SEHN Science Director Ted Schettler will be participating in the California Breast Cancer Symposium, From Research to Action: Two Decades of Change, May 17th-18th. Schettler will be moderating a panel on the environment and breast cancer.
SEHN Science Director Ted Schettler will be participating in the California Breast Cancer Symposium, From Research to Action: Two Decades of Change, May 17th-18th. Schettler will be moderating a panel on the environment and breast cancer.
You can preview the full details of the program by visiting http://www.cabreastcancer.org/symposium/program/index.php.
I have received thoughtful responses to my “Open Letter to Illinois Environmentalists about Fracking Legislation” on May 10, 2013. Many wondered why I disagreed with some of my good friends in Illinois who are pursuing legislation that will regulate horizontal hydraulic fracking. They deserve an answer. I recognize the palpable fear that without legislation, horizontal fracking will proceed willy-nilly. I disagree with my dear friends who are working for regulation and ask them to join me in resisting this piece of legislation. I ask because:
1) Industry needs regulations more than environmentalists do. Notice, industry didn’t oppose the legislation. “Dead Giveaway,” in the words of Charles Ramsey, Ohio hero.
2) Illinois is part of a larger political ecology and other States’ decisions on fracking ride on what Illinois decides. If Illinois stands firm against fracking, other states gain support in their efforts to resist the degradation that has happened in Pennsylvania and elsewhere. New York and California are paying close attention to what Illinois does with this piece of legislation.
3) The legislation instituting regulations is just the beginning of a cascade of a legislation orchestrated by the fossil fuel industry. Most future legislation will restrict right to know, landowner protections, and liability for clean air and clean water. Future legislation will piggy-back on this regulatory bill and claim additional protections for the industry on the basis of trade secrets and other things that are “necessary” for jobs and the economy.
4) We just reached 400 ppm of carbon dioxide in the atmosphere. We are headed towards catastrophe with our reliance on fossil fuels. We have to start somewhere and say “no”.
5) Speaking of pollution levels, the nitrate levels in Iowa’s rivers reached an all-time high this week. Natural gas is the precursor to the fertilizers that washed off Midwest fields and create the Dead Zone in the Gulf of Mexico.
6) In the 1990’s, I was on a three person commission that was charged with deciding whether a site in Illinois was suitable for a low-level radioactive waste facility. A former Illinois Supreme Court justice, the former dean of Civil Engineering at University of Illinois, and I voted unanimously that the site was not suitable for a disposal facility. We were called baby killers, and worse, for our decision. The federal government hired Battelle Memorial Institute to investigate our decision. Eighty two million dollars had been spent on the siting process. But our decision stood. We had the best siting criteria (no shallow land burial!) and the most radioactive waste. We set a remarkable precedent by saying no. And to date, no new low-level radioactive waste facility has taken waste in the United States. Did our decision change federal policy? Sure. Was it the only thing? No. What could not have been predicted is how medical technology evolved in a very short time and reduced the total amount of low-level radioactive waste that required disposal. Medical waste had been the decoy for the nuclear power industry and all of their waste. Let me repeat, to date, no new low-level radioactive waste facility has been opened in the United States. Yes, our decision was exceptionally difficult. I thought my career was over when I voted with my two colleagues.
7) Speaking of radioactive waste, it appears that waste from fracking is often radioactive and proving difficult to manage.
8) Clean and abundant water is a central legacy we must leave to Future Generations. Fracking is one of the greatest threats to water in the history of humanity.
9) Southern Illinois is earthquake prone because it is in the territory of the New Madrid fault. Earthquakes seem to be set off by fracking.
10) As I mentioned in my first letter, it is wishful thinking to depend on regulation in a state where enforcement is invisible, backlogged and impoverished.
For all of these reasons, I oppose the Illinois legislation that attempts to regulate horizontal fracking. I ask that you stand with me for the sake of the planet and future generations.
I think so often of you all and my days as president of the Illinois Environmental Council and State Field Representative of the Sierra Club. I cherish the memories of your dedication and grace. I write to you today because I know how hard you are struggling with the thorny problem of fracking in your great prairie state.
In March, I attended a continuing legal education conference on Illinois environmental law sponsored by the Illinois Bar Association. I had hoped to see old friends and learn about environmental legal innovation. The majority of lawyers in attendance were polluters’ defense lawyers and a few agency staffers. What I discovered was that there is almost no enforcement of environmental laws in Illinois and things are getting worse. The Illinois Environmental Protection Agency and the Illinois Department of Natural Resources are in a financial free fall. The U.S. Environmental Protection Agency was forced to cut back their financial support of Illinois EPA enforcement because of the national budget sequester, even though Illinois is one of the states most backlogged on permitting and enforcement. As you know, over the past few years environmental groups have petitioned US EPA to rescind Illinois’ authority to enforce certain delegated federal laws because they had failed to take appropriate enforcement action.
And then we heard about this new regulatory bill on fracking. I listened carefully hoping that it would actually be something new and different. But no matter how good a piece of legislation it might be (or not), regulation in Illinois will fail because there can be no enforcement. There is no money, no staff, and no political will to enforce environmental laws, even the very best of them. By enforce I mean follow up on permit violations, issue fines, guarantee clean-up or shut down polluters.
The brilliant architect, William McDonough said that regulation is design failure. The simple fact that we consider regulating fracking recognizes that it is a polluting industry. But Illinois has no capacity to enforce even the best legislation. None.
I ask you, on behalf of Future Generations to stand together and oppose the regulatory bill for the simple reason that it cannot be enforced.
When I worked for the Sierra Club, David Brower was the great elder of the environmental movement. He had one regret—a terrible compromise: he led the Sierra Club in sacrificing Glen Canyon in exchange for relinquishing water development at Echo Park. Glen Canyon was flooded. But that terrible loss led them to fight dams in the Grand Canyon. Brower took out full-page ads in The New York Times asking “Should we also flood the Sistine Chapel so tourists can get nearer the ceiling?”
If fracking comes to Illinois, the spills and accidents are inevitable. The law you worked so hard to craft will not be enforced. It can’t be enforced given the financial state of both federal and Illinois regulatory agencies. Future Generations will face a world even more fraught with contamination and devastation than it is now. We should learn from Brower. Don’t compromise.
Ted Schettler MD, MPH
About twenty-five years ago health care institutions began to look more carefully at the public and environmental health impacts of what they were doing. Driven by news reports of syringes and other medical waste washing up on New Jersey and New York beaches they focused initially on waste management. Then came US EPA reports concluding that medical waste incinerators were the leading source of environmental dioxin releases and a major source of mercury. These toxic contaminants build up in the food chain to levels that are unsafe for humans and wildlife. Their origins are of intense interest. It looked as if health care institutions dedicated to providing high quality care to their patients were unwittingly adding to disease and disability burdens in the communities that they served and beyond.
Improvements in waste management soon followed, but many organizations went further. They began to look more deeply into a broader array of their impacts, ultimately confronting organizational systems and values. They began to explore preferential purchasing of products made of safer chemicals and materials, green building design and operations, energy conservation, and procurement of nutritious food produced in more just, sustainable ways.
These initiatives are central to a broad-based effort to re-connect medicine with public and environmental health. They come at a time when the inseparability of human and environmental health is documented daily in scientific journals and stories from around the world. Leading organizations realize that providing safe and effective medical care to their patients connects fundamentally to the well-being of the public, the earth, and the ecological systems on which life depends.
The environment and health:
The term environment refers not only to air, water, soil, plants, and animals but also to biotic communities and systems of food and agriculture, social organization, buildings, and transportation that people have created. An integrated, ecological framework recognizes that individuals are nested within families, communities, ecosystems, societies, and cultures. This perspective features complex, rich interactions within and across levels of organization. Health, however defined, is deeply dependent on these relationships.
The environment influences human well- being even before conception. Various qualities of eggs and sperm of prospective parents are altered by nutrition and exposure to environmental chemicals. Maternal diet, environmental contaminants, and social stressors help to shape the environment of the womb.
Typical US babies are born with measureable levels of dozens of industrial and agricultural chemicals in their mothers’ and umbilical cord blood.   These chemicals are encountered in food and water, the ambient environment—home, community, workplace—and many consumer products. Some of them are known to cause cancer, birth defects, learning and behavioral problems, and various other diseases and disorders. But, most have not undergone adequate safety testing, and we don’t know what their impacts may be.
In 1986, Barker and Osmond reported in the journal Lancet that the offspring of undernourished pregnant women during the Dutch famine of WWII were at much higher risk of heart disease and stroke in adulthood. Studies showed that poor nutrition in early development increases susceptibility to the effects of an abundant diet after birth. Recent science now shows how profoundly other environmental agents can also influence fetal development and disease risk throughout life, including many decades later. 
We have long known that early life exposure to lead, alcohol, tobacco smoke, and some pharmaceuticals can have lasting health consequences. But the list of chemicals and contaminants of concern is now much more extensive. It includes mercury and other metals, various pesticides, and a long list of chemicals commonly encountered in consumer products but inadequately regulated by government.
During infancy, childhood, adolescence, and adulthood, human interactions with the chemical, physical, nutritional, built, and social environments fundamentally influence the health of individuals and communities. Neurodevelopmental problems with lasting impacts on learning and behavior can result from exposure to lead, mercury, flame retardants, pesticides, and many others.   Asthma can be caused or triggered by air pollution and exposures to chemicals in consumer products or the workplace.  Some pesticides and other industrial chemicals increase the risk of various kinds of cancer. The National Toxicology Program’s Report on Carcinogens lists about 240 chemicals as known or reasonably anticipated to be human carcinogens.
The importance of optimal nutrition for health throughout life is well-known but the impact of environmental chemicals on health status in older adults has received less attention. For example, higher lifetime lead exposures result in greater cognitive decline in later years. Exposures to certain pesticides used in agriculture increase the risk of Parkinson’s disease  and some kinds of cancer.  Air pollution increases the risk of myocardial infarction, bronchitis, and asthma.   Emerging evidence also links air pollution to cognitive decline and dementia. 
Recognizing that many of these diseases are treated in their own facilities, leading health care organizations have begun to investigate the extent to which they inadvertently contribute to them and seek ways to reduce that impact by modifying their practices. Moving beyond the institutional level, some are weighing in on development of local, state, and Federal policies addressing public and environmental health. Their rationales differ and tend to evolve.
Some health care leaders reduce their institutional impacts on public environmental health primarily for ethical reasons. They see it as the right thing to do. Faith-based organizations often express this ethical rationale as care for God’s creation. Moral considerations have always had a major influence on medical practice and health care. The imperative to “first do no harm” has deep historical roots in medical practice. This is easily extended to the community and the earth more generally. Commitments to beneficence, respect, promotion and defense of the dignity of people, and concern for the most vulnerable and future generations demand a more clear-eyed view of the positive and negative impacts of what health care organizations are doing.
Economic considerations initially motivated some health care organizations. Facing large and growing disposal costs, they realized substantial savings when their facilities took steps to reduce waste and minimize the volume of more-costly regulated “red bag” waste, even when that meant hiring a waste manager. They saw the potential benefits of reduced packaging and material recycling, but inevitably this meant that manufacturers and suppliers would need to become involved, and efforts moved upstream in the supply chain.
Economies of scale now give health care institutions, through their group purchasing organizations (GPOs), an opportunity to stimulate transformation of the supply chain, by creating incentives for development of cost-competitive, safe, and effective products and processes.
Similarly, many organizations employ measures to reduce energy use, driven primarily by cost considerations, although, chosen wisely, they can also yield environmental and public health benefits.
Public and environmental health-based rationales:
Health care institutions that want to improve the public and environmental health consequences of their practices because they see adverse impacts as inconsistent with their missions can choose among a range of activities. They include:
The volume of hospital waste and its financial and public environmental health consequences are not trivial. In 1998, the AMA estimated the total annual volume of regulated medical waste in the United States to be approximately 465,000 tons, with an expected 7-10% annual rate of growth.  Their report estimated total solid waste generated per person per day in hospital facilities to range from 10 to 25 pounds, of which approximately 10-15% was classified as potentially infectious regulated medical waste.
Today, Practice Greenhealth reports that award winning hospitals generate 33 pounds of waste per bed daily. Extrapolating that figure to the number of staffed hospital beds nationwide yields an estimate of more than 5.9 million tons of waste annually.
In many ways the contents of hospital waste are similar to the general municipal waste stream coming from households and other businesses. But there is an important difference. Hospital waste contains about twice as much plastic as the general municipal waste stream (20-25% vs. 10%)
Regulated medical waste is unique. It is potentially infectious, must be handled carefully, and is considerably more costly to dispose of properly. Many hospitals have undertaken strict measures to make certain that the two waste streams are appropriately segregated to minimize costs. The most common methods of treating regulated medical waste include incineration, autoclaving, microwave deactivation, chemical disinfection, and electro-thermal deactivation. Treatment costs vary by method.
Unregulated hospital waste management has changed considerably in the past 15 years. Previously, many hospitals used on site incinerators for at least some of their waste disposal. Emissions from these were largely unregulated and in 1996, the EPA estimated that approximately 2300 hospital waste incinerators were in operation. Studies showed that medical waste incinerators were leading sources of emission of dioxin, heavy metals, and other hazardous pollutants. These contaminants fouled the air, water, and soil, and some, like dioxins, furans, and mercury, entered the food chain, threatening the health of people and wildlife. In 1997, under the authority of the Clean Air Act, the US EPA issued regulations to control emissions from medical waste incinerators. Since then, many medical waste incinerators have closed. Today, hospitals choose between sending their unregulated waste to commercial incinerators or to landfills.
Despite more stringent regulatory oversight of incinerator emissions, their use is still highly controversial. Emissions from incinerators depend on their design, operation, and composition of the waste stream. The relatively large amount of polyvinylchloride plastic (PVC) in hospital waste is a significant source of chlorine for the de novo synthesis of dioxins, furans, and related hazardous compounds in incinerator exhaust gases, depending on temperature and other operating conditions. Released into the atmosphere, these persistent, bioaccumulative compounds contaminate air, water, soil, and sediments, entering the food chain. If they are captured from the incinerator exhaust stream, they are deposited in the bottom ash, which is typically put into landfills.
Dioxins and furans are potent toxic chemicals. At low levels of exposure, they cause an array of adverse health effects, including impaired reproduction and development, interference with hormones, changes in metabolic enzymes, immunotoxicity, and cancer. In 2012, after nearly 20 years of effort, the US EPA finalized an assessment of the non-cancer health risks related to exposures to dioxins. The assessment of cancer risks is forthcoming. Although dioxin levels in people and the environment have been falling in recent years as sources of emissions have been better controlled, the EPA finds that the level of exposure that begins to cause adverse health effects is close to typical dietary exposure levels in the US today. Thus, efforts to reduce dioxin emissions further are justified.
Reducing the volume and toxicity of the waste stream requires a multi-faceted approach. In hospitals, switching to multi-use products and initiating comprehensive recycling programs can dramatically reduce waste volume. Persuading suppliers to eliminate unnecessary packaging also helps. And careful choices among waste disposal options can reduce harmful exposures in people and wildlife.
Leading hospitals and GPOs soon realized that staff, patient, public, worker, and environmental health concerns led directly to product manufacture. Some began to preferentially purchase products made of inherently safer materials, creating incentives for manufacturers to re-design and re-formulate, phasing out hazardous materials in the life cycle of their products.
An early broad-based purchasing initiative, led by Health Care Without Harm (HCWH) with the support of the US EPA, focused on eliminating the use of products containing mercury and replacing them with safer alternatives. Mercury is a heavy metal used for many years in sphygmomanometers, thermometers, and some electronic equipment. It can also be a low-level contaminant in laboratory chemicals. Metallic mercury is volatile and when exposed to the air, mercury vapors rapidly contaminate indoor air at levels that can pose health risks. In the hospital, mercury spilled from a broken sphygmomanometer must be treated as hazardous waste and can cost thousands of dollars to clean up properly.
When mercury-containing waste is incinerated, mercury not captured in the ash is emitted into the atmosphere and can travel long distances. Metallic and other forms of inorganic mercury are converted by bacteria normally residing in soils and sediments of oceans, rivers, lakes, streams, and wetlands into methylmercury, a highly toxic, organic form of the metal. Methylmercury is environmentally persistent and bioaccumulative—in aquatic systems it builds up to high levels in predatory fish, exposing people and wildlife eating those fish to unsafe levels.
Methylmercury is rapidly absorbed from the intestine and in pregnancy, easily crosses the placenta, exposing the developing fetus. It disrupts normal brain development in children exposed during critical windows of vulnerability. Whereas high-level exposures can cause mental retardation, seizure disorders, and birth defects, lower levels cause more subtle effects on various measures of cognition and psychomotor development. In 2001, the US EPA established a reference dose, later affirmed by the National Academy of Sciences, below which adverse impacts on brain development are unlikely. According to the CDC, approximately 7% of women of reproductive age in the US are currently exposed to mercury at levels exceeding the reference dose. This means that more than 300,000 newborns each year in the US may have increased risk of learning disabilities associated with prenatal exposure to methylmercury. Higher level mercury exposures from eating contaminated fish also contribute to the risk of heart disease and myocardial infarction in older people.
Efforts to eliminate mercury containing products from hospitals have gained wide support and many hospitals are now virtually mercury-free. These hospitals have substituted safe and effective equipment and supplies that do not compromise patient care. This also led to the elimination of mercury thermometer sales in major pharmacy chains throughout the country and similar efforts internationally.
Beyond mercury: PVC/DEHP
While efforts aimed at mercury-free health care were underway, other products also came under close scrutiny. Among them were items made with polyvinylchloride (PVC), a high volume plastic polymer with many applications in health care, construction, and consumer products.
Interest in identifying alternatives to medical devices and supplies containing PVC has grown for several reasons. In addition to the hazardous compounds formed by its incineration, PVC manufacture requires ethylene dichloride, a likely human carcinogen, and vinyl chloride monomer, a known human carcinogen. Workers in PVC manufacturing and fence line communities next to these facilities are at risk for exposure to these chemicals. In addition, wastes associated with PVC manufacture contain dioxins and other hazardous organic compounds that must be disposed of properly.
Many uses of PVC require the addition of plasticizers to the polymer to impart flexibility. Diethylhexyl phthalate (DEHP), a member of another family of chemicals of concern, is the most common plasticizer used. Many laboratory animal studies show that DEHP and related phthalates interrupt normal development of the male reproductive system, resulting in lower sperm counts and various genital defects, at low levels of exposure.
Studies also show that, in some circumstances, DEHP leaches out of PVC medical devices resulting in significant patient exposures. Bags, tubing, and catheters made of PVC plasticized with DEHP can result in some of the highest exposures, particularly when fat-containing liquids flow through them. Quantitative assessments show that developing males can be exposed to DEHP at levels that pose a significant risk to their reproductive tract development, particularly when undergoing multiple interventions with DEHP-containing devices.
Based on these findings, in 2002 the FDA issued a public health notification, advising health care professionals to try to avoid using DEHP-containing devices when procedures with the highest risk of exposures were to be performed on male neonates, pregnant women who are carrying male fetuses, and peri-pubertal males.
As a result of one or more of these concerns, some health care facilities have chosen to purchase medical devices made of alternative materials, without limiting care or sacrificing patient safety. Some hospitals have moved away from PVC in construction and furnishings, as well.
Beyond mercury and PVC: comprehensive chemicals policies:
Other chemicals that can cause cancer, asthma, a variety of neurological, reproductive, and developmental problems, among others, are commonly imbedded in products regularly used in health care delivery, hospital laboratories, offices, furnishings, maintenance, and building materials. Some are indispensable while others are completely replaceable.
Chemotherapeutic agents for treating cancer and other disorders can increase cancer risk in hospital staff handling the drugs.  Since they are currently essential for recommended medical care, personal protection and other staff exposure-reduction measures are critically important. Ethylene oxide, a known carcinogen, has long been used as a sterilant for heat-sensitive medical devices. Studies have shown an increased risk of breast and other kinds of cancer in health care workers exposed to ethylene oxide. Its replacement when possible and strict control measures have lowered although not eliminated the risk.  
Formalin, a dilute solution of formaldehyde, is a tissue fixative in hospital laboratories. Unfortunately, it is a carcinogen, skin allergen, and can cause asthma.   Lab personnel must be cautious when using it in lieu of good alternatives. However, some building materials, for example particle board, can also contain formaldehyde that off-gases into indoor air, directly exposing occupants. Alternatives for those uses are available, and some hospitals have begun to specify carcinogen-free products for remodeling, new construction, and maintenance.
Nurses’ occupational asthma risk is among the highest of all professions.  The risk for custodial staff is 70% higher than the general population. Exposure to asthma-causing irritants and sensitizers is common in health care, including from cleaning products and sterilants. Preferential purchasing of green cleaning products enables facilities to maintain cleanliness and appropriate disinfection while avoiding worker and patient exposure to chemicals that can cause or trigger asthma and allergies. Integrated pest management programs successfully address the problem while reducing the use of potentially harmful pesticides in buildings and surrounding landscaping.
Many purchasers now insist that electronics suppliers have take-back programs, with verified safe recycling, so that used equipment is not sent overseas where it is often dismantled by unprotected workers, some of whom are children, exposing them to high levels of hazardous chemicals. 
In recent years, motivated by wanting to move beyond addressing one chemical at a time, more hospitals and their GPOs have begun a systematic review of their general purchasing policies recognizing:
Hospitals and GPOs are beginning to ask suppliers to identify all ingredients in products so that they can make more informed purchasing decisions, avoiding chemicals that can cause cancer, reproductive and developmental disorders, neurological damage, and interfere with hormones.
Adoption of a comprehensive policy encourages close scrutiny of virtually the entire material flow into and out of a facility, including products for building, operations, and maintenance, furnishings, medical products, electronics, and office supplies.
Building design, operations, and maintenance:
Historically, hospitals have used materials and practices in their design, construction, and maintenance that, ironically, actually contribute to the diseases treated within them. This is no longer being accepted by many health care leaders. Green building design and operations have taken hold in the health care sector, led by the Green Guide for Health Care (GGHC), a multi-year project of HCWH and the Center for Maximum Potential Building Systems.
In the introduction to their book Sustainable Healthcare Architecture, Robin Guenther and Gail Vittori say, “Considering buildings within a life cycle context and viewing them as part of an ecosystem or ecological metabolism, at least metaphorically, signals that buildings have much in common with the human body. Knowing that buildings are a principal determinant of human and global health means that a building that is healthy through the life cycle is key to creating a healthy planet.”
As Rick Fedrizzi, founding chairman of the US Green Building Council notes, “Buildings are human habitat. The way we design, construct, and operate these buildings has a profound impact on our health and the health of our environment. For too many years, the impact has been negative, from carbon dioxide emissions and construction waste to the wanton use of energy, water, and natural resources. Often, indoor air is more polluted than the air outside and has been linked to illnesses ranging from asthma to cancer.”
Recognizing these connections leads first to incremental and then transformational change. In existing buildings, the GGHC outlines operations initiatives in site management, transportation, energy efficiency, water use reduction, building management, reduction in use of toxic chemicals, environmentally preferable cleaning, and sustainable food purchasing. These initiatives offer real benefits within the facility and help to reduce impacts on community and public health.
Renovation and new construction are opportunities for transformational change—for designing and building an aesthetically pleasing hospital that is truly a healing environment. It could be built without materials containing chemicals that can cause cancer, birth defects, or asthma anywhere within their life cycle. It may capture, use, and recycle rain water and take full advantage of natural light and ventilation, incorporating views of the natural world. Properly designed and constructed, energy consumption can be dramatically reduced in this kind of building. This ecological design perspective also improves patient outcomes, reduces stress, and enhances staff functioning.
Second only to the food industry, health care is a highly intensive consumer of energy. According to the Commercial Building Energy Consumption Survey (CBECS), hospitals of more than 200,000 square feet accounted for less than 1 percent of all commercial buildings and 2 percent of commercial floor space, but consumed 4.3 percent of the total energy used by the commercial sector in 2003 and 5.5 percent in 2007. Health care also accounts for about 8 percent of all greenhouse gas emissions in the US.
Energy-related resource extraction, transportation, processing, refining, combustion, and waste management have profound impacts on public and environmental health. Coal-fired power plants generate about 45 percent of the electricity used in the US. According to the EPA, coal combustion produces 84 of 187 hazardous air pollutants that threaten human health and the environment. These plants produce 40 percent of all hazardous air pollutants released from point sources. They are major sources of nitrogen oxides, sulfur oxides, particulate air pollutant, and mercury releases. These emissions have adverse impacts on lungs, kidneys, brains, and cardiovascular systems—substantially contributing to asthma, bronchitis, myocardial infarctions, stroke, cancer, and learning disorders in our communities.
Carbon dioxide released from fossil fuel combustion is a greenhouse gas contributing to climate change. Emissions from natural gas extraction and combustion also add to ground level air pollution. Nuclear energy is faced with intractable waste management problems, threats of catastrophic accidents, and is tightly interwoven with nuclear weapon threats around the world.
Some health care institutions have undertaken substantial efforts not only to reduce energy consumption but also to purchase green, renewable energy for at least a portion of their energy requirements. Properly configured, these efforts can not only reduce costs but also benefit public and environmental health.
Food: Diet, nutrition, human health
What we eat is undeniably among the most important determinants of our health. Epidemiologic and laboratory data show that diet and the agricultural system that produces it can increase the risk of cancer, cardiovascular disease, diabetes, obesity, hypertension, cognitive decline, dementia, Parkinson’s disease, birth defects, and various neurodevelopmental disorders.
Most nutritional scientists and epidemiologists arrive at the same general conclusions: people are healthier when they eat mostly fruits and vegetables, unrefined carbohydrates, limited fats—with a preference for polyunsaturated fatty acids, particularly omega 3s in cold water fish, walnuts, and some vegetables; and monounsaturated fats—low fat dairy, little processed food, and limited animal protein. Opinions about optimal proportions and patterns differ, but there is little disagreement about the basic structure. Unfortunately, this doesn’t resemble what most people in the US actually eat. 
Dietary changes, combined with moderate levels of exercise 20 minutes daily, can prevent the onset of diabetes, even in people already at risk. Atherosclerotic cardiovascular disease can be prevented and even reversed with combinations of diet and exercise.   Observational studies show slowing of cognitive decline in elderly people who follow a Mediterranean-like diet containing abundant fruits and vegetables, fish, unrefined grains, legumes, nuts, olive oil, and low-fat dairy. 
The food system in the US is an outgrowth of incentives and subsidies put in place throughout the 20th century. Concerns about malnutrition meant an early emphasis on producing more calories. Subsidies for commodity crops—corn, soybeans, wheat, and rice—generated large and growing monocultures, heavily dependent on chemical and fossil fuel inputs. This approach led to air and water pollution on farms and downstream in rivers, lakes, and estuaries. Farm workers, their families, and surrounding communities are now exposed to hazardous levels of pesticides with increased risk of cancer, neurodevelopmental problems in children, and Parkinson’s disease.      
About 80 percent of all antibiotics used in America are given to pigs, beef cattle, chickens, turkeys, and other farm animals, mostly to promote growth and not because the animals are ill, although infectious diseases are more likely in concentrated animal feeding operations. This overuse of antibiotics has contributed to the evolution of antibiotic resistant bacteria and threats to human health.  For years, industrial agricultural interests have resisted FDA attempts to monitor or control the use of certain antibiotics in animal food production. In 2012 the FDA arrived at a voluntary, non-binding agreement with the agricultural industry to promote the judicious use of antibiotics. The effectiveness of this voluntary approach remains to be seen.
Historically, much of the food served in hospitals has not been particularly healthy. Excessive fat, refined sugars, highly processed food, and too few fruits and vegetables have been all too common. Some hospitals even house fast food outlets featuring menus guaranteed to contribute to the illnesses treated in wards and operating rooms on the floors above. This has all begun to change with the dramatic growth of a healthy-food-in-hospitals movement.
During the past ten years, many health care systems have adopted food procurement policies aligned with healthy dietary guidelines that reflect the strong connections between food production and public and environmental health. Some systems support farmers’ markers at their facilities. They provide dependable markets for local growers, helping to support the local economy. Others are growing some of the food served in their facilities. Many now regularly compost food waste for local soil renewal. These efforts have led to more nutritious, tasty food for patients, staff, visitors, and the general public. They contribute to the growing shift toward food systems that are ecologically sound, economically viable, and socially responsible.
Increasingly health care organizations are systematically analyzing materials and product purchasing, building design, construction, and operations, energy sources and consumption, and profiles of the food they purchase and serve in their own facilities. They recognize that each of these has consequences within and beyond their facilities. They are joining a growing movement to reconnect medicine with public and environmental health.
This integrated framework coincides with efforts at health care reform in the US. New delivery models are emerging with the goal of improving patient outcomes, improving community health, and reducing health care costs—sometimes called the triple aim. Patient outcomes and satisfaction are improved when people receive high quality care in a truly healing environment, appropriate to their needs. Community health is improved when people have access to clean air and water, nutritious food produced in environmentally sustainable ways, and safe places for social engagement and exercise. Health care costs can be reduced by primary prevention of many prevalent chronic diseases and disorders, such as diabetes, obesity, cardiovascular disease, asthma, and various kinds of cancer. In addition, hundreds of billions of dollars could be saved annually by eliminating unnecessary care that not only may be harmful to patients but also has adverse public and environmental health consequences. Health care institutions can make important contributions to achieving the triple aim through multiple interventions that reduce the environmental and public health impacts of their activities, serving as a model for other sectors, and by eliminating unnecessary care and promoting community health through expanded community benefit initiatives.
Many opportunities have yet to be even tentatively explored. Support for creative talent within existing institutions and establishment of new relationships with other organizations committed to re-connecting medicine with public and environmental health will help achieve the triple aim and make lasting contributions to improved individual, community, and planetary health.
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A few weeks ago, Dr. Sandra Steingraber—renown scientist and acclaimed author— was jailed just as the manhunt for the Boston Marathon bomber intensified. As tanks rolled into Boston, as armed officers scoured emptied streets, and as we waited, still in shock, for news from Watertown, I read the first of Steingraber’s letters from the Chemung County jail. In March, she and ten others had blocked the gates of a storage facility for fracked natural gas near her home. Steingraber had committed a willful act of civil disobedience to contest threats with complicated chains of causation and complicity, like cancers, chronic disease, and miscarriage.
These events—Steingraber’s jail sentence and the Boston Marathon bombing—are incomparable. But I experienced them in parallel. The fact of their co-occurrence shaped my own elusive search for meaning after such senseless loss. How do we respond to the presence of public threats to human life?
Steingraber was one of three sentenced on April 17th for trespassing onto the grounds of Missouri-based Inergy LLC, a salt-cavern storage hub for the products of natural gas extraction near a lake that supplies 100,000 with drinking water. For 12 straight quarters, Inergy has polluted more than is permitted by federal and state authorities. Before her sentencing, Steingraber wrote: “my small, non-violent act of trespass is set against a larger, more violent one: the trespass of hazardous chemicals into water and air and thereby into our bodies. This is a form of toxic trespass.” As my colleagues in sociology and the environmental health sciences have documented, violations like this happen every day, across the country, and disproportionately and unjustly in low-income communities and communities of color.
The spread of fracking represents, to Steingraber and to others in the public health community, an intolerable continuation of an already untenable reliance on fossil fuels; a proliferation of an industry that is inherently toxic to human health and the planet; a feedstock from which other inherently toxic materials are manufactured. As Steingraber says in Living Downstream, the documentary film inspired by her work, “when carcinogens are deliberately introduced into the environment, some number of vulnerable persons are consigned to death.”
How much senseless loss of life can we bear as a society? Whether the loss of life is sudden or whether life slowly slips from us, it’s catastrophic.
As Steingraber spent her first nights in jail, our humanity and heroism were on full display in Boston last week—from the first responders and the ER and surgical teams to the public safety officials who worked without sleep—all in an effort to preserve life. The response and resources marshaled were nothing short of massive, and implemented with an unprecedented degree of cooperation and coordination, despite chaos. Countless acts of selflessness and a collective compassion were cultivated in the face of unspeakable loss and a profound rupture to our sense of self and security. Boston acted decisively, collaboratively, and forcefully, until the threat was removed.
We’ve seen what we are capable of to preserve human life, and it is an awe-inspiring force.
On the one week anniversary of the bombings, which was also Earth Day, Steingraber released her second letter from her Chemung County prison cell. On that day, Bostonians gathered, in Copley Square, in town centers, wherever we were. We bowed our heads in silence and held the victims of all bombings in our hearts. That night, a vigil also congregated outside the jail in Elmira, New York to support Steingraber and her fellow prisoners of conscience. These were both acts of reverence to life beyond our own.
Dr. Rebecca Altman resides in Arlington with her husband and two sons. She is an environmental sociologist who has taught in the Community Health Program at Tufts University. She serves on the Board of Directors of the Science and Environmental Health Network.
Science & Environmental Health Network Warns that the Keystone Pipeline Violates Inalienable Rights of Present and Future Generations
U.S. Department of State Hearing Grand Island, Nebraska
April 18th, 2013
Statement of Carolyn Raffensperger
Ames, Iowa—The Keystone Pipeline poses a threat to our common heritage and national security because it puts at risk fresh water, the climate, and the health of people. Air, water, climate, and other environmental necessities are the foundation of national security and inalienable rights held by both Present and Future Generations.
The role of government is two-fold:
(1) to serve as the trustee of the commonwealth and common health for Present and Future Generations and 2) to protect rights.
The right to a clean and healthy environment is the basis for the rights of life and liberty. It is inalienable. It is a right of Present Generations and Future Generations, or posterity.The Pipeline decision will be made in the face of uncertainty. Cost benefit analysis is not the appropriate decision making tool because it is not a guarantor of rights. The government’s responsibility is to take precautionary measures and protect the right to clean air, clean water, and a healthy climate. Present Generations have a responsibility to pass on a healthy and intact world to Future Generations. In order to fulfill that responsibility the pipeline must be denied.
The Mission of the State Department is to:
Advance freedom for the benefit of the American people and the international community by helping to build and sustain a more democratic, secure, and prosperous world composed of well-governed states that respond to the needs of their people, reduce widespread poverty, and act responsibly within the international system.
According to the State Department water is a fundamental cornerstone to maintaining global peace, security and prosperity.
In addition, the world community must work collaboratively to slow, stop, and reverse greenhouse gas (GHG) emissions in a way that promotes sustainable economic growth, increases energy security, and helps nations deliver greater prosperity for their people.
These statements about the State Department’s mission and policies carry with them an expression of what government is for—what it is meant to be. The primary responsibility is not to foster the economy, or promote the balance of trade; it is to meet the needs of the people and to deliver prosperity. Prosperity is defined as thriving and flourishing and cannot be reduced to mere economics. A morbidly ill wealthy person is not prosperous.
This mission can be stated another way—that government’s primary responsibility is to protect rights and to serve as a steward of the commonwealth and common health of Present and Future Generations. Without a stable climate and adequate fresh water there is no prosperity which includes health and well-being, and the fundamental needs of living beings cannot be met.
2) The right to a clean and healthy environment is the basis for the rights of life and liberty. It is inalienable. It is a right of Present Generations and Future Generations, our posterity.
The U.S. Constitution was established to guarantee the basic rights of people and the basic responsibilities of government so that both Present Generations and Future Generations (posterity in the U.S. Constitution) had the blessings of life, liberty, and the pursuit of happiness. The State Department, as an arm of the U.S. government, has an obligation to Future Generations to protect the prosperity, liberty, and tranquility owed to them. The only decision that can guarantee those inherent rights for us and posterity is to reject the Keystone Pipeline.
3) The decision will be made in the face of uncertainty. Cost benefit analysis is not the appropriate decision making tool because it is not a guarantor of rights. The government’s responsibility is to take precautionary measures and protect the right to clean air, clean water, and a healthy climate.
While some economic and environmental outcomes of the pipeline are not foreseeable, many are not. In the face of scientific uncertainty, prudence requires that the State Department take action to prevent harm to the common wealth and health of the United States. The economic benefits to the people of the United States are far outweighed by the probable environmental harms of water contamination and climate destabilization. If the decision was only to be made on the basis of cost benefit analysis, the outcome would be the same. The small financial benefits are vastly outweighed by the environmental threats.
However, the other rights enshrined in the Constitution and the U.N Declaration of Human Rights are based on a right to existence and require the right to breathe air and drink water. Therefore, cost benefit analysis is not the appropriate decision making tool. If you deny one person the right to drink clean water or breathe clean air, you have denied a fundamental right. Rights are not subject to cost benefit analysis.
The State Department must protect the fundamental right of Present and Future generations to inherit a habitable planet. It must assume the mantle of its responsibility as trustee of the commons that are necessary to fulfill that right. These rights include but are not limited to clean air and clean water as well as a stable climate.
Deny the Pipeline.
Carolyn Raffensperger, M.A., J.D.Executive DirectorScience and Environmental Health Network
By Rebecca Altman Gasior
“I’ve never been to a political rally,” my husband says after I suggest going to the Climate Forward Rally in Washington, DC over February vacation. He is a scientist, an entrepreneur, a pragmatist. Sometimes he slips and introduces me as a “socialist,” though really I’m a sociologist.
“Me neither,” I sigh, “nothing of this scale, and never in Washington.”
He knew I wanted to go, but could sense I was worried about logistics. We have a two and a five year old. We live in Boston. One kid has severe food allergies, making the question “what’s for dinner?” tricky to answer on the road.
The rest of the exchange went like this:
“Wasn’t it enough that we supported Obama?” he asked.
“Doesn’t this moment demand more?” I respond.
“But will it make a difference, a couple more bodies?”
“What if everyone thought that way?”
“Will anyone really care if we don’t show up?” he quips.
“They might,” I say pointing at the kids. “And their kids might. And don’t you think your great-grandchildren might care?”
The next day he made hotel reservations.
* * *
It’s summer 2012. Boston is sweltering; Kansas farm country, not Death Valley, is the hottest place in the country; Midwestern cropland has been crippled by a drought that won’t quit.
We drive the kids to the Boston Museum of Science—for air conditioning and ample distractions. Our one year old becomes absorbed by the Galton Box, a mesmerizing exhibit that demonstrates how the likelihood of mass phenomena tends toward the average outcome.
It’s a plexi-glass box. Through it, a series of balls are dropped down a maze of pegs, each one bouncing randomly this way and that, until coming to rest in one of 17 columns along the base of the exhibit. Over time, the balls fill up the columns and, if you watch long enough, a pattern emerges. The filled columns eventually take the shape of the bell curve, with most balls falling somewhere in the middle columns, and far fewer filling the columns at the tails. Although the balls could drop into any column, each column fills to approximately the same height each time the columns are emptied and the balls are re-released. Scientists call this the normal distribution.
A wide variety of phenomena follow this trend—tending toward the average, though some do fall into the tails, the margins. We call these outliers.
* * *
The late sociologist, Bill Freudenburg, used to say of the bell curve that “the tail wags the distribution.”
He is known for many things, but especially for developing the study of what he called disproportionality in environmental studies. It turns out, as Freudenburg relays in a study published by Social Forces, that a disproportionate amount of pollution is attributable to only a handful of bad actors who emit far more than is typical for other industries within their sector. Not all U.S. industries behave the same, he writes. There’s actually quite a bit of variation in environmental performance across sectors, within sectors, and even from plant to plant within a company (see Freudenburg 2005, 2006). In each instance, there are often extreme outliers, mega polluters.
But, he argues, regulators and policy-makers often treat all industrial units as equals, and assume that most industries have about average environmental performance. This plays into the perception that typical firms typically pollute, and lead many to assume, often mistakenly, that environmental harm is therefore a necessary byproduct of industrial activities and economic growth, when egregious pollution is more likely produced—and politically protected— by a few.
What if regulators—and the public—focused not on the mean, but on the outliers? What if, he writes, we, “went after the worst 10 percent of the polluters and asked them to be no worse than what is considered average in the dirtiest industries?” This could yield a substantial drop in total emissions for those industrial sectors. His project was a work in progress, a set of ideas, still being developed and tested by his colleagues, and yet, compelling: to start, reign in the outliers, reign in those with the most disproportionate impact to the whole and/or to the most vulnerable communities.
And then there’s this: given the effect of just a couple outliers, environmental polluters and their releases might be better modeled by a different curve, a different shape, a different distribution altogether, suggests Lisa Berry in a study published in Research in Social Problems and Public Policy. The bell curve, the normal distribution, no longer fits.
Meanwhile, we march on as a society, extracting unconventional fossil fuels using ever more extreme, toxic, and climate-disruptive technologies. We blow up mountains to expose coal and bedrock to release natural gas. We drill wells deep at sea, and refine oil from dirty tar sands.
We’ve left largely unbridled the outliers on the wrong end of the distribution.
* * *
Mid-summer climate scientist James Hansen releases a new analysis of global temperatures, concluding the entire bell curve for anticipated seasonal temperatures has shifted rightward by an increase in extremely hot weather. A cluster of outliers pulls the average along with it, as if the museum curators ripped the Galton Box from its foundation and moved it over a foot.
* * *
“We decided to take the kids to DC for February vacation,” I tell my mother over the phone. “There’s a climate rally happening the first weekend of break.”
“Ugh,” she groans. “Maybe you should go down later in the week.”
“The rally is the draw, Mom; the rally is why we’re going.”
The following night my mother-in-law asks whether it is safe to bring the kids. My husband fields the question. I’m already on the Internet fretting about whether arrests are expected.
Earlier that night, my husband attends a curriculum meeting for our kids’ school. There, the teachers sketch their plan to engage students on climate change. Projected on the screen behind them is a picture of children beside a tree, one of them with arms wrapped around it. Afterwards he says to me: “we’re not hugging trees, we’re bringing them to DC.”
I think I detect pride in his voice.
* * *
In September, I leave home for the first time since having children. I travel to Moab to participate in a Women’s Congress, co-organized by SEHN, about our collective responsibilities to future generations, about what rights they hold to a livable world. Moab steeps me in a sense of deep time—the striations in the red rocks, millennia of erosion, evidence of a long-gone interior ocean—and in the continuity of human life, the ancient indigenous ruins, the petroglyphs, the abandoned mines, the site once slated for nuclear waste burial.
On the last night of the Congress, the women gather on a footbridge spanning the Colorado River to watch moonrise. There are taiko drummers and their rhythms ricochet off the rocks. At our backs are uranium tailings, almost marking the gates of Arches National Park—such a startling juxtaposition, all that we leave behind.
The next afternoon, on the way home from the Congress, my friend and SEHN colleague, Madeleine Kangsen Scammell and I detour to Rocky Flats, the former nuclear weapons factory, slated to become a wildlife refuge, and also maybe a highway. The clouds coming off the Rockies were thick; the sun shone down in broad columns as we drive the perimeter of the property looking for signs—any sign that might mark the history of what happened on this innocuous, majestic parcel of land. We find nothing on par with our expectations—no memorial, no signs that acknowledge what’s happened here, what’s harbored here, the legacy left in place just inches below the surface where prairie dogs burrow. We turn back toward the airport, crossing Woman Creek, which drains from the property into Standley Lake, whose sediment is now laced with plutonium, whose water still runs from the taps of area communities (see Iversen 2012).
Along the eastern side of the property, we pass a woman on the side of the road. She holds a sign. It reads: “new homes for sale.”
She is dancing. I am crying. We drive away.
* * *
After I returned, I participate in a conference call from the parking lot of my son’s preschool where I wait to take him home. We are to discuss the most pressing environmental crises, and strategies to address them. But instead the focus is on it being too late, that too many thresholds have been crossed, too much irrevocable damage done, too much political gridlock, that the next generations will suffer handedly at our hands. While I listen, from across the parking lot, I watch three year olds skipping across the playground, chasing each other around the elms, scaling the climbing wall, and sliding down in a tangle of knees and elbows and giggles.
Soon after, Sandy swallows the Atlantic and spits it across the Caribbean, the East Coast, and into the interior.
* * *
New York wants to lead on climate change, but struggles to hold back the natural gas barbarians amassing at their gates. Australia’s Bureau of Meteorology adds new hues, magenta and deep purple, to its temperature maps to accommodate temperatures like 125 degrees Fahrenheit.
I had been writing a book about environmental legacy—about pollution we transfer from generation to generation, about problems with uncertain endings. I consult with an editor. He tells me all stories travel a narrative arc, that the arc rises then falls toward a comedic or tragic conclusion. “Which is the story you wish to tell?” he asks me. “A comedy or tragedy? How will it end?”
I stop writing.
* * *
I start reading about stories that follow a different form, about writing that takes a different shape.
We return to the Museum of Science. Yet again, I find myself standing in front of the Galton Box. At my feet, my now two year old wriggles and widely gesticulates with excitement. Twenty minutes pass.
And just when I think I can’t stand there any longer, I begin to watch for outliers, wondering what path they follow to the margins.
* * *
After the New Year, SEHN’s Katie Silberman emails, asks if I would write something for the newsletter. “Has anything changed for you since you wrote the last essay for us? What should we do now knowing it’s too late?” I return to my desk for the first time in months. I open a blank document. I type: “I don’t know.”
Then I type: Idle No More. INM’s global day of action last month drew attention to issues of indigenous sovereignty and treaty rights, human rights and environmental protection in Canada, but is gaining traction and momentum globally.
I recall a conversation in Orion Magazine between writer, Terry Tempest Williams, and economics student turned climate justice activist, Tim DeChrisopther, AKA Bidder #70. DeChristopher spoke with Tempest prior to his sentencing to federal prison for attempting to outbid oil and gas companies during an auction of public land, an un-premeditated act born from a moment in which standing outside the auction, sign in hand, no longer seemed enough.
What I recollect from the exchange, is this: movements move the center, and they do so when a few move to the margins and push. It takes just a few outliers to shift the balance, to shift the entire curve, perhaps even to reshape it. It’s like a lever; wedge it in the right place and you can lift a disproportionate load. Step toward the tails. Or support those already there marching it outward.
* * *
“We’re going to Washington, D.C., to the Space Museum,” I finally announce to my five year old.
“That’s where Wonder Woman lives,” he exclaims before bounding up the stairs.
He returns with an armful of superhero-commanded spacecraft fashioned from Lego’s. “I’d like to bring these.”
“Also,” I stammer, “we are going to take part in history, maybe even be climate heroes.”
“What’s history? What’s a climate hero?” he asks.
My husband shoots me a look from across the table. I flex my biceps, and grin.
* * *
For more information about the Forward on Climate Rally in Washington, DC on February 17th, please visit http://action.sierraclub.org/site/PageServer?pagename=forwardonclimate
To learn more, and to support the Climate Forward rally logistics visit: http://act.350.org/signup/presidentsday
Also, to learn more about Idle No More, you can visit them here: http://idlenomore.ca
Rebecca Altman, Ph.D. in Sociology, is the mother of two boys, serves on the Board of Directors for the Science and Environmental Health Network, and is taking time off from lecturing at Tufts University to work on her first book. She has written numerous columns for OdeWire.com, the online site for the magazine, the Intelligent Optimist, formerly Ode Magazine: http://odewire.com/author/rebeccaaltman
Note: all citations appear as hyperlinked text to the source document.
Special thanks to: Carolyn Raffensperger (who titled the essay, among other vital assistance), Danielle Nierenberg, Katie Silberman, Riley Dunlap, and Phil Brown for spot on suggestions, comments and encouragements.
For further reading:
Lisa M. Berry. 2008. Disproportionality and Inequality in the Creation of Environmental Damage. Research in Social Problems and Public Policy. 15: 239-265.
Debra J. Davidson and Don Grant. 2012. “The Double Diversion: Mapping Its Roots and Projecting Its Future in Environmental Studies.” Journal of Environmental Studies and Sciences 2: 69-77.
Debra J. Davidson and Riley Dunlap 2012. “Building on the Legacy Contributions of William R. Freudenburg in Environmental Studies and Sociology.” Journal of Environmental Studies and Sciences 2: 1-6.
William R. Freudenburg. 2005. “Privileged Access, Privileged Accounts: Toward a Socially Structured Theory of Resources and Discourses.” Social Forces 94 (1): 89-114.
—–. 2006. ”Environmental Degradation, Disproportionality, and the Double Diversion: The Importance of Reaching Out, Reaching Ahead, and Reaching Beyond.” Rural Sociology 71 (1): 3-32.
Kristen Iversen. 2012. Full Body Burden: Growing Up in the Shadow of a Secret Nuclear Facility. Random House. www.kristeniversen.com
By Dianne Dumanoski
Two decades ago, when I covered the first Earth Summit in Rio, the catch phrase of the day was a purported Chinese proverb warning that “if we keep going down the current road, we’ll end up where we’re headed.”
This event still ranks as the largest gathering of heads of state in history. A remarkable plenary session brought together well over 100 world leaders, including the first President George Bush and Cuban president Fidel Castro, to survey the human prospect. One after another, they paraded to the podium to deliver grave warnings, moving speeches about future generations, and pledges to get off the road drawing us to a dead end. President Bush, who had wavered about even showing up, did go off script with his adamant declaration: “The American way of life is not up for negotiation.” But he was just a rogue wave in a sea of earnest rhetoric. The goal endorsed in Rio was to “prevent dangerous anthropogenic interference with the climate system.”
What is astonishing in retrospect is that the good intentions seemed to last about as long as the summit. It now appears a moment of spectacular, ironic political theatre. Once the curtain rang down, the ominous trends that had brought the world to Rio did not slow even a whit.
Instead, the modern human enterprise, aided and abetted by these same world leaders, put the pedal to the floor and hurtled onward even faster. There were other paths and other possible futures, but most are vanishing in the rear view mirror. On climate change, we sailed past the last exit.
Today, the overwhelming factor in the climate conundrum is time. After twenty squandered years, the question now is this: is the global community capable, if it could muster the will, of cutting emissions fast enough to avoid catastrophic climate change by mid-century.
In recent years, the air of unreality in the climate debate has been growing as exponentially as global emissions. The problem isn’t just climate deniers, but also those who are concerned and active. Waving the banners of optimism, hope, vision, many continue to promise that we can solve the climate problem. They advocate new technology, organize campus campaigns to banish fossil fuel stocks from university portfolios, or foster ambitious projects to rethink capitalism and growth, all of which would be worthy indeed, had we but world enough and time.
Time is almost the only thing that now matters. It is an acute constraint. If time is not a part of the calculation, we are talking dreams or faith in technological rapture rather than plans or solutions. Over the past year, I’ve been amazed to hear scientists and activists, who anguish in private that it is too late, show a different face in upbeat public talks. We are not telling the truth about where we find ourselves.
It is way too late to prevent dangerous climate change, the goal set out in Rio.
It is also too late–as news reports drive home with an astonishing litany of disasters–to avoid extremely dangerous climate disruption. Wild, unprecedented weather extremes are battering communities around the world. A prolonged, literally off-the-charts heat wave forced Australian meteorologists to increase the top end of their temperature scale. Then torrential downpours in some areas of the country brought 53 inches of rain in three days. There is no decimal point missing in that number.
The longer range forecast? A leading climate scientist and advisor to the UK government summed it up in a single word: terrifying. Wild weather, which has become a new normal, is occurring after a rise in global average temperatures of .8 degrees Celsius. The currents trends put us on track a stunning temperature rise of 4° C by 2060. The speed of this warming is unprecedented in Earth history: CO2 is rising 10 times faster than during the last great warming 56 million years ago. The implications are unthinkable.
Such a whirlwind of change is, many scientists judge, incompatible with our current, global civilization, beyond adaptation, and likely unstable, meaning that the warming will not reach an equilibrium at four degrees, but likely continue even higher to 6° C or more by 2100. Among other consequences: count on devastation for most ecosystems and loss of at least 40 percent of the world’s corn and rice crops.
Unless some utterly unforeseen event intervenes and jolts the modern enterprise totally off course, this is the road we are traveling.
Chances are good that the trip to 4°C warming will take us past fateful thresholds and into a period of uncontrollable climate change. Natural processes—the disappearance of Artic sea ice and the thawing of the permafrost––are already kicking in. These will accelerate and amplify the warming or could even trigger abrupt, massive shifts in the global climate system.
How bad is it? One measure of the vanishing hope that the world can act in time is the explosion of interest in potential, planetary-scale technological remedies. During the past 6 years, geoengineering has metamorphosed from a highly risky, fringe idea worthy of Dr. Strangelove into the last best hope for modern civilization. Out of desperation, many leading scientists are counting on salvation through CCS (carbon capture and storage)—a technology that may never materialize and prove feasible/affordable on the scale necessary.
So is it REALLY too late to save ourselves by shifting to a non-carbon energy sources, the assumed scenario when we talk about solutions?
Yes, and this has been clear for some time, according to leading researchers like Kevin Anderson of the U.K.’s Tyndall Centre for Climate Change Research who have spent years analyzing emissions reduction scenarios and trying to figure out how to make the future compute. In giving priority to economic growth rather than to protecting conditions necessary for civilization, world leaders have framed the problem in a way that makes it unsolvable. They ensured from the very beginning, that even with rapid, urgent action and optimistic assumptions, it would be impossible to limit warming to much less than four degrees. But the world never even got serious about cutting emissions.
Attempts to find a way to make the future compute continue, but the low-carbon scenarios, which promise to deliver us from catastrophe, typically depend on ever more improbable assumptions and need to rely on CCS to get a satisfactory answer.
So what do we do now?
As one of my friends asked with panic in her voice, “Isn’t doing something, anything, better than doing nothing?
I’ve wrestled with this question for some time.
“It depends,” I replied. “It depends on why you want to jump into action? It might be better to do nothing for a while and sit with the truth that we’re headed for an unimaginable future.”
“But, it just seems so hopeless”, she protested, still itching to flee from dark knowledge.
All the more reason to consider T.S. Eliot’s counsel: “Be still, and wait without hope, for hope would be hope for the wrong thing.”
As the gap between reality and rhetoric has grown into a Grand Canyon of denial, I’ve become increasingly dismayed by a phenomenon I’ve named “palliative activism”, a response that is likely to increase as fear about climate change grows. “Doing something” may NOT be better than “doing nothing”, especially if the measures pursued cannot–without magical thinking –alter the current trends. Veterans of the climate wars tout limited environmental “success stories” to the younger generation and pull punches about the big picture, because they fear leaving their students hopeless and in despair. While such palliative activism does not offer a remedy for the climate crisis, it does have undeniable benefits. It can definitely make someone anxious about climate change feel better and, by staying in motion, it is possible to keep the darkness that stalks us at bay.
For all that has been said and written about the dangers of climate change, one seldom hears mention of the profound psychological, spiritual, philosophical, and cultural trauma that lies ahead. Once the grave danger and our lack of control become inescapable, the emotional chaos may well match the physical upheaval. This juggernaut promises to shatter everything: the world we have known; the future we have counted on for ourselves, our children and grandchildren; our sense of security; and the modern worldview which promised that progress would deliver us from the human condition.
Like many remedies, palliative activism comes with serious side effects. Manic doing born out of fear is a way to avoid thinking hard about where we find ourselves and feeling unspeakable loss. Even worse, it prevents the reflection that might allow us to find our way forward. We need to understand which doors to the future have already closed. We need to be clear-eyed and straight-talking about our intentions and goals. If we urge others into action to combat climate change, what can we honestly aim for in the campaign? Are the promises implicit in these efforts ones we can no longer keep?
The conclusion that it is too late should be followed by a question: too late for what? Odds are it is too late for some cherished hopes for our children and for our civilization. If there are still meaningful things to do and other hopes, they can only be discovered by confronting the bitter truth of our situation and giving hard thought to what may still be possible and helpful. Are we willing to admit the loss of the future we had imagined, counted on, and grieve? Can we muster the courage and strength to renegotiate the grounds for hope?
If our civilization, which has been a radical cultural experiment, is doomed to self-destruct, can we hope for those who may make it through climate hell and write the next chapter of the human story?
Facing the future and telling the truth—this is another kind of very hard work. If we are not honest, then there is, indeed, no hope.
Dianne Dumanoski is a SEHN Board Member and an author and environmental journalist. She has reported on a wide range of environmental and energy issues for broadcast and print media and has been among the pioneers reporting on a new generation of global environmental issues.
By Carolyn Raffensperger
I have a hypothesis about the lack of public support for environmental action. I suspect that many people suffer from a sense of moral failure over environmental matters. They know that we are in deep trouble, that their actions are part of it, but there is so little they or anyone can do individually. Anne Karpf writing about climate change in the Guardian said this: “I now recycle everything possible, drive a hybrid car and turn down the heating. Yet somewhere in my marrow I know that this is just a vain attempt to exculpate myself – it wasn’t me, guv.”
To fully acknowledge our complicity in the problem but to be unable to act at the scale of the problem creates cognitive dissonance. Renee Aron Lertzman describes this as “environmental melancholia”, a form of hopelessness. It is not apathy. It is sorrow. The moral failure and the inability to act leads to what some now identify in other spheres as a moral injury, which is at the root of some post-traumatic stress disorders or ptsd.
The US military has been investigating the causes of soldiers’ ptsd because the early interpretations of it being fear-based didn’t match what psychologists were hearing from the soldiers themselves. What psychologists heard wasn’t fear, but sorrow and loss. Soldiers suffering from ptsd expressed enormous grief over things like killing children and civilians or over not being able to save a fellow soldier. They discovered that at the core of much of ptsd was a moral injury, which author Ed Tick calls a soul wound.
According to the U.S. Department of Veterans Affairs, “[e]vents are considered morally injurious if they “transgress deeply held moral beliefs and expectations”. Thus, the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life, and so forth.”
The moral injury stemming from our participation in destruction of the planet has two dimensions: knowledge of our role and an inability to act. We know that we are causing irreparable damage. We are both individually and collectively responsible. But we are individually unable to make systemic changes that actually matter. The moral injury isn’t so much a matter of the individual psyche, but a matter of the body politic. Our culture lacks the mechanisms for taking account of collective moral injuries and then finding the vision and creativity to address them. The difference between a soldier’s moral injury and our environmental moral injuries is that environmental soul wounds aren’t a shattering of moral expectations but a steady, grinding erosion, a slow-motion relentless sorrow.
My environmental lawyer friend Bob Gough says that he suffers from pre-traumatic stress disorder. Pre-traumatic stress disorder is short hand for the fact that he is fully aware of the future trauma, the moral injury that we individually and collectively suffer, the effects on the Earth of that injury and our inability to act in time. Essentially pre-traumatic stress disorder, the environmentalist’s malady, is a result of our inability to prevent harm.
James Hillman once wrote a book with Michael Ventura called “We’ve Had a Hundred Years of Psychotherapy and the World’s getting Worse.” In it Hillman said that for years people would go into a therapist and say “the traffic in L.A. is making me crazy” and the therapist would say “let’s deal with your mother issues.” Hillman said “deal with the traffic in L.A.”
So much of environmental or health messaging speaks to us as individuals. “Stop smoking, get more exercise, change your light bulbs.” We take on the individual responsibility for the moral failure. Sure, we need to do all that we can as individuals–that is part of preventing any further damage to the planet or our own souls. But that isn’t enough. We all know it. We have to overcome our assumption that the problem is our mother issues (or the equivalent) and deal with the traffic in L.A., climate change, the loss of the pollinators. These are not things we can address individually. We have to do them together.
Healing the moral injury we suffer individually and collectively from our participation in destruction of the planet will require strong intervention in all spheres of life. Actions like creating a cabinet level office of the guardian of future generations or 350.org’s campaign for colleges to divest of oil stocks, or revamping public transportation are beginning steps. Can we think of a hundred more bold moves to make reparations and give future generations a sporting chance? Our moral health, our sanity—and our survival—depend on it.
By Carolyn Raffensperger
In almost every field of influence in the United States men hold more positions of power and often by significant percentage points. Women’s voices are silenced in most political spheres. The question is what difference does that make? On occasion I have been told that I should take a back seat to my male counterparts because they are more credible spokespeople on the environment than I am as a woman. If so, then my stepping back is a service to the Earth and future generations. On the other hand, what if I and other women have something to be said that is different than men and what if that voice is necessary in some way for the protection of the Earth?
The emerging field of acoustic ecology has shown that a healthy ecology has a full and complete symphony of sound. A damaged ecosystem has holes and gaps in the vast sonogram. From coral reefs to prairies to forests, healthy ecosystems are full of sound that varies by time of day and season.
Imagine that the health of the political ecology is also measured by sound. If that is true, we know what is missing: women’s voices. By any indicator women’s voices are missing in media, higher education, science and the environmental movement.
Most of the time the absence of women’s voices is described in political terms like patriarchy, feminism, inequality. But it is also an ecological matter. A woman’s voice in those higher octaves has a different place and function in the cultural landscape. The lullabies, warnings, songs, joys, are different than those of our beloved male friends, family and allies.
At the Women’s Congress for Future Generations (cosponsored by SEHN) we believe we can help restore the ecology of the Earth and of the culture by restoring women’s voices. We believe men and women are both necessary, and equally so. Equality is a central theme in social justice work of all flavors. But equality doesn’t mean “the same”. The planning team of the Women’s Congress is running an experiment. What if women have a unique responsibility as the first environment, the sanctuary, for future generations? Can we speak out of that authority? We believe that women claiming that authority and acting out of it on behalf of future generations is to assert a power on behalf of future generations of women and men, of nature, of future generations. It is to fill that ecological niche that is uniquely and beautifully women’s.
We have invited men to participate in this experiment by being sacred witnesses. We seek a fierce and elegant equality that allows all voices at the table.
The implications of this are not just about the things that women say, but the things that women do. Can the preparation, serving and eating of food be integral to the very fabric of the Congress? Traditionally cooking has been separate from the rest of valued work in large part because it is women’s work. Can every ripe tomato and every ear of corn be offered with the same respect as the next legal idea? We know at a visceral level that food is sacred. It is harder to see the law as sacred. What would the law look like if it was born out of that authority of women speaking as the first environment for future generations? Similarly, if women put their bodies on the line in direct action, would that look different than the kind of direct action that has been used in the civil rights movement and the climate justice movement?
We don’t know the answers to these questions yet. But we believe that a civil rights movement for future generations will be galvanized by finding answers. Our male allies in the social justice movement have voices that are so deep and so beautiful. We are thrilled by the possibility of having women’s voices soar with the descant that only they can sing. We will work together in concert for a whole and health world.
My friend Ilene Evans, historian, singer, storyteller, told me that at the time of the Civil War women said that the soul of the nation was at stake. Women were not able to vote. They couldn’t own property. They were disenfranchised. But women presided over the dinner table. They saw that every child, black or white, needed enough to eat. It was the conversations over those meals that changed the politics of the day.
The soul of the nation and the fate of the Earth is again at stake.