Beyond Global Warming Pluralea

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Beyond Global Warming: Interacting Ecocrises and theCritical Anthropology of HealthMerrill SingerUniversity of Connecticut

AbstractHuman health is at growing risk due to the multiple climatic effects of globalwarming. More importantly, it is becoming evident that individual ecocrisesare not independent phenomenon but are entwined with and contribute to theintensification of other environmental predicaments. In light of a range ofimagined futures that share a narrative about global warming that posits theexistence of global “winners and losers” (regions that will benefit from andthose that will suffer from global warming), this paper examines two specificcases—Midwestern flooding during the summer of 2008 and the acceleratingdegradation of the Sacramento Delta. These examples, expressions of conver-gent ecocrises, here termed pluralea interactions, suggest that going beyondglobal warming reveals the folly of “winner and loser” thinking. The paperconcludes with a discussion of the implications of the health impacts of inter-secting ecocrises for directions in medical anthropology. [Keywords: globalwarming, anthropology of health, imagined futures, pluralea]

Anthropological Quarterly, Vol. 82, No. 3, pp. 795–820, ISSN 0003-549. © 2009 by the Institute for EthnographicResearch (IFER) a part of the George Washington University. All rights reserved.

Beyond Global Warming: Interacting Ecocrises and the Critical Anthropology of Health

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“Our future…is like that of the passengers on a small pleasure boatsailing quietly above the Niagara Falls, not knowing that the enginesare about to fail” (James Lovelock, quoted in Goodell 2007).

Not Just Global WarmingVernon (1993) argues that a country’s willingness to participate in globalenvironmental protection agreements is conditioned by the structure ofthe state and its relationship to what he calls “polluting elites.” One signof how these elites have responded to global warming, which a growingnumber of climate, health, and social scientists see as one of the gravestcontemporary and future threats to human health and safety, observesBegley (2007:1), is that “Individual companies and industry associations—representing petroleum, steel, autos and utilities—[have] formed lobbyinggroups [to mobilize] greenhouse doubters to ‘reposition global warming astheory rather than fact,’ and to sow doubt about climate research just ascigarette makers had about smoking research.” More recently, some corpo-rations have “gone green” and begun to support limited action on globalwarming (while nonetheless still promoting expanded production and con-sumption). These two alternative responses reflect contrastive imaginingsof the future. Even with growing awareness of the potential risks of globalwarming, there has been little support for the development of a broaderbiosocial environmental focus that recognizes that global warming and themultiple and diverse health risks it entails (Baer and Singer 2009) are onlypart of a far larger environmental crisis involving a set of convergent andpotentially interacting anthropogenic threats to the environment and tohuman health.

As Spratt and Sutton (2008:xi) stress, global climate change constitutesonly the exposed “tip of [a] broader global-sustainability iceberg,” thatincludes a litany of environmental degradations that are now “convergingrapidly in a manner not previously experienced.” At the same time thatclimate change is disrupting the planet’s geophysical feedback mecha-nisms that sustain inhabitable environments, Earth is also beset by multi-ple other ecocrises set in motion by human socioeconomic activities (Smil2008). Among these are nuclear dumping, acid rain, disappearance ofwetlands, pesticide and other chemical pollution, air pollution, soil con-tamination and salinization, a global potable water crisis, ocean acidifica-

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tion, deforestation, soil depletion, plastic pollution, depletion of ediblesea life from the oceans, and a general loss of biodiversity through extinc-tions. All of these threats are connected to the transformation of theEarth’s biomass into an ever growing human population (Speth 2008).

These diverse threats, which Foster et al. (2008) label the “environ-ment problem,” have momentous health implications for humans. As,Pimentel et al. (1998) indicate, “Based on the increase in air, water, andsoil pollutants worldwide, we estimate that 40% of human deaths eachyear result from exposure to environmental pollutants and malnutri-tion.” This recognition has led to the development of the concept of“health-based environmental indicators,” which are measures designedto describe the status of human health as a result of environmental con-ditions (Vassilev et al. 2001).

Even more significant than the number of health-related degradationsthat comprise the environment problem is the issue of ecocrises interac-tion. Rather than seeing the various environmental calamities we faceand their respective configurations of health-based indicators as stand-alone threats to human well-being—the conventional but limited out-look that leads to fragmented and even competitive mitigation efforts—it is argued here that adverse human impacts on the environmentintersect; that the resulting interactions significantly exacerbate theoverall human (and plant and animal) health consequences; and theseinteracting ecocrises create the potential for catastrophic outcomes (Rees2003). In this light, the purpose of this paper is to draw attention to thenature and health implications of convergent and intersecting ecocrises,a phenomenon here termed “pluralea interactions” (derived from theLatin words plur, meaning “many” and alea, meaning risks or hazards)—and to discuss the implications for medical anthropology. I illustrate thebiosocial and geoclimatic complexities of pluralea processes using twoexamples: the Midwestern Floods of 2008 and the dire condition of theSacramento Delta area. While pluralea phenomena are occurring world-wide, these two examples are used to emphasize the point that, contraryto the assertion made by some imagined futures narratives, NorthAmerica is not likely to be a “winner” in the time of global warming andis no less at risk from interacting ecocrises than other parts of the plan-et. Finally, it is argued, understanding pluralea provides a new agendafor directions in 21st century medical anthropology.


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Winners, Losers, and Imagined Futures Narratives in a Changing WorldAt the individual level, it is possible and common to imagine one’s futurelife some distance ahead in time; in the West, in fact, being asked to pon-der questions about our imagined personal future has become institu-tionalized in employment interviews and psychological assessments.Citing a pivotal incident from Rohinton Mistry’s (1996) novel, A FineBalance, Mackenzie (2008:122) writes, “ in deliberating, planning, and inworking out how to carry out our personal [life plans], we imaginativelyproject ourselves into the future. Such imaginings usually encompass notonly our own future actions and their consequences but also the imag-ined actions and reactions of others.” Moreover, Mackenzie stresses,imaginings of this sort can help prepare for future events or they can“provide opportunities for self-deception, self-indulgence, wishful think-ing, and other failures of agency leading us to make decisions that welater regret” (Mackenzie 2008:123).

From an anthropological perspective, of course, imagining the futureis understood not simply as an idiosyncratic and individual activity, butrather as a social process involving the narrative construction of sharedcultural meanings. Narrative, defined as “a discourse featuring humanadventures and sufferings connecting motives, acts, and consequences incausal chains” (Mattingly 1998:275), is characterized by contextuallygrounded actions that lead to socially meaningful outcomes. In LauriePrice’s apt phrase (1987:315), hearing a narrative augments a listener’s“fund of cultural knowledge” with which to confront future life chal-lenges. In this sense, as Fisher (1984) affirms, the referent of narration isnot the fictive world of entertainment (i.e., storytelling for the sake ofamusement or distraction); rather it is the construction of taken as truth-ful world understandings. Futures imaginings in narrative form, in effect,are cultural theories “of symbolic actions, words, and/or deeds, that havesequence and meaning for those who live, create, and interpret them”(Fisher 1984:2). Additionally, as Fisher (1985) points out, to be embraced,an imagined futures narrative must be characterized by “probability,”that is, a coherence and consistency that harmonizes with existing cultur-al knowledge. Such narratives “ring true” to a population of listeners.

Within the realm of imagined environmental futures, author/activistShaun Chamberlin (2009:21) argues that people embrace cultural narra-tives that “tell ourselves about life…that allow us to make sense of the

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bewildering array of sensory experiences and the wider evidence weencounter. They tell us what is important, and they shape our perceptionsand thoughts.” With regard to global warming, Chamberlin has identifiedfour competing cultural narratives that have identifiable elite and/or pop-ular constituencies. The first of these, which he labels “Denial,” is anunderstanding of the future that is characterized by a business as usualperspective. In this cultural story, climate change is a minor affair anddoes not play much if any role in the shaping of coming events. The futureis envisioned as being similar to the present, but with more materialwealth because of steady economic “progress.” As suggested in the intro-duction, this scenario has been embraced and promoted by various cor-porate funders of a global warming denial discourse. Witnessed climaticchanges are dismissed as cyclical weather patterns or the product of otherconventional causes.

The second cultural story Chamberlin calls “Hitting the Wall.”Accepting global warming as a significant threat, those who embrace itenvision a future in which we have effectively responded to this dangerwith free market mechanisms (e.g., Green Capitalism, trading of green-house gas allowances) that permit continued expansion of production andconsumption. Thus, this can be characterized as a “business almost asusual” perspective.

The third alternative he labels the “ Impossible Dream.” It visualizes afuture in which a science-based techno-fix saves the planet and its inhab-itants. In this future, rooted in stalwart conviction about our endless abil-ity to invent our way out of problems and to achieve thereby a new envi-ronmental equilibrium, there will emerge exotic new technologiesdesigned to reflect solar energy away from the earth and eliminatemounting stratospheric carbon.

Chamberlin’s perspective on these three collective futures narratives, ashis labels suggest, parallel Mackenzie’s discussion of individual narratives,they are characterized by deception, indulgence, and wishful thinking. Thus,a theme that cross-cuts these first three scenarios (including the denial per-spective, which sometimes incorporates it as a back-up narrative) is thenotion of winners and losers in the time of global warming. As Leichenkoand O’Brien (2006:113) explain: “Under a binary approach, nations, regions,and populations are…categorized as either winners or losers based on aseries of biophysical measures such as changes in mean temperatures andrainfall amounts…” While it is generally recognized by those who foresee a


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future of winners and losers that people in much of sub-Saharan Africa andon small island nations will be losers, they assert that people in what aregenerally low-density populated areas, such as much of North America,northern Europe, Siberia, Tasmania, and New Zealand, will be among thewinners in terms of longer growing seasons and increasingly habitable lands.In other words, as Coreil (2004:3) notes, “Whether a particular impact is per-ceived as negative or positive depends on one’s interests.”

The final scenario in Chamberlin’s scheme involves a future character-ized by a broad transformative response to environmental threat. In thisimagined world, we achieve the mitigation of global warming through theadoption of alternative planet-friendly lifestyles and green energyapproaches. Inevitably, as indicated below in the conclusion, achieve-ment of such a future requires a commitment to environmental justice.

Confronting PluraleaIt is the argument of this paper that all of Chamberlin’s futures narratives,especially those that incorporate an acceptance of winners and losers, failto fully engage the issue of pluralea interactions and the threat they posefor human health and well-being. Of considerable importance in thestudy of pluraleal phenomena are their proximate and ultimate causes,and especially, from the anthropological standpoint, the precise role ofhuman social and economic systems in generating health damaging envi-ronmental stresses and the intertwined ecocrises that result. Also criticalto the pluralea perspective is the development of an understanding of thepathways and mechanisms through which two or more ecocrises interactto produce synergistic, magnified environmental and health impacts.

No less than the alternatives discussed by Chamberlin, the pluraleaperspective is a product of imaginings about the future; most directly, itis a descendent of a lineage of evidence-based calculations of the healthand environmental costs of societal pursuit of “natural resources.” One ofthe earliest published examinations of this issue was The Challenge ofMan’s Future by journalist Harrison Brown (1954). In this seminal volume,Brown (1954) argued that if all nations of the world were to achieve thelevel of development of the West there would eventually be a collapse ofthe natural resource base on which developed countries depend. WhileBrown’s warning had little impact when it was published, 18 years later,in 1972, the Club of Rome issued a similar book, entitled The Limits to

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Growth, that did attract attention from the media, researchers, and poli-cy-makers. Initiated in 1968, the Club of Rome was born of a conferencedesigned to discuss the costs of short-term thinking in internationalaffairs, especially the human penalties of promoting unlimited resourceconsumption in an increasingly interdependent world. Reflecting theefforts of an international and multidisciplinary team of experts who hadaccess to a wide range of data bases on world population, agricultural andindustrial production, resource depletion, and pollution, the book pro-jected a global economic collapse some time before 2100 AD. The causeof the collapse was explained as the calculable limits of the environmentto both provide the massive quantities of resources needed to meet risinglevels of consumption worldwide and to endure the anthropogenic pollu-tion borne of ever-expanding production (Club of Rome 1972). While com-mitted to market-based economics, the authors of The Limits to Growthrecognized the threat that industrial capitalism presents for maintainingthe fragile ecosystems on which all life depends.

Subsequently, in 1983, the United Nations General Assembly passed a res-olution creating the World Commission on Environment and Development.The Brundtland Commission, as it came to be known, first met in October1984 and published its report, Our Common Future, 900 days later, in April1987. Over the 900 days that the Commission was in session, signs of the omi-nous health-related impact of human activity on the environment regularlymade front page headlines around the world. These included:

• A drought-triggered, environment-development crisis in Africa thatput 36 million people at risk of starvation, killing perhaps a million.

• A leak in a pesticides factory in Bhopal, India that killed more than2,000 people and blinded and injured over 200,000 more.

• A liquid gas tank explosion in Mexico City that killed 1,000 and leftthousands more homeless.

• The Chernobyl nuclear reactor explosion that sent a radioactivecloud across Belarus, Ukraine, Russia, Western Europe and other sec-tors of the Western Hemisphere and exposed hundreds of thousandsof people to radioactive iodine-131.

• Agricultural chemicals, solvents, and mercury flowed into the RhineRiver during a warehouse fire in Switzerland, killing millions of fishand threatening drinking water in the Federal Republic of Germanyand the Netherlands.


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• An estimated 60 million people died of diarrheal diseases related tounsafe drinking water and malnutrition; mostly children.

Meanwhile, although it did not capture the attention of the writers ofOur Common Future, the greenhouse gases that propel global warming werecontinuing to build in the earth’s atmosphere, and here and there aroundthe globe, climate, glacial, oceanic and other scientists began to recordsigns of a significant shift in the Earth’s temperature. Early in the new cen-tury, a study by the World Health Organization (2002) concluded that over150,000 people a year were already dying from the effects of global warm-ing and predicted a doubling of this number by 2020, if not earlier.

Stressing the need for a shift in focus from individual environmentalproblems to interlocked environmental (and other) emergencies, theBrundtland Commission (1987) concluded that “The deepening and widen-ing environmental crisis presents a threat to national security—and evensurvival…” The potential for reaching such a dangerous state is not with-out precedent on Earth. The Permian-Triassic (P-T) Mass Extinction ofapproximately 250 million years ago wiped out 95% of all marine speciesand 85% of land dwelling species. Its cause appears to have been the buildup of planet-warming CO2 in the atmosphere (and a resulting rise in tem-perature of 10 to 30 degrees Celsius ), caused by massive lava outflows inSiberia. Atmospheric CO2 ultimately reached 1,000-1,500 parts per million(i.e., as much as 1,500 carbon dioxide molecules for every one million totalmolecules in the atmosphere) (Kiehl and Shields 2005). While current lev-els of CO2 are far lower (in the range of 385 parts per million), they are stillthe highest they have been for over 400,000 years and are rising at a fasterrate—2 parts per million per year with an expected jump to 3 parts permillion in the near future—than at any time in the past 20,000 years. Atthis pace, by the end of the next century levels could reach those thatoccurred with such catastrophic results during the Permian-Triassic.

Most environmental approaches to gaining insight about human healthhistorically have focused on the identification of one-on-one relationshipsbetween specific human health indicators and particular environmentalfactors (e.g., the impact of second-hand smoke exposure on rates of can-cer). Because of the complexity of the relationships between human soci-eties and environments, the simple observation of cause and effect con-sequences in hierarchical, interlocking systems generally has provedinsufficient to provide a complete picture of the nature and extent of the

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adverse human influence on the health of both ecosystems and thehuman beings who inhabit them. Missing has been a critical biosocialframework for comprehending how particular interactions occur (e.g.,social factors that influence the production, sales, and use patterns of apesticide like dioxin, its distribution in the environment, and its directand indirect health effects) (Roberts et al. 2003). Building on anthropolog-ical studies of societies in environmental context (e.g., Cole and Wolf1974, Wolf 1972), the multidisciplinary perspective of political ecology(Blaikie and Brookfield 1987, Foster 1994, Roberts and Grimes 2002)offers medical anthropology a starting point for developing such anunderstanding. This is achieved by integrating “spatially heterogeneousprocesses and actors within a framework of ecological, social, and politi-cal relations that links inquiry across scales of analysis” (Bury 2008:307).This approach is united with critical perspectives in the health and socialsciences (Baer, Singer, and Susser 2003; Krieger 2003; Singer 2009) to forma political ecology of health. The resulting theoretical framework lendsitself to broader research agendas in medical anthropology on the waysthat political, economic, and structural factors shape the interface amongsociety, health, and the environment (Baer and Singer 2009).

In light of this perspective on health and the environment, the remain-der of this paper presents two examples of contemporary interlockedecocrises and examines the diverse components and kinds of interactionthat comprise these health-threatening expressions of pluralea phenome-na. The implications of these developments for medical anthropology arediscussed in the conclusion.

Case 1 Flooding the HeartlandThe Midwest is often described as the most quintessentially “American” ofthe nation’s several regions. First recognized as having a distinct culturaltradition in the early part of the 20th century, Midwestern “character” andaccompanying values are known to have exerted considerable influence onthe American self-conception and identity. As described by Sisson, Zacherand Cayton (2007:12), in the popular imagination Midwesterners are“thought of as hard-working, thrifty, devoted to family values, strong incharacter, comfortable with normalcy, rather sedate and cautious aboutchange.” Yet, with reference to the environment, the Midwest is, in fact, aplace of extensive and rapid change, much of it as the result of intended


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and unintended human action. Exemplary are the environmental transfor-mations that contributed to the extreme weather events, including massflooding, that staggered the Midwest during the early summer of 2008.

The Midwestern location of the weather events in question is notewor-thy because an influential component of contemporary climate changediscourse has focused on the issue of “winners and losers,” namely theassertion that while some regions and some countries will suffer signifi-cant health and social consequences of global warming others will bene-fit and life there will get better. Among the commonly cited winners is theAmerican Midwest, whose corn, soybean, and wheat belts, some commen-tators have claimed, will expand profitably in the coming, warmer, yearsahead. As Easterbrook (2007) asserts,

Rising world temperatures might throw Indonesia, Mexico, Nigeria,and other low-latitude nations into generations of misery, whilecausing Canada, Greenland, and Scandinavia to experience a rip-roarin’ economic boom…. In North America, spring comes ever ear-lier—in recent years, trees have flowered in Washington, D.C.,almost a week earlier on average than a generation ago. People mayfind this creepy, but earlier springs and milder winters can have eco-nomic value to agriculture—and lest we forget, all modern soci-eties, including the United States, are grounded in agriculture.

The folly of such thinking is suggested by the scale of the storms that inun-dated the Midwest during the months of May and June of 2008, and theimplications they have for the alleged rosy future of the region. As graph-ically reported in USA Today (Keen 2008:1):

“Nightmare” was the only word Joe Russell could come up withSunday to describe the ordeal his family has been through in the pastweek. Five days after a tornado tore the roof off their one-storyhome on the banks of the Big Blue River in Indiana, a deluge of rainpoured into the remnants, soaking everything…“We’ve about hadit,” [Russell] said…“People are really stressed out.”…Hundreds ofthousands of customers lacked power across the region. Gov. MitchDaniels [of Indiana]…declared 13 counties as disaster areas, raisingthe total to 23. Jane Jankowski, a spokeswoman for Daniels, saidmore than 1,200 people were staying in shelters. “This thing came on

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fast with such a radical deluge of water that people were describinggoing from a feeling of security to waist-deep water in a matter or 15or 20 minutes,” Daniels said.

In Iowa, the result was extensive flooding involving most of the riversin the eastern part of the state beginning around June 8th. The flood stage(i.e., the point at which a body of water floods surrounding areas andcauses damage) of the Cedar River at Cedar Rapids is12 feet. The previousrecord flood occurred about 80 years ago in 1929, when the Cedar Riverrose to 20 feet. In 2008, the Cedar reached 20 feet and kept rising, withweather experts reporting that they expected the waterway to crest at 22feet. Later they changed this estimate to 24 feet. In fact, the river finallycrested at 31.3 feet, breaking the previous record by more than 11 feet.Cities like Cedar Rapids and Iowa City were hit hard by the storm’s floodwaters. In Cedar Rapids, for example, the downtown flooded and a rail-road bridge collapsed, spilling railroad cars filled with rock into the river.As a result, some Iowans began using the phrase “ Iowa‘s Katrina” to referto their experience.

Across the region, the economic costs (from flooded fields that couldnot be harvested to damaged infrastructure, commercial districts, anddwellings) are massive (and include potential impacts on fuel pricesbecause of the loss of corn fields central to the burgeoning biofuel indus-try, the growth of which has contributed significantly to the expansion ofcornfields into previous buffer zones).

While heavy rains at this time of year are not unusual in the Midwest;rainfall and other storms of the magnitude seen in 2008 are quite unusu-al. In all, nine rivers in Iowa hit record flood levels. Iowa’s Governor, ChetCulver, declared 83 of the state’s 99 counties disaster areas. As one insur-ance company official (quoted in Burns 2008) noted, “I’ve been in thebusiness for 30 years, and I can’t remember a couple of weeks followingMemorial Day that had this many storms one right after another.” Hiscompany logged 11,000 claims in Iowa, Minnesota, Wisconsin andMissouri, nearly double its average number of claims in previous years.

From a climate cycle point of view, flooding of the kind that sub-merged the Midwest is expected to occur once every 500 years (whichmeans that hyrologists, those who study the properties, distribution, andcirculation of water on Earth, believe that a flood of this enormity has a0.2% of occurring in a specific year in a given location). This is the second


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massive flooding of the region to occur since 1993, however. In the earli-er deluge, known as the Great Flood of 1993, 47 people died, 10,000homes were destroyed, 75 towns were engulfed in flood waters, and theregion suffered $15 billion in damages, making it one of the most devas-tating storms in modern US history (although far less than the $41 billion,or more, in damages caused by Hurricane Katrina or the approximatecombined $25 billion in damages wrought by the back-to-back Gulf CoastHurricanes Gustov and Ike in 2008) (Larson 1996; EQECAT 2008a, 2008b).Moreover, during the last 35 years, there have been four floods in theMississippi River basin area that based on their magnitude would havebeen characterized as 100-year floods, while relatively large Midwesternstorms that used to occur approximately every 20 years now arrive everyfour to six years (Zabarenko 2008).

This emergent pattern of larger, more frequent Midwest flooding hasled some climate scientists to investigate the role of global warming inchanging weather patterns because air warmed by the presence of thegreenhouse gases that now blanket the earth can carry far more waterthan cooler air. An analysis of weather data conducted by a group of envi-ronmental organizations from across the country concluded that there hasbeen a marked increase in the frequency of heavy rainstorms, with the fre-quency of “extreme rainfall” increasing by 24% between 1948 and 2006. Inthe Midwest, the frequency of extreme rainfall events has increased by20% since the late 1960s, while the number of days per year that see pre-cipitation greater than four inches has gone up by 50% over the last centu-ry (National Wildlife Federation 2008). Additionally, there has been asteady increase in temperature, streamflow and high streamflow across theUnited States during the 20th century (Groisman et al. 2002). Over the last50 years, hydrologists have recorded increases in rates of evaporation;near-surface humidity; total, low, convective cloudiness (Groisman et al.2001a, Sun et al. 2001); and early snow cover retreat (Groisman et al.2001b), as well as an earlier onset of both spring- and summer-like weath-er conditions, and a rise in thunderstorm activity (Changnon 2001). Inshort, there have been multiple indicators of warmer, wetter conditionsthat form the context for and fuel increases in damaging flooding events.While existing science does not yet allow close calibration of specific envi-ronmental events and broad trends like global warming, as theIntergovernmental Panel on Climate Change (2007:714) points out,“Significant increases in observed extreme precipitation have been report-

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ed over some parts of the world, for example over the USA, where theincrease is similar to changes expected under greenhouse warming.”

Further, Kamyar Enshayan, director of an environmental center at theUniversity of Northern Iowa, has pointed out that the disaster was not“natural” in the sense that the heavy rains fell on a landscape that hadbeen radically reengineered by humans. Notes Enshayan (quoted inAchenbach 2008:A1), “We’ve done numerous things to the landscape thattook away [its] water-absorbing functions.” The changes Enshayan refersto include: a) the replacement of tall grass prairies (which have now allbut disappeared) with plowed fields of corn and soybeans that, unlikeprairie grasses, have shallow roots that do not hinder the flow of waterrun-off as do prairie grasses; b) the thorough draining of developed fieldsthrough the installation of underground pipes; c) the straightening ofstreams and creeks, which has reduced the size of their banks whileincreasing their rates of water flow; d) the filling in and development offlood plains; e) the extension of cultivated land ever closer to creeks andrivers, eliminating the buffer zones that used to hold back rainfall frommoving rapidly from plowed fields to surface water; and f ) the biofuel-motivated removal, between 2007 and 2008, of over 100,000 acres ofland from the Conservation Reserve Program, which pays farmers not tocultivate tracts of potential farmland, thereby reducing the fallowacreage with deep roots in the soil.

As a result of these unrestrained efforts to expand food and biofuelproduction and human occupation, approximately 90% of the wetlands inIowa have disappeared. This loss is noteworthy because wetlands play acritical role in reducing the frequency and intensity of floods by acting asnatural defenses that slow water flows, absorb great quantities of water,and store water in the ground. Wetlands, in short, have an integral role inlimiting the health, economic, and social costs of flooding, which is themost common “natural” hazard in the United States. As a result, wetlands(and their loss) have a direct impact on human health. The primaryhealth-based environmental indicators associated with flooding, besidesdrowning (which claimed the lives of 16 people in the Midwest deluge),are infections caused by waterborne pathogens and water-based diseasevectors; contact with polluted water that contains the outflow of over-whelmed sewage systems, petroleum products, toxins from built environ-ments, uncollected garbage, and dead animals; and respiratory and neu-rological diseases caused by mold that forms in damp structures.


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In the aftermath of the Midwest floods, public health officials expressedparticular concern about several waterborne pathogens, including E. coli,giardia, and cryptosporidosis. Cryptosporidium parvum, for example,became a major health hazard after the 1993 Mississippi flooding ofMilwaukee (Epstein 2005). During a two week period, 25% of Milwaukee res-idents were infected. Victims suffered from painful stomach cramps, severediarrhea, high fever, and dehydration, and over 100 people, especially eld-erly individuals and those suffering from immune conditions, died.

Given the tendency of flooding to form pools of stationary water,another health threat faced by the Midwest was the potential for mosqui-to-borne infections. The Siouxland District Health Department in Iowa, forexample, reported that after the storms ended, the Sioux City area wascovered in mosquito-friendly pools of stationary water. In Indiana, healthofficial reported trapping a number of mosquitoes infected with West Nilevirus (Johnson 2008). The primary carriers of West Nile Virus are Culexmosquitoes, a species that prefers to breed in artificial containers such asold tires, buckets, wading pools and clogged rain gutters, but will also layeggs in pooled water after flooding. The severity of West Nile infectionvaries greatly, with some sufferers developing encephalitis and othersexperiencing no apparent symptoms at all. Among the reported humanWest Nile cases in Iowa in 2008, the most common symptoms were:fatigue (100%), fever (83%), muscle aches (83%), joint pain (83%), headache(67%), and nausea (67%) (Iowa Department of Public Health 2008).

There is a special risk of chemical exposure in areas near flooded struc-tures that contain hazardous materials, include asbestos, propane, chem-icals, gas and oil, and pesticides. In Cedar Falls, Iowa, for example, amaintenance building that contained 2,4,5-trichlorophenoxyacetic acid, apowerful herbicide found in the defoliant Agent Orange, was overrun bythe Cedar River, and some of the chemical spilled into the floodwaters(Johnson 2008).

Another consequence of the flooding of structures is the subsequentgrowth of mold, which is known to be the source of severe allergic reac-tions and potentially fatal respiratory seizures. Particularly dangerous aremolds that produce mycotoxins. People can be exposed to mycotoxinsthrough skin contact, inhalation, or ingestion. Symptoms and diseasescaused by exposure include wheezing, memory and hearing loss, chronicbronchitis, hypersensitivity pneumonitis, learning disabilities, mentaldeficiencies, heart problems, multiple sclerosis, chronic fatigue, lupus,

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fibromyalgia, rheumatoid arthritis, and bleeding lungs. Mycotoxins canalso cause suppression of immune system function, putting sufferers atgrave risk for a wide range of other health conditions, and some mycotox-ins are carcinogenic (Brandt et al. 2006).

In sum, global warming is not likely to bring wealthier and certainlynot healthier times to the Midwest because, contrary to the premises ofthe “winners and losers” perspective, climate change is not an isolatedevent. Rather, because of interaction with other adverse anthropogeniceco-changes in the region, as seen in the flooding of 2008, many if notmost Midwesterners will be climate change “ losers” in the absence of farreaching mitigation efforts.

Case 2 Collapse of the Sacramento Delta

“For all its value and beauty…. the delta is also on the verge ofcollapse” (Yeoman 2008:29-30).

The collapse referenced by Yeoman is affirmed by John Paul Woodley, Jr.,the assistant secretary of the army for civil works, who asserted at the“Still Battling the Inland Sea” conference held in Sacramento in July 2007:“If I had been asked prior to August of 2005 which of the two great cities,New Orleans or Sacramento, was in the most danger of catastrophic inun-dation, my answer would not have been New Orleans, my answer wouldhave been Sacramento” (ASCE News 2007). The reason for Woodley’sassessment is the current state of the Sacramento-San Joaquin River Delta,one of the 60 largest river deltas in the world and the largest on the westcoast of the United States. Situated east of San Francisco on the westernedge of the Central Valley of California, it is one of the few inverted riverdeltas in the world. In this type of formation, the narrow end of thebranching fan of land patches and waterways faces the ocean while thewide end is turned inland to catch water runoff from the western flank ofthe Sierra Nevada Mountains and the south portion of the Cascades, aswell as part of the coastal range. It is a vast watershed that captures morethan half of California’s rainfall and snowmelt, which drains through therivers and other waterways of the Delta on its way through the CarquinezStrait into San Francisco Bay and ultimately the Pacific Ocean. As a result,in the past the Delta flooded over with each spring’s snow melt, forming


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a giant estuary that was once called the Everglades of the West. Given theendangered state of the Everglades, and the causes of its decline, thecomparison is now frighteningly accurate.

The making of the modern Delta is the story of California. In 1846,Edwin Bryant (1848), a Kentucky journalist, visited the area and recordeda description of the Delta in his journal, which, following the discovery ofgold in California (an event that made the state’s name a household wordthroughout the nation), was published and became a best seller:

The Sacramento and San Joaquin Rivers empty into the Bay of SanFrancisco at the same point, about sixty miles from the Pacific, andby numerous mouths or sloughs as they are here called. Thesesloughs wind through an immense timbered swamp, and constitutea terraqueous labyrinth of such intricacy, that unskilful [sic] andinexperienced navigators have been lost for many days in it, andsome, I have been told, have perished, never finding their way out.

With the support of Congress (which in 1850 passed the Swamp andOverflow Land Act conveying ownership of the Delta to the State ofCalifornia), settlers arrived and began to drain the marshes. In the late19th century, levees, comprised of parallel walls of sun-dried peat bricks,were built by thousands of Chinese laborers brought in to help controlflooding and create what soon became an archipelago of 70 highly fertile“peat-dirt” islands (some of which are now 15-20 feet below sea level andsinking at a pace of about three inches a year) surrounded by 700 miles ofwaterways. With its naturally spreading water controlled, the Delta grewinto the pear capital of the world and at one time produced nearly 90% ofthe asparagus grown on the planet. Other Delta crops include cherries,corn, wheat, tomatoes, and wine grapes. Because of its plentiful water(which now serves the domestic consumption needs of two out of threeCalifornians, or approximately 23 million people) and agricultural produc-tivity (yielding a harvest valued at $2 billion a year from just over 300,000acres of land), the Delta became pivotal to the fast-growing economy of arapidly populating and politically powerful state.

From early on, there were fortunes to be made in Delta farming, andmen like Louis Meyers, an orchard magnate—whose four-story 58-roomItalian Renaissance villa with five marble fireplaces, inlaid parquet floors,rare handmade tile work, and imported wood paneling, on the Delta’s

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Grand Island, still stands—were among the promoters and benefactors ofthe re-shaped Delta ecosystem.

Today, however, the fortunes of the Delta seem far less favorable.While its well publicized “Thousand Miles of Waterways” have made recre-ational fishing an important tourist attraction in the Delta—at one time,long time residents report, stripped bass were so plentiful they could bescooped from local waters with a hand net—native fish populations ofsalmon, steelhead, sturgeon, smelt, and striped bass are declining at analarming rate, suggesting that the entire Delta ecosystem is seriously outof balance. Some species, like the delta smelt, verge on extinction. Loss ofthis tiny fish is dangerous because it has long served as a primary foodsource for larger fish. Alien plants and animals (introduced by ships thattravel the Stockton Deep Water Ship Channel that was dredged throughthe Delta in the 1930s to link Sacramento to the ocean) now thrive in thealtered environment. One invader, the overbite clam, is an aggressivecompetitor for estuary plankton, another critical food source for nativefish species. Intertwined agricultural threats to the water species of theDelta include nitrogen fertilizers and pesticides run-off.

Data collected by researchers at the University of California, Davisreveal 57 different pesticides in the waters and soils of the San JoaquinRiver system (Jahagirdar 2006). At almost half of the testing stations setup by researchers along the river system, pesticide levels exceeded theenvironmental safety and public health standards implemented by theCentral Valley Water Board. Moreover, most of the chemicals identified inthe water system have been linked to health problems ranging from can-cer to brain damage. Over the last 35 years, there has been a continualpattern of “pesticide substitution” as each class of agricultural pest killeris found to be harmful and is replaced by a new set of powerful chemicalsthat initially are touted as being free of the negative consequences oftheir predecessors, only in time to be found to be as dangerous or evenmore dangerous to the environment than the pesticides they replaced.Thus, when DDT was banned in 1973, after its deadly effects on wildlifebecame known, it was replaced by the organophosphates. As the harmcaused by these substances was documented, they, in turn, were replacedby the pyrethroids. Current research indicates that pyrethroid pesticidesmay be even more toxic to fish than their predecessors. Notably researchon the San Joaquin River found pollution by all three of these classes ofpesticide (Jahagirdar 2006).


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The river was also found to contain deadly heavy metals, such as sele-nium (which has been responsible for bird kills at Kesterson Reservoir inCalifornia’s Central Valley) and mercury, salts like boron, and other chem-icals that feed rampant algae growth that uses up the oxygen needed byother aquatic wildlife. Many of these chemicals derive from fertilizers,which are high in nitrogen and phosphorous. Nitrate compounds thatform from the nitrogen in fertilizer are a health hazard that at sufficientlevels can cause a fatal condition in young children called “blue baby syn-drome” (i.e., cyanosis).

There is another toxin in the waters of the Delta that is a direct prod-uct of the growing human population in the region. The toxin, ammonia,is a common byproduct of human urine and feces. Studies show that theSacramento region sewage treatment plant—which discharges treatedwastewater produced by almost one and a half million residents (withoutremoving ammonia), is the largest single source of ammonia in the Delta.The ammonia load in the wastewater produced by the residents ofSacramento has more than doubled since 1985 as a result of rapid urbangrowth (Weiser 2008). Moreover, Environmental Protection Agency datareleased by the California Sportfishing Protection Alliance (2007) indicatethat the city of Stockton violated its wastewater discharge permit 50 timesin 2005, allowing ammonia to exceed allowed levels per occasion by 23 to1,245%. In the assessment of Bill Jennings, the executive director of theAlliance, which sued the city:

Stockton’s wastewater control system is a public health and environ-mental hazard…The City’s failure to provide adequate facilities andacceptable levels of maintenance for wastewater control indicatesan outrageous and egregious disregard for the health of Stockton’sresidents and poses a clear threat to the integrity and survival of theDelta’s fish and wildlife resources…

Richard Dugdale and colleagues (2007) at the San Francisco StateUniversity’s Romberg Tiburon Center have investigated the impact ofammonia on the food chain of the Delta. They report that ammonia killsdiatom, an algae that also forms part of the Delta food chain. Larval smeltare also believed to be particularly sensitive to the rising ammonia levels.Further, nuisance algal blooms that have begun clogging Delta waterwayshave been traced to rising ammonia levels.

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These changes, however, are not the only ecocidal forces pushing theDelta toward crisis. The earthen levees that keep the farmlands of theDelta artificially dry are fragile and subject to collapse. On June 3, 2004,for example, a 350 foot section of the levee 10 miles west of Stocktoncrumbled, flooding 12,000 acres of Upper Jones Tract Island and causing$90 million in damage. Six months were needed to pump the water out ofthe area. Over the last 100 years, there have been over 165 levee failures,and, given the ever present threat of earthquakes in California, the poten-tial for widespread levee breach is great.

Global warming, which is causing more frequent extreme weather eventsand pushing sea levels ever higher (estimated to rise two feet on theCalifornia coast by the end of the century), is another growing threat tolevee integrity (Logan 1990). In addition to causing an increase in meanwater surface, which puts direct pressure on the levees, “sea level rise willincrease the frequency and duration of extreme high water events from theco-occurrence of high tidal elevations, El Niño–like disturbances, low pres-sure systems, and high inflows” (Lund et al. 2008:10). The result will be aconsiderable boost in the length of time levees are stressed by high water,significantly raising the likelihood of levee failure. Even without damage tothe levees, a rising ocean will steadily increase the salinity of Delta water.Ironically, farming the Delta has itself contributed to global warming byreleasing a considerable amount of CO2 from the local peat soil into theatmosphere. A study completed in 2005 by a team led by Jeffrey Mount,director of the Center for Watershed Sciences at the University of California,Davis (Mount et al. 2006) projected a 64% chance that up to 20 levees willfail simultaneously at some point within the next 50 years.

Also threatening the levees, and the rapidly declining fish populations,is the massive pumping of water out of the Delta. The water goes both tofeed the sprawling, highly profitable, farmlands of the San Joaquin Valley—a center of US vegetable and fruit production that could not sustain suchhigh-yield farming based on local rainfall and natural stream flow—and toprovide drinking water to many California residents. Massive pumps, builtat two locations, are capable of drawing out millions of cubic feet of waterper hour and pushing the precious liquid into a series of aqueducts, canals,and reservoirs. One pumping station moves water into a canal that travelsover a hundred miles to bring water to the fields of the San Joaquin Valley,allowing the production of $20 billion worth of tomatoes, peppers, cotton,and other crops. The other pump, part of a system known as the State Water


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Project, one of the largest artificial water-distribution initiatives on theplanet, diverts water from Northern California and the Central Valley to 150cities in Southern California, providing them with at least a portion of theirpotable water. Together, during rainy years, the two pump systems divertenough water from the Delta “to flood a 1,000 football fields more than amile deep” (Yeoman 2008:31).

The consequence of these various interacting anthropogenic forces issummarized in a report issued by the Public Policy Institute of California(Lund et al. 2008:7-8), which points out that

Natural systems that have been heavily influenced by human activi-ties—of which the Delta is a prime example—are vulnerable to sig-nificant change from two distinct sources… First, external factors(such as climate change) can dramatically alter conditions. Second,the way human activities interact with natural processes can createadditional pressures. As these systems lose their resiliency, theybecome vulnerable to dramatic and potentially abrupt shifts in phys-ical and biological conditions… These changes are often associatedwith thresholds or tipping points where change is…irreversible….The Delta is at a tipping point.

Without massive, costly intervention (which, because of the magnitudeof the forces involved cannot insure success), dramatic changes in theDelta, that have momentous health and social consequences forCalifornians and the nation, lie ahead.

Conclusions: Moment of Danger, Moment of TruthAs Bodley (2008:49) indicates, “The basic cause of environmental crisis ishumans making too many demands on nature.” These demands take threeprimary forms: 1) reaching rates of resource depletion in the process ofcommodity production and consumption that exceeds rates of resourceproduction through biological and other natural processes; 2) restructur-ing and simplifying environmental systems in ways that upset ecologicalbalances and trigger climatic and other disruptive environmental events;and 3) discarding vast quantities of waste that interfere with natural recy-cling processes. While all human systems through time have put demandson their local environments, and even caused some degree of environmen-

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tal restructuring and degradation, species extinction, or even variousforms of local societal collapse (Diamond 2005), the rise of the global cap-italist system, with its fossil-fuel driven technology, emphasis on everexpanding consumption, and truly worldwide impact has increased thelikelihood of triggering a cascade of interacting and life-threateningecocrises to a level never seen before in human history. Pluralea interac-tions of this sort undercut narratives of regional “winners and losers” ofclimatic or other environmental change. Instead, they imperil—althoughnot necessarily in quite the same ways nor always to the same degree—thehealth and social well-being of all human populations and magnify thecritical need for meaningful mitigation efforts and wider societal transfor-mations. Further, the occurrence of pluralea interactions clarify that ourdominant approaches to the environment, reflected in the first three ofChamberlin’s imagined futures, have put us in perilous times.

Over its relative short history as a named subdiscipline, the field ofmedical anthropology (while a diverse field) has moved from an earlyfocus on environment and health issues towards an orientation that priv-ileges cultural and social structural factors over environmental ones.Greater unification of these approaches—such as examination of theinterplay of cultural narratives and environmental experiences—and thedevelopment of an environmentally conscious critical anthropology ofhealth (or alternatively, an anthropologically informed political ecologyof health [Greenberg and Park 1994]), offers an important direction formedical anthropology in the 21st century. In this regard, one of thestrongest contributions medical anthropology can make to the study ofpluralea phenomenon, in addition to calling attention to their growingimportance in global health, is the careful on-the-ground analysis—verylikely often as members of multidisciplinary teams—of the nature oflocal and regional ecocrises interactions, their social determinants, andcommunity responses to these adverse events. Additionally, given thegrave nature of the issues involved, the tremendous disparities in the dis-tribution of the human consequences of pluralea phenomena, theinequalities in the distribution of political and economic power thatunderlies anthropogenic environmental changes, and the growing emer-gence of local and social movements for change, there is a need for anengaged medical anthropology, one that seeks, in collaboration with thecommunities it studies and activist movements, to apply its insights toamelioration. In short, in light of recognition of pluralea interactions as


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representing grave threats to all human futures, there is a critical need fora new applied narrative of environmental health equity and action.

ACKNOWLEDGMENTS

I want to thank Hans Baer and Pamela Erickson for reading and providing commentson an earlier draft of this paper.

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