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Report uncovers disturbing danger flowing in underground pipes: 'Where you live should not determine whether you get sick'

A perfect storm made this public health crisis possible.

Hookworm found in Lowndes County

Photo Credit: iStock

In Alabama's Lowndes County, hookworm, a gastrointestinal parasite that thrives in extreme poverty, has been creeping up in backyards and bathtubs via sewage for years without any meaningful remediation from the state or county. Now, the federal government is holding local agencies accountable in this environmental justice issue.

What happened?

In 2017, about one out of every three people tested in Alabama's majority-Black Lowndes County were positive for traces of hookworm, a disease typically associated with countries in the developing world, the Guardian reported. This gastrointestinal parasite was thought to be eradicated in the United States decades ago.

A perfect storm made this public health crisis possible. First off, the clay-like soil in that area makes it unsuitable for water drainage. Most homes are not hooked up to municipal sewer lines and instead use septic systems or pipes that can be overwhelmed during heavy rain and floods. This is how raw sewage — including the fecal waste that carries hookworm parasites — is creeping up into people's backyards, bathtubs, toilets, and kitchen sinks, leaving them at risk for infection.

Though officials have known about the issue since at least 2017, they apparently did not take appropriate action to remediate the situation. In November 2021, the Departments of Justice (DOJ) and Health and Human Services (HHS) launched an investigation into the matter, and in May declared that the state and county dropped the ball.

Because the Alabama Department of Public Health and the Lowndes County Health Department (collectively known as ADPH) receives government funding, they are prohibited from discriminating on the basis of race, color or national origin in their federal-funded programs and activities under Title VI of the Civil Rights Act of 1964. The investigation found ADPH to be in violation of this.

"The investigation revealed that despite ADPH's awareness of the issues and the disproportionate burden and impact placed on Black residents in Lowndes County, it failed to take meaningful actions to remedy these conditions," HHS stated in a press release.

Why is this concerning?

According to the Centers for Disease Control, hookworm first presents itself as a localized rash and itching. A heavy infection can result in abdominal pain, diarrhea, loss of appetite, weight loss, fatigue, and anemia. Hookworm can also impact the physical and cognitive growth of children. 

More than 70% of Lowndes County residents are Black, and more than 28% of them live in poverty, making this an environmental justice issue. And it's nothing new: Statistically, people of color and the poor live, work, and play in America's most polluted environments, and many people say that's no accident. 

"Communities of color, which are often poor, are routinely targeted to host facilities that have negative environmental impacts — say, a landfill, dirty industrial plant, or truck depot," according to NRDC. "The statistics provide clear evidence of what the movement rightly calls 'environmental racism.'"

What's being done to improve public health in Lowndes County?

"Environmental justice is a public health issue, and where you live should not determine whether you get sick from basic environmental hazards not faced in other affluent and white communities," Melanie Fontes Rainer, director of the Office for Civil Rights at HHS, said in a press release.

As such, the federal government is holding Alabama and Lowndes County accountable with an interim resolution that will suspend fines, fees, and penalties on residents who lack the means to purchase functioning septic systems; measure the level of health risks that residents face; increase public health awareness about raw sewage exposure; and carry out a comprehensive assessment of what septic and wastewater management will look like in the county, as the Guardian reported.

Moving forward, ADPH has agreed to follow the CDC's public health recommendations. If it fails to establish a long-term plan for addressing sewage concerns by May 2024, the DOJ will reopen the investigation.

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