Stories,Science,and Power in Policy Change: Environmental Health,Community-Based Research,and Community Organizing in a U.S.-Mexico Border Colonia

I. Environmental Health and Organized Power for Change: Threading Together Literatures

In this section we thread together literature on contrasting paradigms in environmental health research, research strategies, and the power of organization in countering ethnic or economic marginality. Phil Brown defines environmental health as a “focus on the health effects caused by toxic substances in people's immediate or proximate surroundings (soil, air, water, food, household goods), a definition that mirrors most research and policy on environmental health” (2007: 1).1 Brown criticizes what he calls the “dominant epidemiological paradigm” for focusing too heavily on individual causes and responsibilities. In its place, he poses what he calls the “public paradigm” and critiques the “scientized views” which frame “political and moral questions in scientific terms” with seemingly objective notions and that defer decisions to experts (2007: xiv; also 17–26). Ultimately, Brown advocates that scientists work with environmental health organizations.

Brown reviews the entrée of many scholars and activists into environmental health: the Love Canal in New York State, buried waste and toxic leakages into water and soil from a chemical plant, and other well known cases. Brown says that laypeople are the “first to notice” disease clusters (2007: 4, 7; also see Tesh on local expertise 2000). We seek to analyze, in a grounded portrayal of findings from a carefully constructed empirical study and ethnographic knowledge of the area, the deeper dimensions of community-based research. Our companion article (“In the Shadow of …”) focuses fully on the numeric analysis of Hispanic health disparities research results.

Brown's densely organized and private university setting in the northeastern U.S. offers splendid conditions that bode well for success in taking research to action. In contrast, we work in a public university, one that is “risk-avoidant” (Staudt and Ruiz 2011), in a region and state with limited civic capacity (TCHI 2013) and few health movements, though many health service organizations. However, the region enjoys organized power from the largest and oldest community-based organizations in the region, affiliated with the Industrial Areas Foundation and multiple organizations at southwest and state levels. The IAF has a long history since its birth in Chicago during the 1930s utilizing principles developed by Saul Alinsky, Ed Chambers, and others (1970; 2003; selections in Orr 2007). The IAF organizers identify and train leaders in cross-class, cross-ethnic, institutional member-based organizations, including faith-based, nonprofit, and work-association groups. IAF identifies its priorities through the use of “house meetings,” wherein participants in the institutional member organizations tell their stories, pressing issues and interests. Organizational agendas emerge, then, from these “grassroots” processes, and leaders work with IAF organizers to develop strategies to develop “relational” power—the power of large numbers of people in relationships with public officials rather than the oft-practiced power of money and electoral campaign donations—to change power relations in a city, county, or state. In accountability sessions for public officials and candidates to audiences of several hundred people, IAF leaders tell their stories, and the carefully timed short stories offer compelling and memorable cases that statistics rarely convey. IAF-researcher collaboration offers an umbrella to examine the story-science tension herein.

Community-based participatory research (CBPR) is defined as “an applied collaborative approach that enables community residents to more actively participate in the full spectrum of research…with a goal of influencing change in community health, systems, programs, or policies” (<http://obssr.od/hih,gov/scientific_areas/methodology/community_based_participatory_research/index.aspx>, accessed November 13, 2011; also see Stoecker 2005, 2011). While chapters in edited volumes document the value of the CBPR approach, processes, and occasional successes (Minkler and Wallerstein 2008; Brown et al. 2012), few focus on Latinos and none on border regions. CBPR offers advantages for research connected with action, including policy change. Compared with a scientific approach alone, CBPR is not divorced from its socio-economic context (Morello-Frosch et al. 2012: 4). Also, CBPR draws on and shares expertise with community members and once findings are available, offers opportunities for dissemination and communication rarely available to academics alone. Finally, CBPR approaches address “disparities in access to knowledge that characterize the lay-expert relationship” (Morello-Frosch, Brody, Brown, Altman, Rudel, Pérez, and Cohen 2012: 235). While some researchers conceptualize “the” community, we acknowledge and focus on diversity within, consisting of complex, multiple voices, some people of whom participate more than others.

Typically, people with low socio-economic status (SES) participate less in most forms of civic activity, whether voting, contacting officials, attending meetings and rallies, or running for office (Macedo 2005). Low SES is also linked to limited political efficacy, or the sense among people that they can make a difference in policy change. One characteristic that can counter that well-established link between SES and participation is organizational affiliation, like with the IAF. When people affiliate with organizations and experience the power that large numbers of people use to push change, their political efficacy and participation increase, thereby erasing the negative effects of low SES. Lisa Montoya has documented these findings drawing on the Latino National Political Survey (2008).

To acquire funding that passes muster in peer-review processes, university researchers typically propose scientific procedures utilizing quantitative methods (see Brown on federal funders' preference for quantitative approaches despite innovative qualitative research strategies [2012: 33]). Community leaders also realize the importance of credible research rather than easily dismissed “anecdotes” that bureaucratic or political decision makers discount, all too often incorrectly attributed to qualitative research (Creswell 2014). Community members and the IAF leaders in this study supported the “scientized” approach that Phil Brown critiques.

II. The Ethnographic Context: IAF, Policy Change, and Westway Leaders

Leaders from affiliates of the Texas IAF in the El Paso region have worked for over thirty years on policy change affecting the City of El Paso and its surrounding colonias, the unplanned semi-urban settlements outside the city limits, some of which subsequently became incorporated into the city (Ward 1999; Staudt 1998; Nuñez and Klamminger 2010; Donelson and Esparza 2010). In the southwestern U.S., urban areas tend to be surrounded less by “suburbs” than by unplanned settlements with low-income residents, some of whom build their own homes on relatively inexpensive land.

Many adult colonia residents are Mexican immigrants, politically marginalized and/or reluctant to become visible because of their less-than-full citizenship status. With its institution members of mostly faith-based institutions with commitments to social justice, IAF leaders have worked on environmental health issues among others, such as water, sewer, and access-to-health issues including broadening CHIP (Children's Health Insurance Program) and Medicaid eligibility in a miserly state on health funding (Sharp 1998, Jillson 2012; LSG 2012).

The oldest regional IAF group, EPISO (El Paso Interreligious Sponsoring Organization), worked with colonia residents and leaders in eastern El Paso County and the statewide IAF network in major urban areas to develop leaders, bring water and sewer services, and pass laws in Texas during the 1980s and 1990s to reduce the practice whereby unscrupulous developers sold land and promised public services that ultimately did not come until strong political pressure, sometimes exercised decades later than settlement (see selections in Donelson and Esparza 2010). The newer, decade-old IAF group, Border Interfaith (BI), works with its leaders in northwestern El Paso County, including those who live in colonias, but in locales without water and utility services or near manufacturing plants which emit toxic pollution with possible health consequences.

Westway leaders and residents became the “first to notice” problems (as Phil Brown would say), because they lived the experiences of pollution, noise, and possible health outcomes people associated with the steel plant. At Westway's western boundary sits not only the big steel plant, but also the Interstate 10. The presence of noxious fumes and pollutants from highways contributes to diseases such as cancer, with one estimate at 60% of causes (Collins et al. 2011), confounding causality attempts in environmental health research when plants are situated near highways. Moreover, another possible source of toxic emissions comes from the Village of Vinton, an incorporated area in which many dirty industries are located, all of which contribute property tax revenue to town council and staff maintenance. Several industrial fires occurred in Vinton, sending billowing chemical smoke into the air.2

Westway has some history with IAF organizing. In an earlier decade, the older IAF group, EPISO, worked with residents to gain access to piped water. After the goal was achieved, a lull occurred in organizing, but residents rarely got responses from attempts to contact their county commissioner about numerous public problems in their community. At campaign forums, before 2005, the county commissioner referred to Westway residents in his district as a “bunch of illegal aliens.”3 When Border Interfaith began working with leaders in Westway, residents said the commissioner or his staff assistant would not return phone calls. Border Interfaith conducted voter registration and get-out-the-vote drives and was thereby able to increase turnout considerably. That achievement was made visible in meetings in which leaders from multiple faith-based institutions communicated with the county commissioner. Since then, the commissioner has been responsive to this community, even going so far as to advocate for and locate funding for a county park in Westway despite his usual philosophy that county government—an arm of the state—should focus on law enforcement alone and make no social investments.

Fr. Pablo Matta, Border Interfaith leader and former priest at the large Catholic church in the colonia, used to tell the story publicly that “he'd never buried so many people from cancer” while serving that parish.4 He said this many times since 2005 (also see quote in Crowder 2010: 21A). Many residents believed that “cancer clusters” existed in this square-mile area of nearly a thousand households of 4,000 individuals. Residents' homes shudder and settle from the old plant's mechanical operations. Soot is found on cars in the morning. Residents complained of billowing smoke emanating from smokestacks during the night; some captured that smoke on video.

From the IAF “house meetings” operational principle, Westway-based Border Interfaith leaders prioritized environmental health issues in meetings, and the larger BI Steering Committee pursued strategies to reduce pollution emission from the plant. One BI member institution, a Presbyterian church, was home to retired environmental engineer Eddie Chew who read the fine print of State of Texas notices in the local newspaper about the steel plant's annual licensing renewal process. BI leaders decided to challenge the renewal, rather than push for plant closure (for, as noted above, jobs are important in the county) and call for monitoring and reducing plant emissions. The newspaper notice came from TCEQ. The former EPA administrator reported that one of every ten children in Texas “suffer from asthma,” according to Texas Department of Health studies in 2008 (Jackson 2011).

Utilizing the IAF relational principles, Border Interfaith leaders from Westway and other BI institutional members in the county began as early as 2005 to meet with county officials, EPA Regional VI officers and appointees, the congressman, state legislative representatives, and TCEQ officials at meetings both in the region and in the state capital of Austin, 600 miles away. They also met with the border steel plant's managers, bought by Villacero (a large Mexican-owned steel company) in 1997, but sold to an India-based company called ArcelorMittal in 2007. Since 2005, and over and over in public and relational meetings, residents told their stories and asked for monitoring and reduced emissions. Border Interfaith leader Eddie Chew, who had worked over twenty years at the Department of Energy, brought expertise to the complex emission discussions, writing letters and testifying at local and state hearings (Border Interfaith Notes on Conference Call…2011; Border Interfaith Draft Short History, 2009).

In summer 2010, local media gave wide coverage to a public meeting with residents expressing different points of view about the plant (the following quotes come from Crowder 2010: 22A). Fr. Matta and Westway residents vocalized the concerns about pollution from the plant's capability to produce “320,000 tons of raw steel from scrap metal to make rebar and steel grinding balls.” An employee of nearby Vinton, the incorporated village which collects property tax from the $37.4 million plant, noted that other industries in the area also emit pollution that westerly winds blow east and into the unincorporated colonia of Westway.

As journalist David Crowder wrote in another report of the two and a half hour meeting of 200 people, “nobody wanted to see the denial of the permit that ArcelorMittal contends will lead to an improved plant” (2010: 21A). However, participants expected TCEQ to decrease emissions from existing levels when it renewed the permit. Several employees who worked at the plant with its 350 workers spoke as well, stating they had no health problems, though one woman said her husband got cancer twice and four children have asthma (as do her dogs). She said “we don't have money to go somewhere where there is no pollution. We live here” (Crowder: 21A).

After five years of persistent organizational pressure, TCEQ finally responded with slightly more regulatory oversight than the annual license renewal, albeit with ambivalent outcomes, given that no precise baseline measurements of emission outcomes existed. TCEQ required the plant to pay an outside firm to conduct a thorough technical report of its emissions; then TCEQ granted the plant the right but to increase emissions by over 400%: from discharging 347 tons of carbon monoxide a year to 1,489 tons (Crowder 2010: 22A). BI leader and engineer Chew, acknowledging that the plant had violated its permit for two years, though without enforcement action, said that he believes that the plant's commitment to spend $4 million on improvements to lower various pollutant emissions and for monitors, showed that the operators “are genuinely trying to do a better job of controlling emissions” (Crowder 2010: 22A). Meanwhile, Westway residents and leaders continued to be concerned about cancer clusters. Several kept lists of cancer victims. Frightening and compelling as these stories were and continue to be, public officials treated them as anecdotes, calling for scientific research.

In sum, then, after extensive organizational pressure and visibility, BI leaders met with local, state, and federal officials, found listeners and empathizers, but ultimately acknowledged that TCEQ had authority and jurisdiction over a plant with relatively new owners and lots of employees in a county with people desperate for jobs. Westway leaders sought a scientific study that would provide evidence of the cancer clusters, and the larger BI steering committee endorsed the idea, so a university researcher designed the major features of the study and found funding for its completion. As such, Border Interfaith leaders drove the agenda for this scientific project, thus conforming to the requirements of community-based research.

After a time-consuming and grueling bureaucratic process, the research team acquired funding to conduct scientific environmental health research on the incidences of cancer, respiratory illnesses, and mental health. The team scrupulously worked with Border Interfaith including Westway leaders, in all research steps, yet encountered obstacles that are essential to understand for the answer to the stories or science question posed earlier: changing political contexts, the departure of key/core IAF leaders like Fr. Matta and his replacement, sheer organizational fatigue after TCEQ approved the permit, and the potential naivety of those who believe that scientific evidence, even backed up with organized power, can change policies in a state like Texas under its current leaders and their support for lax environmental regulations.

III. “Scientific” Research and Reflections on the Changing Context

The research plan proposed a random sample of the entire Westway community. Once approved by three peer reviewers and a federal program officer, the team generated a sample of the Westway community using surveyor maps acquired from the county roads and bridges department, and selecting every ninth household for interviews (with interviewers going left then right if residents refused or were not home after a second attempt). An Institutional Review Board (IRB) Human Subjects Clearance (299734-1) was obtained (required before funding would be disbursed), involving a ten-page, single-spaced proposal, four-page consent letters, and surveys in Spanish and in English. With the funding, two Spanish-speaking graduate students worked for pay on weekends from March to August 2012, going door-to-door with the surveys, offered in Spanish or English for face-to-face interviews. The interviews took approximately 20–40 minutes to complete, and those who finished interviews received a $20 incentive, thanks also to the funding.

Although we utilized scientific research designs, as would EPA or TCEQ had they funded research earlier over the five-year organizing cycle, we enjoyed a high response rate, at 82%, given the connection with community leaders and the trust engendered over visible work in this community. Several leaders reviewed the draft survey in both languages and made suggestions, including the addition of a question about whether previous household occupants acquired illnesses. Those leaders, also members of the neighborhood Catholic Church, the predominant faith institution in Westway, encouraged the replacement priest to allow brief announcements to be made about health research in both services on a Sunday before the interviews began. Presumably, leaders passed word that non-Westway residents would be moving around neighborhoods asking to do research, the findings of which would be shared at a community meeting. We learned that previous research from a scientist at a distant university had been done, but no one knew findings, or whether the research had been completed. (Such problems are all too common in some border colonias, with paracaidista [parachuter] researchers who are never to be seen or heard from again, yet who presumably use findings to advance their own careers. See selections in Ochoa-O'Leary et al. 2013, on the ethics of border research.) Still, interviewers encountered some typical problems in colonia research: aggressive, free-roaming dogs and snakes from a nearby (unregulated wood pallet storage) facility in this mostly fenceless desert region.

Meanwhile, though, after time had passed for proposing and reviewing the grant, acquiring the IRB, and especially for visiting all the targeted households on weekends, coding, and entering/analyzing data, dynamics had changed in a new leadership context. Over a year had gone by. The most important change had been the replacement priest. The former priest, previously responsible for four parishes and exhausted therefrom, was reassigned to two of those parishes, but not in Westway. The replacement priest returned from a lengthy, decades-long stint in Latin America to a changed United States. While he understood the connection of faith to social justice in health, the enthusiasm of the former priest no longer propelled activism among the much-diminished number of Border Interfaith leaders in the community. Former Border Interfaith leaders in Westway turned to other projects such as paving streets and getting garbage collected or opted out of organizing activities altogether—not uncommon in community organizations within communities where people pursue complicated lives or achieve the goals most important to them. After the county built the park, for example, some of the most vocal of Westway leaders stopped attending BI steering committee meetings and large accountability meetings or candidate forums.

Our overall findings did not document an incidence of cancer at higher levels than the 4% rate that other researchers found in the county (Balcazar personal communication 2012, based on the Lapeyrouse et al. 2012 study). Neither did the research reveal the existence of cancer clusters, the expectation of community leaders. Perhaps such clusters would have been identified had the research sampled the universe of households, but the research design used random sampling in its planned and executed procedure in 103 households. Nevertheless, the small count issue could be significant if U.S. policymakers used European precautionary standards rather than certainty standards of 95% (statistical significance) more likely found in larger sample sizes (Edwards 2008; also see Tesh 2000). The full analyses of disparities in access to health and health outcomes are found in a companion piece to this article (“In the Shadow …”).

The research results also uncovered the thin commitment to organizational affiliations and civic life. While the vocal leaders accurately portrayed the many years of people's concerns about the plant, (as documented in the interviews), most residents brought little of the leaders' passionate commitment to organizational processes. Survey results showed that few respondents claimed organizational affiliations and knowledge of their representatives. For example, only 5% knew the name of the county commissioner, (7% said there was no county commissioner), and only 20% claimed affiliation with an organization, including churches. Even knowledge of Border Interfaith was limited. Yet over half voted in the presidential election, and 20–30% (comparable to El Paso and Texas [TCHI 2013] rates) in local and state elections respectively. On three questions that tapped political efficacy, slightly over half responded in efficacious ways. In some ways, our research team was relieved to report these findings about cancer. Had we documented different findings, it could have caused a panic and/or attempted exodus from the area among people whose income barely allowed more than minimal rent or mortgage payments in typically one-car families in an area far from public transportation.

However, the research uncovered an unexpected finding, one that is stigmatized and less likely to drive a community organizing strategy. We documented a surprisingly high percentage of mental illnesses, such as diagnosed depression and anxiety at twice the rates of other studies in the region (Márquez-Velarde 2013). Approximately a quarter to a third of individual respondents cited such problems. These findings were statistically linked to concerns about environmental threats (in a series of questions about the plant, the air, and other related factors) (Márquez-Velarde 2013). Perhaps mental illnesses also resulted from the emissions, as noted in the Smokestack Report cited earlier, from carbon monoxide and manganese. Mental health problems have long been stigmatized in the United States, and past health insurance policies (prior to the Affordable Care Act) did not always provide coverage (on underserved Latino populations at the U.S.-Mexico border, see Villalobos and Islas 2012). The Texas governor's refusal to expand Medicaid coverage under the Affordable Care Act of 2010 will make it unlikely that residents get mental health treatment unless they drive long distances to the city. The local nonprofit medical clinic in Westway, Clínica La Fe, does not offer mental health services. We know of no IAF organization in the state in which house meetings have prioritized mental health coverage.

As promised both to the community and to the funder, a community meeting was held at the elementary school in February 2012 to share research findings with approximately fifty attendees, including some children. We communicated these findings in Spanish and English along with triggers for discussion on individual, local health clinic, and community-wide possibilities for individual and policy change. About fifty people attended, including several Border Interfaith leaders. Only one of the Westway-based Border Interfaith leaders attended. The rest included a coordinator/organizer, a new BI leader (non-Westway resident), retired engineer Chew, and one of the oldest Westway leaders with serious health problems who wears “multiple hats” as a neighborhood leader (formerly working with EPISO) and occasionally with Border Interfaith. Most attendees were mothers and a few fathers who asked questions of the research team and the representative from Clínica La Fe. BI leaders invited people to continue discussing and organizing around concerns.

After the meeting, the older BI leader told the research team leader that he would look for more “lists” of people with cancer. Yet Border Interfaith's achievement, if that is even the right word for a permit renewal that resulted in a more-than 400% increase in emissions, signaled an end to the struggle. Although the random sampling procedure was explained in the power point Spanish-English presentation and handouts, along with the rationale for such sampling, the compelling stories of cancer victims and their families propelled his reaction and persistence, and the mostly young mothers present did not engage much in the public setting. Several ex-Border Interfaith leaders who had pushed the CBPR project from the start and provided a community drive-around tour for the research team, plus the busy priest, did not attend the community meeting despite personal invitations. Even the IAF organizers moved on, in the rotation practice common in its organizational culture (Staudt and Stone 2007).

In some ways, the entire effort shows the difficulty of sustained collective action with a stable group of participants in a region with limited civic capacity and a state which resists attempts to prioritize people's concerns over those of businesses. However, in the time-consuming process of leadership development and relational power with public officials, the work continues, as in IAF attempts in the region and around the state to address health disparities and expand Medicaid in the state in accordance with the Affordable Care Act, passed by Congress in 2010.

Most recently, Border Interfaith has worked relationally with El Paso-wide leaders on the topic of Medicaid expansion in the state—expansion that Texas Governor Perry has adamantly opposed—despite the $9:1 federal-state contribution—one of a few Republican governors who has continued to reject at the time of this writing (late 2013). The Austin-based Center for Public Policy Priorities (<www.cppp.org>) has estimated that Medicaid expansion in the County of El Paso would have increased access to public health benefits for approximately 100,000 residents and resulted in $222 million spent annually in the county on health care service and staff (Dunkelberg 2012).

At a Border Interfaith-EPISO press conference about Medicaid expansion in Texas in El Paso, March 2013, with nearly the entire slate of El Paso's city, county, and state representatives, along with the chief executive officers of public and private hospitals, Border Interfaith leaders told their “stories,” including a newly recruited, young Westway leader whose mother had difficulty getting cancer treatment for lack of insurance. Journalists covered the press conference well, and along with all the public officials, heard the story and possibly remembered the story more than they would the results of any scientific study. After all, system-wide coverage for Texas residents would go much further to address problems than documented problems or health-care changes in Westway colonia. At this point in the sequence of health research and health advocacy, it is the stories that matter, especially for disparate access to health care, rather than the scientific study. The overall community-based research approach is valuable, yet the subtle nuances analyzed herein offer testimony to the continuing power of stories.

The statistical findings will be analyzed and published in scientific peer-refereed journals (the companion article) and in masters' theses. It is doubtful whether Westway residents or IAF leaders or even the media and our political representatives will read such studies. Like cancer victims, much scientific research is buried, but in highly specialized journals.

IV. The Bigger Picture: Will Science Prevail (In What Sort of Political Context)?

Cancer continues to be a risk in the wider El Paso County area, especially in those census block groups (BGs) that hug the international borderline directly across from Ciudad Juárez and the Interstate highway. Collins and his co-authors show 44 BGs “falling at or above the 90th percentile in cumulative cancer risk” though accounted for especially by on-road sources at approximately “60% of cumulative life risk” (2011:338), as noted earlier.

To reiterate from the introduction, at international borders in a global economy, risk-transference occurs from developed to developing countries. This study shows that the reverse also occurs as “spillover” effects of imported scrap metal recycled products from which the steel plant forges its output come from the global manufacturing processes in Ciudad Juárez. Both sides of this border region are at risk for environmental pollutants and the health consequences that emanate therefrom. People live in a state where the political cast of characters is committed to the principles of limited government and regulation. Border people and their voices are rarely heard in the wider state and national political processes. Just as Westway residents are political marginalized vis-a-vis the county, so also is El Paso County and its Hispanic/Latino population marginalized vis-a-vis the State of Texas.

Given spillover effects, it is high time, though unlikely, that border regions become incorporated into a larger North American region, which could—like Europe—begin to incorporate the people who live in cross-border regions along with their voices and health issues (see Staudt and Coronado 2002: Ch. 7). True social and environmental justice rests on fair treatment for border people, whatever side on which they live. Alas, community-based organizations like the IAF rarely develop leaders and strategies for each of the separate sovereign countries of the United States and Mexico.

This study has shown that at least in the short term, stories prevailed over science in the organizing strategies of the IAF organization. Leaders built relationships with the authorities around stories and unenforced regulations from the state environmental commission. Nevertheless, the organizational “victory,” if one can call it such, was to establish a monitoring baseline, but one that authorized the plant to increase emission levels by 400%. The time-consuming scientific research produced findings too late to influence the negotiation, settlement, or incentives for continuing oversight.5 Moreover, the scientific research findings did not provide a clear statistical justification on cancer incidence—the illness that drove leaders' passions—which would warrant other intervention. Had results shown high cancer incidence, the counter or delay for swift action on steel plant emissions would direct attention to factors that confound environmental causality in health outcomes: the Interstate 10 and the other dirty industries nearby (read about the aptly titled Uncertain Hazards in Tesh 2000). Perhaps a better alternative to scientific research would be one where community residents themselves would map cancer incidences, street by street, to confirm or reject the “lists” that Westway leaders claim. The subtle distinctions about Hispanic health disparities, prominent in some federally funded agendas, offer little traction to organizers, especially in single colonias. Moreover, the mental health findings are unlikely to prompt organizers' or leaders' attention, given the continuing stigma of such illnesses.

Besides the story-science tension, even bigger questions might be raised about whether, in the trade-offs between scientific research and corporate marketing, the former will prevail even with documented negative environmental health outcomes. Take the example of lead paint, banned in European countries well before the United States. About a Baltimore scientific study that put toddlers at risk (Lead Wars: The Politics of Science and the Fate of America's Children, Gerald Markowitz and David Rosner (UC Press 2013), Helen Epstein says Markowitz and Rosner

Stories and scientific results that do not support one another, or research findings that offer subtle distinctions among respondents, introduce a tension—the crux of this analysis of power and research methodologies in a community study. Organizers and leaders typically seek singularly strong findings that embellish their talking points.

As long as corporate marketing strategies, along with limited-government principles that exclude health care, reign supreme in the power relations of American politics and policy, neither stories nor science will produce the sort of reform that protects the health and lives of ordinary residents. Policy strategies at wider levels are necessary to foster change, such as what occurred in public health over the last century around toxic waste, sanitation and water supply (Blackwell et al. 2012). With organized power at regional and community levels, including what IAF and other organizations provide, the broad base for policy change will be built.