Dean Baker, MD
Dr. Baker is Director for the Center of Occupational and Environmental Health and a clinical professor at the University of California at Irvine. His major areas of research are the cardiovascular effects of occupational stress and the social and organizational factors that play a role in indoor air quality problems. He is the author of numerous articles and chapters on occupational stress. Currently, he is the head of an ATSDR-sponsored program to provide medical education, community and professional help, and education and consultation to communities living near two hazardous waste sites in Torrance, California.
Dr. Baker's speech is reprinted verbatim.
We are currently doing projects with a community out in California where these issues are very relevant. I have participated before in working with other communities around hazardous waste sites, but a major focus of my research in the past has been occupational stress. One of the approaches that I thought I would take today is to present some of the ideas that we have derived from occupational stress research that I think are focused a little bit more on the environmental characteristics that are constantly responsible for occupational stress.
It is interesting hearing Dr. Johnson's * comments about the emphasis on psychological factors in environmental health, and it reminds me of the struggles that we have had in the field of occupational stress: from people working on the assembly lines and the physical hazards facing toll takers in New York City, to people working in office buildings, there has been a concern among individuals and unions that discussions of psychological effects might somehow detract from the need and the emphasis on dealing with toxins and the physical hazards directly. I think that one sees over time that these are really inseparable; that you have to deal with both. So, the theme that I want to present to you is the need to present an integrated, more holistic approach where you don't separate out the toxic physical hazards and the toxic psychosocial hazards.
Today, I am going to be talking about stress as a phenomenon that includes both physical and psychological outcomes. Another theme from the literature is the chronic perception of threat (in communities around hazardous waste sites). There is uncertainty because of invisible exposures with possible health effects. In many instances, the degree and extent of exposure is unknowable and therefore invisible. The health effects are oftentimes unmeasurable because of latency, etc. and are therefore invisible.
The literature on this topic focused on several major human disaster episodes, such as Three Mile Island (TMI), Love Canal, or more recently, the Exxon Valdez incident. Actually there have been dozens and dozens of human disasters and hazardous waste sites that have been studied.
First of all, stress is a psychobiological process that is heavily influenced by individual appraisals. The most classic definition of stress is that of McGrath: stress is a perceived substantial imbalance between demands and response capabilities under circumstances where failure to meet the demands has important perceived consequences. To give an example of the importance of perception: if you are hot out on the beach, there might be an imbalance between your thermal comfort and the sun, but this may be something you desire; however, if you are trying to get work done in an office building, and you have the same imbalance, and you can't control the thermostat, and you can't get your work done, the perceived consequences may be different.
The other thing about stress is that it is really a two-way street. Psychosocial factors, such as stress and threat, can cause both psychological and physiological outcomes. The focus of my research has been on hypertension and cardiovascular disease, where there have been documented associations between occupational stress and cardiovascular disease. There is some evidence for effects on immune and endocrine function. These are physiological effects from psychosocial factors. On the other hand, psychological effects may derive from both psychosocial factors as well as toxic chemical exposures. For example, where you have hazardous waste sites where there may be neurotoxic compounds, there may be both psychosocial contributions to psychological effects as well as a toxic contribution from various neurotoxins.
Let's compare the effects of natural disasters to exposures to hazardous substances. For example, consider the effects of a hurricane. You can see that even though hurricanes can have significant consequences, the effects are relatively transient. It is coming, it is there, it lasts, it goes away, and recovery can begin. There is a clear low point. You are hit very hard, but then you can see that it is over and now you can move on to the point of recovery. At times like these, people feel like they don't have any control over the situation, but they feel that it is a natural situation, so nobody has any control over it. In contrast, with exposure to hazardous substances, you don't know whether or not you've been exposed. You don't know whether health effects could occur. You don't know how much you've been exposed to. Oftentimes, the exposures are invisible to the senses, even in a spill. You can see a hurricane or a volcano erupting. You can see the dust. You can see the damages.
In some ways, hazardous substances exposures are much more like occupational stress exposures. The toxic hazards are the principal stressors. Oftentimes, in occupational settings, you will have multiple stressors. You will have multiple stressors in a community, but oftentimes the focus is on the toxic hazard. In both settings there are persistent stressors, and in both there is no clear low point. I think in both settings there is a loss of control. Long-term uncertainty is existent for both, and in both the exposures can be visible and invisible. Oftentimes, the consequences of occupational or environmental exposures are not clear.
So, in many ways, occupational stress and exposure to hazardous substances are similar. Let me present a model of occupational stress and try to integrate some of those notions into environmental stress. First of all, there are the stressors that exist out in the environment, and these are the factors that cause stress. Cognitive appraisal of those factors occurs, meaning that a person looks and interprets the nature of the threat which would be both the exposure and its possible consequences as well as how to respond or cope with the threat. Coping or adaptation involves many modifying factors such as social support and an individual's resources. All these modifying factors lead to various responses, which can be psychological, somatic, emotional, cognitive, or behavioral (smoking or drug abuse), or social effects such as conflict.
You can see that the stressors go through cognitive appraisal to a short-term response. If the response does not solve the problem, and it goes unresolved, over time this stress can lead to long-term health outcomes. In terms of modifying factors, there are social or community factors that can help coping or pull individuals down. On an individual level, people with different coping styles may actually be able to look at the situation differently and be able to minimize exposure to the stress of the situation.
One thing the model of occupational stress doesn't answer is what makes an environment stressful? To answer this, we looked at the role of cognitive appraisal. One of the concerns about that view although it has been richly rewarding in understanding the stress process is that it gives the view that stress is purely a subjective phenomenon. It is all in the eyes of the beholder. It tends to ignore somewhat what goes on in the objective environment.
The other contributing line of research has been physiological stress theories. These focus on what is happening in the brain during stress. Basically, they have discovered two mechanisms of how the body responds to stress. One is the adrenal medullary response, which involves the secretion of epinephrine, norepinephrine, and the other is the adrenal cortical response, involving cortisol. The first response is the fight or flight response of an organism challenged by a threat. The second, the cortisol response, is really more of a response of defeat and withdrawal, and in this state, you have higher levels of cortisol and behaviors such as helplessness.
Another way to look at stress is to view human behavior and the environment as a transactional process where you say what goes on between the human and the environment is what results in stress and you look at what goes on in the environment. One offshoot of this model is demands and decision latitude, or demand-control in the workplace. There is now a whole body of literature that has studied workplace conditions. Instead of looking just inside the brain and inside the person, the environment has been examined. The essence of this model is that rather than looking at the limitations of being the individual, being able to respond, it says, "what's a stressful environment?" A stressful environment is one that presents demands on the individual and at the same time constrains the individual's ability to respond and therefore creates an imbalance between demand and response that leads to stress.
In looking at the literature, one area where I tried to make the transition from the occupational model to the environmental exposure setting was in interpreting the threat of long-term fear. The persistent threat from environmental exposures represents a psychological demand on the individual, and the lack of control either because the community and the individual have relatively low control in the situation or because of uncertainty about the nature of the hazard or what to do about it represents a constraint on responding. Therefore, in these communities, you can have a situation of persistent threat and at the same time low control over response. This could plausibly be associated with stress and high strain.
Let's now focus on the issues of fear and threat as stressors and on lack of control interacting with fear as a combination stressor. First of all, fear is a rational response to an imagined or actual threat. This is a rational response. Fear is not a pathological response. Persistent fear may cause chronic stress situations, and this has been documented in the literature that you were given. Also, persistent repeated exposures may become increasingly frightening if the experiences are deemed unavoidable, so there is a lack of control. Both psychological and physical risks from these exposures could contribute to disease and diminished mental health, so there is this interaction between the physical and the psychological. I think that one of the characteristics of living in a community near a hazardous waste site is that it is a very, very long-duration situation. There is loss of control. Again, there is this interaction between threat and loss of control.
Perceived control may be defined as the belief that one can influence an event, but the important thing to keep in mind is that, ultimately, perceived control depends on actual control. I think that the issues that will come later in terms of strategies and approaches are how much can we try to build up the concept of perceived control among community members and how much do we have to deal with the issue of actual control, particularly in a situation where the duration is long? How long can you get people to fool themselves? Learning that events are uncontrollable results in a whole range of motivational, cognitive, and emotional deficits that can eventually result in learned helplessness. So, individual and community control is a key factor that affects stress response.
I think that in these situations uncertainty is associated with the perception of loss of control. Uncertainty not only represents a stressor, it makes appraisal and adaptation difficult. How can you adapt if you cannot fully grasp the threat? The invisibility of these exposures leads to the uncertainty. This concept occurs in an article by Henri Vyner (12). Environmental invisibility is when the contaminant cannot be detected by human senses. There is also medical invisibility associated with environmental exposures. Latent invisibility means that many of the chronic effects of toxic exposures have a long latency period. Sometimes, this period is just a few years for reproductive problems; for neurological disease, sometimes as long as 20; and it can be up to 40 years for cancer. During that latent period of time, even if you have been exposed, and even if you will develop that disease, there is usually no way of detecting that. There are yet no signs or symptoms of that future illness, so it is medically invisible during that latent period.
It is just amazing how many aspects of the problem of environmental exposures are uncertain: whether or not you were exposed, how much of a toxic substance you might have been exposed to, latency of any health effects. You may get undiagnosable symptoms like headaches and fatigue. Prognostically, if you do develop a disease from an exposure, what is the future?
So what are some possible solutions? One thing is the importance of community cohesion. Sometimes it is not totally possible to get rid of the hazard, but I think it's important that the community can pull together and not just deal with people as individuals. There has to be an effective dialogue between community residents and the scientific experts. There has to be a sharing of knowledge. We have to empower the community. Support of the community's development, cooperative community problem solving, coalition building, and advocacy approaches are all things that you can do to try to empower the individuals in the community.
So ultimately, you see that one of my themes here is that while I think emotion-focused approaches are essential and important, there is still going to be persistent threat and uncertainty in these situations. People at some level have to learn to live with the environment. But at the same time, like in occupational stress, we don't want people to just continue working in the same environment and just learn to live with it, we want people to the extent possible to be able to change the environment. The problem- solving approach is just as important where you work with the communities to minimize threat, to minimize uncertainty, and to enhance individual and community control.
Delores S. Herrera
Delores S. Herrera is the Executive Director of the Albuquerque San Jose Community Awareness Council, Inc. (ASJAC). She was born and raised in Albuquerque, New Mexico, and has lived in her neighborhood for 24 years. She received the 1995 Governor's Award for Outstanding New Mexico Women, the 1995 Human Rights Award from the City of Albuquerque, and the Latino Peace Officer's Association 1995 Community Service Award. Ms. Herrera was featured in the project, "Women and Social Change Education at the Grassroots: Women and the Struggle for a Safe Environment," the Kathleen Ridder Conference, Smith College, Massachusetts. She was appointed as the first Hispanic/Latino to the National Environmental Justice Advisory Council (NEJAC) by the U.S. Environmental Protection Agency (EPA) Administrator Carol Browner and is presently completing her second term. She sits on a number of boards and organizations to improve the quality of life for people, especially children, in her community and other similar neighborhoods locally, nationally, and internationally.
Ms. Herrera's speech is reprinted verbatim.
Hello, I am Delores Herrera from the community of San Jose in Albuquerque, New Mexico. It is not San Jose, California; it is New Mexico. I am very, very proud to come from New Mexico because every time I go somewhere people ask about New Mexico. They always have lots of questions. People still have not figured out what I am or who I am. I am a servant of the people, not a slave; there's a difference. My community is going to feel really proud when I tell them I was validated by Dr. Baker as being crazy. People ask everyday, I do not know how many times, "Why do you do this work? You must be crazy." So, I think I am crazy.
Many people have become so accustomed to the smell, the pollution, the lack of attention, accepting the deterioration, the lower quality of life as everyday in the "hood," the low student test scores, the crime, all of the negativism. That is the way that it has always been. Just accept it. Nobody cares about normal. How can things change? San Jose is the oldest community in the South Broadway area of the Albuquerque South Valley. It is the place I am privileged to call home.
A "Mayordomo" system began when settlers moved in around the river, organized the inhabitants, and completed a water irrigation system. The community's boundaries were re-channeled by relatives such as the grandpas giving parcels of their land to their kids because that is all they had to pass on to the future generations. All we have is our land. We are tied to it and have always been. It is our hope that we will thrive again some day. Our homes, our land are not an investment in that we are going to buy, sell, and trade it like stock on the stock exchange or to buy a bigger house in a better neighborhood. San Jose is our neighborhood; it is our heritage, "La Tierra." Most of the people stay because they are historically and spiritually tied to the land, because their grandfathers and others before them are a part of it, and they continue the tradition. Sadly, it became a polluted mess. It is sickening. What has happened? Many people feel trapped. The land today is not worth much in dollars, but it is our home. Industry came in, raped it, and left it for dead until the government mandated cleanup, restoration. Wow, what a deal, 20 to 30 years of remediation no-guarantee?
People in our community and others around the country of color, poor communities, lower socioeconomically depressed neighborhoods do not vote because they do not believe in a system that does not work for them. And why should they? We could attack the scientific statistics to validate the problems because that is a part of the process, but there is a human side, the people side El corazon de la gente: the heart of the people.
Going back to the "gente," what we are left with is the political structure of the Mayordomos, who were actually perceived as "mini-mayors." They decided who was to receive water. They relinquished power to the individuals in communities. They had the voice and established the social and economic climate that retains a pseudo presence today. San Jose was an agricultural community, a farming community. Then the railroad came in and people became attached to wage labor. The railroad shut down major operations and left, leaving an unemployed population and a creosote deposit which is now our Superfund site II. The historical and human perspective should not be relinquished in favor of "true science." We must look at the biological and psychological effects coupled with the socioeconomic and environmental impacts. The whole enchilada, total, including the multifaceted stresses that attack our people and make them feel helpless and trapped. I always visualize those big traps in which a bear or wolf or some other animal's leg is clamped within the metal teeth. You watch the animal's terror-stricken eyes, squirming. It is a horrible, ugly scene! Those poor creatures, trapped without mercy. The people in contaminated communities are victims with no retreat...sick and dying a slow death....Think about it. How would you feel? The neighborhood didn't have to change in the negative. What a price we pay for progress.
I am an activist for people who have been left out, left behind, and without a voice. Many of the reasons people stop being part of the system may possibly be categorized as sometimes my people do not feel comfortable enough; they lack the self-confidence and self-assurance to stand up and be counted; or they are suffering from apathy. The list is probably endless. For whatever reason, it is a tragedy because their destiny is not under their control but rather someone else's. That is a real drag! We do not have grocery stores or shopping centers in our community. The infrastructure is decomposing. We have lots of crime, contamination, and sick people living in an industrial corridor. The totality of injustice sometimes is that the self-confidence needed is nonexistent to assume the challenging leadership position. This is stress unto itself. I am not a scientist; I am a community organizer. I will not dictate the stats. I do know and understand people and I work with them everyday. As I drive out of my driveway, I am in my community. I work in my community, and when I come back home, I am in my community. It is very difficult for me to be here today, as I am always torn between here and there and San Jose.
Now poor, what's poor? Let's talk poor.... I do not know how many people have ever been poor. I am not talking about poor in spirit. I am speaking financially - moolah, dollars, sin dinero.
Empowering? No, in fact it's the complete opposite. Our youth and others in our communities are not being educated. They take all kinds of stuff-drugs to become numb and escape from reality.
In communities that are so environmentally contaminated, we are all crazy, and everybody in this room is crazy. We have to be. Right? I am not going to leave here saying anybody in here is real rational. I think the whole world is crazy in some fashion. Don't you? Think about it: everyone in here cares about what happens to people. Yet, when we look around and see the people that are suffering, what can we do to help in the struggle? What happens to the less fortunate? What will we do? We will stay and fight, work with the system as far as it works for us, and then formulate another plan. Mother Earth and her people are in trouble. What is our recourse? Taking drugs? Young women getting pregnant? Last year, we had 25, 27 students in 3 classrooms of an alternative education program in Albuquerque, and out of 75 of the young ladies, there were 30 that were 12 and 13 years old. What happens? The moral fiber in our society is decaying and we are all to blame. The situation is frightening! Look at the social and financial burdens on all of us, the lives lost and wasted. It isn't just environmental contamination; it is degradation of the human spirit. What are we doing about it?
In my community, people are worried about how they are going to pay their gas bill or light bill, about becoming homeless, and many, many other problems. The most important issue is not about what is going on at Chevron or what the AT&SF railroad has done to poison the people, the environment, or what cancer risks are out there. They are worried about today, survival! They are worried about domestic violence, alcohol, insurmountable social concerns, their sons, their daughters grandchildren, hearing gunshots, living in the midst of violence every night and day. There are many forms of contamination.
Yesterday, I was visiting with one of my neighbors. On Saturday night, she heard a loud noise and thought it was a gun. Sure enough, somebody had shot at her son's car. She lives in the middle of the Superfund area. It is stressful enough when she looks out her kitchen window to see the GE (i.e., General Electric) water tanks around her, and compounded with the violence, she is feeling under siege.
When we talk about negative effects we are talking about socioeconomics correlated with environmental racism-poor, no money. Turn on the television and everything is about money. I got a kick out of a show this morning. Somebody was talking about retiring, where they would go. Wow! Retiring, we are going to see that rainbow in the sky and reach the pot of gold. Retirement for some is not a reality. The trapped animal syndrome, where the heart is beating and we wait to die a slow death. We stay, we struggle, we fight.
Another story is about a woman named Esther, with whom I started teaching religious education about 18 years ago. She began experiencing a little cough. She lives right in Superfund, right by the drainage dump. Over the years, she said, "it's okay, it's okay, my little cough." I know that it is not okay. Her cough is upper respiratory and it has progressively worsened. She still says, "it's nothing." The cough is not normal, but her demeanor is another form of acceptance. We as Chicanos, Mexicanos, Latinos, as Hispanics suffer silently. It is an assumable part of our culture-the culture of people of color and what we stand for. Linking that with the fact of poverty, helplessness, and lack of self-esteem has bolstered our spirit, and we are still going strong as a people.
Whenever I go visit anybody, I am very respectful of their home and their valuable time. As a community, we ask for respect from other people; that is important. We are all products of society. We are responsible for each other. We share a common dignity; remember that. Our problems are environmental, economic, and social. When you go to a bank and you cannot get a loan because the area that you live in has environmental problems or it's located in a socioeconomically depressed area, that is unfair lending banking practices and against the federal law. Hello? How many times do corporations/potential responsible parties break the law? Our community has suffered redlining. We pay back the loans, don't owe as much, but we are many times refused those very things that others take for granted. Does that make sense?
I visit many places and I have to laugh because sometimes people are so freaked and so stressed because they cannot visualize the next half-hour, much less tomorrow. They have lost hope. I never laugh at their misery. I laugh to keep from sobbing. Life is so precious. This work is hard, and you watch people who are suffering that do not even know that they are suffering. Many have learned to accept it. I do not. I will never accept injustice for anyone anywhere. We will mobilize and continue to share all we have to teach others, to stand up for civil and human rights. Not being in control of your own destiny, whether it is because of economics or power or whatever, is injustice. America was built on justice for all the people, not just for some, for everyone rich, poor, male or female, young or old, or color or not.
A hand-up stabilizes; a handout controls. We want to be in control of our future, and therefore we understand that partnerships stabilize. A good example may be when the ASJAC was approached by an engineer to work with the Sandia National Labs Condescending in his attitude, he bugged me, telling me what they could do for the "poor" people in the neighborhood. I said, "We don't need anyone coming in to our community wearing a white hat and riding a white horse to tell us what's best for us. We are the `experts.' We will solve our own problems. If you want to help and partner, that's a different story. The problems do not belong to us alone. People drive cars, have gas and electric utilities, flush toilets, and running water. We have conveniences, right? San Jose suffers the impact of having industry in our community because they are located here, but it is not just San Jose's problem." He looked at me and said, "Well, Delores, we need to have some serious discussion." I replied, "No, first what we really need to do is come to an understanding." The understanding is that human life is not expendable. Every living creature and every living thing matters. It took a while, but he got it. We have formed a wonderful relationship, and we help each other. I respect him to this day because the partnership is based on trust and mutual accountability.
In conclusion, I wish to state that the impacts from social, economic, and environmental racism are strongly felt in San Jose. The helplessness, the guilt, the unhealthy communities, the stuff that people feel every day and every night from every negative force flourishes. It isn't a bed of roses yet, but we are planting seeds and have hope that we will nurture accordingly, and we will grow a strong, healthy, beautiful future for all. We all want a better quality of life for our future generations, especially for our children. We all love babies. What are we going to do about the babies? They grow up into adults. We want to raise healthy, productive members of society that sustain their families and stimulate the economy. That creates a better San Jose, better neighborhoods everywhere, a better world.
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