In the eastern third of North Carolina, racial discrimination and poverty have long impeded the development of healthy communities. Since the Civil War, counties in this region have been economically underdeveloped, racially segregated, and medically underserved. As the largely poor, African-American communities lack the political clout to organize effective opposition, irresponsible industries, including massive hog farms, chicken processing plants, and heavy industry, have established themselves here. These entities have created enormous amounts of pollution, most notably in the form of open hog waste lagoons and the disproportionately high number of Superfund sites (more than 170) in the region. When Hurricane Floyd struck eastern North Carolina in September of 1999, the storm's already extensive damage was made worse as the powerful floodwaters overflowed the numerous waste storage sites and became a frightening and dangerous effluent. The flood hit the vulnerable and dispossessed the hardest; some fifty-one people lost their lives and thousands more lost their property. Particularly affected was the historic African-American town of Princeville, a settlement built by freed slaves located on the low, flood-prone side of the Tar River.
In general, doctors and public health advocates seek to understand the spread of diseases in terms of basic pathophysiology and individual risk factors. Jonathan Mann has argued that they have, however, ignored the key role that social phenomena play in fostering ill health. As exemplified in Princeville and many other places like it, the lack of attention to basic human rights means that factors like low levels of education, inadequate income, discrimination, and lack of safe, affordable housing have rendered one segment of the U.S. population (i.e., poor people of color) significantly sicker than the rest. He suggests that we use a human rights framework to address these social inequalities, since they stand as significant barriers to improving public health.
The government's response to the disaster in Princeville underscores how far we still have to go to meet Mann's suggestion. By December, after having housed disaster victims for weeks in high school gyms, the Federal Emergency Management Agency (FEMA) moved them to temporary refugee trailer camps nicknamed "FEMAvilles." The largest of these, located near Rocky Mount, had nowhere for the children to play safely and nowhere for the residents to hold religious services or even meet as a community until many months after it had come into existence. One FEMAville resident, Vernice Lyons, lamented the overcrowded conditions: "We were crammed into such small little spaces and the state did not include us at all in how the place was run. They just kept reminding us that we had only eight months before they would kick us all out." Lyons, who was taking care of her young autistic granddaughter Tomica, was repeatedly refused any additional accommodations for her granddaughter's needs. For many organizations that had long struggled for decent working and living conditions for the poor of eastern North Carolina, it was troubling to see this population, so recently traumatized, now confined to such a setting.
As the camp was being set up I met with local activist groups and helped form an ad hoc alliance called the Relief and Aid Project (RAP)--the purpose of which was to ensure that poor and working class people would not be forgotten or ignored. Despite the fact that our initial efforts to gain entry into the Rocky Mount FEMAville were confounded by the state government, we established our first FEMAville Health Clinic six months after the hurricane. Our patients' medical problems ranged from severe hypertension to post-traumatic stress disorder. At the end of the clinic days, we met with many of our patients, along with community activists, to talk about our progress and their concerns.
One issue that quickly arose was the safety of the very soil upon which the camp was built. Many residents from nearby Princeville remembered that prior to its current usage, the site had been used as a dump for industrial ash. The residents themselves, while nervously watching their children play in the sandy soil, had called for state officials to investigate this charge, but their concerns went unanswered. One of my classmates, Aaron Pulver, then a student at the University of North Carolina School of Public Health, spearheaded a campaign to spread information about the potential health threat, structuring his efforts according to the concerns voiced by residents.
Weeks into the inquiry, and after further pressure from camp residents and from RAP, public officials finally agreed to carry out further testing of the soil and water. In the months that followed, it became apparent that in past years dumping had indeed taken place at that site, and that state and federal officials had not thoroughly investigated the site's safety before placing the camp there. Fortunately for the residents, the investigation showed that there was no major health threat from the industrial ash that was there. It was a significant moment for the camp residents--for months bullied by state officials--to see the same authorities finally answer to their demands for assurances of safe living conditions.
At the Rocky Mount FEMAville, the collaboration of medical and public health students with residents and local activists continues to be an extremely effective tool for change. Our recent efforts have focused on the broader problem of the lack of affordable housing in eastern North Carolina, a problem that raises numerous health concerns. One man who came to the clinic this past January asked if we could test the lead levels of his four children. He explained, "There really are no good houses out there that we can afford. We moved into an old house in Tarboro for cheap and after we had been living there for a while, the neighbors told us it was full of lead. I'm worried about my four children." Just recently, local community groups, former FEMAville residents, and student health professionals brought their latest case to the steps of the state capitol in Raleigh.
The arguments employed by the campaign have appealed to both human rights and health principles. When many existing low-rent homes are shown to contain lead, as is the case in eastern North Carolina, a health argument can easily be made and is the one to which we feel the state is most likely to respond. At the same time, to mobilize physicians and public health advocates in the struggle, it is useful to invoke human rights arguments suggesting that for the right to health to exist, governments must protect the universal right to a safe living environment.
Mann's proposal that social factors be taken more seriously in diagnosing the ills of communities seems, therefore, to be gaining some ground. In eastern North Carolina, local communities and governments recognize the language of civil rights and also that groups must be treated equally with respect to education, health care, and housing. The human rights framework motivates health care advocates--some of whom were not a part of the civil rights era--to feel like participants in a wider, global effort to assure more equitable health outcomes. It may be a long time before local officials in eastern North Carolina answer to these arguments, but until then we can frame these demands in the language of civil rights, health, and safety--something these officials already recognize.