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Health implications of environmental policy

From EverybodyWiki Bios & Wiki


Health implications of environmental policy refer to the diseases and even death associated with environmental policies. The environment affects our health in a variety of aspects, either through direct ways of exposing people to harmful chemicals or indirect ways of disrupting the ecosystems. Although it is difficult to determine the exact relationship between environmental risks and the development of death and disease, according to the World Health Organization (WHO), approximately thirteen million deaths per year are related to preventable environmental causes.[1] Environmental policies play a significant role in environmental development and public health in the United States in the past century. The health implications of each policy often affect different communities disproportionately.

Clean Air Act[edit]

The Clean Air Act is a United States federal law intended to reduce air pollution. It was created in response to a series of air pollutant-related deaths, specifically in Donora, Pennsylvania, where over 20 people were killed and many more became ill due to heavy air pollution.[2] The Clean Air Act is considered a landmark achievement in pollution control in the United States and is widely considered the most successful environmental statute in U.S. history [3] The Clean Air Act is associated with significant reductions in air pollution in the United States and an improvement in public health.[4]

Air pollution disparities[edit]

Low-income and minority communities are disproportionately exposed to air pollution in the United States, rendering them more vulnerable to air-pollutant related conditions like asthma, lung cancer, and infant mortality.[5][6] Each of these health conditions are associated with air pollution and are understood to adversely impact population health in low-income and minority communities.[5] Dense populations of low-income and minority communities inordinately inhabit the most polluted areas all across the United States, which is widely considered to exacerbate health disparities among these populations and white, upper-class citizens.[5]

Asthma[edit]

Asthma is an inflammatory disease that inhibits air passage to the lungs.[7] Air pollution is widely understood to aggravate existing asthma, exacerbating difficulties in breathing.[8] The Clean Air Act is associated with a significant reduction in asthma hospitalizations among American children, with an estimated 10,000 fewer hospitalizations between 1970 and 2010.[9] Minority and low-income populations are at higher risk of developing asthma.[10] High rates of asthma in low-income and minority communities are understood to reflect larger issues of health inequality.[11] Specifically, African Americans are 1.6 times more likely to develop asthma and three times more likely to be hospitalized for asthma than white children, while Puerto Ricans have the highest rates of asthma-related complications and deaths.[10][12] Both of these racial populations are disproportionately impacted by air pollution and the subsequent health implications of exposure to air pollution.[11]

Lung cancer[edit]

Lung cancer is the leading cause of cancer-related death in the United States.[13] While smoking is the leading cause of lung cancer, long-term exposure to air pollution is understood to be a significant risk factor for lung cancer.[14] The Clean Air Act is correlated with a reduction in lung cancer among American citizens.[15] Minority and low-income populations are at higher risk of developing and dying from lung cancer.[10] Specifically, African American men are 23 percent more likely to develop lung cancer than white men and have significantly shorter survival rates.[16][17] African Americans are also less likely to be offered surgical intervention for lung cancer, further reducing survivability.[17] Low-income populations are also at increased risk of developing and dying from lung cancer, widening the survival gap between low-income and affluent populations.[18]

Infant mortality[edit]

Infant mortality refers to the death of an infant before their first birthday.[19] Air pollution exposure is understood to heighten risk of infant mortality.[20] The Clean Air Act is correlated with a reduction in infant mortality among American citizens.[15] Minority and low-income populations are at higher risk of infant mortality. African Americans are 2.4 times more likely to experience infant mortality than white Americans, rendering them at highest risk of infant mortality of any racial population in the United States.[21] Low-income populations are also at higher risk of infant mortality, with increased rates of infant mortality being closely correlated to income levels below the poverty line.[22] High levels of pollutant exposure in neighborhoods with dense African American and low-income communities are understood to be characterized by increased prevalence of conditions like infant mortality.[23]

Trump Administration and the Clean Air Act[edit]

The Trump Administration has proposed significant budget cuts for the Environmental Protection Agency (EPA).[24] The EPA's key purpose is to protect human health and the environmental, and it is responsible for regulating and enforcing environmental policies, including the Clean Air Act.[25] Trump's budget proposal includes a 31 percent reduction for the EPA's enforcement division, which jeopardizes its ability to fine companies for air pollution violations.[24] Without the ability or jurisdiction to fine companies for air pollution violations, the EPA cannot ensure safe air quality standards, rendering Americans at higher risk of air-pollutant related conditions.[24] The consequences of air pollution already disproportionately impact low-income and minority populations, and worsened air conditions will further exacerbate gaps in the health of these and white and more affluent communities.[5]

Toxic Substances Control Act of 1976[edit]

The Toxic Substances Control Act (TSCA) is intended to regulate toxic chemicals that pose "unreasonable" risk to human health. The TSCA regulates the use and distribution of chemicals known to be damaging to human health, such as mercury and lead.[26] Before the TSCA was enacted, lead was commonly used as a base for paint, while mercury was used in items including jewelry and children's toys.

Health Impacts of Toxic Substances Control Act[edit]

The Toxic Substances Control Act is correlated with significant improvements in population health.[27] Low-income and minority populations are disproportionately exposed to toxic chemicals like lead and mercury, leading to higher prevalence toxic exposure-related health conditions in these populations.[28] Specifically, conditions including prostate cancer, breast cancer, and infertility are understood to be correlated with exposure to toxic chemicals and are found at higher rates in low-income and minority communities.[29]

Prostate cancer[edit]

Prostate cancer affects the prostate gland in males.[30] Exposure to toxic chemicals in understood to be a risk factor for prostate cancer.[31] High prevalence of exposure in low-income and African American neighborhoods is understood to be a risk factor of conditions like prostate cancer.[29] The Toxic Substances Control Act is correlated with a reduction in prostate cancer among American males. Minority and low-income populations are at higher risk of prostate cancer. African Americans are 1.6 times more likely to develop prostate cancer and twice as likely to die from it than white Americans.[32] Low-income populations are also at higher risk of prostate cancer.[33]

Infertility[edit]

Infertility occurs when an individual is unable to reproduce.[34] Infertility in humans is understood to be correlated to exposure to toxic chemicals.[35] The Toxic Substances Control Act is correlated with a reduction chemicals known to cause or worsen infertility. Minority and low-income populations are at higher risk of infertility. African Americans are more likely to experience infertility than white Americans, rendering them at highest risk of prostate cancer of any racial population in the United States. Low-income populations are also at higher risk of infertility with increased rates of infertility being closely correlated to income levels below the poverty line. High levels of pollutant exposure in neighborhoods with dense African American and low-income communities are understood to be characterized by increased prevalence of conditions like infertility.

Trump and the Toxic Substances Control Act of 1976[edit]

Like for the Clean Air Act, budget cuts for the Environmental Protection Agency (EPA) jeopardize its ability to regulate toxic chemical violations.[24] Without the ability or jurisdiction to fine companies for violations, the EPA cannot ensure safety from toxic chemical exposure, rendering low-income and minority populations at higher risk of air-pollutant related conditions. The consequences of toxic chemical exposure already disproportionately impact low-income and minority populations, and worsened air conditions will further exacerbate gaps in the health of these and white and more affluent communities.[5]

Clean Water Act[edit]

The Clean Water Act (CWA) is the primary federal law that governs water pollution in the United States, and has been amended three times, in 1977, 1981, and 1987. The Act didn't reach its potential results partly because before 1987 the EPA was putting an emphasis on the point-source pollutants, which can be tracked fairly easily. However, there were large amounts of pollution coming from non-point sources, which are not easily identified.[36] Therefore, the EPA has spent years implementing programs targeting some major non-point sources. Because large-scale experiments were involved, the implementation of the Clean Water Act has slowed down, and the environmental risks weren't resolved as efficient as planned to be. Moreover, income and racial disparities are clearly presented in not only drinking water quality but also water infrastructure.

Water Infrastructure and Environmental Disparities[edit]

Having access to adequate supplies of clean water is essential to public health; however, very few studies have focused on examining income or racial disparities in drinking water infrastructure. Several case reports documented that there's a lack of piped water and poor water quality problems existing in low-income and minority communities. Some examples of the communities are tribal lands, colonies along the U.S.-Mexico border, and small communities in rural areas. According to the National Housing Survey in 2007, about 0.5% to 1% of US residences did not have piped water, and these percentages are only the ones who reported. There were many documented instances of low income and minority communities where the entire community lacked piped water. For American Indians and Alaskan Natives, approximately 8% do not have piped water, and 11% do not have safe piped water. Moreover, the Environmental Justice Coalition for Water in California found that counties that counties with the highest number of drinking water violations had a higher proportion of Latinos than counties with the lowest number of violations (42% vs 16%). Disparities related to income were less significant though; 17% of those living in counties with the highest number of violations were living below the poverty line compared with 12% of those in counties with the fewest violations.[37]

The Clean Water Act Construction Grants Program[edit]

The third goal of the EPA Office of Water's Environmental Justice Strategy focuses on providing equal access to environmental infrastructure for all citizens, especially the disadvantaged communities. Equitable distribution of funding and grant awards under the Clean Water Act is one way to accomplish this goal. However, study shows that counties with relatively small populations had more difficulty obtaining construction grants, and are more easily affected by the composition of income and minority. High-income communities share more of the awards and grants than poor communities. Moreover, a county’s minority composition was inversely related to the probability of obtaining a grant but positively related to the share of grant awards.[38]

Health Impacts of the Clean Water Act[edit]

Contamination of drinking water supplies can not only occur in the source water but also in the distribution system. Sources of water contamination include naturally occurring chemicals and minerals (arsenic, radon, uranium), local land use practices (fertilizers, pesticides, concentrated feeding operations), manufacturing processes, and sewer overflows or wastewater releases. Some examples of health implications of water contamination are gastrointestinal illness, reproductive problems, and neurological disorders. Infants, young children, pregnant women, the elderly, and people whose immune systems are compromised because of AIDS, chemotherapy, or transplant medications, may be especially susceptible to illness from some contaminants.[39]

Gastrointestinal illness[edit]

Gastrointestinal disorders include such conditions as constipation, irritable bowel syndrome, hemorrhoids, anal fissures, perianal abscesses, anal fistulas, perianal infections, diverticular diseases, colitis, colon polyps and cancer.[40] In general, children and the elderly are at highest risk for gastrointestinal disease. In a study investigating the association between drinking water quality and gastrointestinal illness in the elderly of Philadelphia, scientists found water quality 9 to 11 days before the visit was negatively associated with hospital admissions for gastrointestinal illness, with an interquartile range increase in turbidity being associated with a 9% increase). The association was stronger in those over 75 than in the population aged 65–74. This example is a small reflection of residents of the United States remain at risk of waterborne gastrointestinal illness under current water treatment practices.[41]

Reproductive problems[edit]

Reproductive problems refer to any illness of the reproductive system. New research by Brunel University and the University of Exeter strengthens the relationship between water pollution and rising male fertility problems. Study identified a group of chemicals that act as anti-androgens in polluted water, which inhibits the function of the male hormone, testosterone, reducing male fertility.[42]

Neurological disorders[edit]

Neurological disorders are diseases of the brain, spine and the nerves that connect them. A study led by UCLA epidemiology professor Beate Ritz suggests that "people with Parkinson’s were more likely to have consumed private well water, and had consumed it on average 4.3 years longer than those who did not have the disease."[43]

Flint Water Contamination Incident and Environmental Justice[edit]

After a change in the source of water, the city of Flint, Michigan improperly treat its municipal water system, resulting in raised lead levels in local water system and an increase in children's blood lead levels. Excessive lead exposure can negatively affect young children by harming their intelligence, behavior, development, attention, and other neurological functions. According to data, low-income and minority populations have particularly higher risk for lead exposure.[44]

Trump and the Clean Water Act[edit]

The Trump administration plans to roll back the environmental rules under the Clean Water Act. On February 28, 2017, President Trump already signed documents directing EPA and U.S. Army Corps of Engineers to review and rewrite the Obama administration's "Waters of the United States" rule. President Trump orders them to assess the rules in consistent with promoting economic growth and minimizing regulatory uncertainty.[45]

Superfund and CERCLA[edit]

The Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) is a policy that establishes the Superfund program of the US federal government to clean up sites with toxic contamination. There is much nuance in the health implications of this environmental policy. In certain case studies, the implementation of Superfund is able to prevent or improve public health conditions, yet in others the health implications are still unclear. The amount of resources dedicated to Superfund sites is disproportionately less in ethnic minority communities than in white communities. There are many case studies that explore the nuances of the impacts of Superfund sites.

Implementation of CERCLA[edit]

The Superfund Amendments and Reauthorization Act of 1986 (SARA) added amendments to the existing CERCLA to improve its function. There are currently 1388 existing Superfund sites in the U.S. and approximately 12 million people (4% of the U.S. population) live within a 1-mile radius of a Superfund site.[46] The health risk imposed by these sites is measured by performing a risk assessment, which follows the Risk Assessment Guidance for Superfund (RAGS).

Health Impacts of CERCLA Implementation[47][edit]

The Agency for Toxic Substances and Disease Registry (ATSDR) exists to investigate the health effects of toxic substances, especially at contaminated sites. ATSDR is required to complete health assessments for all sites listed on the National Priorities List (NPL) and tries to standardize the results across multiple sites. ATSDR has estimated that around 80% of NPL sites allow for human exposure to hazardous substances. Furthermore, ATSDR has estimated that 10% of all NPL sites allow for exposure concerning enough to authorize further health studies. ATSDR has determined health risks at most individual Superfund sites, but it has not yet compiled and analyzed this data across all sites nationally. There is also no information available about the number of health advisories issued by ATSDR, although ATSDR has recommended emergency action at several sites. However, if we examine individual cases, there are site-specific health impacts of Superfund cleanups.

In Minority Communities[edit]

Superfund sites have been shown to impact minority communities the most.[48] Of the populations living within 1 mile radius of a Superfund site, 44% of those are minorities despite only being around 37% of the nation's population. It has also been shown that the government responds slower to community demands from minority communities than from white communities.[49] Superfund sites near white communities have seen better clean up and harsher penalties for the polluters than minority communities. Specific examples allow a further exploration of the ways in which the EPA responds to Superfund sites in minority communities.

In African American Communities[49][edit]

In 1978, residents of the rural black community of Triana, Alabama were found to be contaminated with DDT and PCB, some of whom had the highest levels of DDT ever recorded in human history. The DDT was found in high levels in Indian Creek, which many residents relied on for sustenance fishing. Although this major health threat to residents of Triana was discovered in 1978, the federal government did not act until 5 years later after the mayor of Triana filed a class-action lawsuit in 1980.

In West Dallas, Texas, a mostly African American and Latinx community, a lead smelter poisoned the surrounding neighborhood, elementary school, and day cares for more than five decades. Dallas city officials were informed in 1972 that children in the proximity of the smelter were being exposed to lead contamination. The city sued the lead smelters in 1974, then reduced its lead regulations in 1976. It wasn't until 1981 that the EPA commissioned a study on the lead contamination in this neighborhood, and found the same results that had been found a decade earlier. In 1983, the surrounding day cares had to close due to the lead exposure while the lead smelter remained operating. It was later revealed that EPA Deputy Administrator John Hernandez had deliberately stalled the clean up of the lead-contaminated hot spots. It wasn't until 1993 that the site was declared a Superfund site, and at the time it was one of the largest ones. However, it was not until 2004 when the EPA completed the clean-up efforts and eliminated the lead pollutant sources from the site.

The Afton community of Warren County, North Carolina is one of the most prominent environmental injustice cases and is often pointed to as the roots of the environmental justice movement. PCB's were illegally dumped into the community and then it eventually became a PCB landfill. Community leaders pressed the state for the site to be cleaned up for an entire decade until it was finally detoxified. However, this decontamination did not return the site to its pre-1982 conditions. There has been a call for reparations to the community which has not yet been met.

Further Threats to Superfund Communities[edit]

Cuts to the EPA's funding and resources would hinder the regulation and remediation of Superfund sites. This would perpetuate the exposure to health risks that adjacent communities face from proximity to the Superfund site. Delays in government response to Superfund conditions increases the exposure of health risks to proximate communities.

References[edit]

  1. ↑ "World Health Organization Preventing disease through healthy environments: Towards an estimate of the environmental burden of disease".
  2. ↑ Schrenk, H.; Heimann, H.; Clayton, G.; Gafafer, W.; Wexler, H. (1949). "Air Pollution In Donora, Pennsylvania. Epidemiology Of The Unusual Smog Episode Of October 1948. Preliminary Report".
  3. ↑ Light, Paul Charles (2002). Government's Greatest Achievements: From Civil Rights to Homeland Defense. Brookings Institution Press. pp. 113–114. Search this book on
  4. ↑ Ross, K.; Chmiel, J. F.; & Ferkol, T. (2012). "The impact of the Clean Air Act The Journal of Pediatrics, 161(5), 781–786". doi:10.1016/j.jpeds.2012.06.064.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Brulle, Pellow, RJ, DN (2006). "Environmental justice: human health and environmental inequalities". Annu Rev Public Health (27): 103–124.
  6. ↑ Ross, K.; Chmiel, J.; Ferkol, T. "The Impact of the Clean Air Act. Journal Of Pediatrics, 161(5), 781–786".
  7. ↑ ""Asthma Fact sheet N°307". WHO. November 2013".
  8. ↑ Koenig, Jane (October 1999). "Air pollution and asthma". Journal of Allergy and Clinical Immunology. 104 (4): 717–722.
  9. ↑ Wong, E. Y.; Gohlke, J.; Griffith, W. C.; Farrow, S.; Faustman, E. M. (2004). "Assessing the Health Benefits of Air Pollution Reduction for Children. Environmental Health Perspectives, 112(2), 226–232".
  10. ↑ 10.0 10.1 10.2 "Reducing Asthma Disparities". National Asthma Control Initiative. 2012.
  11. ↑ 11.0 11.1 Brown, Phil; Mayer, Brian; Zavestoski, Stephen; Luebke, Theo; Mandelbaum, Joshua; McCormick, Sabrina (2003-08-01). "The health politics of asthma: environmental justice and collective illness experience in the United States". Social Science & Medicine (1982). 57 (3): 453–464. ISSN 0277-9536. PMID 12791488.
  12. ↑ Moorman JE; Rudd RA; Johnson CA. "National surveillance for asthma – United States, 1980 – 2004. MMWR Surveill Summ 2007; 56: 1–54".
  13. ↑ "Lung Cancer".
  14. ↑ "The Connection between Lung Cancer and Outdoor Air Pollution". American Lung Associoation.
  15. ↑ 15.0 15.1 "The Clean Air Act | American Lung Association". American Lung Association. Missing or empty |url= (help)
  16. ↑ O’Keefe, E. B.; Meltzer, J. P.; Bethea, T. N. (2015). "Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010. Frontiers in Public Health, 3, 51". doi:10.3389/fpubh.2015.00051. Retrieved 2017-03-23.
  17. ↑ 17.0 17.1 "Lung Cancer and African Americans: Know the Facts" (PDF). the National Cancer Institute. 2002.
  18. ↑ Aldrich, Melinda C.; Selvin, Steve; Wrensch, Margaret R.; Sison, Jennette D.; Hansen, Helen M.; Quesenberry, Charles P.; Seldin, Michael F.; Barcellos, Lisa F.; Buffler, Patricia A. (2017-04-05). "Socioeconomic Status and Lung Cancer: Unraveling the Contribution of Genetic Admixture". American Journal of Public Health. 103 (10): e73–e80. doi:10.2105/AJPH.2013.301370. ISSN 0090-0036. PMC 3780736. PMID 23948011.
  19. ↑ "Infant Mortality".
  20. ↑ Kenneth Y. Chay; Michael Greenstone (December 1999). "THE IMPACT OF AIR POLLUTION ON INFANT MORTALITY: EVIDENCE FROM GEOGRAPHIC VARIATION IN POLLUTION SHOCKS INDUCED BY A RECESSION" (PDF). NATIONAL BUREAU OF ECONOMIC RESEARCH. Retrieved 2017-03-23.
  21. ↑ "African-American Women and Their Babies at a Higher Risk for Pregnancy and Birth Complications" (PDF). Centers for Disease Control and Prevention.
  22. ↑ Haider, Steven J. "Racial and ethnic infant mortality gaps and socioeconomic status" (PDF). Institute for Research on Poverty.
  23. ↑ Currie, Janet (2017-04-06). "Pollution and Infant Health". Child development perspectives. 7 (4): 237–242. doi:10.1111/cdep.12047. ISSN 1750-8592. PMC 4847437. PMID 27134646.
  24. ↑ 24.0 24.1 24.2 24.3 "EPA hit hardest as Trump budget targets regulations". Reuters. 2017-03-17. Retrieved 2017-04-06.
  25. ↑ EPA,OA,OEAEE,OWC, US. "Our Mission and What We Do". www.epa.gov. Retrieved 2017-04-06.CS1 maint: Multiple names: authors list (link)
  26. ↑ "Summary of the Toxic Substances Control Act". United States Environmental Protection Agency.
  27. ↑ "Healthy States: Protecting Families from Toxic Chemicals While Congress Lags Behind" (PDF). Safer Chemicals. November 2010.
  28. ↑ "Race, Class, and Environmental Health: A Review and Systematization of the Literature – ScienceDirect". www.sciencedirect.com. Retrieved 2017-04-06.
  29. ↑ 29.0 29.1 "Protecting Families from Toxic Chemicals While Congress Lags Behind" (PDF). Safer Chemicals.
  30. ↑ "Prostate Cancer". www.cancer.org. Retrieved 2017-04-06.
  31. ↑ MK, Siddiqui; S, Srivastava; PK, Mehrotra (2002-12-01). "Environmental exposure to lead as a risk for prostate cancer". Biomedical and environmental sciences : BES. 15 (4). ISSN 0895-3988.
  32. ↑ "Prostate Cancer: When Should African American Men Be Screened?". www.pcf.org. Retrieved 2017-04-06.
  33. ↑ Miller, David C.; Litwin, Mark S.; Bergman, Jonathan; Stepanian, Sevan; Connor, Sarah E.; Kwan, Lorna; Aronson, William J. (2009-02-01). "Prostate cancer severity among low income, uninsured men". The Journal of Urology. 181 (2): 579–583, discussion 583–584. doi:10.1016/j.juro.2008.10.010. ISSN 1527-3792. PMC 2683346. PMID 19100580.
  34. ↑ "Infertility definitions and terminology". World Health Organization. Retrieved 2017-04-06.
  35. ↑ "How Chemical Exposures Affects Reproductive Health" (PDF). Physicians for Social Responsibility.
  36. ↑ "Clean Water Act – effects, important, system, source, marine". www.waterencyclopedia.com. Retrieved 2017-03-15.
  37. ↑ VanDerslice, James (2017-03-22). "Drinking Water Infrastructure and Environmental Disparities: Evidence and Methodological Considerations". American Journal of Public Health. 101 (Suppl 1): S109–S114. doi:10.2105/AJPH.2011.300189. ISSN 0090-0036. PMC 3222486. PMID 21836110.
  38. ↑ "Environmental Justice and Water Pollution Control: The Clean Water Act Construction Grants Program (PDF Download Available)". ResearchGate. Retrieved 2017-03-22.
  39. ↑ "Water-related Diseases and Contaminants in Public Water Systems | Public Water Systems | Drinking Water | Healthy Water | CDC". www.cdc.gov. Retrieved 2017-03-22.
  40. ↑ "Digestive Disorders & Gastrointestinal Diseases | Cleveland Clinic". Cleveland Clinic. Retrieved 2017-04-06.
  41. ↑ Schwartz, J.; Levin, R.; Goldstein, R. (2000-01-01). "Drinking water turbidity and gastrointestinal illness in the elderly of Philadelphia". Journal of Epidemiology and Community Health. 54 (1): 45–51. doi:10.1136/jech.54.1.45. ISSN 0143-005X. PMC 1731533. PMID 10692962.
  42. ↑ "https://www.sciencedaily.com/releases/2009/01/090118200636.htm". www.sciencedaily.com. Retrieved 2017-04-06. External link in |title= (help)
  43. ↑ News, Marla Cone, Environmental Health. "Rural Well Water Linked to Parkinson's Disease". Scientific American. Retrieved 2017-04-06.
  44. ↑ Campbell, Carla; Greenberg, Rachael; Mankikar, Deepa; Ross, Ronald D. (2016-09-27). "A Case Study of Environmental Injustice: The Failure in Flint". International Journal of Environmental Research and Public Health. 13 (10). doi:10.3390/ijerph13100951. ISSN 1660-4601. PMC 5086690. PMID 27690065.CS1 maint: PMC format (link)
  45. ↑ Davenport, Coral (2017-02-28). "Trump Plans to Begin E.P.A. Rollback With Order on Clean Water". The New York Times. ISSN 0362-4331. Retrieved 2017-03-22.
  46. ↑ U.S. EPA, Office of Solid Waste and Emergency Response Estimate. 2015
  47. ↑ Siegel, Martin R. (1990). "Integrating Public Health Into Superfund: What Has Been the Impact of the Agency for Toxic Substances and Disease Registry?". Environmental Law Reporter. 20.
  48. ↑ Crawford, Collin (1994). "Strategies for Environmental Justice: Rethinking CERCLA Medical Monitoring Lawsuits". Faculty Publications at Reading Room. 74 B.U. L. Rev. 267.
  49. ↑ 49.0 49.1 Bullard, Robert (2012). The Wrong Complexion for Protection: How the Government Response To Disaster Endangers African American Communities. New York: NYU Press. pp. 100–125. Search this book on


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