Turning Brownfields Into Hospitals Can Improve Public Health. It Can Also Entrench Disparities.

Health centers can provide much-needed health care, but they risk creating health inequities through historical segregation, environmental racism, and futile colonialism.

In this work "Health Colonialism", geographer Shiloh Kruper explores the role of urban brownfield sites in health inequalities and medical racism.

In the early 1990s, mayors of major cities and legislators in urban industrialized countries called on Congress and the US Environmental Protection Agency (EPA) to initiate pilot programs to restore vacant and degraded land in areas highly desirable for urban infill.

Often cheaper than comparable original properties, these abandoned lots have become promising sites for reusing vacant or degraded land in struggling cities, renovating abandoned lots as "green investments" to conserve unused land.

One form of the abandoned site project called Healthfields is to reimagine land restoration as a sustainable public health effort involving community land management and health organizations. This land reuse policy aims to address the lack of healthcare services in underserved BIPOC communities and bridge the biomedical divide by separating physical health and emergency clinical care from environmental conditions.

Sanitary areas are abandoned areas used exclusively for medical purposes, such as medical centers, grocery stores, farmers markets, green spaces, and, in some cases, affordable housing. The EPA website defines health zones as "an economic development strategy targeted at low-income families living in areas of environmental stress."

Public health literature indicates that the Abandoned Sites Act provides an opportunity for local governments and abandoned sites communities to link land reclamation to public health through provisions that allow local governments to spend up to 10% of their grants to improve the health of residents at sites. monitoring. . Exposure to harmful substances and so-called "pre-existing pollution". Often cited health projects range from mapping childhood asthma surveillance linked to school health programs to converting abandoned gas stations into parks, farmers' markets and health centers.

The HealthField program began with the Willa Carson Center for Health and Wellness in Clearwater, Florida. Opened in 2001, the center provides free medical care to the predominantly African-American community in the neighborhood and is run through grants and donations supported by volunteers.

The case was brought by Willa Carson herself, who already runs a community health center and wants to raise enough funds to open a more permanent establishment of free clinics for residents of the urban community of North Greenwood. An abandoned gas station is considered an ideal location for a launch due to its central location in the heart of the community. With the help of EPA funds and a government decommissioning program, four underground storage tanks and 450 tons of contaminated soil were removed from the site. The city then leased the property to the non-profit clinic, which Carson previously ran in two renovated apartments, for 30 years for $1 a year.

Another abandoned space transformation to meet the urgent needs of local residents and dramatically expand access to health care is the Johnny Ruth Clark Health Center in St. Louis. Historic Hospital of Mercy of St. Mary. Petersburg, Florida.

Using oil spills from former taxi companies, as well as hazardous waste from an African-American hospital that has been in operation for over forty years, this health project aimed to create a new community health center in the Jim Crow tradition. The medical activism of African Americans of the time provided residents with immediate access to medical care and an economic foothold to further redevelop the area.

Construction of the city center began in 2003 with a $3.75 million grant from the US Department of Health and Human Services and a $463,000 Residential Community and Urban Development Block grant. African American Medicine in Pinellas County.

The Johnny Ruth Clark Health Center demonstrates the health sector's potential to transform a legacy of health inequities associated with racial segregation into a geography of equality based on community-led healthcare and community regeneration. The site is abandoned in part due to a lack of past medical waste management infrastructure, which was described in a presentation at the EPA Brownfields conference as "an environmental problem at a historically abandoned African-American hospital."

This development of Jim Crow-era inpatient health centers brought more public health services to underserved areas, but did not significantly change the spatial distribution of garbage and racial differences. The emphasis of the Brownfields program and, more broadly, the health sector on environmental health standards and the potential link to future land holding productivity means that significant but uncertain pollution remains.

In this sense, the health sector presents a paradox: such programs can provide much-needed health services, but risk causing health inequities due to historical segregation, environmental racism, and vain colonialism.

Health facilities can only handle soil hazards with care, thus ensuring exposure to contamination. These adverse health effects can be exacerbated by the way the healthcare industry has evolved: broad definitions include corporate grocery stores, non-profit healthcare networks (often referred to as Medicaid manufacturers), or pharmaceutical manufacturing, the latter being the industry's most infamous pollutant. . The fields of health can also support the growth of non-profit charitable capitalist medical care, as well as the creation of elite hospital zones that use undervalued land and receive tax breaks for providing humanitarian services to the poor communities living there.

While medical zones create opportunities for providing medical care to historical geographies outside of hospitals built on the principle of isolation rather than epidemiological necessity, they can also serve as "Jim Crow tax havens" that thrive on the resurgence of downy mildew. .

Although the health camps show to some extent that "the land can be polluted and still develop good relations with the soil," as geographer Max Liboiron writes, " pollution is colonialism," the continued priority of ecology and mining is unequal property values ​​and development projects. . this goal. population at risk. A justly continuing land grab under the slogan of environmental hygiene. Parks, farmers' markets, or other environmental services can enhance geospatiality, waste, and racial cleansing, replacing "green linen" as a multi-layered benefit for locals with health problems.

The Healthfield project links abandoned site reuse to health goals such as local access to medical clinics, but can work for environmental savings, poverty and pollution. Thus, the health sector can perpetuate this disease. Initiatives provide tax breaks and reduce hygiene standards and liability for sanitation projects that eliminate toxic damage: while sanitation programs create opportunities for community-level land improvement, they encourage the growth of drainage development projects that use and do not need degraded land . Give local communities a seat at the economic planning and management table.

The health sector initiative aims to transform targeted areas into hospitals, health clubs and grocery stores, and offers tax credits that encourage green health projects. They promise a purpose-built post-industrial boundary that will make contaminated land available for remediation and regeneration and could serve as an important way to raise money in urban areas with a narrow tax base. A related discourse on late blight argues that the regeneration of abandoned sites improves human health. In practice, however, such redevelopment is designed to reduce hygiene standards and reduce liability.

Abandoned fields and health fields show how blight epithets can be used to improve urban areas or arbitrarily secure more profitable use of sites, and how sanitation facilities discursively reinforce health inequalities, economic inequalities, and environmental risks resulting from segregation and earlier land grabbing. . . . .

Excerpted from Healthy Colonialism: The Urban Wasteland and the Hospital Frontier by Shiloh Krupa. Published by University of Minnesota Press, 2023. Health Colonialism is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). Used with permission.

Shilo Kruper is a geographer and Distinguished Associate Professor in the Culture and Politics Program at Georgetown University. He is the author of The Passionate Observer Report: War Tales of Toxic Waste and co-author of Deadly Biocultures: The Ethics of Life Creation. Kruper was co-editor of The People's Atlas of Nuclear Colorado and directs the National Toxic Lands and Labor Service.

Monitoring environmental data for public health decision making