Break the Cycle of Disadvantage and Disability: Environmental Factors, Education, AIDS, and Food Insecurity

IntroductionThis supplement represents a body of work performed by students from a diverse set of disciplines and a variety of universities from the United States and Santiago, Chile. Each student project was developed for the program "Break the cycle of social, economic and environmental health disparities." Students are required to develop a project, conduct the research and then present the project at an annual national conference and then write the paper for publication. This special issue represents the projects from the eighth annual program, which to date has yielded five monographs and four books from more than 70 students, from more than 20 different universities and disciplines in the United States and Latin America. The program began with two major experiences which have been described in detail elsewhere, but will be briefly summarized here.Prematurity, substance abuse and cerebral palsyIn 1998, we started a cerebral palsy clinic at the Hughes Spalding Children's Hospital in downtown Atlanta serving low income, minority, and underserved children and their families. In 2002, we reviewed the data on the children and found that in addition to the physical and medical conditions and complications, there were significant social and psychological factors at work. There was a high rate of substance abuse during pregnancy, a high rate of premature birth, and the children were more likely to be living with a single mother, a grandmother or in foster care than in a two parent household. The realization of these relationships resulted in the formulation of a cycle of disadvantage and disability, formation of an institute called the Innovative Solutions for Disadvantage and Disability (ISDD), and initiation of the "Break the cycle"(BTC) program in 2004-2005. (see figure 1). In 2008, the concept was expanded to look at a cycle of environmental health disparities and the number of student projects expanded in scope and in number (1).Lessons from Anniston, AlabamaIn 2001, the Southeast PEHSU (Pediatric Environmental Health Specialty Unit) became involved with the people of Anniston, Alabama. The town had been the site of a set of foundries and chemical factories, which had brought prosperity to the area. The factories had dumped the chemical wastes into landfills close to the residential areas of communities living near the factory and employed by the factory, and gave some of the waste material to the employees to use as a pesticide in the soils and for the fence posts to prevent termites. The abundance of toxic substances, predominantly polychlorinated biphenyls (PCB's) seeped into the water table, eventually winding up in the waterways and poisoning fish. Once it was realized that the fish had been poisoned by the PCB's from the factories, the Agency for Toxic Substances and Disease Registry (ATSDR) of the Centers for Disease Control and Prevention (CDC) became involved. They tested a sample of the citizens living nearby revealing that blood levels of PCB were extraordinarily high. This resulted in a legal suit filed against the chemical company, which then shut down the factory, resulting in the loss of a major employer in the community and a consequent dramatic rise in unemployment and decrease in income for individuals and for the community. When the PEHSU team visited the town and spent time with the members of the community, we learned that in West Anniston (which was predominantly, if not exclusively, African American), prior to the finding of the toxins in the water and soil, there had been great pride among the people of the community in their personal backyard vegetable gardens. Unfortunately, with the high levels of PCB's in the soil, they were not able to continue their gardening practices and this, coupled with the loss of income, unemployment, and a toxic environment, left the community economically, psychologically and socially depressed resulting in dramatic health and educational disparities. …