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Journal of Political Ecology: 
Case Studies in History and Society



VOLUME 7 (2000)

Reclaiming the Environmental Debate. The Policies of Health in a Toxic Culture Edited by Richard Hofrichter, Cambridge, MA: The MIT Press (2000), vi, 356 pp

Reviewed by Dennis A. Frate, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson MS

Before reading this book, I was reminded how Rachel Carson's Silent Spring ushered in our national interest in environmental health in the early 1960's. Sustained consumer and scientific interest, however, were not overnight accomplishments; we are still trying to draw both scientific and popular attention to environmental health questions. While perhaps not with the same mobilizing force, Hofrichter's Reclaiming the Environmental Debate is highly recommended to those professionals, students, and consumers who work in or are interested in environmental health issues. This recommendation is not based on my total agreement with all of the authors contributing to this socio-political text, but rather my personal feeling that in order to develop an informed opinion all perspectives should be considered. If any phenomenon lends itself to multiple disciplines and various perspectives it is environmental health.

As stated in the "Introduction," the central theme of this text is that "effective challenges to toxic culture, as well as the potential for creating a compelling vision of a healthy society, grounded in everyday work and life, require reframing objectives so as to produce broad, comprehensive social change." In essence, this text wants to discuss the socio-political underpinnings of environmental actions and policy from a corporate, regulatory, and community perspective, and through this examination reformulate our societal actions and reactions to environmental issues. The book is divided into three parts or sections, although it is difficult to easily discern a clear distinction among the individual sections. Part I is titled, "Challenging Current Perspectives." The seven chapters in this section deal with topics such as the biomedical focus on genetic connections in cancer epidemiological research, workers' health and corporate conflict, and examples of community development and community action on environmental conflicts. This section also addresses concern about risk assessments. In Chapter 7, "When Harm Is Not Necessary: Risk Assessment as Diversion," author Mary O'Brien states, "Environmental risk assessments are overwhelmingly used to construct a scientific-looking claim that an unnecessary, hazardous activity or substance is `safe' or poses `insignificant harm,' or, when dead bodies clearly belie this, is `acceptable'." Such a subjective statement does a disservice to those environmental toxicologists and epidemiologists who are diligently working to refine this assessment tool. I will discuss the limitations of this methodology later.

Part II contains five chapters that deal with how corporate culture affects our group perceptions on the relationships between environmental hazards and human health. A number of these chapters state or at a minimum imply a concerted corporate effort at manipulating images of the environmental movement for their own advantage, or the marketing of a concept of corporate environmentalism that in reality is not consumer friendly. For example, advertising/marketing campaigns using images of Mother Nature to sell refrigerators is taken to task as an inappropriate manipulation of the consumer. It is common practice for any product marketing campaign to associate itself with a "soft", "likeable" image such as pets or children. This example appears to be no different. In Chapter 13, "Rethinking Technoscience in Risk Society: Toxicity as Textuality," author Timothy Luke examines the science of toxicology and risk assessment and agrees to the limitations of the science. However, even the recognition of the inherent limitations does not stop the author from finding fault with those who operate within those limitations. We are currently very limited in developing causal models for environmental contaminant exposure and human health outcomes. Researchers investigating environmental health concerns are left to infer causality from prospective animal studies or, even worse, to rely on cross-sectional or case-control studies conducted on humans. Such retrospective research designs can only be used to develop models of association and should never be used to infer causality. What is required is a prospective cohort study, such as the Framingham cardiovascular disease project. This, of course, would require a major commitment of time and funds; Framingham was a 50-year funded project. Also, ethical (IRB) considerations would be paramount here; can we ethically monitor a population exposed to a particular environmental contaminant over 30 years? The limitations, however, do not exclude launching a societal public health effort if statistical associations to an exposure are found. There is a difference between the development and acceptance of a scientifically based causal model and public health attention over suspected causation. The disease models we now commonly employ, e.g. microbial, have little utility here as a wide range of target organs and biological processes have been implicated or suspected in toxic substance exposure; their expression appears to be not uniform. This list includes the human reproductive system, the immune system, infant growth and development, fetal growth, neurologic disorders, aptitude retardation in children, and cancer. Using the current state of the science, including the use of retrospective study designs, the challenge then, for instance, is how do we epidemiologically tease out the possible relationship between a low birth weight infant and the mother's exposure to a toxic substance when numerous other dependent variables may have played a significant role, separately or in combination, over the entire life span of that woman. For example, how can we measure the effects of passive tobacco smoke that occurred over time? Unfortunately, at this time the analytical techniques available are inadequate.

Part III, "Notes From the Field: Community Struggles," includes four chapters examining organized resistance at the community level to on-going or projected environmental contamination and describing creative collaborations at the grassroots level. Examples concerning environmental justice are included here. This is a very interesting section in that it deals with the reality of how disadvantaged populations can organize to create change. In essence, these chapters are taking, what I termed earlier, a public health approach to the problem. The communities in question have not waited until a definitive causal model is developed by environmental health scientists. Rather, sufficient associations exist with toxic exposure that encourages a public health action or community response. As with some of the earlier chapters, these in Part III occasionally lapse into a subjective dialogue. For example, in Chapter 15, "Bearing Witness or Taking Action?: Toxic Tourism and Environmental Justice," when discussing a community program in the San Francisco area author Giovanna Di Chiro notes "… a community already heavily affected by toxics that has unusually high levels of breast cancer in women under the age of fifty." From an epidemiological perspective, I would have preferred to see a brief table of the expected female breast cancer rates compared to the actual rates over a 10-year period. Without those numbers, or a meaningful citation, such a statement does not reflect responsible science. It is not even clear whether the author is referring to morbidity rates or to mortality rates.

Despite some limitations, this volume is recommended to professionals, students, and consumers involved in or interested in environmental health concerns. It's shortcomings center on the occasional lack of both objectivity and recognition of the limitations of the science. Environmental health can be an emotional issue, but emotion alone will not convert the scientific community or regulatory agencies. All readers should be aware that environmental health scientists are currently working on refining the science. Until more sensitive and accurate measures are developed, we should continue to be aware of and on the alert for regulatory infractions by corporations and hold them accountable; the public's health at a minimum requires that! Also, as a group we should demand that funding agencies that support environmental health research, such as the National Institute of Environmental Health Sciences (NIH) and the U.S. Environmental Protection Agency, increase their research agenda to advance the state of the science so true causal models can be developed, tested, and accepted.