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ATSDR - Mississippi Delta Project"Economic development of the Delta cannot be separated from the and ethnic realities and cannot be planned apart from careful management of its resources and protection of its environment. This report envisions a coming time when ecological mindfulness and economic development are no longer seen as incompatible but as indivisible".
(Lower Mississippi Delta Development Commission, 1990)
The preceding quotation was taken from the report Realizing the Dream...Fulfilling the Potential, which was prepared by the Lower Mississippi Delta Development Commission (1). The words reflect a vision for the Lower Mississippi Delta Region wherein ecological concerns co-exist with economic development and social advancements. The Commission concluded its work and disbanded in 1990. The Commission's final report is a key document that combines concerns for improving the health of ethnic and racial minority populations in the United States and for achieving environmental justice. The work of the Commission provides compelling support for a demonstration project that forms partnerships in pursuit of regional excellence in public health and environment protection. The Mississippi Delta Project_Health and Environment is an attempt by government, academia, private sector organizations, and community residents to implement, within a key geographic region, a program that demonstrates how partnerships can be formed to identify and reduce the impact of environmental hazards. This document outlines the background of the Delta Project, its goal and objectives, its partners, and how the project is organized.
The Mississippi Delta Region was defined by the Lower Mississippi Delta Commission as a 219-county strip along the Mississippi River in Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. The counties and parishes in the Delta Project are listed on the inside of the back cover page of this brochure. The Region is populated by approximately 8.3 million people, including a large number of persons of low income, African Americans, and growing numbers of other people of color.
No comprehensive database currently exists on the environmental hazards in the Delta Region. However, from databases in several federal and state health and environmental agencies, it is known that the Region's environmental hazards include the spectrum of non-point environmental problems such as mercury contamination in some states' surface waters, pesticides runoff in agricultural areas, seasonal degradation of ambient air quality, vector control, and the environmental and health consequences of natural disasters. Point-source environmental problems include releases of toxic substances from waste sites, lead-based paint in older housing, hazardous materials handling, chemical spills and explosions, and inadequate municipal waste treatment capacity. As one example, within the 219 counties, at least 40 uncontrolled hazardous waste sites are on the Environmental Protection Agency's (EPA) National Priorities List (NPL). The NPL is a listing of the most hazardous waste sites nationwide. In addition, states in the Region are responsible for managing the health and environmental risks posed by waste management, including non-federal abandoned waste sites.
Because of the diversity of environmental hazards and the high concern of the public over environmental and health impacts, government and private sector organizations are challenged to make an impact on reducing the risks posed by individual environmental hazards. While some communities and government agencies have worked closely on ameliorating specific environmental problems, a comprehensive regional plan to mobilize partnerships toward the goal of reducing environmental impacts and enhancing development is lacking. By focusing on a region with historic and demonstrated minority health disparities and identified environmental hazards, it is possible to develop the data and experience that will be necessary to shape public health, environmental, and educational interventions within the Region. Federal and state agencies, academic institutions, and community residents in the Region propose that a concentrated effort of sustainable partnerships be undertaken in the Lower Mississippi Delta Region.
The need for a regional demonstration project that proposes to establish regional excellence in public health and environmental protection, through partnerships, stems from the confluence of three concerns: 1) the need for further economic development of the Lower Mississippi Delta, 2) the importance of improving the health of persons of color and underserved populations, and 3) the need to ensure that environmental justice is achieved as a matter of social justice. Each concern has contributed to the genesis of the Delta Project. Details of each concern are described in the following paragraphs.
The Lower Mississippi Delta Development Commission
The Lower Mississippi Delta Development Commission was established in October 1988 to study and make recommendations on economic needs, problems, and opportunities in the Region and to develop a 10-year economic development plan for it. Two reports have been prepared by the Commission. They are Body of the Nation: The Interim Report of the Lower Mississippi Delta Development Commission and The Delta Initiatives: Realizing the Dream...Fulfilling the Potential. The latter report, which was the Commission's final report, notes "This final report is a trumpeting call by the Delta's own people to begin the tasks that will create a new and better tomorrow for this, the body of the nation, and therefore a brighter future for the nation as a whole." The same report concludes that the problems found in the Delta are common to all seven states_Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee_that have counties or parishes in the Region. The Commission makes a clear and compelling call for regional cooperation and cohesiveness in order to reach better solutions to the Region's problems.
The Commission's final report, Realizing the Dream...Fulfilling the Potential, contains sections on education, health, housing, community development, agriculture, natural resources, public infrastructure, entrepreneurial development, technology development, business and industrial development, tourism, and the environment. Each section contains goals and attendant recommendations. The sections on environment, community development, health, and education are especially pertinent to the Delta Project. The Environment section states:
A growing awareness of the need to face environmental problems was expressed by Lower Mississippi Delta citizens in hearings in each state. Yet many people still argue that environmental protection and economic development are incompatible. In fact, the reverse is true.
In the 21st Century, the world cannot accommodate growth and economic development apart from environmental protection. This means that in the long run, protecting the Delta's environment will pay dividends by attracting more new businesses, tourism dollars, research grants for institutions of higher learning and job opportunities. This new economic development concept will foster a great sense of "pride of place" among the Region's residents. All people will have to think of themselves asenvironmentalists. This will build a new environmental ethic and will create policies that reconcile preserving the environment with aggressive pursuit of economic growth.
The Commission developed three goals for environmental protection in the Delta Region:
Goals for community development, health, and education in the Delta include the following:
Minority Health Programs
Preventing adverse health effects in disadvantaged communities and people of color exposed to environmental hazards is a priority for government health agencies at all levels. Minority populations, particularly African Americans, Hispanics, and Native Americans, suffer disproportionately from preventable morbidity and mortality. Regardless of income, education, or geographic locale, these populations are in poorer health than their white, non-Hispanic counterparts. However, the health impact of the environment on minority populations has not been adequately characterized.
Reducing the disparity in health and improving quality of life among disadvantaged groups and among ethnic and racial populations impacted by environmental hazards will require the collective commitment of health professionals and environmental health scientists. Federal agencies and state health departments in the Region all have health outcome data that characterize the health of the public. For example, mortality data and disease incidence data are generally available. However, resources have generally been lacking in terms of linking morbidity and mortality databases and environmental quality data.
As illustration of federal minority health programs, the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC) have conducted a series of projects to assess the impact of the environment on health in minority communities. The agencies' efforts since 1987 have evolved into an important Minority Health Program at ATSDR. In 1988, with the appointment at CDC/ATSDR of the Associate Director for Minority Health, a 5-Year Strategic Plan for Minority Health was completed (See Appendix B). Over the past several years, four goals have been developed for ATSDR's Minority Health Program. All or parts of these goals are believed by ATSDR to be shared by other federal agencies and some state agencies that have undertaken minority health and environmental justice programs.
Environmental Justice Emergence
The emergence of environmental justice as a significant social concern has contributed to identifying the need for the Mississippi Delta project. Although much of the evidence is anecdotal and circumstantial, there are mounting concerns that environmental health risks are borne disproportionately by members of the population who are poor and nonwhite. Concerns that possible disparities in environmentally induced illness are related to socioeconomic class and ethnicity or race have made this issue a top priority on the environmental health agenda of the United States.
Most of the studies cited as evidence of environmental inequities are observational. In other words, these studies document disparities by relying on statistical associations between demographic characteristics of populations, primarily race and income, and indirect surrogates for exposure to hazardous substances, such as residential proximity to pollution sources. According to a variety of sources (2) these investigations have been consistent in finding that members of disadvantaged groups are more likely than affluent whites to 1) live near sources of environmental pollution, such as hazardous waste sites; 2) reside in urban areas where ambient levels of certain pollutants, such as lead and carbon monoxide, are elevated; 3) eat significantly greater amounts of contaminated fish; and 4) be employed in potentially dangerous occupations, such as migrant farm work.
Inequitable distribution of the costs and benefits associated with environmental regulations has been the topic of discussion and study for more than 20 years. During the 1980s, hundreds of grassroots and community action groups brought attention to the environmental problems facing disadvantaged communities. In 1982, demonstrations by members of a low-income, predominantly African-American community against the proposed site for a polychlorinated biphenyl (PCB) landfill in Warren County, North Carolina, garnered national media coverage. The following year, a General Accounting Office (GAO) study found that three of the four largest operating hazardous waste sites in the southern United States were located in primarily African-American communities (3). In 1985, the first national African-American environmental organization, the Center for Environment, Commerce, and Energy, was established. That same year, the National Council of Churches' Eco-Justice Working Group began to address environmental issues.
The United Church of Christ's (UCC's) Commission for Racial Justice released a nationwide study in 1987 on the demographics of populations living near hazardous waste sites (4). The report found that in communities with one or more commercial hazardous waste facilities, the proportion of racial minorities was significantly greater than in communities without such facilities. Similarly, researchers found that African Americans were disproportionately represented in areas around operating (i.e., controlled) hazardous waste facilities around Detroit, Michigan. However, a study by University of Massachusetts investigators did not find any disparities according to racial or cultural groups residing near operating hazardous waste facilities. ATSDR has completed a study of the demographics of communities located near uncontrolled waste facilities. By its analysis, African Americans are represented in disproportionate numbers in communities located near Superfund priority waste sites.
In 1990, ATSDR sponsored the "Minority Health Conference: Focus on Environmental Contamination," which was the first federally sponsored conference of this kind. Media coverage accelerated in 1991 and a number of conferences and symposia were held to examine the issue. In 1993, Congressman Louis Stokes convened the U.S. Congressional Black Caucus Brain Trust Meeting on Environmental Racism. In February 1994, six government agencies with the support of community and academic leaders convened the first federal symposium on environmental justice entitled "The Symposium on Health Research and Needs to Ensure Environmental Justice." This symposium was attended by approximately 1,200 grassroots, academic, government, labor, business, and community leaders. During the symposium, President Clinton signed Executive Order #12898, which states "...each Federal agency shall make achieving environmental justice part of its mission by identifying and addressing, as appropriate, disproportionately high and adverse human health or environmental effects of its programs, policies, and activities on minority populations and low-income populations...." (See Appendix C.)
In response to the Executive Order, federal agencies are developing and implementing strategies to establish a framework to ensure that they design and conduct research, educational, regulatory, service, and support programs in full partnership with stakeholders in a manner that considers, and addresses as appropriate, disproportionate and adverse environmental and minority populations. Of particular relevance to the Delta Project are the environmental justice strategies developed by the Department of Health and Human Services (DHHS) and the EPA in response to the Executive Order. These strategies include several that will be incorporated into the Mississippi Delta Project. Both set of strategies are consistent with the following two working definitions developed by EPA's Office of Environmental Justice :
The goal of EPA's strategy is to ensure that 1) no segment of the population, regardless of race, color, national origin, or income, as a result of EPA's policies, programs, or activities, suffers disproportionately from adverse human health or environmental effects, and all people live in clean and sustainable communities; and 2) those who must live with environmental decisions_community residents; environmental groups; state, tribal and local governments; businesses_must have every opportunity for public participation in the making of those decisions. An informed and involved local community is a necessary and integral part of protecting the environment.
The EPA strategy outlines cross-cutting mission areas in health and environmental research; data collection and analysis; stakeholder access to information; enforcement and compliance assurance; partnerships, outreach, and communication with stakeholders; Native American, indigenous, and tribal programs; and integration of environmental justice into all EPA activities.
Both DHHS and EPA have listed the Mississippi Delta Project as a model interagency environmental justice project. Strategies outlined in both institutions' environmental justice programs will be incorporated into the Mississippi Delta Project (where appropriate for conditions in the Region).
Health Promotion and Disease Prevention
Recommendations in the Lower Mississippi Delta Development Commission's final report advocate actions that would enhance environmental protection and the health and well-being of the Region's people. Similar concerns are evident in government agencies' minority health programs and in the emergence of environmental justice concerns. From experience accrued in many areas of public policy and service, it is now recognized that the most beneficial approach to solving many health and environmental problems is through health promotion and disease prevention measures. That is, prevention of factors that cause excess morbidity and premature mortality is well known by public health officials to be the most cost effective and healthful approach. Similarly, prevention of environmental hazards is to be preferred to remediating hazards after they have occurred. For these reasons, the Delta Project adopts the prevention model as its core concept. Moreover, education strategies to promote and maintain a healthful environment must be undertaken to institute the ATSDR vision of "Healthy People in a Healthy Environment."
The public health prevention model contains the following elements:
Given the concerns of the Lower Mississippi Delta Development Commission for improvements in the social and economic conditions of the Region, and recognizing the importance of using prevention methods to achieve improvements in the public health and environment of the Region in ways consistent with environmental justice, the Delta Project has evolved.
The overall goal of the Delta Project is to demonstrate that partnerships between government, academia, private sector organizations, and community residents can identify key environmental hazards (and barriers to this identification), promote environmental quality, and reduce and, where possible, prevent these hazards from impacting on health and the environment, with emphasis on persons in underserved communities. This goal will be pursued jointly by federal agencies, state and local health departments, local community groups, and institutions of higher education, particularly those that serve large minority populations.
The federal agencies cooperating in the Mississippi Delta Project are the Office of Solid Waste and Emergency Response (OSWER), Office of Environmental Justice/EPA, the National Institute of Environmental Health Sciences/National Institutes of Health (NIH), the National Library of Medicine/NIH, the National Institute for Occupational Safety and Health/CDC, the National Center for Environmental Health/CDC, the Office of the Associate Director for Minority Health/CDC, and ATSDR. Each federal agency brings to this project different statutory responsibilities and resources bearing on specific environmental hazards. Moreover, state and local agencies have specific health and environmental authorities for managing environmental hazards. By joining the interests, authorities, and resources of the relevant federal and state agencies, a more comprehensive and effective effort can be implemented to reduce and, where possible, prevent the health and environmental impacts of environmental hazards.
Because of the demographics and economic profiles inherent to the Mississippi Delta Region, this project will give special emphasis to identifying and reducing the disparities of environmental hazards experienced by disadvantaged communities and persons of color. The participation of communities in the conduct of the project will be essential for long-term success. Working closely with communities and Historically Black Colleges and Universities (HBCUs) in the Region will be an essential component of this project. (See Appendices D and E.)
Therefore, in association with state and local health agencies, regulatory agencies, and academic institutions in the Delta Region, and consistent with the principles of sustainable development and preventing adverse health impacts from environmental hazards, the objectives of the Delta Project are these:
Delta Project's Phases
Phase 1 - Problem Definition and Needs Assessment
The first step is to determine the problems in the Region that are linked to environmental hazards. This is being accomplished through a needs assessment. In this context, a needs assessment is expected to ask what needs to be done, given conditions and circumstances in the Region. For the purposes of the Delta Project, the emphasis is on key environmental hazards that impact underserved communities and persons of color. The needs assessment is being conducted by Meharry Medical College, Nashville, Tennessee, in cooperation with the Minority Health Professions Foundation. The Steering Group for the Delta Project will advise Meharry on the overall conduct of the needs assessment, based on recommendations from the Assessment Workgroup (refer to the following section on architecture).
The needs assessment will be conducted using four profiles developed by Meharry:
Phase 2 - Demonstration Interventions
This phase of the Delta Project will consist of selecting a number of needs identified in Phase I and developing intervention strategies appropriate for preventing health and environmental impacts. The profiles will be reviewed by the Steering Group, as advised by its Project Structure Workgroup (refer to the following section on architecture), to determine specific demonstration interventions recommended for the Region. The Steering Group in conjunction with local communities will select the problems to be addressed, help create partnerships for each demonstration intervention, and serve as a resource to evaluate the effectiveness of specific interventions.
Phase 3 - Regional Health and Environmental Promotion
Given the outcomes from the demonstration community-specific interventions, successful interventions will be identified and promoted for adoption within the Region. The specifics of this phase will be contingent on the outcomes and experiences of Phase 2.
Delta Project's Architecture
A Steering Group will provide guidance and advice to Meharry Medical School and other contractors. This group comprises representatives from government, academia, private sector organizations, and community advocacy groups. Federal agencies include ATSDR, CDC, NIH, and EPA. Each of the seven states has representatives from state health and environmental agencies. The HBCUs, community-based organizations, and other relevant groups are members of the Steering Group, which will choose its own chairperson.
The HBCUs will play a key role in the conduct of the Delta Project, particularly in efforts to educate Delta Region residents about environmental hazards. The HBCUs in the Delta Region have educated a large number of African-American professionals who teach, practice health care, and assume leadership roles in many of the Delta Region minority communities. These professionals have the credibility needed to ensure the success of the project and are strongly committed to supporting HBCUs in the Region. Meharry Medical College serves as the primary HBCU. Meharry's history of providing health care in the Delta Region provides the credibility needed to ensure the trust of the people in the Region.
Reporting to the Steering Group will be workgroups established to provide advice and guidance in support of the Delta Project's overall goal and long-term objectives. The following four workgroups have been established by the Steering Group:
Because creating partnerships for the purpose of developing regional excellence in public health and environmental protection is the heart of the Delta Project, many ongoing projects by federal, state, and private sector organizations are relevant to the overall goal. The Steering Group encourages the conduct of projects in support of the overall goal of the Delta Project. These collaborative projects, as they become known to the Steering Group, will be shared within the Region. Collaborative projects will be selected by the Steering Group, as recommended by the Structure Workgroup, based upon their project officers' knowledge of and commitment to meeting the Delta project's overall goal.
Some current examples are the following activities:
The funding for Phase I of the Delta Project will be provided by participating federal agencies. It is anticipated that the four profiles being developed by Meharry Medical College will be completed by the end of fiscal year 1995. Funds for Phases 2 and 3 will be sought from government and private sector organizations, based on the recommendations from the Steering Group. A timetable for other significant activities for the Delta Project will be developed by the Steering Group.
Delta Commission Report Goals on the Environment
5-Year Plan for the Office of the Associate Director for Minority Health
The Mission of the Office of the Associate Director for Minority Health is to improve the health of the African-American (Blacks), Asian-American/Pacific Islander, Hispanic American, and Native American/Alaskan Native citizens, and where appropriate, similar ethnic/racial subgroups in and out of the United States, through policy development and program analysis at CDC and ATSDR.
The mission will be accomplished through the following major goal, subgoals, and objectives:
To enhance the overall health of the American public by reducing the burden of preventable disease and illness through health promotion and disease prevention initiatives geared specifically toward U.S. minority populations and, where appropriate, similar ethnic/racial subgroups inside and outside of the United States.
Measurable subgoals include the following:
The mission and goal of the Office of the Associate Director for Minority Health are based on the philosophy that to be effective, minority health initiatives must be operational in the centers, institutes, program offices, and programs at CDC and ATSDR. These initiatives, where appropriate, must be transferred to State and local government and non-government agencies and organizations. The Office, therefore, assumes an operational versus a programmatic management approach in actualizing its mission. This management approach demands ongoing interaction and communication between people at CDC, ATSDR, and Public Health Service, other Federal officials, and State and local government officials, and the leadership of non-government agencies and organizations (i.e., voluntary agencies, community based organizations, philanthropic groups, etc.). Programmatic authority and responsibility should be maintained at the program level to maximize fiscal and human resources. However, assessment, advocacy, coordination, and evaluation of processes and outcomes related to the efficacy of minority health activities are focused primarily in the Office of the Associate Director for Minority Health.
The objectives for the Office of the Associate Director for Minority Health related specifically to the three subgoals include the following:
To assure that policy at CDC and ATSDR appropriately directs the agencies' activities towards minority health.
To enhance the research enterprise through innovative scientific investigations in health promotion, health protection, and disease prevention to reduce the disproportionate burden of illness in minority group members.
To develop an effective internal and external communication network related to minority health.
Strategies address the question "How do we met objectives?" "How do we get it done?" They should be supported by a composite of action plans and programs. Strategies are primarily qualitative and can be translated into quantified tactics and action plans. They should be listed in rational and priority order. (See Strategies and Tactics)
Tactics detail how the strategies will be implemented and what specific activities are planned. They must be operational in nature and lend themselves to evaluation. Tactics are subject to change in direction and emphasis. They must lend themselves to qualified activities that can be monitored and controlled. (See Preliminary Assessment of 1989 Strategic Plan under Evaluation)
For the purpose of this report, evaluation is defined as the process of determining the value or amount of success in the achievement of predetermined objectives. This includes at least the following steps: formulation of the objectives; identification of the proper criteria to be used in measuring success; determination and explanation of the degree of success; recommendations for future program activities.
The following five areas will be used in evaluating the activities in the Office of the Associate Director for Minority Health:
Appendix C: Presidential Document ( Federal Actions to Address Environmental Justice in Minority Populations and Low-income Populations (Executive Order 12898) )
Appendix D: Historically Black Colleges and Universities in the Lower Delta Region
Appendix E: President Clinton's Executive Order on Historically Black Colleges and Universities (HBCUs) Executive Order 12876
Questions? - Call the ATSDR Information Center toll free at 1-888-422-8737, or e-mail
Revised March 18, 2002
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