1 Health Consequences of Environmental Degradation and Social InjusticeMartin Donohoe, M.D., F.A.C.P.

2 Am I Stoned? A 1999 Utah anti-drug pamphlet warns:“Danger signs that your child may be smoking marijuana include excessive preoccupation with social causes, race relations, and environmental issues”

3 Our Home

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5 Perspective The earth spins at 1,038 mph at the equator, between 700 mph and 900 mph at mid-latitudes The earth rotates around sun at 18.5 miles/sec The solar system orbits the center of the Milky Way Galaxy at 137 miles/sec One rotation per 225 million years

6 Perspective The sun is one of hundreds of billions of stars in the Milky Way Galaxy The Milky Way is one of over one hundred billion galaxies in the known universe Ordinary visible matter accounts for only 5% of the universe (95% dark matter/dark energy) The universe may be one of an infinite number of universes

7 The Planets

8 Our Solar System

9 Jupiter = one pixel, Earth = invisible

10 Sun = one pixel, Jupiter = invisible

11 Earth/Moon Seen by Voyager Spacecraft through Saturn’s Rings

12 Portland, Oregon Mount Hood

13 Multnomah Falls, Oregon

14 Chief Seattle “The earth is our mother. Whatever befalls the earth befalls the sons of the earth. The earth does not belong to man, man belongs to the earth. All things are connected like the blood that unites us all. Man did not weave the web of life, he is merely a strand in it. Whatever he does to the web, he does to himself.”

15 The Environment The natural environment The built environmentThe social environment

16 Causes of Environmental DegradationOverpopulation Pollution Deforestation Global Warming Agricultural/Fishing Practices Overconsumption / Affluenza Militarization

17 Causes of Environmental DegradationMaldistribution of Wealth National and Global Political and Economic Institutions Poor education Media manipulation and inaccurate reporting Unbalanced political influence Citizen apathy

18 Consequences of Environmental DegradationIncreased poverty and overcrowding Famine Weather extremes Species loss Medical illnesses Infectious diseases

19 Consequences of Environmental DegradationDeath (40% of world’s yearly deaths linked to water, air, and soil pollution) War Ecological footprint (22 hectares/person) exceeds Earth’s biological capacity (16 hectares/person) Malthusian chaos and disaster Tragedy of the Commons

20 Economic Costs of Environmental DiseasesEstimated at $ billion/year in the U.S. alone ($1.25-$2.0 billion in Oregon) Does not count the psychological and emotional costs of the human suffering involved for the victims, their families, and their communities

21 Economic Costs of Environmental Diseases: OregonAdult and childhood asthma: $30 million Childhood asthma: $28 million Adult cardiovascular disease: $342 million Childhood cancer: $9 million Childhood lead exposure: $878 million Birth defects: $3 million Neurobehavioral disorders: $187 million Source: OEC, The Price of Pollution, 2/08

22 Premature Deaths in the U.S.10% due to inadequate medical care 60% due to behaviors, social circumstances, and environmental exposures

23 Overpopulation World population - exponential growth1 billion in 1800 2.5 billion in 1950 6 billion in 2000 7.1 billion in 2013 (1/15 humans ever to live is alive today) est. 9.7 billion by 2050, 12 billion by 2100 More people added to the planet in the last 40 years than in all previous recorded history

24 Overpopulation Africa, Asia, and Latin America primarily affectedCauses: Poverty Women’s rights issues – impaired access to reproductive health care and education, political/legal/economic/social marginalization

25 World Population

26 Urbanization 20-30 million people/year leave rural for urban areas2007: first time in history that more than half the world’s population live in urban areas

27 The Displaced World migrant population = 42 million15 million refugees 26 million internally displaced persons Economic, war and environmental refugees Vast majority of refugees hosted in the developing world

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32 Urban Sprawl Since the 1960’s America’s metropolitan areas have been consuming land at a rate 4x faster that population growth 6,000 acres of open space lost per day

33 Wallace Stegner “We simply need … wild country available to us, even if we never do more than drive to its edge and look in. For it can be a means of reassuring ourselves of our sanity as creatures, a part of the geography of hope”

34 Pollution World’s Most Polluted Places1. Air pollution: Linfen, China (16 of the top 20 cities are in China) 2. Industrial chemicals: Bhopal, India 3. Mercury: Central Kalimantan province, Indonesia 4. Pesticides: Kasargod, India

35 World’s Most Polluted Places5. Chemical weapons/manufacture waste: Dzerhinsk, Russia 6. Organic chemicals: Sumgayit, Azerbaijan 7. Lead: Tianying, China

36 World’s Most Polluted Places8. Hexavalent chromium: Sukinda, India 9. Radiation: Chernobyl, Ukraine 10. Persistent organic pollutants (POPs): Arctic Canada

37 Air Pollution

38 Air Pollution

39 World’s Most Polluted Cities (2014, WHO)

40 Most Polluted Cities in the US Ozone, or Smog (2016)#1: Los Angeles-Long Beach, CA #2: Bakersfield, CA #3: Visalia-Porterville-Hanford, CA #4: Fresno-Madera, CA #5: Phoenix-Mesa-Scottsdale, AZ #6: Sacramento-Roseville, CA #7: Modesto-Merced, CA #8: Denver/Aurora, CO #9: Las Vegas-Henderson, NV-AZ #10: Fort Collins, CO

41 Most Polluted Cities in the US Particulate Matter (2016)#1: Bakersfield, CA #2: Visalia-Porterville-Hanford, CA #3: Fresno-Madera, CA #4: Los Angeles-Long Beach, CA #5: El Centro, CA #6: Modesto-Merced, CA #6: San Jose-San Francisco-Oakland, CA #8: Cincinnati-Wilmington-Maysville, OH-KY-IN #9: Harrisburg-York-Lebanon, PA #10: Lousville/Jefferson County—Elizabethtown—Madison, KY-IN

42 Health Effects of Air PollutionCauses 200,000 premature deaths/yr. in U.S. (6.5-7 million worldwide) Causes 1/8 deaths worldwide Far more than are killed by auto accidents

43 Health Effects of Air PollutionAir pollution causes lung cancer and asthma and impairs lung development and function 220,000 lung cancer deaths/yr (2010) Deaths from cardiopulmonary diseases correlate with air pollution levels in US cities Both day to day and over time Triggers 7.4% of heart attacks worldwide

44 Health Effects of Air PollutionIncreased admissions for CHF, asthma, COPD, PVD, and cerebrovascular disease (stroke and TIA) Increased ventricular arrhythmias Increased lung/breast/liver/upper digestive/pancreatic cancers Decreased exercise tolerance, increased pulmonary symptoms

45 Health Effects of Air PollutionIncreased risk of diabetes Increased risk of DVTs/PEs Increased risk of rheumatoid arthritis Impaired sperm production Premature births (1/3 more common in large towns/cities) Pre-eclampsia

46 Health Effects of Air PollutionIncrease in SGA and LBW infants Increased risk of birth defects (including neural tube defects, circulatory system malformations) Increased risk of appendicitis ?Via link with inflammation?

47 Health Effects of Air PollutionAccelerated cognitive decline, increased dementia Increased numbers of migraines ?Autism? Days lost from work/school Increased risk of suicide

48 Air Pollution Coarse, fine and ultrafine particlesUltrafines not regulated, may be most dangerous Nanoparticles may contribute to health risks Massive dust storms increasing

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50 Air Pollution Costing the 34 member OECD states almost $2 trillion/yr, Europe $1.6 trillion/yr, China almost $1.5 trillion/yr, India over $500 billion/yr Reductions in air pollution under Clean Air Act Account for up to 15% of overall increase in life expectancy in major U.S. metropolitan areas Act has saved $22 trillion in health care costs since 1972 passage Saved 160,000 lives in 2010

51 Ozone Destruction Ozone hole over Antarctic (2½X size of Europe = size of North America) Arctic ozone hole only 9% less than 2000 maximum 40% of Arctic ozone destroyed Hole should gradually decrease in size over many years, close by 2060

52 Effects of Ozone DestructionIncreased cataracts (UV damage) Increased lifetime melanoma risk 1/ 1/68 - today

53 Antarctic Ozone Hole

54 Automobiles

55 Automobiles Number of autos -US: 1.17 car/2 people (88% drive to work)- Average American will own 13 cars during his/her lifetime -Mexico: 1/8 -China: 1/100 (increasing, has surpassed US auto sales) -Worldwide: over 1 billion cars (1/7 people)

56 Automobiles Over 1.2 million killed, million injured/disabled in road accidents annually worldwide Toxic air pollution contributes to car accidents Average miles traveled/car/year in U.S. ,570 mi. ,150 mi. ,460 mi. ,220 mi. 2010 – 12,500 mi.

57 Automobiles Average fuel efficiency of U.S. autos stagnantCars and trucks (2015): 33.8 mpg (sticker, reality 26.1 mpg) Government mandated fleet mpg of 54.5 mpg by 2025 (real-world estimate 40 mpg) European and Japanese standards higher Relatively low oil prices (until recently)

58 Automobiles Growing market for low-efficiency pickups, minivans, and sport-utility vehicles 45% of all vehicles sold today Ford Model T – 25 mpg (1908); Avg. car today – 25.4 mpg (2014)

59 Automobiles: AlternativesRapid transit -industry squashed in 1930’s and 40’s (GM, Standard Oil, Firestone, etc.) -Convicted under Sherman Antitrust Act

60 Automobiles: AlternativesCar sharing Pay-as-you-drive auto insurance Build fewer roads (the more roads you build, the more congestion you create) “Peak Pricing” and “Congestion Fees” E.g., London → 21% decrease in traffic, 43% increase in bus ridership, cleaner air

61 Alternatives to AutomobilesBicycles/walking 30% of all trips by bike in Amsterdam; 2% in Portland, OR Busses Trains 15 x more efficient per passenger than autos Amtrak ridership up, but receives 1/3 the amount of federal funding (adjusted for inflation) that it received 20 years ago Speeds slow compared with other countries

62 Automobiles: AlternativesElectric cars -killed by oil companies, automakers in early 20th century Natural gas, gasohol, and biodiesel Natural gas from fracking now constitutes ½ of U.S. fuel output, over-rated (est. -5% to +9% change in carbon emissions), carries environmental and seismic risks Beware Jevon’s Paradox (Increased efficiency leading to increased overall energy consumption)

63 Automobiles: AlternativesSolar cars Hydrogen-powered cars Byproduct = water Problem: Hydrogen production requires fossil fuels Telecommuting Average American spends about 475 hrs/yr in car, 42 hrs/yr stalled or creeping along in traffic

64 US Energy Consumption by FuelOil – 37% peak oil production originally predicted 2014; new estimates much farther in future, but sources dirtier and more expensive/more dangerous to obtain Natural gas – 24% Coal – 22% - peak coal production 1920 Nuclear – 8.5% Renewables (mostly hydroelectric and biomass; small amounts of geothermal, wind, and solar) – 7.3%

65 U.S. Energy Sources for ElectricityCoal – 51% Nuclear – 20% Gas – 17% Oil – 1% Renewables (mostly hydroelectric) – 9% Electricity generation utilizes 40% of US energy

66 US Energy Consumption Transportation – 29% Industrial – 25%Note ships burn very dirty fuels – just 160 of the world’s fleet of 6,000 cargo ships create the same amount of smog and particulate matter as all the cars in the world Industrial – 25% Residential – 11.5% Commercial – 8.5%

67 True Cost of Fossil FuelsGlobal tax benefits and fossil fuel subsidies over $5 trillion Higher than what governments worldwide spend on public health If all such benefits and subsidies were stopped, 1.6 million preventable deaths/yr would be averted

68 True Cost of Fossil FuelsU.S. = $550 billion in fossil fuel subsidies in 2012 vs. $120 billion in subsidies for renewables (excluding military costs) Public health costs = 2X electricity rates

69 True Cost of Fossil FuelsWhen subsidies and externalities taken into account, renewables look great Even so, Peabody Energy attempting to rebrand coal as a cure for poverty

70 Petroleum Industry ProfitsMergers squelch competition, drive up prices Record-breaking oil company profits 3 of the world’s 10 most profitable corporations in 2016 were oil companies Exxon: $45.2 billion in 2008 and $34 billion in 2016 2008 profits largest in U.S. history (exceed GDP of 2/3 of world’s nations)

71 Belridge, CA Oil Fields Edward Burtynsky

72 Nigerian Gas Flare

73 The U.S. and Oil U.S. consumes > 20 million bbl/dProduces 5 million bbl/d World’s largest crude oil importer Ironically, greatest export in 2011 is gas, diesel, jet fuel, and other fuels Strategic Petroleum Reserve holds more than 700 million bbl ANWR contains 4.3 – 11.8 billion bbl oil One year supply

74 The U.S. and Oil 23 billion bbl under remaining U.S. territory2.5 million abandoned oil and gas wells litter U.S. (20-30 million worldwide) Pollution, explosion hazards Alberta Tar Sands (shale oil), Keystone Pipeline controversies

75 Oil and War Countries that export oil are >40 times more likely to be engaged in civil war than those that do not Gulf Wars I and II The Future?

76 Coal 33% of U.S. carbon emissions (41% of world’s)Coal mining dangerous (explosions, cave-ins, black lung disease) 48 deaths in 2010 from “accidents”/cave-ins 75,000 deaths from black lung disease in U.S. ( )

77 Coal Mountain-top removal damages ecosystemsCoal-fired power plants top source of mercury worldwide EPA’s 2011 limits on emissions to prevent 11,000 premature deaths, 4,700 MIs, 130,000 cases of childhood asthma

78 Proposed Coal Shipments through Pacific NW100 million tons/yr from Powder River Basin (WY, MT; 40% of US coal deposits) Purchased from public lands and to be sold cheaply to markets in Asia 20 trains/day, each miles long, each over 100 cars and powered by 4 diesel engines 12 barge tows/wk down Columbia River Amount expected to possibly quintuple by 2030

79 Risks of Proposed Coal Shipments through Pacific NWDiesel Fuel Produces 15% less CO2 than gasoline, but 4X more NO2 and 22X more particulate matter Diesel particulate matter: Impairs lung development; associated with asthma, COPD, heart disease, stroke, and cancers Coal dust: COPD, pneumoconiosis – black lung, contains heavy metals

80 Risks of Proposed Coal Shipments through Pacific NWNoise: Associated with fatigue, ischemic heart disease/HTN/arrhythmia, increased risk of stroke, exacerbation of mental health problems, fatigue, cognitive development, quality of life Train traffic delays affecting emergency responders Derailments, car vs. train accidents

81 Risks of Proposed Coal Shipments through Pacific NWGlobal warming, ozone, mercury Jobs gained: Building and operating transfer facilities Temporary; dangerous Coal terminal workers have 3-fold increased risk of lung cancer Job loss: Local businesses cut off for 1-2 hours per day from auto traffic

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83 Coal and Oil Many new coal and oil terminals planned for Gulf of Mexico (if Pacific NW plans do not work out) $500 million oil terminal proposed for Portland Supported by state and federal funds If all coal export terminals, oil-by-rail facilities, oil pipelines, and natural gas pipelines planned for the Pacific NW are completed and fully utilized, the region could export fossil fuels carrying 5X as much carbon as the proposed Keystone Pipeline

84 Coal and Oil Plans to use railways and terminals to transport Canadian Tar Sands and North Dakota Bakken Oil Field fracked oil through Pacific NW for export 2008: 9,500 rail cars carrying oil in the U.S. 2014: over 400,000 cars (a 4,000% increase)

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86 Coal and Oil Pipelines on wheels2013: Trains carrying crude oil exploded, spilled, or derailed 117 times E.g., Lac-Megantic, Quebec – 47 killed, $1.2 billion damage (2013) More crude oil spilled in U.S. rail accidents in 2013 than in previous 40 yrs combined

87 Lac-Megantic, Quebec, 2013

88 Coal and Oil Federal government predicts trains hauling crude oil or ethanol will derail an avg of 10X/yr over the next 2 decades, causing more than $4 billion in damage and possibly killing hundreds if they occur in a densely populated region 16 million Americans live within 0.5 km of one of the existing lines

89 Coal and Oil Old (dangerous) tanker cars slowly being phased outSpeed limit of 40 mph set for cities with large populations Track, bridges aging, fire departments not prepared to handle blazes (special equipment required) Crude by Rail Safety Act pending in Senate

90 Coal and Oil 2015: US Interior Department’s Regional Management Plan authorizes sale of $10.2 billion of Powder River Basin coal (on 106,000 acres of public land) at far below market prices Would negate most other Obama administration actions to control carbon emissions

91 Proposed Coal and Oil Shipments through Pacific NWFacing strong community opposition Nineteenth Century technologies vs. program of sustainable, clean energy for the 21st Century Opposition having some success For more details, see slide shows on the Environmental Health page of the PHSJ website

92 Other Sources of Air PollutionIndustry - #1 Indoor air (chemicals)

93 Indoor combustion of coal and biomassFor cooking, heating and food preservation Used by 3 billion people worldwide Causes close to 2 million deaths/yr Associated with multiple pulmonary conditions Women and children predominantly affected Combining agricultural and kitchen waste with ash and char residue from cooking fires creates material highly resistant to decomposition – can be added to infertile/degraded soil to create highly-fertile, highly carbonated soil

94 Other Sources of Air PollutionWorld Trade Center bombings (9-11) 3,300 fatalities Over 18,000 people suffering health problems linked to attack and rescue (multiple toxic pollutants in smoke and rubble First responders suffer elevated rates or asthma, abnormal spirometry, GERD, depression, PTSD, panic disorder, and cancer James Zadroga Health and Compensation Act of 2010 provides for some coverage of monitoring, treatment, and victim compensation

95 Noise Pollution Common in inner cities, hospital wardsAverage sound level 72dB in hospital wards WHO recommends no more than 35dB Adverse health effects include increased risk of HTN, ischemic heart disease, delayed wound healing, aggressive behavior, need for psychiatric and pain medications, GERD symptoms, hearing loss in neonates, and increased rates of rehospitalization

96 Garbage

97 Garbage 98% of the country’s total refuse is industrial waste; 2% municipal waste Making 1 lb of sellable product generates avg. 32 lbs. of waste

98 Garbage American produce 4.5 lbs/d garbage1,680 lbs/person/yr In a lifetime, the average American generates 102 tons of trash

99 U.S. Garbage CompositionPaper and Paperboard - 34% Average American household receives 100 lbs of junk mail per year Yard Waste - 13% Food Waste - 12% Plastics - 12% Metals - 8% Glass - 6% Wood - 5%

100 Where Does U.S. Trash Go? 53% discarded 34% recycled13% combusted for energy

101 U.S. Recycling Rates (2013)

102 Garbage Average recycling rate for cities = 34% San Francisco = 78%One half of US has no curbside recycling pickup Landfills

103 Garbage Incinerators Between ¼ and ½ of rural Americans burn their trash Accounts for 1/3 of U.S. dioxin emissions Outlawed in some states Global trash burning releases 5% of man-made emissions of CO2

104 Garbage Garbage Exports Scrap is the leading US exportMafia involved in $22 billion-a-yr illicit wasted trade 15 million grassroots recyclers / waste pickers living in garbage dumps worldwide

105 Exporting Waste “Just between you and me, shouldn’t the World Bank be encouraging more migration of the dirty industries to the LDCs (Lesser Developed Countries)?...I’ve always thought that underpopulated countries in Africa are vastly underpolluted.” World Bank President Larry Summers (1991); Later became Secretary of US Treasury under Clinton, President of Harvard University, then Chairman of Obama’s White House National Economic Council under Obama

106 Toxins

107 Toxins 6 trillion tons of over 85,000 chemicals produced annually30,000 lbs chemicals manufactured or imported per U.S. citizen (2012) new chemicals registered each year 2/3 of those introduced since 1983 marked “trade secret,” making investigation difficult More than 90% have never been screened for toxicity Consequence of 1976 Toxic Substances Control Act (TSCA)

108 Toxins TSCA updated (2016) Requires EPA to regulate based solely on health and environmental concerns, and identify populations at high risk EPA must conduct both cost-benefit and cost-effectiveness analyses Increased number and speed of safety reviews Still will leave vast majority of chemicals untested/unregulated

109 Toxic Pollutants The chemical industry is a $450 billion enterprise in the U.S. alone Chemical manufacturers are not required to prove safety The legal burden is on the government to prove that a product is dangerous

110 Pesticides Based on the poison gasses developed in WW IVandana Shiva: “We are eating the leftovers of World War I”

111 Pesticides 5.1 billion lbs/yr pesticides worldwide 30% in US17,000 products $44 billion worldwide market 10 firms control 90% of market

112 Pesticides CA, NY, and OR are the only states currently tracking pesticide sales and use OR system under-funded Many pesticides used in U.S. banned in other countries

113 Pesticides EPA estimates U.S. farm workers suffer up to 300,000 pesticide-related acute illnesses and injuries per year NAS estimates that pesticides in food could cause up to 1 million cancers in the current generation of Americans 1,000,000 people killed by pesticides over the last 6 years (WHO)

114 Pesticides Even so, the EPA and NAS have OK’d human subject testing…..Monsanto’s Roundup purchased by US government for aerial spraying in Colombia as part of “War on Drugs”

115 Pesticides Pesticides inhibit nitrogen fixation, decrease crop yieldsEvidence suggests these actually promote pests (vs. natural pesticides) 30% of medieval crop harvests were destroyed by pests vs % of current crop harvests Implies organic farming more cost-effective

116 Pesticides Linked to autism, Parkinson’s Disease, Alzheimer’s disease, ALS, diabetes, obesity (with prenatal exposure), depression, ADHD Autism spectrum disorders affect 1/68 children in U.S. Children living on or near farms score 5 points lower on IQ tests and other mental and verbal tests May be due to pesticide exposure

117 Anthropological Study of Children Exposed to PesticidesChildren from villages practicing organic agriculture Children from villages practicing non-organic agriculture

118 Pesticides

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120 Pesticides $2.4 billion worth of insecticides and fungicides sold to American farmers each year Pesticide runoff contributes to coastal dead zones Over 200 (e.g., Baltic Sea, Mouth of Mississippi in Gulf of Mexico, Chesapeake Bay, off Oregon/Washington coast) Red tides Pesticides inhibit nitrogen fixation, decrease crop yields

121 Pesticides and ProduceThe Dirty Dozen: strawberries, apples, nectarines, peaches, celery, grapes, cherries, spinach, tomatoes, sweet bell peppers, cherry tomatoes, cucumbers The Clean 15: avocados, sweet corn, pineapples, cabbage, sweet peas (frozen), onions, asparagus, mangoes, papayas, kiwi, eggplant, honeydew melon, grapefruit, cantaloupe, cauliflower

122 Toxins Body burden of industrial chemicals, pollutants and pesticides high Environmental Working Group (2004)found 287 pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage in umbilical cord blood Many other compounds not even tested; numbers undoubtedly higher

123 Toxins Fetuses and children most vulnerableBirth defects, learning disabilities increasing Toxins play important role UK Food Standards Agency has called for a phase out of 8 artificial dyes linked to hyperactivity in children

124 Toxins and gender Sex ratio changing: Cryptorchidism increasingNormal = 105 boys/girls born (skewed by early male mortality) Fewer boys being born in industrialized countries Other causes include obesity, older parental age, stress, fertility aides Situation far worse in Arctic Cryptorchidism increasing Risk factor for testicular cancer Micropenis, hypospadias increasing

125 Phthalates/Bisphenol AFound in construction materials, clothing, toys, cashier receipts, cosmetics, pills, dental fills/sealants, cigarette filters, added to PVCs in IV tubing/other plastics At least 47 million prescription meds Exposure levels very high FDA approves 5 million metric tons consumed by industry per year (13% in the U.S.) Exxon Mobil and BASF dominate the market

126 Phthalates/Bisphenol AWal-Mart, Target, Toys ‘R’ Us phasing out, San Francisco, California, Europe, and Canada have banned phthalates; Australia phasing out use in baby bottles 9 states, Chicago, Multnomah County (Portland), OR, and Suffolk County, NY have banned BPA in baby bottles and sipper cups Consumer Product Safety Commission reforms of 2008 eliminate lead and phthalates from toys and children’s products Sugar-derived epoxy lining could replace BPA in cans

127 Phthalates/Bisphenol A2009: Ban Poisonous Additives Act (to ban use of BPA in food and beverage containers and items used by young children) submitted in U.S. House and Senate 2009: BPA-Free Kids Act (to ban BPA in food and beverage containers and utensils marketed for children aged 3 or younger) introduced into U.S. Senate

128 Phthalates/BPA 2012: EPA bans BPA in baby bottles and sippy cups, but not food packaging EU has also banned BPA in baby bottles 90% of government-funded studies found adverse health effects vs. 0% of industry-funded studies Substitutes (e.g., polystyrene [Styrofoam] and biphenol sulfonate [BPS]) also estrogen-like endocrine disruptors

129 Phthalates/BPA Associated with:Demasculinization and alterations in genitalia in male infants Prematurity and low birth weight Lower testosterone levels Early menarche (12-13 now, down from baseline 16-17) PCOS in women Early menopause

130 Phthalates/BPA Associated with: Infertility Miscarriageslower sperm counts in adults; impaired sperm function male sexual dysfunction; decreased libido in women Decreased effectiveness of IVF

131 Phthalates/BPA Associated with:Childhood behavioral, emotional, and conduct problems, including depression and inattention Obesity Destruction of tooth enamel Asthma Childhood HTN Heart disease

132 Phthalates/BPA Associated with: diabetes breast cancer prostate cancerelevated liver enzymes Meningiomas Weaker teeth/poor enamel growth

133 Feminine Care ProductsFragranced products contain phthalates Tampons contain dioxins (byproducts of bleaching process)

134 Phthalates/PVCs and Medical DevicesEPA regulations weak, based on 50-year old study FDA has advised healthcare providers to use alternatives to DEHP-containing PVC medical devices, esp. in neonatal units Banned by EU, CA, and WA Federal legislation bans use in children’s products

135 Triclosan Pesticide used as an antimicrobial in many soaps and hand sanitizers, including those commonly used in hospitals Also found in toothpastes, deodorants, colognes Linked to reproductive, endocrine, and developmental damage, and cancer in animals

136 Triclosan FDA: Antibacterial soaps are no more effective than regular soap and water in fighting infection; banned from soaps (2016), but still found in toothpastes AMA: It may be prudent to avoid the use of antimicrobial agents in consumer products Use restricted in EU, Canada, Japan

137 Food Dyes None of the 9 artificial food dyes approved for use in the U.S. has been proven safe E.U. warning labels required for six food dyes: “may have an adverse effect on activity and attention in children.” Animal studies suggest some may be carcinogenic

138 Teflon (PFOA – perfluorooctanate)Non-stick material made by Dupont and other companies until 2013, when they agreed on a voluntary phase-out (although substitutes no safer) Chemicals released under high heat and when cookware damaged Exposure linked with cancer, birth defects, gestational hypertension, heart disease, peripheral arterial disease, liver damage, and early menarche Dupont hit with largest-ever civil penalty ($10.25 million) in 2006 for concealing health consequences and transmission from mother to fetus

139 Flame Retardants Polybrominated diphenyl ethers (PBDEs) found in furniture produced before 2004 ban Endocrine disruptors Associated with behavior and cognition difficulties; thyroid dysfunction in women Provide no meaningful protection from fire; actually increase smolder propensity

140 Flame Retardants Newer brominated and chlorinated flame retardantsSlow spread of flames, but release carbon monoxide and hydrogen cyanide when burned (these compounds account for 60-80% of fire-related deaths) Also endocrine disruptors, damage DNA

141 Pepper Spray Contains TCE (trichloroethylene) and PCE (tetrachloroethylene) Both can cause liver and kidney cancer, lymphoma, and other illnesses

142 Toxins in Apparel Formaldehyde – permanent pressPhthalates, PVC – softeners, decorative printing PCBs - ink Nanosilver- antimicrobial agent to inhibit odor-causing bacteria

143 Toxic Pollutants – Economic CostsChemical brain drain – value of lost IQ points in children worldwide estimated at hundreds of billions of dollars Americans pay more than $55 billion annually for direct medical expenses plus special schooling and long-term care for pediatric diseases caused by lead This excludes the greatest toxic pollutant - tobacco

144 Lead Present at “actionable levels” in nearly 20% of water systems in U.S. (e.g., Flint, other cities, as well as many schools and child care facilities) Found in car batteries, paint (pigment and drying agent), gasoline (anti-knocking additive), second-hand tobacco smoke, and some cosmetics Most paint sold in Asia-Pacific region contains large amounts of lead

145 Lead Affects brain development; associated with lower IQ, ADHD, hearing loss, depression, panic disorder, early menopause No safe level for neurological development

146 Lead Levels between 4 and 10 significantly increase risk of cardio- and cerebrovascular disease Elevated levels associated with depression, anxiety, schizophrenia, Alzheimer’s disease, crime, and violent behavior, obesity in children MRI changes in gray matter areas responsible for attention, regulation of emotions, and impulse control; disruption of white matter

147 Lead Childhood exposure linked to violent crime, impulsiveness/aggressiveness, and teen pregnancy in later life Exposure leads to permanent loss of gray matter in prefrontal cortex Rates of consumption of leaded gasoline correlate with violent crime 20 yrs later

148 Lead 535,000 US children age 1-5 (1/38) have levels exceeding 5 mcg/dLPoor, African-Americans, and Hispanics more commonly exposed Levels declining in US, however Lead paint still widespread in older buildings (built before 1978) 35% of homes with some lead paint; 22% with significant lead paint

149 Lead 83,000 tons of lead shot into environment annually in U.S. (bullets) Gun shop/range owners/patrons heavily exposed, as are those who consume shot wild game California bans (2013); Obama’s Interior Department bans on federal lands (2017); Trump administration overturns ban (2017) U.S. military increasing use of “green bullets” (containing copper/copper alloys)

150 Lead Developing world at riskDue to increased environmental exposure and, possibly, early umbilical cord clamping 12 million people worldwide lead poisoned Economic loss to developing nations estimated at close to $1 trillion (over 1% of worldwide GDP)

151 Lead Leaded gasoline banned in Canada in 1990, US in 1996 (after 25-year phase-out period), EU in 2002, Africa in 2006 Still used in piston-engine aircraft (the chief source of U.S. lead emissions) Ban fought by industry for decades Lead paint banned in U.S. in 1978 after decades of industry push-back Still widely used in developing world Lead banned from plumbing in U.S> in 1986

152 Leaded Gasoline 6 countries still sell small amounts of leaded gasoline: North Korea, Iraq, Afghanistan, Algeria, Myanmar/Burma, and Yemen (all to phase out by 2013 Until recently, used in tire vulcanization Still used in airplanes (mostly U.S.) Alternatives available

153 Lead Cleanup Lead costs US economy $50 billion/yrCleanup cost: $20 billion/yr for 20 yrs Benefits: $200 billion dollars annually (cognitive and health benefits and decreased crime) 10:1 return on investment (some estimates as high as 200:1)

154 Mercury Syphilis Treatment - 15th Century onward- abandoned 1940 for penicillin Recognized as cause of disease in 19th Century (Hunter-Russell Syndrome) - chemists, hatters

155 Mercury Added by US government to industrial during Prohibition to make it more lethal and discourage moonshine production ( ) Led to more than 10,000 deaths

156 Mercury: S/S, Dx, and Rx S/S: neuropsychiatric symptoms, excessive salivation/inflammation of gums, rash, nephropathy Linked to autism Dx: mercury levels in air, blood, urine (>100 mcg/l in blood and/or urine = toxic) Rx: chelation with BAL, penicillamine, DMPS, DMSA

157 Minamata Disease: Signs and SymptomsAcute / Chronic Poisoning: numbness, slurred speech, ataxia, unsteady gait, deafness, poor vision, dysphagia, hypersalivation, confusion, drowsiness/stupor to irritability/restlessness; chronic liver disease, liver cancer, hypertension, autoimmune disorders death within a few months if severe Rx EDTA – only partially effective 

158 Minamata Disease: Signs and SymptomsCongenital: high dose → infertility; medium dose → spontaneous abortions; low dose → congenital disease (including anencephaly and spina bifida) S/S: poor physical growth, developmental delay, ADHD, impaired speech/chewing/swallowing, muscle tone abnormalities, involuntary movements, constricted visual fields, hearing loss - EDTA not effective

159 Mercury Released into air by coal combustion, industrial processes, mining, waste disposal, and volcanoes; concentrated (along with lead, arsenic, and other heavy metals) in coal ash 4500 tons/yr

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161 Mercury Travels throughout atmosphere and settles in oceans and waterways Bacteria convert it to toxic methyl-mercury Travels up food chain via fish Avoid top predators (tuna, shark, swordfish) 1/3 of US exposure to methylmercury from canned tuna

162 Gold Mining Gold = Cyanide + MercuryMercury used to capture gold particles as an amalgam Gold leached from ore using cyanide Cyanide paralyzes cellular respiration At least 18 tons of mine waste created to obtain the gold for a single 3 oz., 18k ring

163 Gold Mining and MercuryContaminated groundwater often sits in large toxic lakes held in place by tenuous dams Release of cyanide and mercury into local waterways kills fish, harms fish-eating animals, and poisons drinking water

164 Mercury 16% of women of childbearing age exceed the EPA’s “safe” mercury level Freshwater fish mercury levels too high for pregnant women to eat in 43 states Fish intake decreases risk for SGA newborn, but mercury can cause SGA

165 Mercury Mercury dental amalgams pose health risks to pregnant women, unborn babies, and children (FDA) Contaminant in high fructose corn syrup Mercury costs U.S. economy $5 billion/yr

166 Decreasing Causes and Limiting Consequences of Mercury PollutionPhase out coal burning power plants Hospitals phasing out mercury thermometers Stop buying gold (e.g., wedding rings) Make healthy seafood purchases Screen and treat when appropriate Avoid tainted cosmetics

167 Minamata Convention A set of legally binding measures to curb mercury pollution As of 10/16/14, 128 countries have signed and 6 (including the U.S.) have ratified Takes effect 90 days after 50 nations ratify

168 Minamata Convention Best emission-control technologies requred for new power plants, boilers and smelters Compact fluorescent lightbulbs containing over 5 mg Hg banned by 2020 Primary mercury mining banned (old mines get 15 yrs to close down) Allows use of mercury in artisanal and small scale gold mining; encourages nations to phase out use altogether

169 Minamata Convention Exempts dental fillings, but encourages alternatives Vaccines with thimerosol exempt Bans Hg-containing batteries by 2020 (button-cell batteries exempt) Bans switches and relays with Hg by 2020

170 Minamata Convention Limits Hg in soaps and some cosmeticsBans Hg in medical devices by 2020 Exempts religious and traditional uses of Hg Bans use in certain types of manufacturing

171 Arsenic Contaminates groundwater in Bangladesh, also, India, China, Mexico, Argentina, Thailand, Vietnam, and parts of the U.S. 200 million affected worldwide 13 million Americans have drinking water exceeding EPA’s “safe level” Exposure also via rice (esp. brown), seafood Also found in apple and grape juices, wine

172 Arsenic One serving/wk puts infants and children over safe limitBrown rice contains 80% more arsenic than white rice Organic = non-organic Rinse rice thoroughly before cooking; cook in large volume of water Consider alternatives (quinoa, buckwheat, millet)

173 Arsenic Known as “inheritance powder” in the Middle Ages (expedited the generational transfer of wealth and power) Used to pressure treat wood in US and elsewhere Primarily wooden structures built before 2005

174 Health Consequences of Arsenic ExposureCauses discoloration of skin, GI upset/N/V/D, numbness, paralysis, and blindness Linked to learning disabilities, neurobehavioral problems, elevated blood pressure, heart disease, strokes, diabetes, bacterial infections, kidney/bladder/lung/skin cancers, and bone degeneration and deformities

175 Health Consequences of Arsenic ExposureMiscarriage, low birth weight Weakened immune system Resistance to antimonial preparations used to treat Leishmaniasis

176 Heavy Metals Heavy metals found in over half of low cost jewelry sold in the U.S. Lead, mercury, or arsenic found in 1/5 of both U.S.- and India-manufactured Ayurvedic medicines purchased via the internet

177 Manganese Welders exposed via fumesCauses “manganism” (like Parkinson’s Disease) Welding companies covered up link for decades (like lead paint, etc.)

178 Cadmium Cigarettes most common source of exposure; also found in rice; contaminant in phosphorus-based fertilizers Can delay pregnancy and cause neurological damage, hearing loss, osteoporosis/fractures, periodontal disease, breast cancer, and premature aging

179 Phosphorus/PhosphatesPhosphorus in dishwater detergents Contribute to eutrophication, harmful algal blooms Banned in 16 states Phosphate in fertilizers Agricultural runoff contributes to toxic algal blooms, dead zones World supply running critically low Composting would recycle, return to soil

180 Algae Cyanobacteria (blue-green algae can cause gi illness, skin rashes, are hepatotoxic, and may cause liver cancer) Global warming expected increasing algal blooms

181 Perchlorate (PERC) PerchlorateToxic air pollutant, endocrine (thyroid) and reproductive toxin, likely human carcinogen, exposure increases risk of low IQ, bipolar disorder and PTSD Used in rocket fuel, dry cleaning Alternative = “wet cleaning” with compressed, liquefied CO2 EPA requiring phaseout of use in residential areas by 2020

182 Parabens Preservative used in food products, toiletries, cosmeticsEstrogenic May increase risk of breast cancer

183 Radon Comes from natural decay of uranium in soil1/15 U.S. homes has elevated levels Cause of lung cancer Causes 15,000 to 22,000 lung cancer deaths in U.S. each year Home detectors available, relatively inexpensive Remediation lowers risk

184 Supplements and Milk Melamine scare with Chinese milk productsKidney failure 37/40 herbal dietary supplements tested by GAO in 2010 contained trace amounts of at least one hazardous metal (lead, mercury, arsenic) Supplements do not require FDA approval pre-marketing

185 Artificial Turf Made from “crumb rubber,” derived from recycled tire bits Contains lead, mercury, arsenic, benzene, halogenated flame retardants, harmful bacteria High levels of inhalational exposure among young athletes New York City park officials will no longer use tire crumbs in artificial turf fields (alternative = sand-based product)

186 Cell phones ?Link to parotid gland tumors?Link to brain tumors per WHO Gliomas Acoustic neuromas Precautionary principle – hands-free headset ?Other safety benefits?

187 Toxic Pollutants 85,000 known or suspected hazardous waste sites in the U.S. Plus up to 600,000 lightly contaminated former industrial sites (“brownfields”) Will cost hundreds of billions of dollars to mitigate environmental impacts

188 Toxic Pollutants 1 in 4 U.S. citizens lives within 4 mile of a Superfund site (over 1600 sites listed; another 2,500 sites eligible) ½ live within 10 miles Taxpayers paying increasing share of cleanup costs Overall funding decreasing

189 Environmental Racism and Toxic ImperialismPolluting factories/waste dumps/incinerators more common in lower SES neighborhoods “Cancer Belt” (Baton Rouge to New Orleans) More cardiovascular disease Toxic Imperialism WHO estimates toxic chemical exposures responsible for 4.9 million deaths and 86 million DALYs in 2004

190 Toxic Pollutants: The Basel ConventionThe Basel Convention on the Control of Transboundary Movements of Hazardous Wastes (designed to control dumping of hazardous wastes from the industrialized world in developing countries)

191 Toxic Pollutants: The Basel ConventionRatified by 170 countries Despite being the largest producer of toxic pollutants in the world, the U.S. has signed but not ratified this agreement

192 Bathtub, Toilet, and Source of Drinking Water

193 Persistent Organic PollutantsToxic, remain in environment long-term, resist degradation, can travel long distances Bioaccumulate - higher concentrations as you move up the food chain Most are endocrine disruptors

194 Endocrine Disruptors 800 known/suspected chemicals Linked to: ObesityInsulin resistance Diabetes Early age of onset of puberty in young girls ; 1920 – 14.6; 1950 – 13.1; 1980 – 12.5; 2010 – 10.5; 2012 – 9.9 (whites), 8.8 (blacks) Boys too (9-10)

195 Endocrine Disruptors Linked to:PCOS, endometriosis, uterine fibroids, premature ovarian failure, early menopause Male and female reproductive tract abnormalities Impaired fertility, defective sperm Low birth weight, impaired fetal development and fetal anomalies

196 Endocrine Disruptors Linked to: Lower IQ Increased behavioral problemsMultiple cancers (including breast, colon, prostate, testicular) Thyroid disease Neuroendocrine abnormalities Epigenetic effects

197 Endocrine Disruptors Cost U.S. economy $340 billion/yr, European economy $217 billion/yr Endocrine Society, AMA, and APHA have called for policies to decrease public exposure to endocrine disruptors

198 Persistent Organic PollutantsUN Environmental Program organizing worldwide phaseout of top 12 through the Stockholm Convention on Persistent Organic Pollutants Including DDT, PCBs, and dioxins U.S. has signed, but not ratified

199 Toxic Pollutants Floriculture Diamond and Gold MiningCosmetics (see Fragrances Menstrual hygiene products Scented candles Nanoparticles

200 Tobacco – Weapon of Mass DestructionGrown in more than 100 countries on over 5 million hectares of arable land Which could otherwise feed million people 20-50 million trees cut down/yr to cure tobacco Heavily pesticide-dependent crop Tobacco industry has lobbied to weaken environmental regulations

201 Cigarette Litter Nearly billion pounds of cigarette butts littered per year 4.5 trillion butts (1.7 billion lbs) Comprised largely of filters made from cellulose acetate, a non-biodegradable plastic Filters trap toxins, heavy metals which can leach into environment The most littered item in the world

202 Medical Waste The 6,000 US hospitals generate 2 million tons of waste per year; clinics and doctors’ offices an additional 700,000 tons 850,000 tons incinerated 15% infectious waste incinerated pollutants include dioxin, mercury, cadmium and lead

203 Medical Waste One hospital bed generates between 16 and 23 lbs/day of waste Outbreak of hepatitis B in India due to black market in medical waste and supplies (2009)

204 Medical Waste Solutions: Strengthen EPA regulationsSegregation and alternatives to incineration would cost < $1/patient/day 80% of thermometers no longer contain mercury Remove PVCs from medical supplies (e.g., IV tubing)

205 Medical Waste Organizations: Health Care Without HarmGreen Health Center Movement NAS: Hospitals built and operated on more environmentally sound principles save money and produce better patient outcomes

206 Electronic Waste 50 million tons/yr66 lbs/person/yr in U.S. Average lifespan of a computer is 2 years Only 5-10% of computers recycled

207 Electronic Waste Discarded materials (including gold, silver, iron, and copper) worth over %50 billion Poor burn to retrieve, exposed to heavy metals, other toxins Most sent overseas Some e-waste returns to U.S. in children’s jewelry

208 Electronic Waste EU now requires electronics firms to recycle and to eliminate lead, cadmium and mercury from their products Maine passed first law requiring electronic manufacturers to pay for recycling their discarded products 2012: US requires electronic equipment bought with federal dollars to be recycled

209 Water UN adopted water as a human right in 2002International Covenant on Economic, Social, and Cultural Rights US has signed but not ratified

210 Water Only 2.5% of the earth’s water is fresh2/3 of this locked up in glaciers and ice caps As glaciers and polar ice caps melt, this is mixed with sea water

211 Water U.S. water consumption: 81% irrigation, 6% domestic useWater and sewage system infrastructures decaying 1 of every 6 gallons in city pipes leaks away into ground Cost to upgrade existing water infrastructure = $500 million; to add new water infrastructure for anticipated population growth = $500 million

212 Water Global water consumption doubling every 20 yearsWorldwide freshwater supplies dwindling Drying up: Aral Sea, Great Lakes (hold 95% of U.S.’s usable water), Great Salt Lake, Ogallala and California deep water reservoirs, etc. Water extraction causing cities to sink, damaging infrastructure E.g., Mexico City

213 Water Peak water reached in U.S. in 1970sPrice of water increasing dramatically Water expected to be major cause of wars worldwide in 21st Century

214 Water Clean Water Act of 1972 has decreased pollution in the USBut 80% of US waterways never receive any comprehensive testing for pollutants EPA estimates that more than half of US waterways are in “poor condition for aquatic life”

215 Water In developing countries, 90-95% of sewage and 70% of industrial wastes are dumped untreated into the local water supply 13,000-15,000 deaths per day worldwide from water-related diseases 35% of people worldwide have no access to any latrine, toilet, bucket or box

216 Water Pollution and Plastics120 billion lbs of plastics generated each year, using 4% of world oil supplies Every year more than 500 billion plastic bags discarded worldwide Bioplastics made from agricultural waste using renewable energy could be carbon neutral or even carbon negative Agar (derived from algae) on possibility

217 Water Pollution and Plastics80% of ocean trash = plastic 9 million metric tons/yr 20% marine based, 80% terrestrial Only ten states have container deposit laws

218 Cigarettes/cigarette filters - 2,117,931 Most commonly found pieces of trash washed up on shore One day litter tally during Ocean Conservancy's International Coastal Cleanup in selected spots around the world Cigarettes/cigarette filters - 2,117,931 Food wrappers/containers - 1,140,222 Beverage bottles (plastic) - 1,065,171 Plastic bags - 1,019,902 Caps, lids - 958,893 Cups, plates, forks, knives, spoons - 692,767 Straws, stirrers - 611,048 Beverage bottles (glass) - 521,730 Beverage cans - 339,875 Paper bags - 298,332

219 Water Pollution and Plastics5 major ocean garbage patch gyres (North Pacific, Indian Ocean, North Atlantic, South Atlantic, and South Pacific) Great Lakes also affected The world’s garbage patches contain over 250 million tons of plastic debris

220 Water Pollution and PlasticsTexas-sized “great garbage patch” in North Pacific holds estimated 100 million tons of mostly plastic trash 6 times the mass of plankton there Most has degraded to microplastics, which bond with PCBs, DDT, and endocrine disruptors, making this area a million times more toxic than surrounding areas Harmful to marine life; works its way up food chain

221 Water Out of 191 nations in the world, 10 nations share 65% of the world’s annual water resources A woman in a developing country walks an average of 6 km/day to obtain water

222 Water Privatization schemes supported by the World Bank, its International Finance Corporation, and the International Monetary Fund lead to price increases, worsen poverty 5-10% of world’s water privatized – increasing $1 trillion market Privatization increases costs, incites social unrest (e.g., Cochabamba, Bolivia) 15% of US water in private hands IFC also investing in privatized health care

223 Bottled Water Bottled water a $400 billion/yr profit-driven industry11.7 billion gallons/yr in U.S.; over 50% of population drinks Lacks essential minerals, fluoride

224 Bottled Water Costs 1,400 to 3,000 times more than tap waterUses up to 2,000 times more energy to produce than tap water 45% is tap water

225 Bottled Water Ratio of amount of water needed to produce 1 plastic bottle to amount of water in the bottle = 2:1 Weaker standards, dangers of plastics, energy costs/global warming, reduction of local water tables, recycling rate of plastic bottles only 23%

226 Bottled Water “Water is an efficient product. It is a product which normally would be free, and it is our job to sell it.” Suez CEO Gerard Mestrallet

227 Bottled Water San Francisco, other cities have banned city purchases of bottled water Cities bringing back water fountains Water expected to be the major cause of wars by 2050 or sooner

228 Water Pollution – Increased Beach Closings

229 Infamous Industrial DisastersMinamata, Japan, 1920s-1970s Chisso Corporation Methylmercury poisoning 400 dead; 10,000 injured

230 Minamata Disease W Eugene Smith

231 Infamous Industrial DisastersBhopal, India, 1984 (Union Carbide, purchased by Dow in 2001) – 40 tons of methyl isocyanate gas released ,000 dead within 3 days, 15,000-20,000 more over next 10 years; 150, ,000 injured and/or with resulting health problems Persistent water and soil contamination

232 Infamous Industrial DisastersBhopal U.S. has refused Indian government extradition request for Warren Anderson Union Carbide settled with Indian government for $470 million in 1989 (victims received $1,500/death, $500/injury) 2012: US Court absolves Union Carbide of liability (decision confirmed by Second Court of Appeals, 2016)

233 Infamous Industrial DisastersLove Canal: Hooker Electrochemical Company (parent company Occidental Petroleum) dumps over 21,000 tons of chemical waste in 1940s and 1950s Miscarriages, birth defects, cancers Occidental found liable

234 Infamous Industrial DisastersLeads to Superfund Law Today only seven states prohibit construction of schools on or near hazardous waste sites Half-million children attend schools within ½ mile of toxic waste dumps in NY, NJ, MA< and MI alone

235 Infamous Industrial DisastersChernobyl, USSR, nuclear power plant explosion 200 times the radiation of Hiroshima + Nagasaki died immediately, up to 1,000 injured acutely, NCI estimates 10-75K thyroid cancers (other estimates much lower) - some estimates as high as almost 1 million deaths

236 Chernobyl Higher risk of neural tube defects and childhood leukemia among those living near nuclear power plants Anxiety a major problem Ukraine still spends 6% of its GDP each year on Chernobyl-related matters

237 Infamous Industrial Disasters1989 Alaska, Exxon Valdez - oil spill -wildlife devastated, $5 billion damage Punitive damages overturned by U.S. Supreme Court Renamed “Oriental Nicety,” still sailing 2001 Gulf Oil spill (Retreating Iraqi Army pumped 8 million barrels oil into Persian Gulf to prevent US marines from making landfall)

238 Infamous Industrial Disasters2006 BP Alaskan pipeline ruptures 2010 BP Gulf disaster (and Michigan oil spill) Over 4 million barrels escape into Gulf of Mexico By 2016: Legal settlements of almost $30 billion and counting, along with $4 billion to resolve criminal charges But no jail time for anyone from company 2011 Exxon Mobil oil pipeline rupture and spill into Yellowstone River

239 Oil and Gas Spills 6,000 onshore oil and gas spills in U.S. (2012)At least 16 million gallons of oil, fracking fluid, wastewater, and other fluids released Undercount: some states do not report, excludes spills from interstate pipelines and offshore wells

240 Oil and Water 1.3 million metric tons of oil enters oceans each year46% seepage from natural deposits 8% tanker spills Exxon Valdez 38,800 metric tons ABT Summer disaster off southwest coast of Africa (1991) – 260,000 metric tons Remainder = industry, runoff UN phase-out of single-hulled tankers begins 2010

241 Oil Pollution is Expensive to Clean Up

242 Oil Slicks Kill Marine Life

243 Deforestation Forests cover 30% of earth’s land surface areaTropical forests constitute 7% of land surface area, contain > 50% of plant and animal species Majority of tropical forests destroyed

244 Deforestation Over one acre of world’s forest cut down every second3 trillion trees on planet 15 billion cut down/yr; 5 billion planted 50% of global wetlands destroyed (54% in U.S.) 100,000 acres lost per year in U.S.

245 Deforestation Historical -Easter Island (Polynesians), Middle East, U.S. Southwest (Anasazi Indians) Contemporary -Mauritania, Ethiopia, Haiti deforested -Philippines and Thailand are now net importers of forest products, looking at Latin America

246 Deforestation Indonesia and Malaysia – replacing tropical forests with palm oil plantations Nearly 100,000 fires in SE Asia between 2006 and 2015 (to clear land and secondary to climate change) creating more carbon emissions/yr than the entire U.S. Others - Amazon, B.C., Alaska, Burma, Papua New Guinea, Russian Far East, many other areas

247 Deforestation: CausesNew agricultural settlements (overpopulation, poverty, unsustainable farming practices) Logging Up to 50% of harvested timber worldwide cut illegally (generating between $10 billion/yr and $15 billion/yr in untaxed revenue

248 Deforestation: CausesFire suppression and “fuel reduction” (logging in the name of fire protection) disrupt natural forest cycles Oil and gas exploration Drilling in ANWR would drop gas prices 4 cents per gallon, after a 15 year waiting period, and assuming companies sell oil to U.S. consumers

249 Deforestation: CausesCattle ranching Drug cultivation -Peru, Bolivia, Columbia

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251 Clearcutting

252 Clearcutting

253 Clearcutting with Corridors

254

255 Global Warming

256 Global Warming Greenhouse effect30% increase in atmosphere CO2 since industrialization began (6.25 billion tons/year) Fossil Fuels (CO2)

257 Global Warming Greenhouse effectMethane, choloroflurocarbons, nitrous oxide, sulfur oxides Methane 34 times more heat than CO2 (over 100 yrs), large amounts stored in permafrost Aliso Canyon (CA) leak (2015) worst man-made greenhouse gas disaster in U.S. history Obesity

258 Global Warming 80% of carbon emissions from burning fossil fuels; 20% from deforestation, other land use changes 404 ppm CO2 (280 ppm pre-industrial; over 350 ppm dangerous)

259 Global Warming CO2 currently being released at almost twice the rate it is being removed Plants and soil absorb 1/3, ocean waters about ¼, the rest stays airborne If all identified fossil fuels on planet were burned (all 5.5 trillion tons of oil, coal, and natural gas now underground), the earth could heat up by as much as 18 degrees

260 Global Warming Sources of methane: Natural – 41%Wetlands - 29% Lakes, wild animals and termites, bodies of water - 12% Human Influenced – 59% Animal agriculture – 21% Natural gas / oil – 13% Waste disposal – 10% Coal and biomass – 7% Rice – 6% Other 2%

261 Global Warming The last 20 years have been the hottest ever recorded (data go back to 1856) 2016 hottest year on record Average global surface temperature = 58.3° Hottest temperature in last 10,000 years

262 Global Warming Worldwide average temperature increased by 1.6° F between 1901 and 2012 Estimated degree increase in average global temperature by 2100 Far North, Pacific Northwest warming up faster than other parts of the planet

263 Consequences of Global Warming400,000 deaths and million disability-adjusted life years lost per year (Climate Vulnerability Monitor, WHO, UN Environment Program) Expected to double by 2030 5% of existing disease burden due to climate change carried by children under 5 (in industrialized and developing countries)

264 Consequences of Global Warming↑ Weather extremes/natural disasters/insurance claims Drought, flooding, severe storms Weather-related disasters caused over $140 billion damage, cost U.S. taxpayers $100 billion (2012) 90% of disasters in U.S. result from flooding – National Flood Insurance Program phasing out flood insurance, $24 billion in debt, unable to pay off Hurricane Katrina and Sandy claims

265 Consequences of Global WarmingOcean acidification → Decreased plankton (basis of the ocean’s food chain) Corals dying Rise of jellyfish (cockroaches of the sea), crabs, and oysters Entire ecosystems affected

266 Consequences of Global WarmingFloods, cholera, rising malaria zone Dengue fever, malaria, yellow fever, even plague now being seen in Europe Increased Chagas, yellow fever, chickungunya virus in U.S.

267 Weather Extremes Headline from “The Onion”Hurriphoonado Cuts Swath Of Destruction Across Eastern, Western Hemispheres

268 Consequences of Global WarmingPolar icecaps/glaciers/Greenland ice sheet/Patagonian glaciers/Himalayas/permafrost melting, sea levels rising (est. at least 3 feet over 21st Century) Glacial lake outbursts (tsunamis) possible 13 of world’s 20 largest cities are coastal; 1/3 of world’s population lives within 60 miles of a shoreline

269 Consequences of Global WarmingArctic ice pack has lost 40% of its thickness compared with 1960 West Antarctic ice sheet in irreversible collapse Arctic and boreal forests warming twice as fast as other parts of the world Contain 30% of globe’s forest cover

270 Consequences of Global WarmingBeach resorts losing sand, suffering economic losses Sand forms over thousands of years Most used in construction industry Large countries mine seabed Poor island residents sell sand, eroding beaches Large black market trade in illegal sand

271 Consequences of Global WarmingGlacier National Park’s glaciers melting (150 one hundred years ago, 25 in 2014, none expected by 2030) Great Lakes ice coverage down 71% over last 40 years Snows of Kilimanjaro down 85% compared to 1912; may be gone by 2020s Ski resorts making snow, suffering economic losses

272 Consequences of Global WarmingWildfires, droughts World’s oldest/biggest trees dying (10X background rate) Ice islands threaten shipping lanes and offshore oil platforms 3% increase in violent crime/1° F rise in avg. temperature (Science, 2013)

273 Glaciers Calving

274 Polar Bears Stranded / Dying Off

275 Greenland’s Ice Cap Melting: 1992

276 Greenland’s Ice Cap Melting: 2002

277 Greenland’s Ice Cap Melting: 2005

278 Atlantic Ocean Excited To Move Into Beautiful Beachfront Mansion Soon (Headline from “The Onion”)

279 Consequences of Global WarmingIncreased allergies/asthma/anaphylaxis Rising temperatures increase smog/ground level ozone Ozone stunts plant growth (although planting trees can help remove ozone from the environment Higher levels of CO2 favor growth of ragweed and other pollen-producing plants

280 Global Warming The top 1/5 of the world’s largest 145 countries account for 63% of global C02 emissions (lowest 1/5 = 2%) US = 23 tons/person/yr greenhouse gas emissions (global average = 5.4 tons/person/yr) The countries likely to be most affected by global warming are those least responsible for the increases in global temperature

281 Global Warming Climate refugees Kiribati to disappear by 2050President has bought land in Fiji for ultimate relocation of entire population Disappearing locales: Tuvalu, Vanuatu, Kivalina (Alaska), Male (Maldives)

282 Global Warming Increases Droughts

283 Global Warming UN Intergovernmental Panel on Climate Change: irreversible WHO: the greatest threat to human health this century Pentagon: an immediate threat to national security

284 Agriculture Global per capita cropland down over 50% from 1961 to 0.6% acre Soil erosion exceeds soil formation 60- to 100-fold increase over last century due to intensification of farming In the past 40 years, 1/3 of U.S. topsoil has eroded Takes 1,000 years to “grow” 1 inch of soil

285 Agriculture Livestock responsible for more greenhouse gas emissions than the entire transportation sector Methane, CO2, and NO Grass-fed cattle healthier, produce less methane, contain less saturated fat/higher levels of beneficial fatty acides and antioxidants/fewer antibiotic-resistant bacteria

286 Agriculture Water use has tripled since 1950, up 6-fold over 20th Century 70% of freshwater use in agriculture; 20% for agriculture; 10% for domestic purposes

287 Large scale irrigation/power projectsChina’s Three Gorges Dam World’s largest power station (second largest generator after Itaipu Dam on border of Brazil and Paraguay) $59 billion project Displacing 1.5 million people Loss of valuable archeological sites

288 China’s Three Gorges Dam

289 Dams 85,000 in U.S. (45,000 major dams – 15 m or higher) worldwide½ no longer serve their intended purposes Removal ongoing (over 1,000 so far)

290 Food Waste Each year, 2.9 trillion lbs of food (1/3 of world production) is not consumed $750 billion loss

291 Food Waste In the U.S., 53% is not consumed:20% lost during picking and sorting 3% lost during storage and shipping 2% lost during juice production, canning, or baking 9% discarded at wholesalers and supermarkets 19% uneaten and discarded in homes

292 Wasted Food Household food waste adds up to $43 billion/yr in the U.S.40% of all food produced in U.S. wasted An average American family of four tosses out $590/yr food Americans discarded 3 times as much food in 2005 as in 1985 96 billion lbs/yr in America (2009)

293 Decreasing crop diversity30, ,000 plant species are edible Humans have utilized 7000 plant species for food Rice, wheat, and maize provide 2/3 of the world’s food supply 20% of species provide 80% of the world’s food supply Consequences: decreasing genetic diversity, vulnerability to disease, huge crop losses (e.g., Irish potato famine)

294 Factory Farming Factory farms have replaced industrial factories as the # 1 polluters of American waterways 1.4 billion tons animal waste generated/yr 130 x human waste 1 hog farm in NC generates as much sewage annualy as all of Manhattan

295 Factory Farming

296 Factory Farming

297 Factory Farm Waste Most untreated Ferments in open poolsSeeps into local water supply, estuaries Kills fish Causes human infections - e.g., Pfisteria pescii, Chesapeake Bay Creates unbearable stench Widely disseminated by floods/hurricanes

298 Agricultural Antibiotic UseAgriculture accounts for 80% of U.S. antibiotic use Use up 50% over the last 15 years

299 Antibiotic Resistant PathogensCDC: “Antibiotic use in food animals is the dominant source of antibiotic resistance among food-borne pathogens.” $4billion/yr to treat antibiotic-resistant infections in humans Campylobacter fluoroquinolone resistance VREF (poss. due to avoparcin use in chickens) Antibiotics among the most counterfeited medicines worldwide

300 Alternatives to Agricultural Antibiotic UseDecrease overcrowding Better diet/sanitation/living conditions Control heat stress Vaccination Increased use of bacterial cultures and specific antibiotic treatment in animals when indicated

301 Ending Agricultural Antibiotic UseEU bans use of all antibiotic growth promoters effective 1/1/06 Three years after a Danish ban on routine use of antibiotics in chicken farming, the prevalence of antibiotic-resistant bacteria in chickens dropped from 82% to 12% US Preservation of Antibiotics for Medical Treatment Act, 2007 – awaiting vote

302 Overfishing Fisheries collapsing: Newfoundland cod West Coast salmon1/3 of fish species threatened with extinction 90% drop in # of largest predatory ocean fish since 1950 Global fisheries collapse predicted by 2048 unless practices change

303 Overfishing Fish getting smaller due to global warming (warm water holds less oxygen) 20%-32% of wild-caught seafood imported into U.S. comes from illegal or “pirate” fishing 20% of fish sold in U.S. mislabeled

304 Harmful Fishing PracticesLong-lining, bottom trawlers, drift nets Tear up seafloor, damage corals Large amounts of bycatch discarded Up to 20 lbs per lb of desired catch Cyanide fishing (400 kg/year) Dynamite Reef fishing Fishing with pesticides

305 Factory Trawlers

306 Dynamite Reef Fishing

307 The Military Harms FishEnvironmental destruction Navy sonar harming/killing off whales (agreement reached in 2016 to increase protections, limit sonar) Japanese/Norwegian whaling compounds problem Comercial whaling has cut global whale populations by up to 90% over last few centuries

308 The Military Harms FishDolphins as mine detectors (in Vietnam and Iraq) Weaponizing sharks, dolphins, etc. (DARPA) Sharks already in severe decline due to hunting for fins

309 Coral Reefs Generate $30 billion/yr globally in fishing, tourism, and protection from storm surges Reefs make up 1% of ocean floor, support ¼ of all marine life

310 Coral Reefs Threatened by bleaching due to rising ocean temperature, acidification from increased CO2, runoffs from deforestation, pesticides, sunscreen (oxybenzone) pH of oceans down 0.1 from preindustrial times to 8 With current trends, pH will be 7.7 by 2100 At pH 7.8, shell formation ceases

311 Coral Reefs 10% of world’s reefs ruined (90% in Philippines), 30-40% in critical condition 50% of Great Barrier Reef coral coverage lost over last 30 yrs (and 25% of reef coral killed in 2016 heatwave); 95% of reef affected by bleaching 80% of Caribbean reefs lost

312 Coral Reefs Americans purchase 350,000 pieces of live coral broken off from reefs per year vs. 90,000 for the rest of the world Coral gardening under development Jellyfish populations burgeoning (“cockroaches of the sea”)

313 Aquaculture 50% of fish now consumed worldwide is farmed (vs. 4% in 1970) 5-10% of U.S. fish consumption Almost all catfish and trout farmed Majority of shrimp 1/3 of salmon

314 Consequences of AquacultureNo compensation to general public for potentially exclusionary use of public services for private profit Feed inefficiency (2-6 lbs of wild fish to raise 1 lb farmed fish) Decreased diversity Escapes, interbreeding with (and lowering fitness of) wild stocks

315 Consequences of AquacultureAntibiotics (incl. chloramphenicol), hormones, dyes, herbicides, pesticides, algicides → increased pollution and sewage Damage to local estuaries, birds of prey Disease

316 Aquaculture Good seafood (clean water): Farmed bivalves: eat planktonFreshwater farm fish (with pollution controls): rainbow trout, tilapia, catfish, arctic char

317 Aquaculture Bad seafoodFarmed salmon contains 10X as much PCBs as wild salmon PCBs linked to chloracne, lower levels of testosterone in boys, irregular menses, weakened immune systems, liver and biliary tract cancers

318 Maldistribution of WealthRichest 1% (net worth of $800,000+) owns 48% of the world’s wealth Just under 2,500 billionaires worldwide, with a collective net worth of $7.7 trillion Top 62 billionaires worth $1.8 trillion, the combined income of bottom 3.6 billion people (1/2 of world’s population)

319 Maldistribution of WealthAmericans make up half the world’s richest 1% U.S: Richest 1% of the population owns 50% of the country’s wealth ; richest 10% owns 75% (worldwide the richest 1% hold as much wealth as the bottom 99% combined) -poorest 90% own 30% -widest gap of any industrialized nation -U.S. median individual net worth = $44,900 (2014) -U.S. family median net income = $55,775 (2015)

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323 The Stock Market 20% of Americans own stock; 92% of stocks and bonds owned by 20% The top 1% owns 35% of all stocks, bonds, and mutual fund assets. “Business” news

324 The Stock Market The top 1% of Americans owns 35% of all stocks, bonds, and mutual fund assets 48% of Americans own no stock Major focus of “business news”

325 Congressional Wealth and Influence½ of legislators are millionaires (vs. 1% of U.S. citizens) 10% of Congress owns 80% of Congressional wealth Average personal fortune: Senator = $13 million Representative = $5 million Median wealth of Congressperson = $1.1 million (vs $56,355 for typical American family) [2014]

326 Supreme Court Wealth and InfluenceAll 9 Supreme Court justices hold over $1 million in personal net worth and sit comfortably within America’s richest 2%

327 The Stock Market Interesting Fact: As a group, U.S. Senators beat the market by an average of 12% from (study published 2004) The best fund managers average 3% STOCK (Stop Trading on Congressional Knowledge) Act passes Congress (2012): Removes loophole exempting Congressional lawmakers and staff members from being prosecuted for “insider trading” for using knowledge gained in their work (political intelligence)

328 Consequences of Differential Stock OwnershipCorporations are answerable to their shareholders Governments are answerable (at least in theory) to their citizens (either through elections or revolutions)

329 Maldistribution of wealthThe worldwide gap between rich and poor doubled between 1960 and 1990, and grew an additional 20% between 1990 and 1998, and continues to grow today Gap is higher in the U.S. than in any other industrialized nation Associated with 880,000 deaths per year over expected number if gap was same as in Western European nations BMJ 2009;339:b4471

330 Worldwide statistical breakdown of wealth (2012)Wealth over $2,138 = top 50% Wealth over $61,000 = top 10% Wealth over $510,000 = top 1% Top 2% of individuals own more than 50% of global wealth 34% of world’s wealth held in U.S. and Canada; 30% in Europe; 24% in wealthier Asian-Pacific countries; 12% in the rest of the world

331 The Walmart 1% The 6 Walmart heirs control more wealth than the bottom 42% of Americans combined

332 Maldistribution of wealthLess than 4% of the combined wealth of the 225 richest individuals in the world would pay for ongoing access to basic education, health care (including reproductive health care), adequate food, safe water, and adequate sanitation for all humans (UNDP)

333 Declaration of Independence“All men are created equal.”

334 “Some people are more equal than others”George Orwell “Some people are more equal than others”

335 Hudson River, 2009

336 Maldistribution of Wealth/Resources Threatens National Security and Requires a Permanent War Economy“The U.S. has about 50% of the world’s wealth, but only 6.3% of its population. This situation cannot fail to be the object of envy and resentment. Our real task in the coming period is to devise a pattern of relationships which will permit us to maintain this position of disparity withoug positive detriment to our national security.” George Kennan, U.S. State Dept. Policy Planning Study, 1948

337 Voltaire “The comfort of the rich rests upon an abundance of the poor”

338 Primo Levi “A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”

339 Thomas Jefferson “Experience declares that man is the only animal which devours its own kind, for I can apply no milder term to … the general prey of the rich on the poor.”

340 Racial Disparities: EconomicMedian income of black U.S. families as a percent of white U.S. families: 60% in in 1968 62% in 2002 59% in 2010 (69% for Hispanic families)

341 Racial Disparities: EconomicRecession, housing crisis has hit black and Latino families harder than white families 7.5% on Blacks live in substandard housing (vs. 2.8 % of Whites) Educational disparities Higher levels of unemployment

342 Racial Disparities: EconomicCriminal justice system involvement Toxic waste sitings / environmental injustice / environmental racism Persistent overt / subtle discrimination E.g., “driving while black”

343 Racial Disparities in Health Care CoveragePercent uninsured: Whites = 7% Asians = 8% African-Americans = 11% Hispanics = 16% Undocumented immigrants = 40% (emergency care exception) CA Proposition 189

344 Non-Citizens 25 million non-citizens in U.S.40% lack health insurance, 2/3 lack source of non-emergency care (and many afraid to visit emergency rooms) Children particularly affected

345 Undocumented Immigrants11-12 million individuals 80% of these in labor force Constitute 30-50% of agricultural and 20% of meat processing/food service workforce 60% lack health insurance (emergency care exception) CA Proposition 189

346

347 Racial Disparities: Health CareHigher maternal and infant mortality Higher death rates for most diseases Shorter life expectancies Less health insurance Fewer diagnostic tests / therapeutic procedures

348

349 Health Disparities Among LatinosHigher rates of: Overweight and obesity Certain cancers Stroke Diabetes Asthma/COPD Chronic liver disease/cirrhosis HIV/AIDS Homicide

350 Income Inequality KillsHigher income inequality is associated with increased mortality at all per capita income levels Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000 Whereas medical advances averted 176,633 deaths AJPH 2004;94:

351 Income Inequality Lower life expectancyHigher rates of infant and child mortality 20 million deaths/yr worldwide Short height Poor self-reported health AIDS

352 Income Inequality Depression Mental Illness Obesity Crime Child abuseDiminished trust in people and institutions 2/3 of Americans trusted the government “most of the time” in 1966; 1/5 in 2016

353 Headline from The OnionScientists: Rich People, Poor People May Have Shared Common Ancestor

354 Overconsumption (Affluenza)I = P x A x T (Human Impact = Population x Affluence x Technology) U.S. = 4.5% of world’s population Own 50% of the world’s wealth

355 Overconsumption (Affluenza)U.S. responsible for: -25% of world’s energy consumption -33% of paper use -72% of hazardous waste production (1 ton/person/year)

356

357

358 But are we happier? U.S. ranks 24th in citizen satisfaction with quality of life Workloads increasing, vacation and free time decreasing

359 But are we happier? U.S. only OECD country not to guarantee paid sick leave 70% of full-time workers and 64% of private sector workers in U.S. have paid sick leave Only 19% of part-time workers Many cities, some states now guarantee

360

361 Guaranteed Paid Sick Leave: International Comparisons

362 Maternity Leave US and Papua New Guinea only 2 countries which do not guarantee paid maternity leave Lack of paid maternity leave linked to lower rates of breastfeeding and childhood immunizations and higher rates of infant and child mortality and depression in mothers

363 But are we happier? Average American wastes 62 hrs/yr sitting in rush hour traffic Average American working 200 more hrs/yr than in 1960 (#1 in world) 8/10 Americans want a new job (CNNMoney.com, 11/03) Loneliness, common among the elderly, linked to physical and cognitive decline and eclipses obesity as a predictor of early death

364 But are we happier? Stress up / satisfaction with life down5% of U.S. population suffer from a serious mental illness Anti-depressant use doubled between 1993 and 2005

365 But are we happier? 1/10 Americans over age 6 currently taking a psychotropic medication Pharmaceutical marketing plays a significant role 8.7 million Americans considered suicide in 2011 1.1 million attempted suicide

366 Erosion of social capitalErosion of social capital is strongest where maldistribution of wealth is largest Americans have an average of 2 close friends today Down from 3 in 1985 Lack of social interaction as or more harmful than smoking, alcohol abuse, hypertension, obesity

367 Erosion of social capital1 in 4 Americans say they have no one with whom they can discuss important matters Includes nuclear family Was 1 in 8 in 1985 “Most people can be trusted” 1960: agree = 58% 1994: agree = 37% Greater income inequality associated with less trust in people and institutions

368 Maldistribution of WealthIn countries with moderate levels of wealth, happiness is highest where income inequalities lowest and taxes most progressive Major League Baseball: teams are more successful when players’ salaries are more equitably distributed In more equal societies, people attend more cultural events, read more books

369 Wealth Associated with: Sense of entitlementLess attention to lower classes Presumption of superiority, “earned” rights Less ethical behavior

370 The Booming Economy Inflation-adjusted income of the median U.S. household $54,600 $49,000 $44,389 $49,777 $51,861

371 The Booming Economy Weekly wages for the average American worker are up 9% from 1973, but productivity is up 72% $3.6 trillion needed to repair nation’s infrastructure Roads, bridges, water and sewer systems

372 Booming No Longer Financial meltdown of 2008 → Causes:De-regulation of banks, insurance companies, and financial services companies via repeal of Glass-Steagall Act Housing bubble, sub-prime mortgages Greed Requiring huge bailouts Consumer Protection Agency may help

373 Vacation Time Down Americans work more than any other country: 1970 hrs/yr Canada (#2): 1800 hrs/yr Industrialized EU countries: hrs/yr Many advocate 30 hour workweek

374 Vacation Time Americans allotted 13 days leave per year (take less than 10) Italy 42 France 37 UK 28 Canada 26 Japan 25

375 Minimum Wage ≠ Living WageFederal minimum wage = $7.25/hr 25 states and DC have higher minimum wages (Oregon = $9.75/hr, 2017; will rise to $13.50 by 2022) $10,423/yr for full-time job Real value down 42% compared with 1968 Inadequate to pay rent, buy food and clothing

376 Minimum Wage ≠ Living WageIncreasing to $9.25/hr on Jan 1, 2015 Movements supporting $15/hr (still inadequate) Over ½ of nation’s basic public assistance funds go to working families (substitute for benefits, therefore, taxes support corporations)

377 Homeless 3 million homeless (13-17% of homeless adults work)7% lifetime prevalence 83,000 chronically homeless (decreasing) Housing subsidies decrease homelessness Combined income of 10 richest American’s could pay one year’s rent for every homeless person

378 Supplemental Nutritional Assistance (Food Stamp) ProgramCovers 26 million Americans 35 million Americans (1/3 of them children) live in household that cannot consistently afford food) $1.40/person/meal 5-year residency requirement for adult legal immigrants Undocumented immigrants not eligible Inadequate signup rates

379 Minimum Wage ≠ Living Wage¼ of US jobs pay less than a poverty-level income Wage theft common, worst among lowest paid workers Robs workers and governments Public service sector workers earn less than private sector employees (after adjustment for age, education, and years of experience)

380 Functional Apartheid Undocumented immigrants face constant threat of deportation, disruption of family and social relationships Undocumented immigrants pay taxes: State and local income Property Excise taxes Employer’s share of Social Security Medicare Unemployment taxes

381 Functional Apartheid BUT, they are not eligible for many public services: Medicaid Supplemental Nutritional Assistance Program Social Security Medicare Immigrants contribute est. $115 billion more to the Medicare trust fund than they took out ( ) Unemployment benefits Temporary cash assistance Open borders would add $39 trillion to global GDP over 25 yrs

382 Undocumented ImmigrantsSee Public Health and Social Justice website page on migrant and seasonal farm workers at and PHSJ website page on Race, Ethnicity, and Culture at

383 Congressional and Supreme Court WealthIn 4 of the last 5 years, Congress granted itself a $5,000 cost of living salary increase ½ of legislators are millionaires (vs. 1% of U.S. citizens) Average personal fortune: Senator = $13 million Representative = $5 million All 9 Supreme Court justices hold over $1 million in personal net worth and sit comfortably within America’s richest 2%

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386 Exorbitant CEO Pay Median U.S. CEO salary (for S and P 500 corporations) = $10 million (2016) American public thinks = $1 million U.S. CEOs of large companies make almost 3 times what non-U.S. CEOs make CEO salaries up 997% since 1978 Average worker pay up 11% “Performance pay” loophole allows corporations to skirt $30 billion/yr in taxes

387 Most Recent Annual CEO Pay Average for Large Corporations, in Millions of Dollars (2016)Japan: $2.4 France: $2.8 India: $3.1 Australia: $5.4 Germany: $8.4 Canada: $9.3 UK: $9.6 USA: $17.0

388 Exorbitant CEO Pay The average CEO makes 373X the salary of the average U.S. worker ( X) Mexico 45:1 Britain 25:1 Japan 10:1 US Military: 20:1 (top rank : lowest rank) US ratio of average CEO to minimum wage worker = 774:1

389 Exorbitant CEO Pay: The Role of Boards of DirectorsSalaries determined by boards of directors Board members predominantly other CEOs and members of top management of other companies Board members’ average salary = $258,000 (2015) for 5 hrs/wk work Vested interest in keeping CEO pay high

390 Exorbitant CEO Pay Dodd-Frank Executive Pay provision requires corporations to report SEC figuring out how to implement Much compensation outside of salary (stock, stock options, other perks) Shareholders only allowed “advisory” say on pay voting rights

391 CEO Personality CharacteristicsSome data suggest certain traits common among psychopaths are also commonly found in CEOs (and politicians, world leaders, and serial killers): Grandiose sense of self worth/narcissism Persuasiveness Superficial charm Ruthlessness Lack of remorse Manipulation of others

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393 The Mega-Rich Worried / Investing in personal security BodyguardsArmored cars Bullet-proof windows; machine gun proof doors Home security fogs Panic rooms Fully-stocked home medical suites Yachts with escape submarines Islands

394 U.S. Debt US national debt $17 trillion in 2014$52,000 for every US citizen ($146,000/taxpayer) Personal savings down Annual bankruptcies up approximately 50% between 2007 and 2010

395 CEO Personality CharacterisiticsSome data suggest certain traits common among psychopaths are also commonly found in CEOs (and politicians, world leaders, and serial killers): Grandiose sense of self worth Persuasiveness Superficial charm Ruthlessness Lack of remorse Manipulation of others

396 U.S. Debt Average household debt (for mortgages, car loans, credit cards and all other debt combined) growing Debt exacerbated by Predatory lending practices, sub-prime mortgage collapse Payday loans (22,000 stores, serving 10 million people/yr, $46 billion/yr business) Rent-to-own companies

397 Total Credit Card Debt Up$243 billion $560 billion $1.5 trillion $800 billion $951 billion Average number of credit cards per U.S. adult = 3.5

398 Bankruptcies 1.6 million bankruptcies between 6/09 and 6/10Over 60% of bankruptcies due to health care expenses (and ¾ of these individuals were insured) exceed # of college graduates/year, # of persons diagnosed with cancer per year Bankruptcy “reform” bill grossly unfair

399 Pensions Pensions in jeopardyShift from Defined Benefit Plans to Defined Contribution Plans Reductions in / elimination of employer contributions

400 The “Global Economy” 53 of the world’s 100 largest economies are private corporations; 47 are countries GM was, until recently, larger than Denmark, Thailand, Hong Kong, and Turkey Apple is larger than Poland Wal-Mart is larger than Israel and Greece AT&T is larger than Malaysia and Ireland

401 The “Global Economy” Until 2007, the combined revenues of GM and Ford exceed the combined GDP of all sub-Saharan Africa Combined sales of the top 6 Japanese companies are nearly equivalent to the combined GDP of all of South America

402 Corporations Almost 6 million corporations ¼ non-profits500 companies control 70% of world trade 148 corporations control 40% of world’s wealth (most are financial institutions)

403

404 Corporations - Milton Friedman“The [only] social responsibility of business is to increase its profits.” - Milton Friedman

405 Corporations “Corporations [have] no moral conscience. [They] are designed by law, to be concerned only for their stockholders, and not, say, what are sometimes called their stakeholders, like the community or the work force…” -Noam Chomsky

406 Corporations Internalize profitsExternalize health and environmental costs Confidential legal settlements keep important public health and safety information secret May delay governmental intervention, cause unnecessary morbidity and mortality

407 Corporate Taxation Nearly 1/3 of all large corporations (assets > $250 million or annual sales > $50 million) pay no annual income tax

408 Corporate Taxation Big business claims that U.S. corporations pay the highest corporate taxes in the world (35%) FALSE: The rate actually paid, after foreign governments get their cuts, money sent to foreign subsidiaries, loopholes, etc. = 2.3% (U.S. Treasury Department); 17% for corporations with assets over $10 million Corporate taxes are at their lowest level since WW II

409 Corporate Taxation 2004: Bush administration offered temporary tax holiday on foreign earnings $300 billion in profit repatriated 92% went to dividend payouts, stock buybacks, and corporate coffers Only 8% went to R and D, new factories, and hiring

410 Reasons for Inadequate Corporate TaxationTax breaks, corporate welfare, corporation-friendly tax laws, loopholes, transferring assets overseas Cities and states offer incentives to companies to locate in their communities, in exchange for the promise of jobs Companies often leave when a better offer becomes available

411 Reasons for Inadequate Corporate TaxationIncentives: Cash grants and loans Sales tax breaks Income tax credits and exemptions Free services Property tax abatements Highway and school construction $80 billion in 2011 Income tax breaks - $18 billion Sales tax relief - $52 billion

412 Reasons for Inadequate Corporate TaxationCheating and under-payment common Auditing program understaffed and underfunded 1/3 high school students admits to stealing something from a store in the past year

413 Reasons for Inadequate Corporate TaxationAt least 367 (73%) of the Fortune 500 companies operate one or more subsidiaries (at least 10,366 subsidiaries) in tax haven countries Lost annual tax revenue: $250 billion worldwide $100 billion in US

414 Reasons for Inadequate Corporate TaxationOffshore tax havens and shell companies shelter capital (for corporations, organized crime, and human-rights-abusing despots) Up to $32 trillion estimated (1/3 of all global wealth) 72% of U.S. corporate cash holdings (2016) $11.5 trillion in individual wealth U.S. GDP = $16 trillion Cayman Islands: Population 150,000 Home to 92,000 corporations

415 Ugland House, Cayman Islands 18,000 Corporations Registered Here

416 Job Creators?

417 Corporate Crime Each year in America, we lose;$3.8 billion to burglary and robbery $100-$400 billion to health care fraud; $40 billion to auto repair fraud, $15 billion to securities fraud, etc.; the S and L fraud cost between $300 billion and $500 billion

418 Corporate Crime Fines meager, often considered a cost of doing business Corporate crime under-prosecuted, prosecutors under-funded Hide no Harm Act (pending in Senate) would hold corporate officers criminally accountable if they knowingly concealed serious dangers that led to consumer or worker deaths or injuries

419 Corporate Crime 25% decrease in federal prosecutions of white collar crime, including corporate crime, since 1999 Increase in non-prosecution and deferred-prosecution agreements 3/5 U.S. companies settling corporate crime cases illegally deduct some or all of the settlement to the IRS

420 Corporate Crime Companies mandating forced arbitrationSCOTUS allows corporate binding arbitration contracts, limiting class action lawsuits (AT&T v. Concepcion, 2011) Arbitration Fairness Act would counteract ruling Arbitrators private business people, thus hope to please corporate entities that retain them

421 Tort “Reform” (Deform)Federal laws, SCOTUS decisions, and laws in 38 states impede consumers’ ability to seek punitive remedies and limit corporate liability Number of suits low, despite public perceptions Liability costs (lawsuits and insurance) $4-5/$1,000 revenue Corporate lawyers, as sworn “officers of the court” (as are all lawyers), have a professional duty to look out for the overall administration of justice and not arbitrarily block the courtroom door

422 Corporate Crime 1,288 whistleblower lawsuits ; government ruled for whistleblower in only 17 US Supreme Court (Garcetti v. Ceballos, 2006) sharply restricted rights of public employee whistleblowers Congress passed Whistleblower Protection Enhancement Act (2011) Obama has pursued more whistleblowers than any U.S. president

423 Unemployment 9-12% unemployment rateTrue percentage likely higher (approximately 16%) Only 1/3 of the unemployed are eligible for unemployment insurance Women slightly more likely to be unemployed than men Black women 2X white women Under-employment rate approximately 10%

424 The Rise of the Permatemp94% of all new jobs added between 2005 and 2015 were either temporary or contract-based Temporary agency workers million million 40% of US jobs part-time or seasonal

425 Expatriation of jobs : U.S.-based multinational corporations cut 2.9 million jobs in U.S. while increasing foreign employment by 2.4 million Overseas factories often lack adequate occupational health and safety and environmental standards

426 Job Loss and The Decline of LaborResults: millions of jobs lost, early (sometimes forced) retirements, job insecurity, fewer benefits, no retirement savings, more uninsured, etc. 50% of U.S. households have no retirement savings

427 Job Loss and The Decline of LaborLabor union membership declining since 1950 Now 12%: 7% in private sector 36% in public sector Employers generally anti-union Employee Free Choice Act would make it easier for workers to unionize

428 Labor Unions Unionized workers earn more; have better health benefits, retirement, and disability portfolios; and have safer working conditions, Industrialized countries with a greater fraction of workers in unions invest more in social welfare Corporate class turns U.S. laborers against their natural advocates (workers in other countries, undocumented immigrants, etc.)

429 Political Spending Corporations vs. LaborU.S. Chamber of Commerce spent $139 million on 2012 Congressional elections AFL-CIO and SEIU (two largest labor unions) spend $6 million combined

430

431 Abraham Lincoln “Labor is prior to, and independent of, capital; that, in fact, capital is the fruit of labor, and could never have existed if labor had not first existed. Labor is the superior of capital and deserves much the higher consideration.”

432 Railroad magnate Jay Gould“I can hire one-half of the working class to kill the other half.”

433 Overseas Labor MarketsCurrently made overseas: 83% of all garments sold in the U.S. 90% of sporting goods 93% of shoes

434 Overseas Labor MarketsOverseas factories often lack adequate occupational health and safety / pollution controls (e.g., maquiladoras) Even in U.S., up to 80% of occupational illnesses and injuries missed 2/3 of workers fear disciplinary reaction for disclosing 1/3 of physicians asked to undertreat to avoid triggering an incident report

435 Value of Workers to SocietyTax accountants destroy $47 for every $1 in value they generate Advertisers destroy $11 for every $1 they generate Bankers destroy $7 for every $1 they generate

436 Value of Workers to SocietyWaste recycling workers generate $12 in value for every $1 they are paid Hospital cleaners generate $10 in social value for every $1 they are paid Childcare workers generate $7-$9.50 for every $1 they are paid

437 Worker Health and SafetyILO: 2.2 million die of work-related injuries and diseases worldwide each year Considered vast underestimate, due to poor reporting in many developing countries Almost 4700 U.S. workers die each year due to job-related injuries Highest numbers: construction, transportation and warehousing, forestry, fishing and hunting OSHA inspections rare, fines/jail time minimal

438 Worker Health and SafetyWorkplace Violence Over 2 million victims in U.S. each year Health care industry leads all other sectors Costs $120 billion/yr

439 Outsourcing 2 million U.S. jobs lost to outsourcing since 1983Exact numbers difficult to obtain, companies do not have to report Over the last few years, compared to other firms, CEO compensation has increased five times faster at the 50 U.S. firms that do the most outsourcing of jobs

440 Asian Sweatshop

441 Violations of Employment and Labor Laws26% of low-wage workers paid less than legally-required minimum wage 25% of workers had put in overtime Avg. 11 hrs, 75% not paid overtime rate Off-the-clock, meal break, pay stub, tipped job violations common

442 Violations of Employment and Labor LawsIllegal deductions, employer retaliation, and workers’ compensation violations Women, foreign-born, non-English-speaking, less educated, and non-unionized face more violations Violations common in home-based work and industry

443 The Global Workforce 30 million enslaved laborersIndia, China, and Pakistan top 3 countries Slavery occurs in every country in Africa (Unicef) 800,000 persons trafficked across international borders annually Dollar value of commerce in human beings rivals drug trafficking and illegal arms trade

444 The Global Workforce 215 million child laborers (over 260,000 child farm laborers in US) ¼ children in sub-Saharan Africa 60% exposed to hazardous conditions; 25% exposed to hazardous chemicals Violations of child labor laws common in U.S.

445 Child Labor

446 Outsourcing the GovernmentMore than ½ of federal jobs now outsourced to private corporations More than ½ of contracts no-bid Threat to democracy Outsourcing of military Mercenaries Demoralizes troops

447 Thomas Jefferson The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government

448 The Third World Debt CrisisOver 40 of the poorest countries in Africa, Latin America, and Asia owe a total of almost $300 billion in foreign debt countries borrowed when loans cheap and easy to get money lent to corrupt/undemocratic governments during Cold War corruption world prices for main exports declined new loans (at higher interest rates) required to pay interest on debt

449 The Third World Debt CrisisCreditors US, UK, Japan, France and Germany interest rates up to 20-22% in 1980’s

450 The Third World Debt CrisisEach African child inherits approximately $379 in debt at birth debt % of GDP for Tanzania, Zambia, Ethiopia, and others Per capita income in Sub-Saharan Africa has declined in real terms by 6% since 1975 Live Aid (1985 raised $200 million) Equal to the amount all African countries pay back on foreign debts each week (in 2001)

451 The Third World Debt CrisisCountries spend more each year repaying debt than on education and healthcare. Debt will never be paid off

452 Effects of the Third World Debt CrisisIndebted countries drastically cut wages, which slows the economy and decreases purchases of U.S. imports makes U.S. jobs less secure Currency is devalued. imports more expensive; exports cheaper Government price controls eliminated basic goods more expensive

453 Effects of the Third World Debt CrisisGovernment spending on food, fuel and farming subsidies reduced One week of developed world farm subsidies = Annual cost of food aid to eliminate world hunger Social service (healthcare/education) program spending cut Countries strip and sell their natural resources increased global pollution, etc.

454 Debt and Microfinance Muhammad Yunus (2006 Nobel Peace Prize) – Grameen Bank Microfinance promises growth of individual and small business Reality – interests and default rates often high, corruption common Perpetuates unfair economic system

455 Solution to the Third World Debt CrisisDebt forgiveness

456 Foreign Aid In total dollars: U.S. #1As a % of GDP, U.S. ranks 21st among the world’s wealthiest nations More money flows out of developing countries in the form of interest payments, profits of foreign corporations, and clandestine investments in financial markets of rich countries than flows into them as loans, aid, and foreign direct investment

457

458 Foreign Aid U.S. Aid: Over 1/3 military, 1/4 economic, 1/3 for food and development Most U.S. aid benefits U.S. corporations, is spent on military, goes to Egypt, Israel, Turkey, Pakistan, and the Philippines

459 Foreign Aid Aid agencies often forced to buy from U.S. companies at inflated prices 70% of aid effectively returned to U.S. Food aid inefficient, benefits large agribusiness at expense of local farmers/economies Takes $2 taxpayer money to generate $1 in food aid

460 Foreign Aid 0.19% of the total federal budget, vs. UN target of 0.7%On average, Americans think that 28% of the federal budget goes toward foreign aid

461 Approximately $250 billion/yearU.S. Charitable Giving Approximately $250 billion/year 2.5% of income 2.9% at height of Great Depression

462 U.S. Charitable Giving by Income Bracket$15K and under: 26% $15K - $30K: 9% $30K - $50K: 5.3% $50K - $100K: 3.8% $100K - $200K: 3.0% $200K and over: 3.4% Empathy Gap: wealthier people ruder with strangers, less charitably generous than poor people

463 American Charitable GivingReligious Groups: 35% Education: 13% Multipurpose Foundations: 10% Social Services: 8% Health: 8% Arts and Culture: 6% NEA and NEH combined budget = $292 million 0.008% of national spending (2013)

464 American Charitable GivingScience: 5% Environment and Animals: 3% International Aid: 2% Other: 9% - Includes individual, corporate, foundation, and bequest donations Less than 10% goes to groups which directly help the poor

465 The Gates Foundation Endowment of approximately $37 billion, with another $31 billion pledged by Buffett Foundation Donates 5% of its worth/yr, invests 95% (typical for charities) Drives international public health agenda As do other corporate donors (“philanthrocapitalists”) Most grants go to organizations in high-income countries

466 The Gates Foundation Lack of external oversight, accountabilityAt least 41% of its assets invested in companies that counter the foundations charitable goals or socially concerned philosophy E.g., Oil and chemical companies, agrobusiness, pharmaceutical industry, soda Similar problems for Warren Buffet’s Berkshire wealth Lancet 2009;373:

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468

469

470 Discretionary Federal Spending (2013)

471 The Military and PollutionWorld’s single largest polluter 6-10% of global air pollution 2-11% of world raw material use

472 The Military and Pollution97% of all high level and 78% of all low level nuclear waste 104 commercial U.S. nuclear reactors (495 worldwide) – most aged, many unsafe More than 210 million liters of radioactive and chemical waste stored at Hanford, WA Site plagued by leaks, cost overruns

473 The Military and PollutionPentagon generates 750,000 tons hazardous waste/year Numerous toxic waste sites Exempt from most environmental regulations

474 The Military and Pollution“The more birds that the [Department of Defense] kill[s], the more enjoyment [people] will get from seeing the ones that remain: ‘Bird watchers get more enjoyment spotting a rare bird than they do spotting a common one.’” From a 2002 court summary of the U.S. Defense Department’s argument for exemption from the Migratory Bird Treaty Act of 1918

475 World Military Spending (2012)

476 War and Peace World military budget = 1.7 trillion (2011)230X what the UN spends on peacekeeping US: Largest military budget; largest arms supplier Greatest debtor to peacekeeping fund

477 Economic Cost of War, U.S.

478 The Military: Diversion of Resources Away from Health Care3 hours world arms spending = annual WHO budget 1/2 day of world arms spending = full childhood immunizations for all world’s children 3 days of U.S. military spending = amt. spent on health, education, and welfare for U.S. children in 1 year

479 The Military: Diversion of Resources Away from Health Care and Other Scientific Projects3 weeks of world arms spending/yr. = primary health care for all in poor countries, incl. safe water and full immunizations 25% of the world’s 2.5 million research scientists and engineers work entirely on military R and D Anthropologists co-opted under U.S. Army’s Human Terrain Team

480 The Military: Diversion of Resources Away from Health Care and Other Scientific ProjectsIraq/Afghanistan war creating enormous U.S. debt Federal and state budgets strapped States - $55 billion budget gap (2012)

481 War Deaths,

482 Arms Exports

483 Arms Imports

484 Weapons of Mass DestructionNuclear Weapons: 1054 U.S. nuclear tests since 1940s, 331 in atmosphere 23,360 nuclear weapons at 11 sites in 14 countries (1/2 active or operationally-deployed) 5200 active U.S. warheads today (½ on hair-trigger alert); similar number in Russia START treaty signed by Obama, Putin Awaiting Senate approval Will limit US and Russia to 1,550 long-range warheads (still overkill)

485 Weapons of Mass DestructionBiological Weapons Chemical Weapons See WMD slide show on “War and Peace” page of phsj website

486 “Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and not clothed.” ~ Dwight D. Eisenhower

487 “The problem in defense spending is to figure out how far you should go without destroying from within what you are trying to defend from without.” ~Dwight D. Eisenhower

488 Poverty and Hunger US: 14% of residents and 21% of children live in poverty Rates of poverty in Blacks and Hispanics = almost 3X Whites 2016 federal poverty level = $11,880 gross annual income (individual); $24,300 for family of 4 Hunger rate increasing nationally Poverty associated with worse physical and mental health, poor cognitive development, less sleep

489 Poverty, Health Insurance, and Food and Energy Insecurity13.5% (43 million people) in poverty (2015) 9% (29 million people) lack health insurance (2016) Cost of maintaining COBRA health insurance for a family consumes 84% of worker’s unemployment benefits Food insecurity 15% / Energy insecurity 5% (2016)

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491

492

493

494

495

496 Poverty At least 1 billion people live in urban slums650 million people lack access to safe, clean drinking water -1.8 million child deaths/year 2 billion suffer from vitamin/mineral deficiencies

497 Poverty 2 billion have no electricity2.3 billion do not have adequate sanitation services Lack of clean water and sanitation cause 4 billion cases of diarrhea and 1.6 million deaths per year

498 Poverty 2.8 billion live on less than $2/day (71% on less than $10/d)3 billion have never made a phone call 3.8 billion have no cash or credit with which to make purchases 770 million unable to read Net transfer of capital from poorer countries to rich ones

499 Human Poverty

500 Poverty

501 Poverty, Hunger, and MicronutrientsCost of providing vitamin A and zinc supplements to malnourished infants and toddlers under age 2 = $60 million/year Benefits (including prevention of blindness and malnutrition) > $1 billion/yr Cost of providing iron and iodized salt = $286 million/year Benefits (including prevention of iron-deficiency anemia, cretinism) = $2.7 billion/yr

502 Poverty and PrioritiesAmount of money needed each year (in addition to current expenditures) to provide water and sanitation for all people in developing nations = $9 billion Amount of money spent annually on cosmetics in the U.S. = $8 billion

503 Poverty and PrioritiesAmount of money needed each year ( in addition to current expenditures) to provide reproductive health care for all women in developing countries = $12 billion Amount of money spent annually on perfumes in Europe and the U.S. = $12 billion

504 Poverty and PrioritiesAmericans bought > $57 billion worth of lottery tickets in 2008 (more money than is spent on movies, music, and books combined) In 2006, Americans spent $31 billion on toys and video games Almost as much as the rest of the world combined 80% of U.S. toys made in China American American buys 60 items of clothing per year (2012, vs. 31 in 1985) Consider alternate gifts, charitable donations

505 Toy Exports

506 Toy Imports

507 U.N. Declaration of Human Rights“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care”

508

509 Famine 1.2 billion not consuming enough calories to prevent stunted growth/other health risks Hunger and malnutrition kill over 3 million children per year worldwide Hunger kills 18,000 people per day, most under age 5 Hunger-related causes kill as many people in 8 days as the atomic bomb killed at Hiroshima

510 Famine We are close to utilizing the sustainable limit of 15% of the Earth’s surface that can be exploited for crop production There are now more people (1.1 billion) who get too much to eat than those who don’t have enough to eat (800 million)

511 Famine UN FAO: enough food produced daily to provide every living person with over 2700 calories/day Even so, half the world’s food is wasted (UN FAO) Better methods of food preservation needed Diversion of food crops to biofuels significant contributor to rise in food prices, along with food commodities speculation and trading

512 Monetization and Food AidUS food aid purchased from already-subsidized US agribusiness US shipping lines transport food to aid organizations in developing countries Undermines local farmers and destabilizes local agriculture Farmers in U.S. and abroad have high suicide rates

513 Monetization and Food AidEU has almost entirely phased out monetization UN World Food Programme (the world’s largest distributor of food aid) has rejected monetization and refuses monetized food aid

514 Famine Rich governments and corporations buying up rights to millions of hectares of agricultural land in developing countries in order to secure their own long-term food supplies One week of developed world farm subsidies = annual cost of food aid to solve world hunger Hunger: solution requires political will

515 Feast and Famine For the first time in history, there are now an equal number of people – 1.1 billion – who get too much to eat as those who don’t have enough to eat

516 Famine

517 Famine Affects the Old and Young

518 Medical Care 50% of global health care budget spent in the U.S.Currently only 10% of funding devoted to diseases affecting 90% of world’s population Per capita expenditure on health care: U.S. = $8,233 Average for low income developing nations = $22-25

519 Medical Care Even so… U.S. has 41 million uninsuredRanks 24th worldwide in overall population health as judged by disability-adjusted life expectancy Ranks 42nd in global life expectancy

520 Medical Care Lack of health insurance responsible for 48,000 deaths/yr in US Lack of universal health care limits workforce mobility 2008 study: 7% say they or a family member has married in order to get health insurance

521 Headline from The OnionUninsured Man Hopes His Symptoms Diagnosed This Week On House

522 Infectious Diseases Increased morbidity and mortality due to changing distributions of disease vectors, reservoirs, and agents -overpopulation and population shifts -malnutrition -drought -decreased immunity

523 Infectious Diseases Malaria min zone expands million additional cases/year by 2100 TB Viral encephalitis Schistosomiasis AIDS Influenza Trypanosomiasis

524 Infectious Diseases Onchocerciasis Dengre Leishmanasis Rabies HookwormYellow fever West Nile Virus

525 HIV/AIDS 2008: 33 million infected 2007: 2 million deathsSub-Saharan Africa hardest hit Only 20% of HIV+ individuals in low and middle-income countries know they are infected Less than 1/3 of those needing therapy receive any medication

526 HIV Prevalence

527 Malaria Deaths

528 Species Loss Earth contains an estimated 5 to 100 million speciesBest estimate 8.7 million +/- 1.3 million 6.5 million on land (est. 86% not yet discovered) 2.2 million in water (est. 91% not yet discovered)

529

530 Species Loss Only 1.8 million have been identified50 new species identified each day Background rate of extinction = 0.1 species/yr Current rate of extinction = 100-1,000 species/year, highest estimates = 4 species/hour Mass die-offs common but increased now

531 Species Loss 50,000 vertebrates7,100 of 10,000 bird species threatened with extinction (25 million killed illegally each year in the Mediterranean alone) Vultures dramatically declining, in part due to use of diclofenac 9now banned in India) – increases risk of human infectious diseases, including rabies

532 Species Loss 50,000 vertebrates: 1/4 of 4,400 mammalian species70% decline in wild chimpanzees over last 30 years 1/2 of 232 primate species (including man?) Bush meat trade contributing 1/3 of 24,000 fish species 30-50% of 10,300 reptile and amphibian species (may be higher, limited assessment)

533 Species Loss Vital invertebrates have declined by 45% since 198020% of all invertebrates at risk of extinction 1/5 of world’s plant species, and almost ¾ of flowering plants, at risk of extinction

534 Species Loss 50% decline in number of wild animals over last 40 yearsPrecipitous decline of alpha predators (apex consumers) will have enormous repercussions for ecosystems/other species 90% already extinct

535 Species Loss Dilution Effect Hypothesis:Biodiversity loss increases number and types of parasites and herbivore pests, thus disrupting the production of natural ecosystems and causing increases in human, wildlife, and plant diseases

536

537

538

539 Species Loss 6000-8000 Orangutans left in Borneo3500 wild tigers worldwide 5,000 – 10,000 in captivity in U.S. (only 350 in accredited zoos) 110 killed per year 720 wild gorillas 30-50 Florida Panthers 1 Pacific Manzanita Plant

540 Species Loss 2,100 animals on ES list today – many more at risk73% of plants and animals that have gone extinct since 1973 were not listed 49% decline in marine vertebrate populations between 1970 and 2012 (WWF)

541 Species Loss Yangtze River dolphins extinct as of 2007Polar bears, Adelie penguins at risk of extinction due to global warming Bees and bats imperiled

542

543

544 Causes of Species Loss Habitat loss (logging, overpopulation, etc.) - #1 cause now Global warming – est. #2 cause by 2050 Overhunting Chemical pollution of environment

545 Causes of Species Loss Exotic species invasions (e.g. rabbits/Australia; role of ballast water, link of shipping with GDP): Cost = $1.4 trillion/yr (5% of global economy); $130 billion/yr in US Ballast Water Convention (few signatories to date)

546 Causes of Species Loss Rise of fungi and fungus-like pathogens (oomycetes) Account for 65% of pathogen-driven species loss

547 Causes of Species Loss HUMANS

548 Species Loss Norwegian government built artificial cave in frozen mountain at edge of Arctic Circle (Svalbard) to preserve 2 million varieties of seeds from ??? Global Genome Initiative – 200,000 DNA samples and counting De-extinction Pleistocene Re-wilding

549 Extinction: Lost PharmacopoeiaDrugs from plants and native peoples’ health knowledge -More than 1/2 of the top 150 prescription drugs contain an active compound derived from or patterned after natural products -e.g. aspirin, acyclovir, lovastatin, digoxin, vincristine, etoposide, captopril, cyclosporine, sirolimus, vancomycin, paralytic agents, warfarin, etc. Of the more than 250,000 known flowering species, <0.5% have been surveyed for medicinal value

550 A Cure for Cancer?

551 The Black Market in Endangered Animals$20 billion market -equal to smuggled arms market -less than contraband drug market ($30 Billion) -criminal syndicates involved, profits fund terrorist and other extremist groups

552 The Black Market in Endangered AnimalsLaws poorly enforced Convention on International Trade in Endangered Species (CITES) Until recently, allowed more than 100 million individuals of rare species to be bought and sold each year, but strengthened in 2016 WildLeaks (Wikileaks for wildlife) to help identify perpetrators

553 The Black Market in Endangered Animals100 million sharks killed per year (many for shark fin soup) Tigers killed for tiger penis/fur, or sold to wealthy as pets 30,000 African elephants slaughtered annually for ivory (for Asian medicine and religious icons) Helps fund terrorism Population down 73% over last 40 y Rhinos slaughtered for horns (Asian medicine) Population down 95% over last 40 y

554

555

556

557

558 Invasive Species > 50,000 invasive animal, plant, and microbe species Estimated annual cost = 5% of the world’s economy Cost to U.S. economy = $120 billion Second biggest threat to endangered animals after habitat loss

559 Invasive Species Examples: Rabbits and cane toads in AustraliaBrown tree snakes in Guam Pacific rats in Polynesia Kudzu in the U.S.

560 Invasive Species Examples:Zebra mussels in U.S. (but have filtered pollution in Lake Erie and other waterways, promoting revival of aquatic plants, and feeds a growing population of smallmouth bass and lake sturgeon

561 Invasive Species Examples: Asian carp - threatening U.S. Great LakesHuanglongbing (“citrus greening”) – devastating Florida orange crops Jellyfish (“cockroaches of the sea”)

562 Invasive Species HOWEVER, many scientists find the term specious, recognize that most species were at one time “invasive”, and note certain benefits associated with “invasive species”, and find fault with studies estimating damaging effects on environment Question corporate role in exacerbating threats, since invasive species fought with “chain saws, bulldozers, and poisons (e.g., pesticides).”

563 Worrisome Trends Environmental Audit LawsIncreased federal pre-emption of state laws WTO/World Bank/IMF Policies MAI Food Disparagement Laws SLAPP Lawsuits

564 Trade Agreements, International Bodies Promote Corporate InterestsNAFTA, CAFTA, TPP anti-democratic, secretive IMF, World Bank, and WTO structural adjustment programs exacerbate hunger in the developing world by forcing debtor nations to restructure their agricultural base toward export crops and away from nutritional foodstuffs for local consumption

565 Worrisome Trends Corruption of judiciary by campaign contributions86% of US judges are elected Many federal judgeships remain vacant, as Senate refuses to confirm nominees

566 Bush Administration Key administrators/committee members/regulators former industry representatives and/or lobbyists Corporate profit before public good Unsound/distorted/suppressed science “Climategate”

567 Bush Administration Eco-harassment Criminalizing activistsRollbacks of key environmental laws Lax enforcement of existing laws OMB estimates annual benefits of major federal regulations between 1996 and 2006 = $99 billion - $484 billion, annual costs = $40 billion - $46 billion

568 Bush Administration American exceptionalism:“The American lifestyle is non-negotiable” Huge tax cuts primarily benefit wealthy

569

570 Obama Administration Large industry influence Very slow progress

571 Obama Administration Overturns global gag ruleSome improvements in FDA, EPA Withdrawal (partial) from Iraq Failure to consider single payer health care Supports genetically-modified crops Appointees holdovers (philosophically and personally) from prior administrations Trump - ecocidal

572 Status of Women in the Third WorldPoverty Impaired access to employment and education Lack of reproductive health services, early childbearing, large families

573 Status of Women in the Third WorldPolitical marginalization Discriminatory and “cultural practices” -forced prostitution, female genital mutilation, etc. Trafficking, sex slavery

574 Status of Women Economic discrimination Povertywomen do 67% of the world’s work receive 10% of global income own 1% of all property Poverty Women make up 45% of the global employed workforce, yet are 70% of the world’s poor

575 Status of Women Women in the U.S. working full-time make $ $0.81/$1.00 males Those in unions have higher salaries, better benefits Part-time salary balanced $1.04/$1.00 60% of differential due to women’s choosing lower-paying and more portable careers in order to support a spouse or allow for more time to care for children or elders

576 Gender Pay Gap (US)

577

578 Education Worldwide More education = longer life (for mother and her child) Less education = worse health Infant mortality rates vary by mother’s education Parents’ education is linked with children’s health

579 Education Worldwide Education increases health knowledge and healthy behaviors Greater educational attainment leads to better employment opportunities and higher income, which are linked with better health

580 Public Education in DisarrayInadequate funding, decaying infrastructure National HS graduation rate 65-70% No change from 1970s Lower incomes youths 6X as likely to drop out 25% of Americans functionally illiterate

581 Public Education in DisarrayCollege tuition costs rising; state funding decreasing Increasingly marginalizes poor, minorities 70% of students come from wealthiest ¼ of US families 14% from the poorest half But 39% of highest-achieving students from poorest half

582 Would You Sign a Petition to Ban Dihydrogen Monoxide?1. It can cause excessive sweating and vomiting 2. It is a major component in acid rain 3. It can cause severe burns in its gaseous state 4. It can kill you if accidentally inhaled 5. It contributes to erosion 6. It decreases effectiveness of automobile brakes 7. It has been found in tumors of terminal cancer patients

583 Geographic Ignorance Percent of US teens unable to locate the following on a map: United States – 11% Pacific Ocean – 29% Japan – 58% United Kingdom – 68%

584 Pseudoscientific BeliefsPercentage of Americans who believe “at least to some degree” in these “phenomena” Astrology (35%, 2014) 37% % UFOs 30% % Reincarnation 25% % Fortune-Telling 14% 4%

585 Ignorance/Pseudoscientific BeliefsHalf of US citizens do not believe in evolution and do believe that humans and dinosaurs coexisted (2007); 35% (2014) 40% think scientists still generally disagree about evolution Only 12% of U.S. Protestant pastors believe in evolution 20% of high school biology teachers are creationists

586 Pseudoscientific Beliefs40% - 70% believe in global warming 54% believe places can be haunted (2014) 25% believe in UFOs (2007) 24% believe in reincarnation (2014) 24% believe in astrology (2009)

587 Ignorance/Pseudoscientific Beliefs16% believe that people with the “evil eye” can cast curses or harmful spells 22% of Americans don’t know whether an atomic bomb has ever been dropped (2000) 25% of Americans don’t know the earth revolves around the sun (2014)

588 Ignorance/Pseudoscientific BeliefsSome states require instructors to teach “creation science,” “intelligent design,” and “climate change skepticism” Americans rank last overall in environmental attitudes and habits (survey of 20 developed countries, 2014) Those who are less green feel less guilt

589 Ignorance/Pseudoscientific Beliefs18% believe in Bigfoot and the Loch Ness Monster (2007) 8% of men / 18% of women believe in astrology and fortune tellers (2007) 14% have consulted a psychic or fortune teller (2009) Widespread misconceptions regarding vaccine efficacy and safety and antibiotic use/resistance

590

591 Ignorance/Pseudoscientific BeliefsAnti-vaccination Puts unvaccinated child and general public at risk Promoted by “celebrity” and former Playboy Playmate Jenny McCarthy (“The University of Google is where I got my degree from”) MS mandates vaccination (and has lowest rate of vaccine-preventable diseases); others considering Childhood vaccinations prevented more than 100 million cases of serious disease between 1924 and 2012, with very rare adverse effects 53% of Americans think vaccines are safe and effective (2014)

592 Greenwash Public relations / ad campaigns -Chevron’s “People Do” Campaign, butterflies/refinery -BP invests $100 million annually in clean energy = amt. it spends annually to market its new name and environmentally-friendly image of moving “Beyond Petroleum” -Dupont Freon Campaign in 1970’s -Grants to a few scientists who challenge environmental warnings -tobacco ads in 1950’s Bluewash: association with UN principles/logo

593 Astroturf Artificially-created grassroots coalitionsUtilize specially tailored mailing lists, field officers, telephone banks, fax machines, intense lobbying May be one or two individuals, or run by a PR firm, or have “volunteer” employee members

594 Corporate Front GroupsThe American Council on Science and Health The Alliance for Responsible CFC Policy The Oregon Lands Coalition National Wilderness Institute The Environmental Conservation Organization The Foundation for Clean Air Progress Council for Biotechnology Information Cornell Alliance for Science Similar semantics for new laws/congressional bills

595 Corporate PR Tactics Advertising“The art of convincing people to spend money they don't have for something they don't need.“ (Will Rogers) Astroturf - artificially-created grassroots coalitions Corporate front groups Invoke poor people as beneficiaries

596 Corporate PR tactics Characterize opposition as “technophobic,” anti-science,” and “against progress” Portray their products as environmentally beneficial despite evidence to the contrary Corporate espionage: spying, bribes Bribery of foreign officials illegal under Foreign Corrupt Practices Act

597 Public Relations $200 billion industryPR flacks now outnumber journalists 40% fewer journalists than just a decade ago “Fake news” epidemic; gaslighting

598 Sponsored Environmental Educational MaterialsCorporate-sponsored and supported by a loose coalition of antiregulatory zealots, corporate polluters, lapdog scientists and misguided parents

599 Sponsored Environmental Education Materials (Examples)Exxon’s “Energy Cube” -“Gasoline is simply solar power hidden in decayed matter” -“Offshore drilling creates reefs for fish” - Exxon deliberately hid data showing fossil fuels can contribute to devastating climate change since the 1970s, instead spread disinformation

600 Sponsored Environmental Education Materials (Examples)International Paper -“Clearcutting promotes growth of trees that require full sunlight and allows efficient site preparation for the next crop” American Coal Foundation 4th grade lesson packet (published by Scholastic) entitled “The United States of Energy) Omits mention of toxic waste, mountaintop removal, and greenhouse gasses

601 Sponsored Environmental Education Materials (Examples)Pacific Lumber Company -“The Great American Forest is. . . renewable forever” American Nuclear Society’s “Activities with the Atoms Family” Dow’s “Chemipalooza” Council for Biotechnology Information’s “Look Closer at Biotechnology”

602 Textbook Publishers Facilitate Corporate MessagingScholastic, Inc. World’s largest publisher of children’s educational materials Found in 90% of U.S. classrooms Has taken money from Big Coal, Disney, Microsoft, Nestlé, and Shell to produce books and lesson plans 2011: Announces plan to terminate some industry contracts, set up quasi-independent review board to review corporate materials

603 Advertising US now spends $290 billion/yr on advertisingAlmost $1,000/person/yr in the U.S. 10% of a two-year olds nouns are brand names The average American can recognize over 1,000 corporate logos, but fewer than 10 plants and animals native to his/her locality

604 Advertising/PR "Those who manipulate the unseen mechanism of society constitute an invisible government which is the true ruling power of our country. We are governed, our minds molded, our tastes formed, our ideas suggested largely by men we have never heard of. →

605 Advertising/PR In almost every act of our lives, whether in the sphere of politics or business, in our social conduct or our ethical thinking, we are dominated by the relatively small number of persons who understand the mental processes and social patterns of the masses. It is they who pull the wires that control the public mind.” -Edward Bernays, Pioneer of Corporate PR and Propaganda

606 Worrisome Trends TelevisionAverage American watches over 4 hours of TV daily Average American child aged 8-18 spends 8 hrs/day using an electronic device or watching TV TV sets now outnumber homes in America Average US teen: Spends 9 hrs/d using social media (8-12 year olds = 6 hrs/d) Sends/receives almost 100 text messages/d

607 Channel One (Primedia, for-profit)12 minutes per day: Includes 2 minutes of ads (mostly for junk foods, video games) Viewed by 8 million students in 12, 000 classrooms Disproportionately shown in low income and minority communities Costs taxpayers $1.8 billion per year Opposed by major education groups

608 Worrisome Trends Public Education in disarray1/3 of America’s 80,000 schools need extensive repair or replacement 1/3 or more have mold, dust, indoor air problems (contribute to asthma, absenteeism Higher Education increasingly expensive

609 Anti-Science LegislatorsCurrent and recent members of the House Science Committee Paul Broun (R-GA): Evolution, embryology, and the Big Bang Theory are “lies straight from the pit of hell;” climate change is a “hoax” Ralph Hall (R-TX): Agrees with TX Governor Rick Perry that climate scientists are involved in a conspiracy to receive research funding. Jim Sensenbrenner (R-WI): The science on global warming is “inconclusive”

610 Anti-Science LegislatorsCurrent and recent members of the House Science Committee: Todd Akin (R-MO): “If it’s legitimate rape,” women will not get pregnant (lost 2012 election) Dana Rohrbacher (R-CA): Claimed an earlier period of global warming may have been caused by “dinosaur flatulence,” suggested that if global warming is real it could be addressed by cutting down trees, does not believe that CO2 is a cause of global warming

611 Nation’s Schoolchildren Call For Cuts in Math/Science Funding

612 Education in America 16% of adults have not completed high school30% have no schooling beyond high school 27% have attended but not completed college 28% are college graduates Rates vary dramatically across racial and ethnic groups

613

614 Educational ApartheidHigh levels of de facto school segregation by race and SES Gross discrepancies in per-pupil spending and teacher salaries Achievement and graduation gaps growing

615 Benefits of Education For every $1 spent on early childhood education, up to $17 are saved from increased school achievement, improved health, reduced crime, and reduced reliance on public assistance Income increases 11% for every year of education

616 Benefits of Education College graduates live 5 years longer than high school dropouts Eliminating educational inequities would have saved 8X as many lives as medical advances from

617 Academics at Risk Increasing corporatization of academiaPrivate commercial funding of university research increasing: $264 million in 1980 $3.2 billion in 2009 Federal funding decreasing Accounts for 1/4 of U.S. R and D

618 Academics/Professional Organizations AffectedIncreasing corporatization of academia For-profit schools Charter schools Educational corporations Top 25 US hedge fund managers take home more income than all kindergarten teachers combined

619 Academics/Professional Organizations AffectedFor-profit colleges (e.g., University of Phoenix, ITT Tech, Trump University) were growing, marked by corruption, high interest rates on loans to the un- and under-qualified (some have shut down, paid fines, settled lawsuits) Student loan debt almost $2 billion one decade ago, now $1.2 trillion Greater than all Americans’ credit card debt Benefit largely from taxpayer money

620 Academics at Risk Secrecy/PseudoscienceAAPG Notable Achievement in Journalism prize to Michael Crichton for State of Fear (which denies global warming) Undone science See slide shows on corporations and on science and pseudoscience on phsj website

621 Academics at Risk Including government scientistsSubversion of science by Bush Administration Obama administration slow to roll out ethical standards Discourages young scientists

622 Academics at Risk Contingent (adjunct) faculty up from 43% (1979) to 75% today Paid ¼ amount of regular faculty No benefits No job security, opportunities for career advancement Dramatic decrease in tenured faculty, rise in number of administrators Many very well paid

623 Academics/Professional Organizations AffectedDramatic decrease in tenured faculty, rise in administrators Over 30 private university presidents make over $1 million in annual salary (football coaches often make much more) 75% of faculty members now adjunct (avg. salary $25,000)

624 Academics at Risk University faculty members spend about 40% of their research time writing grant applications and fulfilling grant paperwork requirements Funding agencies favor worthy but incremental research over risky but potentially transformative work Solutions: Increase research budgets Longer funding cycles Fund people, rather than projects

625 Academics/Professional Organizations Affected↑Private commercial funding of university research Front-end domination and rear-end repression affect research agenda, dissemination of knowledge Undone science Secrecy/gag clauses Corporate-sponsored harassment of scientists

626 Academics/Professional Organizations Affected2001 – 2011: Number of published papers increased by 44%; number of retracted articles increased 15-fold (3/4 for errors, ¼ for fraud) Gagging of researchers at federal agencies demoralizing, can affect recruitment of quality scientists

627 Academics at Risk College tuition up (440% from ), administrators’ salaries skyrocketing, faculty salaries stagnant Average debt for graduating college students = $25,250 ($175,348 for med school graduates) Total US student loan debt $1.3 trillion (carried by 42 million Americans) Delinquency rates higher than for mortgages and credit cards

628 Academics at Risk Job market poor for graduating college students50% of college students do internships, up from 17% in 1992 1/3 – ½ of internships are unpaid Unpaid interns receive as many job offers as those who never intern

629 Academics/Professional Organizations AffectedDramatic decrease in tenured faculty, rise in administrators Over 30 private university presidents make over $1 million in annual salary (football coaches often make much more) 75% of faculty members now adjunct (avg. salary $25,000)

630 Union of Concerned Scientists (2015)

631 Academics at Risk Teachers underpaid Teachers’ unions under attack47% of K-12 teachers graduate in bottom 1/3 of college class Forced instruction in creationism, intelligent design, etc.

632 The Medical Brain DrainU.S. – 280 physicians/100K people (vs. sub-Saharan Africa – 20/100K people) Five times as many migrating doctors flow from developing to developed nations than in the opposite direction Example of “inverse care law”: Those countries that need the most health care resources are getting the least

633 Science in the Developing WorldLack of scientists in developing world (1/50th of developed world per capita) Impaired access to scientific data (publications/textbooks too expensive, hence information outdated

634 The Media Most media organizations owned by multinational, multi-billion dollar corporations that are involved in a number of businesses apart from the media, such as forestry, pulp and paper mills, defense, real estate, oil wells, agriculture, steel production, railways, and water and power utilities

635 Global Warming: Controversial?Of 928 articles in peer-reviewed scientific journals, 0% were in doubt as to the existence or cause of global warming Of 636 articles in the popular press (NY Times, Washington Post, LA Times, WSJ), 53% expressed doubt as to the existence (and primary cause) of global warming Science 2004;306:1686-7 (Study covers ) IPCC / Al Gore share 2007 Nobel Peace Prize

636

637 Legislative Mandates Bills allowing teaching of creationism or “intelligent design” alongside evolution Bills requiring global warming to be taught as a “theory”

638 Anti-Science LegislatorsMembers of the House Science Committee (2012) Paul Broun (R-GA): Evolution, embryology, and the Big Bang Theory are “lies straight from the pit of hell;” climate change is a “hoax” Ralph Hall (R-TX): Agrees with TX Governor Rick Perry that climate scientists are involved in a conspiracy to receive research funding. Jim Sensenbrenner (R-WI): The science on global warming is “inconclusive”

639 Anti-Science LegislatorsMembers of the House Science Committee (2012) Todd Akin (R-MO): “If it’s legitimate rape,” women will not get pregnant (lost 2012 election) Dana Rohrbacher (R-CA): Claimed an earlier period of global warming may have been caused by “dinosaur flatulence,” suggested that if global warming is real it could be addressed by cutting down trees, does not believe that CO2 is a cause of global warming

640 The Media 5 corporations control majority of US media (down from 50 in 1983) Mass Media Sources, 2002: 92% white 85% male Where party affiliation identifiable, 75% Republican Predominantly conservative/centrist

641 Lobbying Approximately 40,000 lobbyists (11,781 full-time)Estimates of return on lobbying range from $28 to $212 for every $1 spent (higher values more likely) Return on campaign contributions for elections for the most politically active companies = $760 per $1 spent

642 Lobbying/Campaign ContributionsKoch brothers spent over $400 million (2012) All single issue ideological groups combined (e.g., pro-choice, anti-abortion, feminist and consumer organizations, senior citizens, etc.) = less than $100 million (2012) Lobbying groups spent 3.2 billion in 2014

643 Political Spending Corporations vs. LaborU.S. Chamber of Commerce spent $85 million on Congressional elections (2012); $85 million on lobbying in 2015 CEO Tom Donahue highest-paid corporate trade group chief AFL-CIO and SEIU (two largest labor unions) spend $6 million combined

644 Top-Spending Industries, 2014Pharmaceutical industry - $230 million Business Associations - $163 million Insurance industry - $151 million Oil and gas industry - $141 million Computers/Internet - $140 million Electric utilities - $122 million

645 Lobbying/Campaign ContributionsRichest 0.01% of American voters account for over 40% of political contributions Koch brothers spent over $400 million All single issue ideological groups combined (e.g., pro-choice, anti-abortion, feminist and consumer organizations, senior citizens, etc.) = $76.2 million Lobbying promotes international non-cooperation/isolationism

646 Pharmaceutical Industry$230 million dollars spent on lobbying in 2014 2.3 lobbyists for every member of Congress Revolving door between legislators, lobbyists, executives and government officials

647 Drug Company MalfeasanceThe pharmaceutical industry is the biggest defrauder of the federal government, as determined by payments made for violations of the federal False Claims Act (FCA) Accounted for 25% of all FCA payouts between 2000 and 2010 Defense industry – 11% Has paid out almost $20 billion in civil and criminal penalties over the last 20 years

648 Lobbying Agribusiness/oil industry lobbying dwarf environmental lobbying Active lobbying (new laws, not enforce existing laws or fund existing programs) “Lobbying for lethargy” (maintain status quo)

649 Corporate Influence Leads to Large Taxpayer Subsidies to Polluting IndustriesMining - $3.6 billion/yr Nuclear power - $10.5 billion/yr Coal - $8 billion/yr Ranching (grazing on public lands) - $52 million/yr Timber (below cost sales of national forest trees) – approx. $350 million/yr Oil and gas - $550 million/yr

650 U.S. Supreme Court DecisionsCitizens United v. Federal Election Commission (2010): Corporations can effectively be treated as persons No limits on campaign spending Not persons when it comes to liability for causing harm to the environment or the public’s health 196 donors contributed nearly 80% of money raised by super-PACs in 2011

651 U.S. Supreme Court DecisionsMcCutcheon v. Federal Election Commission (2014): abolishes limit on amount any individual can contribute to federal candidates in a two-year election cycle

652 “We have the best Congress money can buy.” Will Rogers “We have the best Congress money can buy.”

653 Privatization of Public ServicesWater Roads Public schools Child support enforcement Military Others Iraqi reconstruction, disaster capitalism

654 The Decline of DemocracyTrue democracy demands an informed citizenry (education), freedom of the press (media), and involvement (will, time, money) “Information is the currency of democracy” Thomas Jefferson

655 Colonial ExploitationCecil Rhodes (Rhodesia, Rhodes Scholarship, DeBeers Mining Company): “We must find new lands from which we can easily obtain raw materials and at the same time exploit the cheap slave labour that is available from the natives of the colonies. The colonies would also provide a dumping ground for the surplus goods produced in our factories.”

656 Colonial ExploitationWinston Churchill (speaking in favor of RAF’s “experimental” bombing of Iraqis in 1920s, which killed 9,000 people with 97 tons of bombs): “I am strongly in favor of using poisoned gas against uncivilized tribes to spread a lively terror…against recalcitrant Arabs as an experiment”

657 Colonial ExploitationChristopher Columbus’ log entry upon meeting the Arawaks of the Bahamas: “They…brought us…many…things…They willingly traded everything they owned…They do not bear arms…They would make fine servants…With fifty men we could subjugate them all and make them do whatever we want.”

658 The US: Rogue Nation History: Native Americans, slavery, current excesses, disparities and injustices Co-opting Nazi and Japanese WWII scientists Minimum 277 troop deployments by the US in its 225+ year history

659 The US: Rogue Nation Since the end of WWII, the US has bombed:China, Korea, Indonesia, Cuba, Guatemala, Congo, Peru, Vietnam, Laos, Cambodia, Nicaragua, El Salvador, Grenada, Libya, Panama, Afghanistan, Sudan, Yugoslavia, and Iraq

660 The US: Rogue Nation Conservative estimate = 8 million killedUS invasions/bombings often largely at behest of corporate interests European colonial history similar

661 The US: Rogue Nation The US spends vastly more on militarization than on peacemaking The US maintains over 1,000 bases worldwide today (737 in 69 other “sovereign” countries) Continued funding of the Western Hemisphere Institute for Security Cooperation

662 The US: Rogue Nation “Which country is the greatest threat to peace?”Pakistan - 8% China - 6% Afghanistan - 5% 2014 Gallup poll, 66,000 worldwide participants

663 International Non-Cooperation/IsolationismFailure to sign or approve: Kyoto Protocol on Climate Change International Covenant on Economic, Social, and Cultural Rights Convention on the Prohibition of Anti-Personnel Land Mines Convention on Cluster Munitions

664 International Non-Cooperation/IsolationismFailure to sign or approve: Treaty to ban cluster bombs Comprehensive Nuclear Test Ban Treaty Convention on the Rights of the Child Convention on the Elimination of Discrimination Against Women UN Declaration of the Rights of Indigenous Peoples

665 International Non-Cooperation/IsolationismConvention for the Suppression of Traffic in Persons UN Convention on the Rights of Disabled Persons WHO International Code of Marketing of Breast Milk Substitutes UN General Assembly Recognition of Human Right to Water and Sanitation

666 International Non-Cooperation/IsolationismFailure to sign or approve: Protocol 1, Article 55 of the Geneva Conventions, which bans methods or means of warfare which are intended, or may be expected, to cause widespread, long-term and severe damage to the natural environment

667 International Non-Cooperation/IsolationismFailure to sign or approve The Stockholm Convention on Persistent Organic Pollutants The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes The Cartagena Protocol on Biosafety (re GM foods)

668 The US: Rogue Nation Death Penalty:US one of only 20 countries to execute civilians (2011) Until recently, the US was the only country to execute both juveniles (ended 2005) and the mentally ill (ended 2002)

669 The US: Rogue Nation Failure to follow World Court DecisionsFailure to recognize International Criminal Court Largest debtor to the UN (only 40% of dues paid)

670 The US: Rogue Nation Patriot Act, government spying, revocation of habeas corpus, presidential signing statements Cited by Human Rights Watch, Amnesty International for Human Rights Violations

671 Positive Trends Majority of U.S. citizens rate the environment as one of the most important issues facing the country, think the government is doing too little to safeguard the environment, and favor environmental protection over economic expansion Power/voice of green groups increasing Involvement of religious groups growing

672 Religion in the U.S. 85% of US citizens call themselves Christian (75% of Israelis call themselves Jewish) 75% pray daily, 33% attend church weekly (self-reported)

673 Religion in the U.S. Misinterpretation of the Bible commonOnly 40% of Americans can name more than 4 of the 10 commandments 50% can cite any of the four authors of the Gospels 12% believe Joan of Arc was Noah’s wife 75% believe the Bible teaches that “God helps those who help themselves” (Ben Franklin)

674 Religion in the U.S. “Most Americans have replaced the Christianity of the Bible, with its call for deep sharing and personal sacrifice, with competing creeds” Bill McKibben Stress personal responsibility over collective action Celebrate financial success Apocalyptics

675 Environmental Crime $70 billion - $213 billion per year problemIncludes traffic in endangered species, illegal logging and mining, illegal transportation and discharge of toxic waste, bribes, extortion, kidnapping, and murder Organized crime involved Supports extremist militias Enforcement limited, penalties low

676 Positive Trends Insurance industry urging reductions in global emissions due to dramatic increase in weather-related claims Analogy with smoking

677 The “Benefits” of Sterility-Causing Chemicals in the Workplace?12 September 1977 Dr. Eula Bingham, Assistant Secretary for Occupational Safety and Health [Regarding] worker exposure to DBCP. While involuntary sterility caused by a manufactured chemical may be bad, it is not necessarily so. After all, there are many people who are now paying to have themselves sterilized to assure they will no longer be able to become parents... If possible sterility is the main problem, couldn’t workers who were old enough that they no longer wanted to have children accept such positions voluntarily? Or…some [workers] might volunteer for such workposts as an alternative to planned surgery for a vasectomy or tubal ligation, or as a means of getting around religious bans on birth control when they want no more children? Sincerely, Robert K. Phillips, National Peach Council

678 Environmental (Partial) Success Story: The Montreal Protocol (1987)Phaseout of chlorofluorocarbons (CFCs) by 1996 CFC MDIs phased out in US by 2008 (tetrafluoroethane or HFA = substitute) Major cause of Antarctic and Arctic ozone holes Hole still size of North America Size only 9% down from 2000 maximum Should gradually decrease and close by 2060

679 Environmental (Partial) Success Story: The Montreal Protocol (1987)Current substitute, HCFCs, much less damaging to ozone layer, also to be phased out in developed world through Kigali Agreement (signed 2016) Produced in large quantities in China Large black market with international smuggling Methyl Bromide (ozone-damaging gaseous pesticide) banned, but still being used (particularly by CA strawberry growers - causes SGA babies, birth defects)

680 REACH Registration, Evaluation, and Authorization of ChemicalsEuropean Treaty requiring companies to test chemicals already on the market by a set timetable and test new products before putting them on the market

681 REACH Cost of evaluations < 1% of chemical industry’s total salesEconomic analyses show REACH could bring environmental benefits worth €95 billion over the next 25 years and result in health cost savings of €50 billion over the next 30 years Upgrades to treaty to address mixtures of chemicals

682 Convention on Biological DiversityCalls for: conservation of biological diversity sustainable use Includes Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization - aimed at stopping biopiracy and ensuring that developing countries get their fair and equitable benefits from biodiversity and indigenous knowledge

683 Solutions Based on the Precautionary Principle“When evidence points toward the potential of an activity to cause significant, widespread or irreparable harm to public health or the environment, options for avoiding that harm should be examined and pursued, even though the harm is not yet fully understood or proven”

684 The Precautionary Principle: Practical EssentialsGive human and environmental health the benefit of doubt Include appropriate public participation in the discussion Gather unbiased, scientific, technological and socioeconomic information Consider less risky alternatives

685 The Precautionary PrincipleEndorsed by APHA, ANA, CMA, others Institute of Medicine/National Research Council have endorsed for FDA policies Puerto Rico, San Francisco have adopted, among others Big business, US Chamber of Commerce oppose

686 The Four Laws of Ecology Barry Commoner1. Everything is Connected to Everything Else. There is one ecosphere for all living organisms and what affects one, affects all. 2. Everything Must Go Somewhere. There is no "waste" in nature and there is no “away” to which things can be thrown.

687 The Four Laws of Ecology Barry Commoner3. Nature Knows Best. Humankind has fashioned technology to improve upon nature, but such change in a natural system is likely to be detrimental to that system. 4. There Is No Such Thing as a Free Lunch. Everything comes from something. There's no such thing as spontaneous existence.

688 Connectedness Globalization – benefits and drawback Homogenization:7,000 extant languages 78% speak the 85 largest languages Within one century, nearly ½ expected to disappear Technology/Social Media: dual capacities for good and evil

689 Solutions Shift from a throw-away economy to a reduce/reuse/recycle economy Support local economies Enhance fair trade policies

690 Solutions Rebuild decaying infrastructure:Federal outlays for basic infrastructure: 1968 = 3.3% of GDP 2011 = 1.3% of GDP Am Soc Civil Engs estimates $2.2 trillion needed, over 5 years, to adequately maintain and upgrade the nation’s roads, dams, drinking water, school buildings, etc.

691 Solutions Recognize nature’s net worth (Natural Capitalism)Annual value of ecosystem services worldwide = $33 trillion (1997 estimate) $44 trillion (2012); nearly 2X global GNP of $24 trillion Calculate economic prosperity based on Genuine Progress Index or Global Happiness Index, rather than Gross Domestic Product

692 Solutions Consider democratic alternatives to capitalismParticipatory economics (with component of natural economics) – aka Parecon Ground-up system Net neutrality

693 Solutions Decrease energy consumption Zero waste production systemsExtended producer responsibility / Extended product liability 70+ laws in US Cover electronic devices, mercury-containing thermometers, fluorescent lamps, paint, batteries, pharmaceuticals

694 Solutions Production-side environmentalism (reducing “planned obsolescence”) Recycling laws Only 11 states have bottle deposit laws (recycling rates 63% vs. 12% in those without)

695 Solutions Eliminate patenting of genes, revamp drug pricing to reflect true costs and funders of drug development Pharmaceutical Take-Back Laws Drug companies fighting

696 Solutions Combat the spread of illegal, dangerous black market pharmaceuticals Cause 100,000 deaths/yr worldwide $75 billion business

697 Solutions Restructure tax system Decrease taxes on work and savingsIncrease taxes on wealthy Lower taxes on wealthy are not associated with economic growth, are associated with more inequality Maximum income (France, England considering)

698 Solutions Restructure tax systemIncrease capital gains tax from 15% to (at least) prior 25% rate Resume transaction tax on stock sales/purchases (1/2 of U.S. stock market activity = computer-assisted “microtrades” Increase taxes on destructive activities (e.g., carbon emissions, toxic waste generation)

699 Solutions Create progressive state taxation systems (all currently regressive) Greater regulation of financial markets Eliminate confidential legal settlements and confidential business information relevant to public health and safety Eliminate binding mandatory arbitration

700 Solutions Stronger clean air and water standardsFurther revise and update TSCA Pass SB 7-14 (to phase out top 22 persistent, bioaccummulative, and toxic chemicals – e.g., asbestos, brominated flame retardants, Cd, Hg, Pb, others)

701 Solutions Drink tap waterIncredibly cheap and, in the US, almost always safe Exceptions include private well water, from which 15% of Americans get their drinking water Not regulated by Safe Drinking Water Act 40% contaminated to some degree with arsenic, radon, nitrates

702 Solutions Eat less meatIt takes lbs of grain and 2500 gallons of water to produce one lb of hamburger Avg. American adult consumed 198 lbs of meat in 2014 (global avg. = 75 lbs) Catch-share agreements to decrease over-fishing

703 Solutions Eliminate fossil fuel industry tax breaks and subsidiesCarpooling Keep car longer > ½ of energy consumption attributable to vehicles occurs during manufacturing

704 Solutions Sweden plans to be world’s first oil-free economy by 2020EU to cut CO2 emissions 20% by 2020 UK committed to 80% reduction by 2050 California mandates 25% cut in global warming gasses by 2020

705 Solutions EPA to regulate carbon emissions under Clean Air Act (2011)2016 Paris Climate Agreement to limit global warming to 1.5 degrees above pre-industrial levels 2017: Kelsey Cascadia Rose Juliana et al. v. USA et al. Federal lawsuit brought by young people under public trust doctrine accusing government of violating its duty to protect future generations from climate change

706 Solutions Climate Security Act: weaknesses include unfair “cap and trade” provisions, carbon capture and storage (CCS) Cap and trade for water in Australia, proposed for American West New EPA rules re mercury, coal ash (2011) New EPA rules to reduce methane emissions from oil and gas drilling

707 Solutions Replace annual crops with perennials Sequesters CO2Support organic farming converts carbon from a greenhouse gas into a food-producing asset

708 Solutions Solar and wind power (prices decreasing dramatically); appropriate biofuels (i.e., cellulosic ethanol, algal bio-diesel; not food crops), not CCS (carbon capture and storage) or nuclear CCS raises specter of Lake Chad, Lake Nyos, and Lake Monoun disasters Implies dangers likely to be associated with carbon capture and storage

709 Solutions Increase tax breaks, subsidies, research for renewable energy Renewable energy now 3% of transportation fuel market (ethanol) and 9% of the electricity market (wind, solar, biomass)

710 Thomas Edison (1931) “I’d put my money on the sun and solare energy. What a source of power! I hope we don’t have to wait until oil and coal run out before we tackle that”

711 Solutions Streamline EPA -25% of 14 billion superfund payouts have gone to lawyers and consultants Composting / Recycling organic wastes Safe disposal of pharmaceuticals Europe, Canada have take-back systems Shift medical research agenda

712 Solutions Decrease light pollution ($2 billion energy wasted per year) and see the stars! 2/3 of US population and over ½ of EU population can’t see Milky Way - Czechoslovakian anti-light pollution law - light pollution also adversely affects some ecosystems

713 Solutions Insulation Energy-efficient lightingEurope bans incandescent lightbulbs (2009) Australia mandates use of compact fluorescent light bulbs by 2012 US manufacturers to phase out traditional lightbulbs in favor of compact fluorescent bulbs (contain mercury) and very long-lasting LED bulbs by 2104

714 Solutions Decrease excessive packaging¼ of world lives with ban or fee on plastic bags 15¢/plastic bag tax in Ireland ↓’d use by 90%, England now charging 5p/bag More than 30 states have enacted or proposed plastic bag restrictions

715 Solutions Decrease excessive packagingCA, Seattle, Chicago, Portland (OR), Austin, Mexico City have outlawed plastic bags Canada, China, Italy, Bangladesh, and a few other countries have banned; others considering ban Charge for paper bags (LA) – markedly decreased use France has banned all plastic cups, plates, and silverware (law takes effect in 2020)

716 Solutions Sustainable forest management Plant treesThe average urban tree removes nearly one ton of greenhouse gas during its first 40 years of life Stop receiving catalogues contact Direct Marketing Association

717 Solutions Prevent Congress from weakening NEPA (National Environmental Policy Act) Requires federal officials to conduct environmental impact assessments; allows citizens to challenge the government’s conclusions

718 Solutions Change or eliminate Office of Information and Regulatory Affairs White House Dept. which operates in relative secrecy and has power to rework various federal agencies’ (e.g., EPA, FDA, OSHA) rules and delay new regulations

719 Solutions Oppose Congressional attempts to create “Sunset Commissions” with the power to review federal programs and recommend which programs live, die, or get realigned

720 Solutions Punish environmental scofflaws with large fines and jail time Increase enforcement budgets to combat international environmental crime Establish International Court of the Environment Alien Tort Claims Act designed to hold corporations accountable for human rights abuses overseas

721 Solutions Safe storage of nuclear wastes Green electricity - $3/monthBioprospecting Ecotourism De-extinction Rewilding (Contemporary vs. Pleistocene)

722 Solutions Green burial Biodegradable, inexpensive “coffins”Alkaline hydrolysis (85-90% fewer emissions than cremation) Cremation – requires energy equivalent of gals gasoline, avg C02 emissions 150 lbs, contributes 2-3% of US mercury emissions Conventional burial with caskets, concrete vaults, toxic formaldehyde, and maintenance of cemetery lawns – most ecologically damaging Consider donation of organs, entire body

723 Solutions More equitable distribution of medical research funds and health care dollars Worldwide In U.S. Every $1 invested in community-based programs to increase physical activity, improve nutrition, and prevent tobacco use saves $5.60 in health care costs

724 Address Social Factors Responsible for Illness and DeathDeaths in 2000 attributable to: Low education: 245,000 Racial segregation: 176,000 Low social support: 162,000 Individual-level poverty: 133,000 AJPH 2011;101:

725 Address Social Factors Responsible for Illness and DeathDeaths in 2000 attributable to: Income inequality: 119,000 (population-attributable mortality – 5.1%) Area-level poverty: 39,000 (population-attributable mortality – 1.7%) AJPH 2011;101:

726 Deaths per year Tobacco = 400,000 (+ 50,000 ETS) Obesity = 300,000Alcohol = 100,000 Microbial agents = 90,000 Toxic agents = 60,000 (likely higher) Firearms = 35,000 Sexual behaviors = 30,000 Motor vehicles = 25,000 Illicit drug use = 20,000

727 Address Social Factors Responsible for Illness and DeathDeaths in 2000 attributable to: AMI – 193,000 CVD – 168,000 Lung CA – 156,000 AJPH 2011;101:

728 Major Contributors to Illness and Death40% of US mortality due to tobacco, poor diet, physical inactivity, and misuse of alcohol Every $1 invested in programs covering above items saves $5.60 in health care costs Up to $1/$50 for tobacco control

729 Maldistribution of Wealth is Deadly880,000 deaths/yr in U.S. would be averted if the country had an income gap like Western European nations, with their stronger social safety nets

730 Prevention 2-4% of national health care expendituresEvery $1 spent on building biking trails and walking paths would save nearly $3 in medical expenses Every $1 spent on wellness programs, companies would save over $3 in medical costs and almost $3 in absenteeism costs

731 Public Health SpendingPublic health spending minimal Mortality rates fall 1-7% for every 10% increase in public health spending

732 Solutions Reverse medical and scientific brain drainPrograms for education and return to home country Eliminate unnecessary health care waste; re-use/send overseas hospital and surgical supplies Open-access publication (see Dr Gavin Yamey’s slide show on the “Activism and Education” page of the phsj website

733 Solutions Federal Research Public Access ActWould require federal agencies that fund over $100 million in external research/yr to make their study results publicly available on-line Currently before Congress

734 Solutions Strengthen family planning programsDecrease “demand” for large families  education  status of women  child mortality

735 Solutions: Fair, Representative ElectionsPublicly financed campaigns and campaign finance reform Members of Congress spend between 30% and 70% of their time fundraising 50% of Senators and 42% of Representatives become lobbyists after leaving office

736 Solutions: Fair, Representative ElectionsOpen debates, free air time for candidates Proportional representation Instant runoff (ranked choice) voting/cumulative voting/range (rating) voting Halt disenfranchisement, overturn voter restriction laws

737 Solutions: Living WageOver 140 municipalities have adopted living wage laws Including NY, LA, SFO, Seattle, Chicago, and Philadelphia 25 states and DC now have minimum wages that exceed the federal requirement 10 states have passed pre-emptive laws forbidding cities and counties from raising the minimum wage True living wage at least $15/hr.

738 Solutions: Maximum Wage/Higher Taxes on the RichBritish-, French-, and New Zealand-proposed income-cap legislation (“maximum wage”) France: 75% tax on income over 1 million euros

739 Solutions: Maximum Wage/Higher Taxes on the RichU.S. proposals to create maximum wage of $400,000 (president’s salary) 25X annual pay of the lowest-paid federal worker Patriot Corporations Act would cap pay at 100X pay of lowest paid worker

740 Solutions Join and contribute to environmental and social justice groups (Greenpeace, Doctors without Borders) Local grassroots groups especially good Land purchases Litigation (e.g., EJLDF, NRDC)

741 Solutions Join community groups – become involved in local as well as national issues Green investing -Returns as good or better than the S & P 500 Terror-free investing Celebrities/Jocks for Justice

742 Solutions Activism / Letter writing / Protesting / WhistleblowingUS Supreme court ruled in 2006 (Garcetti v. Ceballos) that public employees have no free-speech rights re whistleblowing and no constitutional protections against retaliation by bosses Death toll among activists has doubled over last decade to 2/week Over 900 environmentalists murdered worldwide between 2003 and 2013 (only 10 killers convicted); additional 116 killed in 2014

743 The health impact pyramidFrieden, T. R. Am J Public Health 2010;100: Copyright ©2010 American Public Health Association

744 “Western science and efficiency has made major contributions to minor needs”- Buddhist Monk, quoted in Wade Davis’ The Wayfarers

745 Solutions: Vote US voter turnout low (139/172 worldwide)Wealthy vote at almost twice rate of poor Whites > Blacks > Hispanics Old > Young Property owners > Renters

746 Voter Turnout

747 Voter Turnout Average senator = 62 yo Average representative = 57 yoIncreased voter turnout by marginalized groups likely to lead to a younger, more progressive Congress Limiting incumbency would also help (incumbents have a huge advantage in elections)

748 Solutions Fair, representative elections Campaign finance reformPublicly financed campaigns Better candidates Lower voting age to 16

749 Solutions Increased exposure to natureLog off, spend less time in the virtual world, more time in the real world Cultivate relationships

750 Solutions Improvements in education Multidisciplinary LiteratureHistory Law Photography Community Service

751 The Role of Literature Vicarious experienceExplore diverse philosophies Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge Encourages creative thinking Allows for group discussion/debate

752 Why Use Literature Encourage appreciation of non-medical literatureDevelop reading, analytical, speaking and writing skills Promote ethical thinking (narrative ethics) Identification with authors who are health professionals (e.g., Keats, Chekhov, Maugham, Williams, Sanger, Nightingale, etc.)

753 Homelessness Doris Lessing “An Old Woman and Her Cat”From the Doris Lessing Reader (New York: Knopf, 1988)

754 Race and Access to Care Ernest J Gaines “The Sky is Gray”in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: African American Perspectives on Health, Illness, Aging and Loss. Yarmouth, Maine: Intercultural Press, 1992

755 Poverty Orwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, New York: Harcourt, Brace and World, Inc: pp Checkhov, Anton. Letter to AF Koni, January 26, 1891, Letter to AS Survivor, March 9, In Norman Cousins, ed. The Physician in Literature Philadelphia: WB Saunders, 1982. Eighner, Lars. Phlebitis: At the Public Hospital. In Travels with Lizbeth. New York: St. Martin’s Press, 1993.

756 “Activist” Journals American Journal of Public HealthPublic Citizen’s Health Letter PNHP Newsletter Mother Jones Harpers Z Magazine Hightower Lowdown Synthesis/Regeneration

757 “Activist” Journals Rachel’s Democracy and Health NewsRachel’s Precaution Reporter Sierra The Amicus Journal Bulletin of Atomic Scientists Multinational Monitor Dollars and Sense Some articles in NEJM, JAMA, JGIM, SSM, Policy, Politics, and Nurs Prac, others

758

759 “The first job of a citizen is to keep your mouth open.”Günter Grass “The first job of a citizen is to keep your mouth open.”

760 “You must be the change you wish to see in the world.”Mahatma Gandhi “You must be the change you wish to see in the world.”

761 Alice Walker “The most common way people give up their power is by thinking they don’t have any”

762 “A nation of sheep will beget a government of wolves”Edward R Murrow “A nation of sheep will beget a government of wolves”

763 Margaret Mead “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has."

764 African Proverb If you think you are too small to have an impact, try going to bed with a mosquito in your tent

765

766 Public Health and Social Justice WebsiteContact Information and References Public Health and Social Justice Website