Dear Portland: how about we promote best public health practices for drinking water

Carole Smith, Superintendent

Carole Smith, Superintendent of Portland Public Schools, has been criticized severely by many parents for failures of leadership surrounding the lack of notification about unsafe lead levels at two public schools, for weeks.

Ed. Note, July 16, 2016: See update below regarding the city deciding not to adjust the water’s pH to address corrosion/lead and water issues.

On June 5, 2016, I wrote a letter to Portland Mayor Charlie Hales and Commissioner Nick Fish, head of the Portland Water Bureau, asking for some leadership. Right now, it appears Portland’s management of its critically important drinking water system is now being called into question, and rightly so. If you have not heard, the city’s schools are in a tailspin because kids and families were not properly advised of unsafe levels of lead in drinking water at two schools, for weeks. Soon after, all drinking water was shut off at all schools until fixes are made, and parents have called for the immediate resignation of Portland Public Schools Superintendent Carole Smith. This has since grown into a larger crisis impacting school systems dependent on the city’s water.

The actions at the schools and in our water system impact the entire community. While I am not alarmist by lead level readings in parts per billion, and I deeply worried that leadership is lacking and ideas that undermine public health are now being embraced in the decision-making culture of our schools and our local government. This matters, because nothing is more critical to public health than clean drinking water. And when trust is eroded, the public will not support public health with public money, which is how we ensure public health for all.

COPY OF LETTER SENT:

Dear Mayor Hales and Commissioner Fish: I work on many issues for my job, including educating the public about water. I love informing people how amazing our country’s drinking water systems are in promoting public health. So I feel passionately about the topic and appreciate all the work all of our water purveyors do daily, without much thanks they deserve, all the time. And my thanks are extended to the staff at the Portland Water Bureau. They keep us healthy, 365 days a year.

For the record, I have a background in public health and spent two years promoting community water fluoridation in the Tacoma/Pierce County area. I am proud of the many proven public health measures with our water systems adopted nationally since the early 1900s have saved lives, improved human health, and lead to better overall public health. This includes fluoridation and chlorination.

The Crude death rate for infectious diseases - United States, 1900-1996. Chlorination proved one of the greatest life savers to promote public health.

The Crude death rate for infectious diseases – United States, 1900-1996. Chlorination proved one of the greatest life savers to promote public health.

I am writing both of you now because I am becoming alarmed as a resident of the city, who is waiting for the outcome of a lead/water test at his home, of a “philosophy” expressed by some of our most important leaders regarding how we should provide clean, healthy drinking water–the greatest public health intervention we have for our community.

It appears as a city may have been taken badly off the rails by perhaps improper cost-based decisions and philosophically-based decisions over a long period of time.

OPB reported on June 3 that the U.S. EPA has become alarmed by the city’s decisions: “The manager, Marie Jennings, was concerned that the Portland Water Bureau isn’t doing enough to minimize the amount of lead at taps in Portland. She wrote that the EPA’s regional administrator, Dennis McLerran, had ‘heightened concerns about drinking water quality, including the [Portland Water Bureau’s] implementation under the Lead and Copper Rule.'”

We also, as a city, do not appear to be promoting best practices because of the vocal “natural-health,” vaccination-denying minority who don’t understand public health and whose sometimes radical views now threaten our kids, and everyone else in many areas. The consequences were very harmful with the public vote on water fluoridation. Continuing stories on how the city’s and its schools’ lead and water protocols are handled have me growing more concerned the more I learn about the many actions taken by the city dating back to the 1990s.

So, for the record, I WANT treated water. I think we can all agree there is NO SUCH THING as pure water. All water has minerals and chemicals that are adjusted to optimize public heath. Give me my chlorine/chloramines, please. I love that taste. It means I’m not going to get a water-borne illness that might kill me.

Mayor Hales, I would hope you can use your bully pulpit in the remaining few months to promote a dialogue on the benefits of healthy drinking water, including chlorination systems, one of the greatest life-savers ever adopted in this country. And please communicate using facts not fairy dust that Portland has “pure” water or that WE Portlanders “expect purity” in our drinking water. This is a very dangerous message with real consequences as we are now seeing.

We as Portlanders don’t want minimally treated water. We want optimally treated water. I want my chemicals in the water to ensure we stay healthy based on proven science. Having this message below used by our public health champions (and they are our champions) is not a best practice to promote public health. Let’s stop the nonsense about keeping our water pure. Did we learn anything from Flint?

I'll have my water with the appropriate treatment to optimize health--and yes that includes chemicals, thank you.

I’ll have my water with the appropriate treatment to optimize health–and yes that includes chemicals, thank you.

FROM THE OPB STORY:  http://www.opb.org/news/article/portlands-water-hasnt-gotten-the-lead-out/

The public’s strong preference for keeping Portland’s water source pure and natural – in open air reservoirs and free of chemical treatment  – hindered efforts that would have reduced the amount of lead in drinking water.

Portland remains the largest city in the country that does not add fluoride to its water. The city finally decided to phase out its open-air reservoirs after more than a decade of debate.

“Portland residents have said pretty clearly that they want a minimal amount of treatment in their water, so that’s something that needs to be taken into account” [Scott] Bradway said.

 Ed. Note: Scott Bradway is a lead hazard reduction specialist at the Portland Water Bureau.

UPDATE JULY 16, 2016:

The Oregonian published a story that addresses the concerns I raised with Mayor Hale’s and Commissioner Fish. Neither office replied to two emails I sent to their office. In the story by Oregonian reporter Brad Schmidt, it appears Portland is continuing to take a position not to address issue of the corrosive qualities of the water. This is likely in part because of a misguided view seen in the statement from Bradway that residents want minimal treatment of water. That is a false statement–we want our water treated optimally to maximize public health for everyone.

This view undermines the ability of government to promote public health and dangerously cedes public health decision making to the anti-fluoride and anti-vaccer voices that have made Portland and Oregon public health poster children for how not to promote health for all. If these views are guiding our policy-makers, this remains very disturbing and should be a great concern to anyone who practices public health in Oregon and Portland. Did anyone in Portland learn anything from the example of Flint, Michigan?

The story noted: “But Fish cautioned Portland may not simply add more chemicals to the water to reduce corrosion. Officials could explore options for ‘more robust outreach and education,’ more water testing or potentially some sort of program that helps homeowners replace lead-tainted plumbing.

“‘We think we can do better’ — Portland Commissioner Nick Fish on lead levels in drinking water.

“‘Until we’ve completed our assessment, we don’t know what’s the best option,’ Fish said.

“In August, city officials will meet with state and federal regulators to review preliminary results from a study looking at pipe corrosion within Portland’s water system. The meeting has yet to be scheduled.

Although city officials haven’t committed to making any changes to their treatment process, they have agreed to present a ‘detailed proposed schedule for selection, design, construction, and implementation’ of treatment techniques to lower lead levels, state records show.”

Policy, systems, and environmental change: the current, faddish, cow-patty flavor of public health

One thing I have never shaken since my days as a rookie reporter is my penchant for calling out the obvious. This is one of the sacred duties of the press: to speak truth to power. This also means calling a spade a spade, and bullshit for what it is, and what it smells like.

Anyone who has ever worked in the business of reporting news and telling facts knows this is one of the press’s sacred trusts—and myths—and the clearer we are in doing that, the better our society is from having that unbiased information.

I captured these various images on Google when I typed in a few keywords, and clearly this concept has a lot of widespread acceptance by people who know a cow patty when they smell one.

I captured these various images on Google when I typed in a few keywords, and clearly this concept has a lot of widespread acceptance by people who know a cow patty when they smell one.

Today, I stumbled on Marcy Wheeler’s blog, the Empty Wheel, which tackles many hot-button policy issues. Last year she blogged about climate change in a piece called “The Cost of Bullshit: Climate Change, National Security, and Inaction.”  She pointed out that the cost for maintaining the status quo was too high, even when major government agencies from the Department of Defense and the Department of State concluded that the issue was a critical concern to U.S. national interests. Yet, no actions were being taken by the government, and all of the reports on the emerging crisis were “mere bullshit—more wasted government employees’ time and taxpayer money.”

Sure easy for a blogger not on the payroll to diss hard-working public workers and policy-makers, right? Or, is Ms. Wheeler simply calling out the obvious, like reporters have always done, or thought they were doing.

Will a public health fad meaningfully address the main killers of Americans?

The cost of bullshit has been on my mind late, particularly regarding public health jargon that inflates busy-looking arm-waving, but does not change reality.

For me, one of the most frustrating aspects of working in the public health is the field’s faddish way it labels its collective actions to address chronic disease issues, such as obesity, using fancy sounding concepts like “policy, systems, and environmental change.” Mon dieu, what big words, what big ideas.

This is an expression coming from the top, from the venerable U.S. Centers and Disease Control (CDC), to explain national efforts to tackle the monster that is chronic disease—the leading causes of death in our ever-fattening and ever growing income-unequal country.

These diseases kill seven in 10 Americans, and of the CDC’s meager budget of under $7 billion for our national public health effort is a mere drop in the bucket compared to other priorities of the $1.2 trillion national budget that is so-called “non-discretionary spending.”

The Congressional Budget Office released this info graphic on government spending and revenues for 2013. Go here for original: http://www.cbo.gov/publication/45278.

The Congressional Budget Office released this infographic on government spending and revenues for 2013. Go here for original: http://www.cbo.gov/publication/45278.

The CDC still estimates 18% of U.S. GDP spending is on healthcare, and a third of it at the place where the most outrageously overpriced and at the same time least effective primary care interventions can take place—hospitals.

So what do public health officials do, when faced with a handful of breadcrumbs thrown to them from Congress? They invent concepts that make it appear that public health is doing something, when there is little or no clear evidence population benefits are accruing based on investments at this level in the large ocean. Yes, I am talking about the catchy and jargon-laden ideas like “policy, systems, and environmental change.”

This is a hodge-podge of activities that encompass everything from starting farmers markets to promoting smoke-free buildings. Here are a couple of definitions I randomly found from some online sources:

  • State of Mississippi: “Our environment and the policies and systems in it shape the pattern of our everyday lives and have a profound influence on our health. The design and walkability of communities, the availability of low-cost fruits and vegetables, and the smoking policies in our workplaces have a direct impact on our physical activity, diet and health.”
  • State of Maryland: “Policy, systems, and environmental change (PSE change) refers to public health interventions that modify environments to provide healthy options and make healthy choices easy for everyone.”
  • Fairfax County Virginia: “Policy, systems and environmental change is a way of modifying the environment to make healthy choices practical and available to all community members. By changing laws and shaping physical landscapes, a big impact can be made with little time and resources. By changing policies, systems and/or environments, communities can help tackle health issues like obesity, diabetes, cancer and other chronic diseases.”

Budgets for this kind of intervention exist in most public health jurisdictions, and public health leaders are doing to the talk, because they have so few funds to do the walk. But public health experts end up playing in a small sandbox when these investments are measured against other spending, and then we spend a lot of time trying to convince ourselves through published papers, webinars, conferences, and the like that this is working. The illusion is powerful, like the illusory power of the Iron Throne in the Game of Thrones, except the shadow from a fad still does not make meaningful change when the numbers are crunched and the costs are calculated regarding chronic disease.

From the Game of Thrones, a lecture on power and illusion, for Westeros and beyond.

From the Game of Thrones, a lecture on power and illusion, for Westeros and beyond.

Public health departments who get funding through competitive grants from the CDC spearhead these efforts and then spend extensive amounts of time documenting their work trying to prove the bread crumbs made a difference to the overall health crisis facing Americans.

About $200 million was doled out from 2011 and 2012 through an effort called Communities Putting Prevention to Work (the amount initially announced in 2010 was about $380 million). In one case, Public Health-Seattle & King County published findings that show its CPPW-grant-funded efforts in schools cut youth obesity in specific schools by 17 points. Great job, except the funding was not permanent and it was not renewed when the grant ran out. The program is now in the past tense.

In 2014, public health professionals learned another funding source, the Community Transformation Grants, which also promote the policy, systems, and environmental work, is being cut too. Some can argue the money is being allocated to other programs that tackle chronic disease, focusing on heart disease and diabetes.

More musical chairs without really changing the big picture again?

I do not mean to belittle the work of public health people doing this work. They are my colleagues. I respect them. And the work being done, like promoting activities to reduce tobacco use and get more people eating healthy food, should be continued.

But as a field, I am convinced this type of work is self-delusional because it hides the nasty realities of how much larger issues shape the public’s health, such as how transportation budgets are allocated, how cheap petro-based energy is spurring obesity in measurable ways, how legislation is crafted by special interests at the state and federal level, and how the principle of health care is considered a privilege not a right in the United States. (In Denmark, by contrast, the public funds about 85% of all health care through taxes, and the system is rooted in both law and a social contract that is premised on system where all citizens are provided free and equal access to quality health care.)

Emilia Clark, mother of dragons in the smash HBO TV series Game of Thrones, is a good visual metaphor of what public health is not in the bruising world of budget appropriations at the state and federal levels of government.

Emilia Clark, mother of dragons in the smash HBO TV series Game of Thrones, is a good visual metaphor of what public health is not in the bruising world of budget appropriations at the state and federal levels of government.

The nasty realities we do not want to think about, using a contemporary TV metaphor, would be what happens when the violent kings of Westeros cut deals and cut heads, to maintain order in that mythical, lovable place with White Walkers, a giant ice wall, and fire-breathing critters. Mother of Dragons, public health is not, that is for sure!

I imagine a new fad will emerge in public health in the next three years, like it does in management. We might change the concept, but we likely may even have a smaller piece of the government pies.

No, public health jurisdictions cannot stop working until we see changes on these fronts. But the more we in public health delude ourselves that we are making a difference with scraps from the table, the more easily we are duped into accepting that the larger model is as it should be, and how it shall always be.

We will continue kvetching about farmers markets and soda machines, but not moving in a rigorous way upstream, where budget deals are made with transportation dollars, for starters. And I think we have to start being honest with ourselves about what we are accomplishing in the sandbox and whether this is the best use of our meager and diminishing resources.

Cheap energy poses a threat to Americans’ health

One of the most talked-about initiatives taking place in public health, with funding supports from the Centers for Disease Prevention and Control (CDC), is policy, system, and environmental change to address the rise of chronic disease in the United States, the country’s leading cause of death. According to the CDC, chronic diseases are responsible for seven out of 10 deaths of all Americans annually, and one half of all Americans have at least one chronic illness. Worse, three-quarter of the $2.5 trillion (yes trillion) dollars spent annually on health care in the United States goes to battling chronic diseases. The CDC’s grant funding is being disbursed to health departments to undertake a range of interventions. But none of these interventions is going after what some say is one of major sources for the rise of obesity and chronic disease—the cheap price of energy in the United States.

According to Ian Roberts of the London School of Hygiene and Tropical Medicine, the overall obesity rate is highest in the United States among all other nations because the price of gasoline is very low. “So where gasoline is really cheap, we over-consume it, it’s bad for the environment and actually because we should be using food energy for human movement – if we use gasoline for human movement, then we store the food energy and you know where we store it.” And there are other costs associated with being a fat nation, says Roberts. “So there’s obviously an increased demand on food supplies, but also there is an increased demand on everything. You know, bigger people need more energy to move them. Airplanes take more energy to get off the ground. It takes more of the shares that, you know, of the Earth’s resources to actually support all that extra weight.”

In the United States, the U.S. Energy Information Agency estimates we use 317 million BTUs per person a year. In this country, nearly half of all of our energy comes from petroleum and natural gas, and the country ranks seventh globally in terms of per capita energy use, trailing Canada and some smaller nations like Luxembourg and Trinidad and Tobago. However, the United States is  No. 2 (19% of global demand) in terms of global consumption of energy after China (20.3% of global demand), which just took the No. 1 slot.

Feeder pipelines gather crude oil produced at Prudhoe Bay, which is eventually shipped to the lower 48 for consumption on the West Coast.

A significant negative outcome can be seen in the widening waistlines of Americans. Charles Courtemanche of the Department of Economics at the University of North Carolina at Greensboro published a study in 2009  (A Silver Lining? The Connection Between Gasoline Prices and Obesity) that found increases in gas prices were associated with an uptick in walking or bicycling and public transportation use (and more people walking to bus and subway stops) and a drop in the how often people eat at restaurants, all impacting weight. Courtemanche estimates that:

– A $1 rise in the price of gasoline would reduce overweight and obesity by 7% and 10% in the U.S. The reduction in obesity would save approximately 11,000 lives and $11 billion per year, savings that would offset 10% of the increased expenditures on gasoline.

– An 8% of the recent rise in obesity from 1979 to 2004 can be attributed to the decline in real gasoline prices during the period.

According to Dr. Brian Schwartz, professor at the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health Sciences and co-director of the School’s Program on Global Sustainability and Health, cheap energy also is responsible for creating our built environment, which is exacerbating our poor health trends. Schwartz argues that since World War II, the United States and other developed countries “have invested in large tracts of low density, non-compact, single use developments, which are highly reliant on the automobile and often lack public transit options.  This type of housing and transportation system is totally reliant on cheap and plentiful oil.”

The built environment of U.S. suburbs has been shaped by the relatively cheap price of petroleum paid by U.S. consumers at the pump.

Schwartz argues the average foodstuff in the United States requires about 10 units of fossil fuel-based energy input for each unit of food energy derived from the food, and that ratio jumps to 100 to 1 for many meats. Less energy would lead to declines in food calories too, as many kinds of food would become too expensive to produce and too expensive for consumers. What’s more, Schwartz suggest that this unsustainable suburban lifestyle would change dramatically after peak oil, that future and historic moment when global production of both oil and natural gas reaches its historic peak and begins to decline, setting off chain reactions impacting every facet of our life to what we eat, how we work, how goods and people move about, and how nations respond on a massive scale. (Go here for a summary of peak oil and its health impacts, as explained by Schwartz.)

Schwartz also notes that our entire health care delivery system, on top of our suburban-sprawl development pattern, food production systems, and supply chains, also is tied to unsustainably cheap energy in the form of cheap fossil fuel. “Large energy-inefficient health care facilities are staffed by health care workers living in distant suburbs who require large quantities of paper, plastic, and electronics to do their work. Systems for provision of care will need to be completely redesigned to adapt to the new reality of more expensive energy.”

Portland, Ore., that oh-so progressive Northwest city that has become a beacon of contemporary planning that tries to vaguely resemble what they do in Netherlands or Denmark, for instance, already has assembled a Peak Oil Task Force, back in 2006. The group prepared a report and drafted a resolution, passed by the City Council in 2007. That resolution sets out an ambitious goal to “reduce oil and natural gas use in Portland by 50 percent in 25 years and take related actions to implement recommendations of the Peak Oil Task Force.” It may be no surprise Portland was recently ranked the No. 1 biking community in the United States.

What continues to baffle me is how unengaged or willfully silent the United States’ professional public health system is to the connection between cheap energy and health, notably obesity. I just did a keyword search today (Sept. 3, 2012) on the word “obesity” for the upcoming American Public Health Association (APHA) Annual Meeting and Exposition to be held in San Francisco in October 2012. There were 797 hits for the word–many for papers being presented on the topic. When I typed in the word “oil” I yielded 33 hits, some on the Deep Horizon oil spill and its impacts and others on shale gas development, such as a paper being presented by Dr. Roxana Witter of the University of Colorado called “Comprehending health implications of natural gas development through public health research.” But I saw no papers on any linkage between the so-called “obesygenic environment” and energy prices tagged under the word “oil” in the searchable database of presentations and papers. I did a search for the word “energy” and got 82 hits, but most related to topics like high-energy drinks, not on oil, gas, or energy policy issues impacting human health.

Seattle like other cities is entirely dependent on relatively cheap petroleum, and as a consequence suffers from some of the worst traffic congestion of any metro area in the country, as well as a sprawl development in the city and throughout surrounding King County.

I dream of the day when public health professionals will organize their advocacy less around what kids eat at school and talk more about what our state and national lawmakers are doing to create meaningful tax policy that prices energy–making it more expensive while using revenues to promote renewable energy sources–to create larger downstream impacts. To completely cede this issue to supporters of cheap energy and the status quo and to deny that there are serious public health implications by doing so is to turn one’s back on best available evidence and the duties those in the field have to promote healthy outcomes for the U.S. population.  I did try to raise this issue in one of my classes at the University of Washington School of Public Health, and was met with unusual silence. I hope one day perhaps UW faculty in the economics department, school of business, and schools of public health and public affairs get together one day to pursue research examing negative health impacts of national energy policy.

Looking back at a North Carolina landfill, and who got dumped on

I have finally compiled my graduate thesis on environmental racism into a more easy to read PDF format. This document dates from July 1993, when I completed my MA in journalism at the University of North Carolina at Chapel Hill School of Journalism and Mass Communication. For my research project, I examined how a then-small, historically African American and poor community, Holly Springs, was chosen to become the site of Wake County’s new mega municipal landfill. Holly Springs, N.C., already had multiple open and closed landfills, and the rest of the county had not equitably assumed the same burden for waste generated in the most populous county in North Carolina, which is also home to the state capital, Raleigh.

The Raleigh News & Observer published this photo of the South Wake County landfill, in Holly Springs, in March 2012, found here: http://www.newsobserver.com/2012/03/15/1931937/wake-county-plans-future-development.html.

My efforts to publish an investigative series for a regional alternative weekly serving Chapel Hill and Durham, N.C., were nixed by a number of forces, including pressure from senior Wake County officials who communicated with the weekly I had approached and successfully led that paper to disassociate itself from me and this project before it was published. (That is my version of events.) However, I did publish the thesis online in 1998. The articles were found by residents of Holly Springs in 1998, who contacted me, and my research became part of a major legal dispute that went to the North Carolina Supreme Court and federal courts, where litigants eventually lost and then finally settled with the county for remediation work to lessen the impact. Many of the legal issues raised in the case were cited first in my thesis. After years of legal wrangling, the Wake County Commissioners finally voted to approve a major municipal landfill in 2006.

I am proud of this work. It is factually sound, rigorously investigated, fair to all parties, and written in the spirit of good enterprise journalism on behalf of persons who had the least power and resources to advocate for themselves against much more powerful and organized interests (in this case Wake County’s government).

Here is the abstract to my original 1993 thesis titled: Environmental Racism in Our Own Backyard: Solid Waste Disposal in Holly Springs, N.C.

For more than two decades, the historically black and poor township of Holly Springs in Wake County, N.C., has been targeted for landfills.  The pattern continues with Wake County’s proposed 471-acre landfill, scheduled to open in Holly Springs by 1998.  Each facility was sited adjacent to existing black communities, whose residents never participated in the siting process.  The first story of this thesis’ three-article series examines the inequitable pattern for distributing these dumps countywide and how their placement fits a national pattern.  The second article and Appendix A discuss the new “environmental justice” movement, whose grassroots and minority activists are protesting unwanted pollution and alleged environmental discrimination.  The movement’s members have coined the term “environmental racism” to describe the unfair apportionment of environmentally noxious facilities.  Article three discusses whether municipal solid waste landfills can cause ground water contamination.  Federally mandated landfill technology to be installed at the planned landfill may not provide pollution protection for ground water, used by Holly Springs for its municipal water source.