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common ground

Stewards of the Human Landscape
Spring 2001

Online Archive

*  The Heart of the Problem: The Local Burden of National Policies

(image) Illustration of park constituants.

"Environmental problems create winners and losers . . . Losers suffer from lost resources, health, and livelihood. Their powerlessness is often tied to poverty, ethnicity, or religion. "

Barbara Johnston

by Edward B. Liebow

If there is one thing I have learned over the past two decades of providing policy advice on a number of social, public health, and environmental issues, it is this: the problems we leave for government are among the stickiest, the ones for which no simple, ready solution can be found, the ones where the stakes are high, the uncertainties great, and the impacts broadly felt for the longest time.

Who do we count on to promote world peace, to clean up the toxic by-products of a vigilant defense effort? Who do we expect to care for sick people who are least able to pay? Who do we tap to support the open-ended pursuit of knowledge, confident of a payoff someday, even if we can't predict its precise nature?

That's right, it's "we, the people"—our government. And if the business of government is policymaking, it is an article of faith that if you start with the wrong formulation of the problem, you will end up with bad policy. And problem structuring is an important aim in having a cultural anthropologist on a policymaking team.

A few highlights from recent projects show how, in the landscape of problems entrusted to government, cultural anthropologists engage those most likely to bear the local burden of national policies.

Dealing with Nuclear Contamination

One of the more polluted places on earth, the Department of Energy's Hanford nuclear facility has been suspected of posing health risks to thousands of people who have shared its air- and watersheds in the Pacific Northwest. Cultural anthropologists have been part of a multidisciplinary team assisting the U.S. Public Health Service in reconstructing where and how people were living when they might have received the greatest exposure to contamination.1

How many people were exposed to unhealthy levels? At what ages? What kinds of food, drinking water, time spent outdoors, or occupations placed them at greater risk? Did certain groups—tribes, migrant farm workers, military personnel—receive higher doses? How prepared are the region's health care providers to answer their questions? These are the issues in deciding the appropriate kinds of health care and education.

The singular contribution of anthropologists has been in equipping communities to take part in making the decisions. In a sense, a mutual transformation is taking place among agency scientists and the public they are trying to serve. Just as communities and tribes have learned to talk the talk of environmental toxicology, health physics, and hydrology, specialists in these fields have learned from seeing their models implode, their introspection a poor substitute for considering the many, sometimes conflicting values held by the public.

A strategy of inclusion, collaboration, and acknowledgment of local insight, fashioned with the help and oversight of anthropologists, helps assure that the "public interest" in fact embraces a broad scope of perspectives, particularly those held by disadvantaged groups historically excluded from the dialogue.

Disposing of Chemical Weapons

Across the country, chemical weapons are slated for destruction, to reduce the risk of contamination and to honor an international treaty. Where there are large stockpiles, incineration is the choice of a National Research Council committee directed by Congress to weigh the hazards of different disposal alternatives. Many citizens' groups remain unconvinced of the incinerators' safety. The U.S. Army, who is carrying out the task, not only faces choices about the disposal technologies, but also questions about public health and the environment once the choices are made.2

A multidisciplinary team of social scientists, including an applied anthropologist, conducted more than 200 individual interviews and 40 focus groups in communities near where the weapons are stored. Interviews were also conducted with Army managers. We found out a great deal about the underlying reasons for the conflict. The Army managers saw their job as carrying out technical studies to demonstrate that incineration, a choice made by Congress, can be done safely. In contrast, the residents' concerns were broader, echoing those of local groups across the country: Who is making the decision? Is it fair? Has the public been given opportunity for involvement? Has the agency's track record demonstrated concern for the community? What can the community expect in the future? Can the public trust agencies responsible for their safety?

Our research highlighted the real problem: the impossibility of addressing issues of technology without addressing issues of fairness, safety, and agency credibility. In the public's view, those aspects of the chemical stockpile program were all inextricably linked.

Tracking an Outbreak

Syphilis has just about been eliminated in most parts of the country, but not in several southern states, where it is heavily concentrated among African-Americans. When the South was awash in an outbreak during the late 1980s and early 1990s, federal health officials assumed it was from people exchanging sex for crack cocaine, whose use was on the rise at the time.

Conventional wisdom holds that for many sexually transmitted diseases, persistence depends on a group of people who frequently change partners, as they can be a reservoir of infection among the sexually active. The implications of this "core transmitter group" are clear for disease policy: track and treat the group spreading the infection and you will protect the public. Tracing contacts also helps avoid long-term costs like caring for congenitally infected infants and children.

At the request of the U.S. Centers for Disease Control and Prevention, a multidisciplinary team of public health researchers and applied anthropologists assessed the agency's strategies for supporting control and prevention by state and local agencies.3 This work revealed a much more complex social landscape for transmitting the disease. Sex-for-drugs exchanges are risky, but so are other social situations. Incarceration in state prisons and local jails, being homeless and nearly-homeless, and men having anonymous, unprotected sex with other men in public venues like parks and highway rest stops all placed people at elevated risk for becoming infected.

We suggested to CDC that the notion of a "core group" is at best misleading, because it directs the focus to an extremely small number of people, rather than taking a step back and seeing a number of distinct, if not altogether mutually exclusive, social players. What's more, we suggested that stigmatizing individuals as members of a so-called "core group" can undermine trust in public health. We also suggested that, rather than "reinvent the wheel," CDC collaborate with local institutions since many of the at-risk already have ties to them. By re-framing the problem in terms of risk scenarios, we helped to identify the people most likely to acquire or transmit the disease, the institutions likely to reach them, and the ways to mobilize these institutions.

Who Makes the Big Decisions?

In each of these cases, the central policy question is how to reduce the public's exposure to hazards. Finding acceptable answers involves value-laden, conflict-riddled choices over who will bear the burden locally in order to achieve a widespread benefit. In practical terms, the issue is whose values should inform the choices. Who ought to sit at the table when the big decisions get made? Too often, choices are regarded as matters of "fact" to be made only by specialists with the right knowledge or "expertise." Non-specialists are labeled "inexpert," their judgments discounted as ill-informed, politically motivated, or both. In my experience, excluding them from decisions promotes a lack of trust in the specialists, a feeling that the hazards and remedies are beyond the control of those most affected.

One specific aim of the applied anthropologist's involvement is to give voice to the insights of the non-specialists, lending authority to lay judgments about health dangers and the agencies responsible for managing them. In recent decades, anthropologists have been forced to learn that sharing ethnographic authority—relinquishing its sole possession, really—is essential to building policy that serves the public interest in the next century. Now we must rise to the challenge of transforming the practice of scientific undertakings, helping scientists to re-examine the premise of "scientific authority" on which all science-based policy is founded.

Anthropologist Edward Liebow has conducted research and public policy analysis throughout the United States and in Australia, examining a variety of energy, public health, and social policy issues concerning disadvantaged communities. For more information, contact him at the Environmental Health and Social Policy Center, 909 NE 43rd Street, Seattle WA 98105, (206) 675-1002, fax (206) 675-1005, e-mail liebow@policycenter.com

Notes

1. In particular, the Centers for Disease Control, Agency for Toxic Substances and Disease Registry, and the Indian Health Service. For more information about the Hanford-related public health studies, look to the world wide web at www.doh.wa.gov/hanford/. Also, the Intertribal Council on Hanford Health Projects, a consortium of nine tribal governments involved in the Hanford work, is described in Wilkinson, J.R., and E.B. Liebow, 1998, "Tribal Involvement, Tribal Capacity, and Historical Dose Reconstruction," in T. Takaro, editor, Proceedings of the First Annual Conference on The Health of the Hanford Site: Current Challenges, December 3-4, 1997, Richland, Washington, Seattle: School of Public Health, University of Washington.

2. For more information about the Army's program for disposing of chemical warfare materiel, look for additional reading and background information on the web at www-pmcd.apgea.army.mil/ and at the not-for-profit Keystone Center's online "Dialogue on Assembled Chemical Weapons" at http://dialogue.pmacwa.org/. Also, see Liebow, Edward B., Judith A. Bradbury, Kristi M. Branch, et al. 1998. "The Landscape of Reason: A Scheme for Representing Arguments Concerning Environmental, Health, and Safety Effects of Chemical Weapons Disposal in the U.S.," High Plains Anthropologist 18(2): 115-126.

3. For an overview of the epidemiology of syphilis in the South, see Thomas, James C., Alice L. Kulik, and Victor J. Schoenbach, 1995, "Syphilis in the South: Rural Rates Surpass Urban Rates in North Carolina," American Journal of Public Health 85(8): 1119-1122. An anthropological analysis of sex-for-drugs exchanges can be found in Ratner, Mitchell S., 1993, "Sex, Drugs, and Public Policy: Studying and Understanding the Sex-for-Crack Phenomenon," in Crack Pipe as Pimp: An Ethnographic Investigation of Sex-for-Crack Exchanges, Mitchell S. Ratner, ed., New York, NY: Lexington Books. See also our recent evaluation report: Liebow, E.B., K.R. Mitchell, K.J. Goodman, G.P. Myers, L.A. Fish, M.L. Hare, and M.O. Butler, 1996, Assessment of STD Prevention Program Responses to the Early Syphilis Epidemic in the Southern United States, prepared for U.S. Centers for Disease Control and Prevention, Center for Prevention Services, Division of STD/HIV, Contract No. 200-93-0626, Seattle: Battelle Seattle Research Center, Report No. BSRC-700/96/011.

MJB/EJL