What constitutes a disease? If the symptoms are sub-clinical and the cause is an environmental contaminant, what is the appropriate public health response? Once an environmental hazard is identified, who is responsible for removing that hazard to protect people from ongoing exposure and to what extent – or is society’s responsibility limited to treating those individuals already harmed?

These are questions central to Lead Wars: The Politics of Science and Fate of America’s Children, Gerald Markowitz and David Rosner’s provocative new book that tells the disheartening story of our ongoing failure to fully protect American children from lead poisoning. While enormous progress has been made in reducing children’s exposure to high levels of lead, the latest science suggests that nearly half a million American children remain exposed to dangerous amounts of lead. In 2012, the US Centers for Disease Control and Prevention (CDC) lowered by 50% what it considers an elevated childhood blood lead level, dropping that level to 5 micrograms per deciliter (5µ/dl). (Between 1960 and 1990 that level was dropped from to 25µ/dl; in 1991 it was lowered to 15 µ/dl, and in 2003 to 10 µ/dl.) The CDC now says that no level of lead exposure appears to be without “deleterious effects.” There is also increasing evidence that early childhood exposure to very low concentrations of lead can create profound and lasting neurological damage. So while most American children are no longer exposed to lead levels that prompt acute symptoms, those who are exposed risk suffering lifelong and life-altering adverse effects.

“Industrial societies in the West may have significantly reduced the levels of new lead contamination, but the horror of lead poisoning here is hardly behind us, exposure coming from lead paint in hundreds of thousands of homes, in airborne particles from smelters and other sources and from contaminated soil, lead solder and pipes in city water systems, and some imported toys and trinkets,” write Markowitz and Rosner.

In many ways a sequel to Deceit and Denial, the authors’ landmark account of how companies that produced lead-containing products – notably paints, pigments and leaded gasoline – continued to do so long after their products were identified as health hazards, Lead Wars shows that we have yet to resolve key questions regarding this toxic legacy: Who can be held legally responsible for exposing children to the hazards of lead paint and for removing that hazard?  Given what’s known about lead’s toxicity, how thorough must abatement be, and how should that work be prioritized?

Paint manufacturers have yet to be held liable
Cases now underway, including in California, seek to hold lead paint and pigment manufacturers financially responsible for removing lead paint. In previous cases, notably one involving some 240,000 Rhode Island homes, juries have ruled against the manufacturers. But those verdicts were overturned on appeal. “So as of now,” explained Markowitz and Rosner via email, “no lead company has been held liable.”

Numerous state and federal laws restrict the use of lead, many with regulations designed to protect children’s health. Yet US policies make it extremely hard to hold a manufacturer responsible for a chemical product’s health hazards – especially when symptoms are not acute or are slow to manifest. In the case of lead, courts have ruled against landlords for violating lead-paint laws, as they have in Baltimore. The Environmental Protection Agency has fined companies for improper lead abatement. In the Rhode Island case, the court said landlords of the homes where leaded paint was used – rather than the paint manufacturers – should be responsible for preventing lead-poisoning “ignoring the fact that the industry had been aware of the harmfulness of its products when it sold lead paint to homeowners,” write Markowitz and Rosner.

While the details of proving this liability are legal and political, these cases’ arguments rely on the interpretation of science. Lead Wars shows persuasively how regulation has struggled to keep up with evolving science, even for a toxicant as well-characterized as lead. As recently as the mid-1980s, medical professionals were still debating whether “biological change resulting from lead exposure was itself a cause for concern,” recount Markowitz and Rosner. Some experts maintained that without observable effects there was no reason to lower “safe” exposure levels. Others argued that to wait for visible symptoms was medically irresponsible. At the same time, companies manufacturing lead products continued to call for more evidence that low levels of lead exposure were harmful and sought to prolong scientific determinations that might prompt further regulation of their products – arguments that extended to debate over regulation of leaded gasoline.

Lead paint was taken off the US market in 1978, but lead paint remains in more than 30 million homes across the country. (The 25-year US phase-out of leaded gasoline concluded in 1996 although some uses are still allowed)  Some states have laws that require homeowners and landlords to inform prospective buyers and tenants about lead-paint hazards before selling or leasing homes with lead paint. The costs of lead-paint removal and medical expenses associated with childhood lead poisoning are tax-deductible in some states. This sounds helpful but Markowitz and Rosner point out that most residents endangered by lead poisoning can’t afford to do the necessary renovations. This is but one of the many elements of environmental injustice that plague lead-contamination issues.

Meanwhile, manufacturers of leaded paint and pigment are not required to contribute directly to the costs of removing lead paint or to lead-poisoning treatment programs. This leaves these costs thoroughly externalized with individual households and taxpayers shouldering the expense. And while the problem is very far from solved, in 2012 funding for the CDC’s “Healthy Homes/Lead Poisoning Prevention Program” was cut from $29 million to $2 million.

Because renovation of lead-painted buildings can produce large amounts of lead dust, workers and residents both need protection. Without proper precautions lead abatement can endanger workers removing the lead paint and create new hazards from lead dust and paint chips for residents, particularly young children. In addition the cost of thoroughly removing lead paint has repeatedly been cited as an obstacle to full abatement. Rosner and Markowitz write that the cost for removing all the lead paint thought to be in US homes in 1976 was estimated to be between $28 and $25 billion – or $111 to $139 in 2012 dollars.

Ongoing impacts
That lead largely (but far from exclusively) has affected low-income and minority children living in poorly maintained housing has complicated the social response to lead exposure. That lead is a neurotoxicant that depresses IQ and can prompt behavior problems and primarily affects the country’s  poorest children, has contributed to learning problems and reinforced cycles of poverty. It also allowed some opponents of lead regulation to suggest that confounding social factors – rather than lead exposure – might be causing the observed neurological problems. The history Lead Wars tells is often not only appalling but also shocking to those who did not live through it.

Also central to Lead Wars is a discussion of what Markowitz and Rosner see as a shift in public health programs that aim to improve public health by eliminating environmental hazards to those that emphasize individual treatment. The latter, they argue, has not helped the lead elimination cause.

While the story of lead contamination is in many ways unique, Markowitz and Rosner point out that lead is but one of numerous near ubiquitous environmental pollutants now affecting public health. “Presently,” they write, “the public health profession faces a conundrum: as the threats from industrial and environmental pollutants multiply, will the profession of public health remain true to its traditional mission of working to prevent disease or will it accommodate itself time and again to the politics of “economic feasibility”? And what will we as a society insist upon?”

Lead Wars is not a happy story or a story with a happy ending. It is a sobering, cautionary and ongoing tale. “For more than a hundred years, we have knowingly poisoned our children and destroyed the futures of millions of our citizens,” write Markowitz and Rosner. “Lead poisoning, we remind ourselves, is a completely preventable disease that we have had foisted on us by rapacious industries that have knowingly profited from our human suffering.” The lessons of this history, they write, “should not be forgotten, for in future years we will again and again face the Faustian bargain in which today’s technological “progress” will be paid for with the health and well-being of future generations.”

Meanwhile outside the US and Europe, leaded paint and gasoline continues to be sold. And if abatement is problematic and has been deemed too costly to complete thoroughly in Baltimore and Oakland, what are the prospects for properly protective abatement in Mumbai and Manila?

Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.

Here’s Klein with an anecdote that captures Oregon’s drive to invest in preventing health problems, rather than just continuing to treat costly disease episodes:

Oregon Gov. John Kitzhaber (D) loves to tell the air-conditioner story. He loves to tell it so much, in fact, that it has become something of a running joke in Oregon health-policy circles. At this point, even Kitzhaber is in on it. Before he repeats it to me, he says, “I probably shouldn’t bore you with my air conditioner story.”

Here’s the air conditioner story: There’s a 90-year-old woman with well-managed congestive heart failure who lives in an apartment without air conditioning. That’s actually the whole story.

Kitzhaber, a former emergency room physician, sees this as the perfect example of what’s wrong with our health-care system. “A hot day could send the temperature in her apartment high enough that it strains her cardiovascular system and kicks her into full-blown congestive heart failure,” he said. “Under the current system, Medicare will pay for the ambulance and $50,000 to stabilize her. It will not pay for a $200 window air conditioner, which is all she needs to stay in her home and out of the hospital. The difference to the health-care system is $49,800. And we could save that $49,800 without reducing her benefits or her quality of life.”

…“The fundamental problem with our health-care system is the growing discrepancy between the cost of care, the resources available to pay for it and the tenuous connection between that expenditure and actual health,” Kitzhaber said. “What we’re doing is instead of putting our budget into the ER and paying for congestive heart failure after congestive heart failure, we’re putting it into care coordination and community health workers. We’re investing in health. It’s just a paradigm shift.”

Oregon is getting $1.9 billion from the federal government to overhaul its Medicaid program, in exchange for a commitment by the state to keep its Medicaid cost growth below the rate in the rest of the country, saving a total of $11 billion over the next decade. (Sarah Kliff has more details on Oregon’s plan.) The state may find that giving free air conditioners — and, I’d hope, vouchers to help with related electric bills — to residents with congestive heart failure reduces medical costs.

Oregon’s 15 coordinated care organizations (CCOs) will likely come up with many such prevention projects, and see which ones are worthy of continued investment. In addition to interventions that deliver an immediate benefit, like air conditioners, the state and individual CCOs could invest in programs and infrastructure that increase physical activity and improve access to healthy food, which can reduce disease occurrence and severity years into the future. In fact, these are the kinds of interventions that the Prevention and Public Health Fund — one of the less-noticed pieces of the Affordable Care Act — was designed to support. Congress and the Obama Administration have repeatedly diverted money from this fund, however, so it can’t do all that Congress envisioned when it first included the Fund in the ACA.

Oregon is betting that investing in prevention will save money over the long run. It’s important to note, though, that prevention investments are worthwhile if they improve people’s quality of life, whether or not there are savings. But governments have limited amounts of money to spend, and they have to prioritize. Here’s Bill Gates giving Ezra Klein an example of a problematic spending tradeoff:

My deep interest in this came somewhat because it’s fascinating but also because our big cause in the U.S. is education, and if you look at state budgets, they are moving money from education to health. They have to because the health costs are just exploding. So very quickly say to yourself, gosh, if there’s going to be any money left for university education and adequate money for K-12, even to stay flat, you have to figure out health-care costs.

Unfortunately, in rich-world health, innovation is both your friend and your enemy. Innovation is inventing organ replacement, joint replacement. We’re inventing ways of doing new things that cost $300,000 and take people in their 70s and, on average, give them an extra, say, two or three years of life. And then you have to say, given finite resources, should we fire two or three teachers to do this operation? And with chemotherapies, we’ve got things where we’ll spend our dollars on treatments where you’re valuing a life here at over $10 to $20 million. Really big, big numbers, which if you were infinitely rich, of course that would be fine.

So most innovations, unfortunately, actually increase the net costs of the healthcare system. There’s a few, particularly having to do with chronic diseases, that are an exception. If you could cure Alzheimer’s, if you could avoid diabetes — those are gigantic in terms of saving money. But the incentive regime doesn’t favor them.

The reason we’re worried about the rate of healthcare-cost increase (which has generally outpaced GDP growth over the past decades) is that ever-growing healthcare spending will crowd out spending in other areas, like education. Given that better-educated populations tend to have better health, reducing education spending to pour ever-greater shares of federal and state budgets into Medicare and Medicaid could itself contribute to higher healthcare costs in the future. Governments will need to prioritize spending on the most worthwhile interventions. We should be paying close attention to Oregon’s experiment to see what they learn about getting the most bang for their healthcare bucks.

Researchers in southern California explored that question in a new paper published in the Journal of Adolescent Health.  They teamed up with the community-based group Youth, Family, School and Community Partnership in Action to recruit about 100 adolescents aged 12 to 21 years to participate in the study.  Each participant made two restaurant visits, one to a McDonald’s and one to a Subway restaurant, on predesignated dates and times.  They were instructed to order a meal, turn in their receipts (on-site) to a research assistant and complete a short written survey.  The researchers prepared food intake surveys for each participant’s meal in order to calculate calorie intake and other nutritional information about the meal purchased.

The mean age of the participants was 16.9 years, 61 percent were males and 47 percent were Asian.   The adolescents purchased 1,038 calories of food at McDonald’s, compared to 955 calories at Subway.  The overall 83-calorie difference was not statistically significant.  At McDonald’s, the participants purchased more grams of carbohydrates and sugars, and fewer grams of protein.  There was no difference, however, in the amount of fat or saturated fat purchased at the two restaurants.   The difference in price of the meals was statistically significant with the McDonald’s meal averaging $4.46 and the Subway meal averaging $6.14.

The authors conclude:

“the true measure of a healthy restaurant is whether people actually consume a healthy meal there.”

Both McDonald’s and Subway offer less calorie-dense options, but making healthier choices requires mindful, not mindless eating.  After all, Jared Fogle  lost 245 pounds eating Subway sandwiches and went on to become the company’s spokesperson.   The Jared lunch consisted of a modest 6-inch sub (about 250 calories) and 120-calorie bag of baked potato chips.  That’s fewer than 400 calories.   I guess the teenagers in the study who racked up 955 calories at Subway were going for the footlongs, smeared with mayo and layered with cheese.

It’s not surprising that more DC commuters are biking, because over the past few years the city has made substantial investments in bicycling infrastructure. Our Capital Bikeshare system keeps expanding, and our District Department of Transportation has created 56 miles of marked bike lanes and installed 2,300 bike parking racks in recent years.

Investing in making bicycling safer and easier gets results: The League of American Bicyclists identified Bicycle Friendly Communities and found that the bike commuting rate has risen 80% in the largest of these communities, compared to 47% nationwide. The Robert Wood Johnson Foundation’s County by County blog draws an even clearer line between cycling and pedestrian infrastructure improvements and public health, noting, “Research shows that cycling and pedestrian infrastructure improvements such as bicycle lanes, bicycle racks, bicycle/walking trails, and shared bicycle programs promote physical activity.

Riding a bike is a great way to get some exercise while saving money on transportation. Still, cycling isn’t as safe as it could be. The National Highway Traffic Safety Administration reports that in 2011, 677 cyclists were killed and another 48,000 injured in traffic crashes. Drivers and cyclists both need to be aware of one another and follow the rules, and infrastructure that physically separates bike lanes from traffic lanes can also be helpful. Enforcement is also essential, as many cyclists frustrated by U-turning drivers on DC’s Pennsylvania Avenue bike lanes can attest.

The Department of Transportation’s Share the Road Safely website has tips for drivers, cyclists and pedestrians. Keep your fellow road users in mind as you make your way home tonight!

The residents’ quest for answers took the form of a petition delivered in late 2009 to the Board of County Commissioners of Garfield County, the Colorado Department of Public Health and Environment, and the Colorado Oil & Gas Conservation Commission.  The residents’ group, called Battlement Concerned Citizens, urged the government officials:

“to defer any permitting decisions related to natural gas exploration and/or production within the Planned Unit Development of Battlement Mesa until a thorough study of public health, safety and welfare concerns associated with urban natural gas development has been completed.”

BCC specifically asked County and State officials to conduct a Health Impact Assessment (HIA) before any special use permit for natural gas exploration and development was approved within the Battlement Mesa community.  BCC had done their research on HIAs, knowing they are a systematic tool for assessing the potential health consequences of a proposed policy, program, or project.  Some of the gas wells would be about 500 feet from homes.

Within a few months, the Garfield County Department of Public Health was collaborating with the Colorado School of Public Health (CSPH) to develop the HIA.   Funding was provided by Garfield County and a $150,000 grant from the Pew Charitable Trusts.  A forthcoming paper in the American Journal of Public Health written by the CSPH team reports the findings of the assessment, and then the fallout.

First the findings.  Based on extensive input from the community and other stakeholders, eight major areas of public health concern were identified:

• health effects from air emissions
• water contamination
• truck traffic
• noise and light pollution
• accidents and malfunctions
• strain on healthcare system
• psychosocial stress associated with community changes, and
• housing value depression

Based on the research team’s review of the available data, they concluded that

“air pollutant levels were likely to increase in Battlement Mesa as a result of the natural gas development project.”

They noted that residents in an adjacent community with current gas-well development have reported short-term symptoms (e.g., headaches, upper respiratory irritation) during “odor events” that occur with gas well operations.  In addition, they projected a substantial increase in vehicle traffic.  Based on information provided by the gas developer, residents could expect an additional 40 to 280 truck trips per day to each gas well pad.  In addition, about 120 to 150 workers would commute into the community.  The authors write:

“Because Battlement Mesa does not house other industrial activities and commercial activities are minimal, this change in traffic patterns would represent a consequential change.”

The CSPH researchers also projected that noise levels would increase during the well-development period and could result in health impacts, such as sleep disturbances, fatigue, mood changes, and impaired condition.  Residents’ concerns about property value declines were found to be grounded in fact.  The researchers referred to a Garfield County specific study which reported an average 15% decline in property values during well development, which persisted for two years after completion of the wells.  “Declining land values,” the CSPH authors wrote, “could cause residents psychosocial stress,” and its health effects “should not be discounted.”

In contrast, they did not think exposure to contaminated drinking water was likely given the community’s source water is located upstream of the project.  The researchers concluded that industry-related chemical or waste spills would be unlikely, as would fires and explosions.  They did not project measurable increases in crime, sexually-transmitted diseases, or school enrollment that could be attributed alone to the gas development project.

Second, the fallout.

A first draft of the HIA was available for stakeholder input in Fall 2010.   Interest in the document was intense, not just from the Battlement Concerned Citizens’ group or residents of Garfield County, but nationwide.   The HIA was the first of its kind related to natural gas development.  A broader group of interests, including an industry trade group, “caused the focus of the HIA to shift from addressing possible exposures to parties sparring over risk assessment methods,” as the CSPH authors write in their paper.  A process and document that was supposed to help local officials make an informed decision turned into a battle before the Garfield County Commission.

NPR’s Elizabeth Shogren reported in May 2012 on the HIA fallout.  The West Slope Colorado Oil & Gas Association said the CSPH researchers “used what we believe was questionable data, at best.”  A long-time Garfield County Commissioner told Shogren:

“this is a football in the arena of global warming and anti-oil and gas, or anti-environment. We said enough is enough, people.”

The County Commission voted to leave the HIA as an unfinished document and to end the project.  Regardless, the information contained in the draft HAI is valuable.  It illustrates a site-specific and systematic way to evaluate potential health impacts of a proposed policy.  I’ve no doubt that the residents of Battlement Mesa are better informed about the magnitude and severity of the likely health impacts related to natural gas development in their community, than they were before the HIA was developed.  To their credit, the Garfield County Department of Environmental Health has the draft HIA and other project documents on its website.

• OSHA projected it would issue in March a final rule to enhance protections for workers involved in electric power transmission and distribution.  It’s still “under review” at the White House’s Office of Information and Regulatory Affairs (OIRA) and has been for more than 10 months.
• MSHA suggested it would issue this month a final rule for proximity detection devices to protect underground coal miners from crushing injuries.   Since 2010, at least 85 mine workers have been injured, including eight fatally, from incidents involving underground equipment used at the coal face.   MSHA has yet to submit the final rule to OIRA for review.
• OSHA indicated it would be convening in April a group of small business representatives to review a draft rule on protections for healthcare and social services workers from infectious diseases, such as tuberculosis.  That review panel has yet to be convened.
• OSHA projected that two proposed regulations, one on respirable crystalline silica and the other to modernize the tracking of work-related injury and illness, would be issued this month.  Publication of those proposals would trigger the beginning of the public comment process.  Both of these regulatory initiatives have been stuck at OIRA for review.  The OSHA proposal on crystalline silica has been “under review” for 26 months and injury tracking proposal has racked up 18 months of “review.”
• MSHA indicated it would issue in June a final rule to reduce miners’ exposure to respirable coal dust in order to prevent black lung and other respiratory diseases.  MSHA has yet to submit the final rule to OIRA for review.

As I recapped for myself this lack of progress, fresh on my mind are the reflections of Georgetown law professor Lisa Heinzerling in Inside EPA: A Former Insider’s Reflection on the Relationship between the Obama EPA and the Obama White House.  She explains how OIRA violates Executive Order 12866 and abuses its power so that some regulatory packages simply, as she says,“wither quietly on the vine” and die.  I wonder if that’s the fate of these worker safety rules?

Heinzerling served from January 2009 to December 2010 as a senior Obama Administration official at the Environmental Protection Agency (EPA).   I wrote last month about some of Heinzerling’s initial remarks, but this longer paper is more illuminating and disturbing.    Heinzerling writes from her experience environmental protection rules, but I fear the “wither on the vine” tactics are at play with worker safety regulations.    How is it that OSHA’s proposed rule on crystalline silica is “under review” for more than two years?

OIRA’s review of agency rules is supposed to last no longer than 90 days, with one 30-day extension permitted (in writing) if agreed to by the agency head and the director of the Office of Management and Budget.   The requirement is laid out plainly in Executive Order 12866.   Heinzerling explains how it actually works.  She draws on her own experience, as well as what is now in print by President Obama’s former OIRA director Cass Sunstein.  Heinzerling writes:

“Sunstein explains that, in fact, the prevailing understanding of EO 12,866 holds that an agency head may, on her own, request an indefinite extension of OIRA review.   This would mean that neither the requirement that the OMB Director agree “in writing” to the extension nor the requirement that the extension be once, for 30 days only, holds under the present understanding of EO 12,866.  This would, in turn, mean that if an agency head asks for an extension, there actually is no deadline for completing OIRA review.  This remodeling of EO 12,866’s structure on the timelines for review is news in and of itself.  Many outside observers believe that there is in fact a deadline for OIRA review.  OIRA itself encourages this (mis)understanding by displaying 90 days as a timing benchmark on its regulatory dashboard.”

“But it is worse than that.  It is worse because the way that agency heads come to request extended review, in my experience, is that OIRA calls an official at the agency and asks the agency to ask for an extension.  It is clear, in such a phone call, that the agency is not to decline to ask for such an extension.  Thus, not only is there no deadline for OIRA review, but OIRA itself controls the agency’s “requests” for extensions.  In this way, it comes to pass that rules can remain at OIRA for years.”

So technically, the reason that OSHA’s silica proposed rule is still being “reviewed” at OIRA after 26 months, and its proposal on tracking injuries is still there after 18 months, is because the OSHA’s chief requested it?  What a bunch of baloney.  While the White House allows OIRA’s abuse of power to go on, public protections suffer.  The White House knows how OIRA operates.  They obviously like it that way.

I won’t be holding my breath any longer to see much progress in Obama’s second term on new worker safety regulations.

Earlier this month, Florida lawmakers wrapped up their latest legislative session. And nearly 500 miles south of Tallahassee in Miami-Dade County, workers’ rights advocates breathed yet another sigh of relief.

Ever since Miami-Dade adopted the nation’s first countywide wage theft ordinance in 2010, it’s been under attack. For the first two years after its passage, state legislators tried to pass legislation to pre-empt local communities from passing their own wage theft laws; this last legislative session, they tried again but included a carve out for Miami-Dade and for Broward County, which passed its own wage theft measure in 2012. All three tries have died in the state Senate, but worker advocates aren’t optimistic that the fight is over.

Still, in a state that decided to dismantle its department of labor a decade ago, Miami’s wage theft ordinance is a milestone for Florida workers and one that’s slowly spreading throughout the Sunshine State. Just last month, the northern county of Alachua passed a wage theft measure, and north of Miami in Palm Beach County, the local Legal Aid Society runs a wage theft pilot program that could pave the way for a legal ordinance.

“Wage theft is a huge problem in South Florida — it’s absolutely huge,” said Jeanette Smith, executive director of South Florida Interfaith Worker Justice, one of the groups that led the passage of Miami-Dade’s ordinance. “As individual organizations we couldn’t solve this problem on our own. Cases just kept coming and coming and we needed something systematic, a more institutionalized solution.”

Since Miami-Dade’s wage theft ordinance went into effect, hundreds of thousands of dollars in stolen wages have been recovered and more workers are filing wage theft complaints. Much of the progress to date is credited to the broad and diverse coalition that came together to tackle the problem — the South Florida Wage Theft Task Force (today, it’s known as just the Florida Wage Theft Task Force). Its members include faith-based groups, immigrant rights organizations, unions, women’s groups, researchers, legal aid and many more.

The groups originally came together about seven years ago to help a group of day laborers in Cutler Bay just southwest of Miami. At the time, a local developer had begun harassing the workers and their potential employers. At one point, the developer was arrested for physically attacking workers. In response, advocates came together in defense of the day laborers and quickly began talking about other issues facing workers in South Florida. Wage theft was at the top of the list. It was the first step on the road to a countywide ordinance.

“Today, people are talking about wage theft, workers are speaking up,” Smith told me. “The success has been so much broader than just the ordinance itself.”

Sun, surf and wage theft

In the span of just two-and-a-half years, more than $28 million in unpaid wages has been recovered by the U.S. Department of Labor’s Wage and Hour Division in Florida, county staff enforcing Miami-Dade’s wage theft ordinance and by advocacy groups throughout the state, according to a 2012 report from the Research Institute on Social & Economic Policy at Florida International University (FIU). But even though it’s clear that Florida has a serious wage theft problem, as of late 2011, Florida’s attorney general hadn’t taken a single civil action to enforce the state’s minimum wage law, and there is no state agency charged with enforcing wage and hour laws. Miami-Dade County leads the state in wage theft cases.

Cynthia Hernandez, a co-author of the report and a senior research associate at the institute, estimates that the South Florida economy is losing between $2 million and $6 million every year to wage theft. And that, by no means, reflects the larger impact of wage theft on families, neighborhoods and local economies, Hernandez told me. Hernandez and her colleagues first began investigating wage theft in 2006, interviewing immigrant workers and employers in the region’s plant nursery industry. Many of the employers interviewed said they pay below minimum wage because they can get away with it, while others said it was the only way to compete.

“We were definitely surprised,” Hernandez said. “I think everyone at the table was surprised they would just admit to it.”

From there the researchers began digging deeper. While immigrants and agricultural workers were certainly among the most vulnerable to wage theft and more likely to experience it, they weren’t the only ones. Wage theft complaints were coming in from the tourist, retail, hospitality and constructions sectors, but also from workers not typically associated with wage theft problems, such as teachers, attorneys and accountants.

“Unfortunately, it’s just become the way of doing business in South Florida,” Hernandez said.

At South Florida Interfaith Worker Justice, staff had spent years helping workers on a case-by-case basis to recover their wages. Their approach was similar to worker centers throughout the country — approach the employer and let him or her know that this worker is not alone. Ask for the owed wages or negotiate a payment plan. If that doesn’t work, it’s time for direct action, such as protects and attracting media attention. (See past stories on worker centers addressing wage theft and other employer abuses in Austin, El Paso, Houston, and the Rio Grande Valley.) The cases, however, just kept coming and there was no systematic incentive for employers to stop practicing wage theft in the first place. That’s where the South Florida Wage Theft Task Force came in.

After first coming together to help the day laborers in Cutler Bay, task force members spent two years meeting with officials and stakeholders, looking for any measure or authority already in existence that could address wage theft. But other than taking cases to federal labor investigators or to court — an option very much out of reach for low-wage and immigrant workers — there was nothing that could effectively stem the rising tide of wage theft in South Florida. Having sought and found no other alternatives, when task force members went to their local elected officials to call for a wage theft ordinance they could truly say that a local ordinance was the best chance for a solution.

State Rep. Jose Rodriguez, who at the time was working with Florida Legal Services, developed most of the ordinance language, and task force members found a champion in County Commissioner Natacha Seijas (she’s no longer on the commission). On Feb. 18, 2010, county commissioners voted 10-0 to pass the nation’s first countywide wage theft measure — it was technically a unanimous vote, though some commissioners left the room instead of voting.

Throughout the process, advocates didn’t call a lot of attention to their work. It turned out to be a great advantage, Smith said, as the business community didn’t catch wind of the wage theft proposal until the last minute. Eventually, the Florida Retail Federation did catch on, but it was too late to stop a vote. The federation did end up filing a lawsuit challenging the constitutionality of the ordinance (a judge threw it out last year) and is behind the statewide attempts to pre-empt local wage theft measures.

With passage of the ordinance, the county’s Small Business Development division was responsible for dealing with wage theft complaints (the task has now been shifted to the county’s Consumer Services Department). The process works like this: County staff directly contacts employers engaged in wage theft and leads negotiations between workers and employers. If employers don’t respond, the case goes to an administrative hearing, where both sides present their cases before a hearing officer. If the officer determines that wage theft has occurred, he or she can order the employer to pay up to three times the amount of wages owed as well as administrative costs.

Within the first year-and-a-half of the ordinance’s passage, hundreds of thousands in owed wages was collected simply by having county officials pick up the phone, said Francesca Menes, policy and advocacy coordinator at the Florida Immigrant Coalition, a member of the South Florida Wage Theft Task Force.

“As a local organization we can call an employer, but it doesn’t come with the power of the government,” Menes told me. “We’ve made so much progress. Not everything is perfect, but we’re learning as we go along.”

Progress and protection

According to a September 2012 report from the Research Institute on Social & Economic Policy, Miami-Dade County staff had recovered more than $500,000 in owed wages and received nearly 2,000 wage complaints. It took an average of 103 days to recover wages. Still, more than $2 million in owed wages has yet to be collected, and wage theft complaints have doubled every year since the ordinance went into effect. At the time of the report, only 1.5 county staff were responsible for addressing wage theft cases, and hundreds of workers were still waiting to be helped.

While there have been some hiccups along the way, Menes said that task force members regularly meet with county officials to monitor the program’s effectiveness.

“If these wages aren’t going into workers’ pockets, it’s not going into the local economy and that’s detrimental to all of us in the end,” she said.

Jonathan Fried, executive director of We Count!, an immigrant workers advocacy group and a member of the wage theft task force, said the ordinance hasn’t been as effective as he’d hoped. He said he’s concerned that many workers are being misclassified as independent contractors and that “there’s a bias creeping in in favor of employers.” He noted that with such a backlog of cases and limited county resources, many cases never got heard and the workers involved have already left the area. We Count! also has a history of combating wage theft cases on an individual basis via employer-employee negotiations and direct action.

“We’re concerned that workers aren’t getting a fair hearing and the process is disadvantageous to workers who don’t have an attorney,” Fried told me. “It’s been a big step forward, but there’s some small changes that could be made to really improve it. Ultimately, my belief is that in addition to a state department of labor, we need some changes in federal law and federal enforcement. You shouldn’t be able to get away with not paying a worker.”

Hernandez at FIU said she’ll be spending the summer studying the ordinance’s effectiveness and how it can be improved, including the issue of having an attorney present at an administrative hearing (both sides can bring an attorney if they want, though it’s not required). In the long run, Hernandez said Florida “needs a statewide strategy so we’re not just on the defense.”

Beyond just wage theft, Hernandez noted that employers that break wage and hour laws also seem more likely to ignore workplace health and safety regulations. Smith agreed — “wage theft and health safety violations go hand in hand,” she said.

“As we’ve been working on wage theft, we’ve been looking at workplace health and safety…and now a few of us are working together to be more mindful and deliberate about workplace safety,” Smith said. “It’s complicated to get people to focus on safety because a first concern is getting their wages and keeping their jobs. We’ve been looking at it as an offshoot, but we need to pay it more attention.”

To learn more about Miami-Dade County’s wage theft progress, visit www.stopwagetheft.org or www.risep-fiu.org/tag/florida-wage-theft-task-force.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

The Bangladesh garment industry, a national golden goose, is politically well-connected. Clothing accounts for a whopping 80% of the country’s $24 billion in annual exports and employs 4 million people, with dozens of lawmakers closely linked to factory owners.

And though many Western apparel companies adopt codes of conduct, they’re keen to drive production costs down and maximize profit atop an industry of constantly changing subcontractors. Feeding all this are Western consumers looking for cheap deals.

The average wage for garment workers in Bangladesh is 10 to 30 cents an hour, labor activists say, and many of the factories lack fire escapes, windows or emergency exits.

Garment factory fires have been a recurrent problem in Bangladesh, killing about 700 people since 2006, according to the Clean Clothes Campaign. Last year, at least 110 people were killed in a fire at the Tazreen Fashions factory, with another eight killed in January.

Magnier reports that Bangladesh has announced temporary closures of 18 factories deemed to be dangerous and plans to hire 200 more building inspectors within six months.

For the Associated Press, Jonathan Fahey and Anne D’Innocenzio explain that it will be difficult for major brands to pull out of Bangladesh, because the country has enough workers and manufacturing capacity to reliably produce clothing at high volume and low prices. They also note that retailers rarely know where all of the pieces of a particular garment are produced, because contractors will subcontract out to many small factories.

Several major clothing retailers, including H&M, have just signed on to a legally binding plan under which retailers will help finance fire safety and building improvements in the Bangladesh factories that make their products. The New York Times’ Steven Greenhouse reports:

Consumer and labor groups hailed the move by Sweden-based H&M – which is the largest purchaser of garments from Bangladesh – as an important step toward improving factory safety in Bangladesh, saying it would increase pressure on other Western retailers and apparel brands to do likewise.

Within hours of H&M’s Monday statement, C&A of the Netherlands and two British retailers, Primark and Tesco, also joined in.

The factory safety agreement calls for independent, rigorous factory safety inspections with public reports and mandatory repairs and renovations underwritten by Western retailers. A legally enforceable contract, it also calls for retailers to stop doing business with any factory that refuses to make necessary safety improvements, and for workers and their unions to have a substantial voice in factory safety.

In other news:

MSNBC: Over 100 workers from roughly 30 different St. Louis fast-food restaurants walked off the job, as part of a campaign to raise the state’s minimum wage and win the chance to unionize without intimidation. (For more background, see Josh Eidelson’s Salon piece on St. Louis fast-food workers.)

Washington Post: Retired NFL players often require extensive, costly medical care years after their football careers end and the league stops providing their health insurance. The NFL disability board denies nearly 60% of disability claims.

Huffington Post: In an op-ed, US Representative Gwen Moore and AFL-CIO Executive Vice President Arlene Holt Baker warn that House Republicans’ “Working Families Flexibility Act” gives employers flexibility not to pay overtime. “In reality, this bill would provide more work and less pay,” they write.

Los Angeles Times: Cal/OSHA has fined Bumble Bee Foods almost $74,000 for violations related to the death of Jose Melena, 62, who was burned to death inside an industrial pressure cooker.

NIOSH Science Blog: For Women’s Health Week, researchers take a look at women in the workplace and summarize findings: “Women generally have more work-related cases of carpal tunnel syndrome, tendonitis, respiratory diseases, infectious diseases, and anxiety and stress disorders,” and health hazards related to reproductive health and pregnancy are also a concern.

As bodies of workers continued to be pulled from the wreckage of the collapsed Rana Plaza factory complex outside Dhaka, Bangladesh, pushing the death toll past 900, and news was breaking of at least seven deaths in a garment factory fire in Bangladesh on May 9, labor rights advocates meeting in Bangkok called for changes in the system that has led to disasters that have killed more than 1300 workers in the past eight months. “Events of the last 8 months have clearly demonstrated a complete failure of the CSR [corporate social responsibility] and hollowness of the ‘self-regulatory’ standards and industry audits that manufactures and brands have been adopting,” said the Asian Network for the Rights of Occupational and Environmental Victims (ANROEV) in a statement issued as the group gathered for its 13th annual meeting. “ANROEV members also express their deep outrage at the colossal loss of life, which is now unprecedented by any scale.  Fire and structural safety of the buildings is the basic right that workers in Asia rightfully deserve,” said ANROEV in its statement. “Enough is enough. Stop these murders at workplaces in Asia.” .

A network of NGOs based in more than 14 Asian countries that advocate for occupational health, safety, and labor rights, ANROEV was initially formed following fatal Kader and Zhili toy factory fires in Thailand and China in the early 1990s. This year’s meeting is being held on the twentieth anniversary of the fire that killed 188 workers at the Kader factory in northern Thailand that was considered the worst factory fire until last year’s fires at factories in Bangladesh and Pakistan. “Not much has changed in the past 20 years,” said Sanjiv Pandita, executive director of the Hong Kong-based Asia Resource Monitor Centre (AMRC). We shouldn’t have to be talking about these kinds of disasters anymore, he said.

“We need to recover from the mentality of only trying to fix things after an accident then waiting for another accident before demanding additional change,” said Repon Chowdury, executive director of the Bangladesh Occupational, Safety, Health and Environment Foundation (OSHE), discussing the Rana Plaza disaster. “We are hoping this disaster being treated as a national disaster will change the scenario in Bangladesh,” said Chowdury. “If this doesn’t change things, nothing will,” he said.

In its statement, ANROEV harshly criticized the reliance on voluntary policies that it says “has led to the weakening of the state regulatory mechanisms, which otherwise could have allowed inspections of these facilities by local authorities and thus disasters could have been prevented.” The recent and ongoing disasters, said ANROEV, have “shown the failure of both for-profit and nonprofit social auditing, that seems to be detached from the realities at ground.” ANROEV calls for the following changes:

1.    Companies should be obliged to comply with national and international health and safety measures, whichever is a higher standard, in a serious manner through which should be monitored locally by strengthening the local independent inspections
2.    Union and workers participation at all levels in health and safety policies and decisions has to be recognized as indispensable component in ensuring safe and healthy workplaces. Concrete steps should be taken to ensure freedom of association.
3.    Active formation and recognition of victims’ organizations as legitimate representatives of the injured and dead workers

“We need organizations at the ground level, at the home base,” said Chowdury, “not all the window dressing,” that has come with current CSR policies in practice. And he cautioned, “Having the buyers close up leave and move elsewhere is not a solution.”

“We need to replace the current system with one where companies have to pay into support for locally based inspections,” said Pandita. He and other ANROEV members described what they call a failed system of auditing and inspection. Many at the meeting spoke of inspectors “colluding with employers,” and those managing factories that produce for multinational brands. One NGO representative recounted how a local factory manager had asked about how he should pay the individual conducting a third-party audit.

Current CSR policies, said ANROEV in its statement, have effectively privatized what should be the government function of ensuring strong labor laws and enforcement of occupational safety and health policies and building codes. Coupled with current employment practices that rely heavily on temporary workers rather than full-time employees and on migrant labor, the result is a work environment that has kept these workplaces “virtually union-free.” ANROEV also called for criminal prosecution of those responsible for conditions at the Rana Plaza complex.

The lack of local laws is not necessarily a problem, said Pandita. “The problem is political will to implement the laws.” That the Rana Plaza factories were allowed to operate despite obvious structural hazards is ample evidence of a failure of enforcement. Meanwhile, adding to the problems for the workers and families involved, he said, is the fact that so many workers in such Bangladeshi factories “are not registered with social security,” which compounds problems they will have in securing any compensation.

As horrific as the death toll from the current spate of south Asian industrial disasters is, “even more workers are dying of occupational diseases,” said Pandita. “But they die slowly,” he said.

The Taliban alleged that the campaign was a cover for espionage.

Efforts to tackle the highly infectious disease have been hampered over the years by local suspicion about vaccines being a plot to sterilise Muslims, particularly in Pakistan’s conservative and poorly educated northwest.

“We are worried because this new case comes as an example of a bigger impending outbreak of disease in the region,” the WHO official said.

As we’ve noted before, it’s not entirely unreasonable for Pakistanis to think a vaccination campaign might be cover for espionage, because the CIA ran a fake vaccination campaign in Abbottabad, Pakistan in an attempt to get DNA samples showing that members of Osama bin Laden’s family were living there. After nine polio vaccinators were killed in Pakistan in December, deans of schools of public health wrote to President Obama denouncing the CIA’s ruse and stating:

International public health work builds peace and is one of the most constructive means by which our past, present, and future public health students can pursue a life of fulfillment and service. Please do not allow that outlet of common good to be closed to them because of political and/or security interests that ignore the type of unintended negative public health impacts we are witnessing in Pakistan.

Pakistan is one of only three countries where the polio virus still circulates (Afghanistan and Nigeria are the others). Global eradication of the disease would be a public health triumph, and could save as much as $2 billion a year. Last month, an international group of scientists released a statement declaring their “conviction that the eradication of polio is an urgent and achievable global health priority” and calling on the global community to implement the Global Polio Eradication Initiative’s Eradication and Endgame Strategic Plan. At the Global Vaccine Summit held in Abu Dhabi two weeks ago, global leaders pledged financial and political support to the plan and its goal of a lasting polio-free world by 2018.

The new polio case in Pakistan underscores the urgency of the situation, and offers a reminder that new approaches may be necessary now that the CIA’s actions have weakened trust in existing vaccination efforts. In the latest issue of the Lancet, Qanta A Ahmed, Sania Nishtar, and Ziad A Memish urge that the Muslim world assume a more active role in the effort to eliminate polio in Pakistan, with Saudi Arabia taking leadership. They write::

Saudi Arabia and its health authorities are uniquely placed to bring about change in Pakistan for two reasons. First, as the site of Mecca and Medina and host to the Hajj, Saudi Arabia wields enormous influence in Muslim Pakistan. Second, Saudi Arabia has experience of introducing new public health recommendations and strengthening public health outreach by legitimising new public health measures with both formal Islamic authority, in the form of fatwas, and informally, through public opinion.

Saudi theocrats and public health officials are experienced in effective public health messaging in the diverse Muslim public space. … Pakistan’s Taliban views vaccination programmes as not being Islamic and a western innovation to be repudiated, at the peril of the murder of health workers and the inexorable rise of poliomyelitis. Saudi Arabia’s clerics have shown the opposite view through their willing and engaged acceptance of diverse forms of advanced medicine — e.g., the use of alcohol-based hand hygiene agents, and use of porcine medicinal products if no alternative is available.

The authors point out that it’s in Saudi Arabia’s interest to help eradicate polio in Pakistan, because nearly 200,000 Pakistanis travel to Saudi Arabia annually for the Hajj pilgrimage. (Their piece notes that Saudi Arabia has public-health measures in place to prevent pilgrims bringing polio into the country, including requiring vaccination for visa issuance to pilgrims coming from countries where poliovirus is actively circulating.)

Whatever roles individual countries play, it’s crucial that the global community act quickly and decisively to eradicate polio before it can gain a foothold again. And the US intelligence community needs to refrain from imperiling major public health achievements that save millions of lives worldwide, because health is a key component of security.