pesticide Action Network North America, 2016), http://www.panna.org/sites/default/files/KOF-report-final.pdf.
10. Unless otherwise noted, research, events, and other claims in this article are extensively documented in two of my recent books, A Terrible Thing to Waste: Environmental Racism and Its Assault on the American Mind (New York City: Little, Brown Spark, 2019) and Infectious Madness: The Surprising Science of How We “Catch” Mental Illness (New York City: Little, Brown and Company, 2015).
11. “Lead Poisoning and Health: Key Facts,” World Health Organization, August 23, 2019, https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-hea….
12. E. Grossman, “What You Need to Know About the EPA’s Assessment of Atrazine,” Civil Eats, June 6, 2016, https://civileats.com/2016/06/06/what-you-need-to-know-about-the-epas-a….
13. F.T. Farruggia, C.M. Rossmeisl, J.A. Hetrick, M. Biscoe, R. Louie-Juzwiak, and D. Spatz, Refined Ecological Risk for Atrazine (Washington, DC: Environmental Risk Branch III, Environmental Fate and Effects Division, 2016): 38.
14. D. Michaels, Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health (New York City: Oxford University Press, 2008).
15. M. Hanna-Attisha, J. LaChance, R.C. Sadler, and A. Champney Schnepp, “Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response,” American Journal of Public Health 106, no. 2 (2016): 283–90.
16. P. Orum, Who’s in Danger? Race, Poverty, and Chemical Disasters (Brattleboro, VT: Environmental Justice and Health Alliance for Chemical Policy Reform, 2014), https://ej4all.org/assets/media/documents/ej4all-Who'sInDangerReport.pdf; and L. Downey and B. Hawkins, “Race, Income, and Environmental Inequality in the United States,” Sociological Perspectives 51, no. 4 (2008): 759–81.
17. J. Lincoln Kitman, “The Secret History of Lead,” Nation, March 2, 2000, https://www.thenation.com/article/archive/secret-history-lead/.
18. “Blood Levels in Children,” National Center for Environmental Health, https://www.cdc.gov/nceh/lead/ACCLPP/Lead_Levels_in_Children_Fact_Sheet…; and “Childhood Lead Poisoning Prevention, Blood Lead Levels in Children,” Centers for Disease Control, May 28, 2020, https://www.cdc.gov/nceh/lead/prevention/blood-lead-levels.htm.
19. T. Neltner, “Progress Takes Vigilance to Reduce Children’s Exposure to Lead,” Environmental Defense Fund (blog), April 21, 2017, http://blogs.edf.org/health/2017/04/21/progress-on-lead-takes-vigilance/.
20. S. Detrow, “Scott Pruitt Confirmed to Lead Environmental Protection Agency,” NPR Politics, February 17, 2017.
21. M. Green, “EPA Halts Surprise inspections of Power, Chemical Plants,” The Hill, July 18, 2019.
22. J. Eilperin and B. Dennis, “EPA to Scale Back Federal Rules Restricting Waste from Coal-Fired Power Plants,” Washington Post, November 3, 2019.
23. K. Stafford, M. Hoyer, and A. Morrison, “Outcry Over Racial Data Grows as Virus Slams Black Americans,” ABC News, April 8, 2020.
24. E. Gould and H. Shierholz, “Not Everybody Can Work from Home: Black and Hispanic Workers Are Much Less Likely to Be Able to Telework,” Working Economics (blog), Economic Policy Institute, March 19, 2020, www.epi.org/blog/black-and-hispanic-workers-are-much-less-likely-to-be-….
25. C. Bunn, “Black Health Experts Say Surgeon General’s Comments Reflect Lack of Awareness of Black Community,” NBC News, April 15, 2020.
26. J. Jouvenal and M. Brice-Saddler, “Social Distancing Enforcement Is Ramping Up. So Is Concern That Black and Latino Residents May Face Harsher Treatment,” Washington Post, May 10, 2020.
27. I.X. Kendi, “The Day Shithole Entered the Presidential Lexicon,” The Atlantic, January 13, 2019.
28. J. Viala-Gaudefroy and D. Lindaman, “Donald Trump’s ‘Chinese Virus’: The Politics of Naming,” The Conversation, April 21, 2020.
29. J. Reinstein, “A Man Who Allegedly Tried to Kill an Asian American Family Because of the Coronavirus Could Face Hate Crime Charges,” BuzzFeed News, April 1, 2020.
30. E. Sandoval, “86-Year-Old Is Killed in E.R. over Social Distancing,” New York Times, April 8, 2020.
31. C. Harrison “Covid-19 Does Not Discriminate by Body Weight,” Wired, April 17, 2020.
32. X. Wu, R.C. Nethery, M.B. Sabath, D. Braun, and F. Dominici, COVID-19 PM2.5, A National Study on Long-Term Exposure to Air Pollution and COVID-19 Mortality in the United States: A Nationwide Cross-Sectional Study (Harvard University, 2020) https://projects.iq.harvard.edu/covid-pm.
33. H. Washington, “How Environmental Racism Is Fuelling the Coronavirus Pandemic,” Nature, May 19, 2020, https://www.nature.com/articles/d41586-020-01453-y.
34. R. Fiore (@Robert_Fiore), “Is it about race or obesity? It would seem that obese people fair worse. Also males as well as people who smoke and drink alcohol,” tweet to @MarkLevineNYC, April 4, 2020, https://twitter.com/Robert_Fiore/status/1246483741125611521?s=20.
35. C. Harrison, “Covid-19 Does Not Discriminate by Body Weight,” Wired, April 17, 2020, www.wired.com/story/covid-19-does-not-discriminate-by-body-weight/.
36. Y. Sun, Q. Wang, G. Yang, C. Lin, Y. Zhang, and P. Yang, “Weight and Prognosis for Influenza A(H1N1)pdm09 Infection during the Pandemic Period Between 2009 and 2011: A Systematic Review of Observational Studies with Meta-Analysis,” Infectious Diseases 48, no. 11–12 (2016): 813–22.
37. D. Rosner and G. Markowitz, “‘A Problem of Slum Dwellings and Relatively Ignorant Parents’: A History of Victim Blaming in the Lead Pigment Industry,” Environmental Justice 1, no. 3 (2008): 159–68.
38. Preventing Lead Poisoning in Young Children (Atlanta, GA: Centers for Disease Control, Department of Health and Human Services, 1985), https://www.cdc.gov/nceh/lead/publications/plpyc1985.pdf.
39. One Hundred and Forty-Sixth Annual Report (Baltimore, MD: Department of Health, 1960), https://health.baltimorecity.gov/sites/default/files/City%20of%20Baltim…, 207.
40. B. Sears, “Holt: Moms May Deliberately Poison Children with Lead Weights,” Daily Record (Baltimore, MD), August 15, 2015, https://thedailyrecord.com/2015/08/15/holt-lead-poison-fishing-weights/.
41. B. Edwards, “Flint, Mich., Official Resigns after Being Caught on Tape Blaming Water Crisis on ‘Niggers’ Who ‘Don’t Pay Their Bills,’” The Root, June 5, 2017, www.theroot.com/flint-official-resigns-after-being-caught-on-tape-blami….
42. Associated Press, “Woman Dies after Being in Water-Drinking Contest,” Los Angeles Times, January 14, 2007.
43. P. Grandjean, “Paracelsus Revisited: The Dose Concept in a Complex World,” Basic & Clinical Pharmacology & Toxicology 119, no. 2 (2016): 126–32.
44. D. Grossman and D. Slutsky, “The Effect of an Increase in Lead in the Water System on Fertility and Birth Outcomes: The Case of Flint, Michigan,” Working Papers Series in Theoretical and Applied Economics, University of Kansas, Department of Economics (2017), http://www2.ku.edu/~kuwpaper/2017Papers/201703.pdf, 17–25.
45. T. Neltner, “Latest Federal Data on Lead in Food Suggests Progress Made in 2016 Was Fleeting,” Environmental Defense Fund (blog), October 3, 2019.
46. J. Kay, “Should Doctors Warn Pregnant Women about Environmental Risks?,” Scientific American, December 10, 2012.
47. V. Tinney et al., “Medical Education for Obstetricians and Gynecologists Should Incorporate Environmental Health,” American Journal of Obstetrics and Gynecology 212, no. 2 (2015): 163–66.
48. T. Colburn, D. Dumanoski, and J. Peterson Myers, Our Stolen Future: Are We Threatening Our Fertility, Intelligence, and Survival? A Scientific Detective Story (New York City: Plume, 1997), 27.
49. K. Butler, J. Hamann, J. Ross, and G. Snyder, “EPA Needs to Provide Leadership and Better Guidance to Improve Fish Advisory Risk Communications,” report no. 17-P-0174, EPA Office of Inspector General, April 12, 2017,
https://epa.gov/sites/production/files/2017-04/documents/_epaoig_201704….
50. B. Spittle review of P. Grandjean, “Only One Chance: How Environmental Pollution Impairs Brain Development—And How to Protect the Brains of the Next Generation,” Fluoride 46, no. 2 (2013): 52–58.
[illustrations by Ojima Abalaka]