By Azita Amiri PhD, RN, Chair, Environmental Task Force | Assistant Professor, University of Alabama in Huntsville
Citizens in Uniontown, Alabama, a small town in Perry County surrounded by rural areas, have been suffering physically, mentally, and emotionally for more than two decades. Uniontown has had a failed “waste treatment” spray field for many years. In this city, sewage water is sprayed out on the fields where it is supposedly absorbed by the soil. The soil in that area, however, percolates water very slowly, which results in stagnant water on the fields. Not too far from the failing sewage spray fields is a cheese plant that adds a huge amount of rotten butter milk (whey) to the environment and after treatment, its effluent water is sprayed in the surrounding ponds.
“County health ranking and roadmaps (2016) ranked Perry County the 66th healthiest county (out of 67) in Alabama.”
New to this environment is the mega-landfill holding 4 million tons of toxic materials. In 2009, after the coal ash dike at TVA Kingston fossil plants was ruptured and released 5.4 million cubic yards of coal ash into Emory river in Tennessee, as a part of cleaning process, Arrowhead landfill in Uniontown received the spilled coal ash. A total of 4,021,934.73 tons of coal ash was transferred to Arrowhead in 6 shipments from July 2, 2009 to December 4, 2010.
Coal ash is the residue and one of the byproducts of coal power plants and is considered hazardous waste. Coal ash contains many toxic materials including heavy metals such as arsenic, chromium, copper, lead, mercury, nickel, selenium, thallium, vanadium, and zinc. Arrowhead landfill is located 4 to 5 miles from Uniontown and the nearest residence is approximately 250 to 300 feet away from the site. Filthy odors, corrosive dust, and concerns about toxic air, soil, and water have become facts of life for Uniontown’s citizens.
This environmental injustice, combined with other factors such as poverty and low health literacy, has resulted in significant health disparities in this area. Uniontown has about 2,400 people, with more than 88% African American, high numbers of elderly, single, unemployed, and disabled individuals. The people who can afford to leave the city, have done so.
Here is the situation in Uniontown:
- There is only one doctor’s office in town.
- The nearest Health Department is over 20 miles away in Marion (Perry County Health Department).
- The nearest hospitals are 30+ miles in either direction and most residents choose to travel greater distances (70-100 miles) to Montgomery, Tuscaloosa or Birmingham to seek professional health care needs.
- There is no transportation system available and most individuals in Uniontown cannot afford to travel 200 miles roundtrip to visit a specialist.
- County health ranking and road maps (2016) ranked Perry County the 66th healthiest county (out of 67) in Alabama. In this ranking, two types of health outcomes, length of life and quality of life, were measured. This county suffers from high rates of premature death, poor mental health days, and poor health days, low birth weight, and high sexually transmitted infections, children in poverty, and children in single parent households, when compared with national and state levels.
- The primary care physician and mental health providers are 3,340:1 and 4,910:1, respectively.
- Alabama Department of Health, 2013, data shows that Perry County is combating with higher rate of heart diseases, pancreas and ovarian cancer, stroke, diabetes, pneumonia, and Alzheimer’s disease.
- The citizens reported that Uniontown has incredibly high rates of depression and other mental and emotional disabilities.
- Environmental Working group (EWG), for tap water testing in 2004-2005, reported a high level of aluminum in the water, which exceeded both health and legal limits, and a high level of lead (5-10 ppb), which exceeded health limits.
Have they really been forgotten? Are we, as Alabama nurses, aware of the health status of different counties and cities in our state? In fact, I was not aware of the struggles of this small city, until a few weeks ago, when a citizen, which had heard about my studies on environmental sampling called and said “We need help!”
My suggestions are to:
- Raise awareness about Alabama State’s health profile in regional conferences and include it in nursing curriculum, e.g., community health course, for undergraduate students
- Arrange statewide medical mission trips
- Include medically underserved areas as the clinical sites for nursing students at graduate and undergraduate levels
- Study the role of toxins in air, water, and soil on health outcomes
- Apply appropriate evidence based interventions for improving health outcomes and health literacy
- Become an advocate and a powerful voice to bring environmental justice to underserved areas like Uniontown.
Usually, nurses are on the front line to serve patients from low-income and medically underserved communities at the national and international level. I would like to ask Alabama nurses, who are in practice or academia, as well as ASNA committees to consider finding ways to help this medically underserved population.