community health

Indigenous Health Indicators: What, where, when how, and why?

em>November is Native American Heritage month. Throughout the month, we are featuring blogs related to Tribal Science.

By Jamie Donatuto

The Youth Canoe is practicing for the Canoe Journey in the Skagit Bay, near Snee-oosh beach. Photo credit: Caroline Edwards

The Youth Canoe is practicing for the Canoe Journey in the Skagit Bay, near Snee-oosh beach. Photo credit: Caroline Edwards

For going on 15 years, I have been fortunate enough to be employed by the Swinomish Indian Tribal Community, a Coast Salish Tribe in Washington. Like most tribal employees, I “wear many hats,” meaning that when an environmental health-related project comes up, I will likely be involved in some way. This makes for an ever-engaging work environment.

Some of my most meaningful learning experiences have come from working with community members, who have graciously shared their knowledge with me about the many, deeply-held connections between environmental and cultural health.

As an example, the annual Swinomish Blessing of the Fleet is a community gathering that occurs at the start of the fishing season and asks for the protection of the fishers. This celebration honors the aquatic natural resources that protect and sustain the people, especially the salmon. Also called the First Salmon ceremony by some Coast Salish communities, this gathering illustrates the strong relationships between people and the natural environment, as demonstrated through the culture.

While community members intimately understand the many connections between humans, the environment, their culture and community health, it is difficult to explain to those unfamiliar with tribal communities. It is even more difficult to equitably include the impacts that environmental changes may have on community health.

November is Native American Heritage Month.

November is Native American Heritage Month.

Larry Campbell, Swinomish Elder and Tribal Historic Preservation Officer, and I have worked together for many years developing a set of indicators, the Indigenous Health Indicators, meant to evaluate aspects of community health that are often left out of health impact assessments. The indicator set encompasses community health priorities such as self-determination, natural resources security, and cultural use and practice. The indicators can be tailored to individual communities and may be useful for a number of purposes, including baseline community health assessments, climate change impact assessments and planning, natural resource damage assessments, and health risk analyses. Larry and I enjoy working with other tribal communities and are excited to share our work and learn from communities.

The Swinomish Canoe Family sings a blessing song for the salmon and for the safety of fisherman.

First Salmon Ceremony and Blessing of the Fleet. The Swinomish Canoe Family sings a blessing song for the salmon and for the safety of fisherman. Photo credit: Caroline Edwards

At the moment, much of my focus is on our EPA-supported project, “Coastal Climate Impacts to First Foods, Cultural Sites, and Tribal Community Health and Well-being.” This work involves both biophysical and social science. We are building a wave model to assess potential sea level rise impacts to Swinomish shorelines—areas with important aquatic habitats such as juvenile salmon, crabs and clams. These areas have been considered culturally important to the Tribe for countless generations and are still regularly visited today.

Based on the model’s findings, we will work with Swinomish community members to evaluate possible community health impacts for use in the Swinomish Climate Change Impact Assessment and Action Plans. We applied for the EPA grant with several years’ worth of background research and pilot-testing, the internal capacity, and the desire to move forward in our community health and climate change research. These new projects, coupled with the fact that we have some of the most dedicated employees working with a great community, are rewarding.

About the author: Dr. Jamie Donatuto is an Environmental Health Analyst with the Swinomish Indian Tribal Community, a federally recognized Tribe whose homeland is located in the Salish Sea (part of the Pacific Northwest). She and her colleague, Swinomish Elder Larry Campbell, collaborate on developing culturally meaningful and appropriate community-based indicators of indigenous health.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action.

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Harvest of Shame

By Ashley Nelsen

Have you seen Edward R. Murrow’s documentary Harvest of Shame? It’s a Peabody-award winning film about the agricultural conditions of migrants in the 1960s. The opening scene is in Florida. It shows African Americans in a parking lot where labor contractors are repeatedly shouting, “Over here! Seventy cents!” while urging migrant workers to get on a bus to go work in the fields harvesting produce for 70 cents a day, often working in fields while they are being sprayed with harmful pesticides.

The Harvest of Shame vividly showed the American public the deplorable cycle of human poverty and labor abuse used to ensure the variety of produce at affordable prices we’ve come to expect. Fast forward to 2014, the demographic of migrant farm workers has changed to predominately Latino, but the challenges remain the same: poor and unsafe labor conditions and low wages.

My office at EPA, the Certification and Worker Protection Branch, realized that to reach this environmental justice population and educate them about pesticide safety would require more than the typical “top-down” government approach. To find such an invisible population we decided on a “bottom-up” approach involving partnerships with stakeholders who interact with farm workers on a regular basis.

Graphic for Recognition and Management of Pesticide Poisonings DocumentWe partnered with the Association of Farm Worker Opportunity Programs, a national network of trainers who deliver pesticide safety training. Their newest training module, co-developed with EPA, is Project LEAF, which educates farm workers and their families on the hazards of take-home pesticide exposure. Another wonderful partner we have is the Migrant Clinicians Network, an association of clinicians in rural areas that educates healthcare providers on how to recognize, treat, and report pesticide poisoning. We also recently collaborated with physicians and subject matter experts to update our “Recognition and Management of Pesticide Poisonings.” This manual is used nationally and internationally by healthcare professionals in treating patients with pesticide-related illnesses. Pesticides are often colorless and odorless, and symptoms of exposure mimic the cold and flu, making this manual instrumental for those providing healthcare for farm workers.

REI 3 CroppedWe also recently proposed changes to the Worker Protection Standard (WPS). The WPS, originally enacted in 1992, was developed to reduce the risk of pesticide poisoning and injury among agricultural workers and pesticide handlers. The proposed changes would require annual mandatory pesticide safety training, expanded posting of no-entry signs for some of the most hazardous pesticides, and, for the first-time ever, children under the age 16 would not be allowed to handle pesticides (unless on a family farm).

Language barriers, cultural differences, documentation status and physical migration continue to make the farm worker population virtually invisible in this country. However, by working with stakeholders who have the common interest of improving the well-being of the American farm worker, we at EPA are working to help end the harvest of shame.

NOTE: If you would like to support the proposed changes to the agricultural Worker Protection Standard by leaving a comment please visit: EPA-HQ-OPP-2011-0184. Comments must be received on or before August 18, 2014. Additionally, you can click here for tips on how to effectively comment on EPA proposed rules and changes.

About the author: Ashley Nelsen began working at the EPA’s HQ Office in Washington, DC, September 2009. She became passionate about farm worker issues after serving as a Peace Corps Volunteer and Kiva Fellow in Latin America.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action, and EPA does not verify the accuracy or science of the contents of the blog.

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Around the Water Cooler: Sewage Science

By Sarah Blau

Cheddar Blog PhotoAs a pre-veterinary student and a dog owner, I probably pay more attention than most to what comes out the tail end of my pooch. And yes, I’m talking about poo. Though it sounds gross at first, excrement can actually tell us a lot about the health of the poo-producer.

As I dutifully scoop the offending pile into a biodegradable bag, a brief glance lets me know if my pup is dehydrated or has any GI upset I may need to address. And when we go for our annual checkup at the local vet’s office, microscope analysis of a fecal sample will find worms or other heath risks I need to know about to protect my little girl.

So, why am I going on and on about egesta (aka, poo)? Well, EPA scientist Christian Daughton is dabbling with the idea that knowledge of a community’s health can be gleaned from community waste—or, sewage—in much the same manner that bodily health knowledge can be gleaned from the waste of my pup!

This fascinating new research concept is referred to as “Sewage Chemical-Information Mining” (SCIM). It targets analysis of community sewage from waste-treatment plants for specific biological or chemical substances broadly associated with human health or disease. In this way, scientists might someday quickly screen for and locate community populations that are possibly exposed to health risks or susceptible to disease outbreaks. It could also be used to rank communities in terms of overall health.

Daughton published two papers last year describing the unique concept of SCIM and the results of his work to date. This research is intended as a catalyst for future work by federal agencies and others, presenting an innovative way to measure, monitor, and protect public health.

So, as off-putting as it seems, don’t pooh-pooh the importance of monitoring waste. This ground-breaking method of analyzing community sewage for chemicals that can reflect community health has the potential to turn into a whole new field of science!

And this is what I’ll be thinking about as I scoop up the steaming present my hound will undoubtedly “pooduce” for me this afternoon – how brilliant our world is that so much useful information can be found in a stinky pile of…

About the Author: Sarah Blau is a student services contractor working on the Science Communications Team in EPA’s Office of Research and Development. She doesn’t often discuss poo around the water cooler – she finds it turns people off – but she does dispose of her dog, Cheddar’s, excrement on a daily basis.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action.

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