IV. PUBLIC HEALTH

The Meaning of Health

Health means more than an absence of disease, as is recognized in the Constitution of the World Health Organization (WHO): “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Governments worldwide, including the governments of Canada and Manitoba, have formally accepted this definition. It recognizes the importance of psychological and social dimensions of health as well as physical ones. In 1984, the WHO Regional Office for Europe redefined health as “the extent to which an individual or group is able, on the one hand, to realize aspirations and to satisfy needs, and on the other hand to change and cope with the environment.” This emphasizes the importance of the concept of “population health,” a concept which is embedded in the policies of Health Manitoba and in proposed amendments to The Public Health Act (Health Manitoba 1997).

This concept accepts that health is possible only where resources are available to meet human needs and where living and working environments are protected from pollutants, pathogens, and physical hazards. But health also includes a sense of well-being and security. Deficient living and working environments are associated with both physical and psychosocial health problems.

The 1992 Report of WHO on Health and Environment has found that violence and alienation are associated not only with poor or low-paid job prospects but also with poor quality housing, deficient services, and inadequate provision for recreation, relaxation, and development. This perspective, and the WHO definition of health, will be used in this report to be consistent with the policy directives of the governments of Manitoba and of Canada.

Determinants of Health

The maintenance and improvement of health must be at the centre of concern about environment and development (WHO 1993). Since 1991, Environment Canada and Health Canada have been developing indicators of physical environment and ecology in relation to health. All Canadian governments acknowledge that there is much more to health than health care, and that population health strategies must address the entire range of factors that determine health (Environment Canada 1991).

Determinants of health are the pre-pathological components of health problems. The governments of Canada and Manitoba have identified and adopted several key factors which influence population health. Three of these factors are relevant to the information received by the commissioners at the public hearings and in other documents: 1. income and social status; 2. employment and working conditions; and 3. safe and clean physical environments. The cross-jurisdictional variety of scientific data and anecdotal evidence on these key determinants of health in the context of intensified corporate hog production and processing form the basis of this section. Public discussion of these factors is necessary, since government still retains its central responsibility for protecting individuals against threats to their health and environment. Health Canada has identified as a “key priority” that “currently accepted definitions of health and the known determinants of health” are “the two most important priorities” in considering health in Environmental Assessment (1997).

Income and Social Status

Large-scale corporate hog production is one of the most contentious issues to confront rural North America in recent history. The social fabric of many communities has been ripped apart by controversy between opposing views about these large-scale corporate hog operations. Other effects include reduced quality of life, increased potential for health risks, and a displacement of independent hog farmers (Transcript. Ikerd, Dye, Stull, and Braun). Low wage jobs and the transient work forces they often create, coupled with preferential concessions granted to these corporations, have decreased the quality of life in many communities. Despite their separation by large distances, and their differing historical and cultural traditions, these communities face similar challenges—population mobility, rising rate of crime, health and social problems, and strains on infrastructure and social services (Transcript. Broadway, Stull, and Thu).

The industrial recruitment model used by the pork processing plants in North America has been shown to offer wages consistently lower than average per capita income. Historically, employee turnover in packing plants averages 100% annually and many employees are never at one plant long enough to earn the average wage and benefits or to establish community roots. The income of most workers is at, or near, levels required for one or more government assistance programs. These factors have a profound influence on overall community health and the delivery of health care. Public health problems are on the rise (Transcript. Broadway, Ikerd, Thu, and Stull). The social costs of large-scale hog production (characterized by regional specialization and vertical integration) include increased homelessness, crime, domestic violence, and demands for social assistance ( Transcript. Broadway, Stull).

If “income and social status” is an identified determinant of health according to government policy, then clearly there are significant health risks associated with large-scale hog production and there is a significant role that government must play in identification and mitigation of these risks.

Employment and Working Conditions

Processing: The coming of large hog corporations to many centres in the United States and Canada could be referred to as a “mixed blessing,” in that alternative opportunities for economic expansion in some of these jurisdictions were foregone by focusing effort and incentives on bringing large-scale corporate hog operations into the area.

The positive effects were creation of new jobs in the community, an increase in population, an increase in tax base, and an increase in the number of business establishments. However, these benefits were associated with some dramatic changes and considerable “costs,” some of which are measurable while others cannot yet be measured because of the absence of developed methodology (Transcript. Broadway, Dye, Ikerd, Stull, and Braun).

The United States Occupational Health and Safety Administration has described meatpacking as the most dangerous industry in the United States during the 1980s and 1990s. As productivity and speed increase, injury and illness also increase (Transcript. Broadway). One in three slaughterhouse workers will be injured on the job this year (Transcript. Dye). The cost of such injury is often a public cost. Smithfield Foods, which has acquired 10 other major pork corporations in 1998 and 1999, is the largest pork producer and processor in the world. In 1997, Smithfield Foods was convicted in federal court and fined $12.6 million for what ultimately turned out to be nearly 7,000 counts of illegally discharging hog plant wastes into a major Virginia waterway, the Pagan River, and then falsifying records to cover up its activities. Its fine for safety violations levied under the North Dakota Occupational Health and Safety Act is the largest recorded to date.

Production: Intensification of pig farming methods has led to increased animal density in confined buildings where several air pollutants may be concentrated. Epidemiological studies by several authors that were presented by Drs. Pip and Paton indicate that pollution inside hog confinement buildings represents a real human and animal health hazard. Significant correlation has been found between altered pulmonary function in workers and frequency of respiratory tract diseases in their pigs. “Hog dust” includes tiny particles from animals, feeds, and manure, which can act as carriers for endotoxins and pathogens. These are among the most harmful pollutants encountered in the air of pig buildings (Bongers et al.1987). Endotoxins are nonliving, complex molecules which are part of the cell wall of the gram-negative bacteria and occur in manure. Exposure to high concentration of airborne endotoxins can cause acute fever and lung function alteration accompanied by respiratory complaints such as chest tightness, cough, shortness of breath, and wheezing. Long-term endo-toxin exposure may lead to decreased pulmonary function and chronic bronchitis (Bongers et al. 1987). Ammonia is a highly water-soluble gas frequently found at high levels in confinement buildings. It is readily absorbed by distal airway mucous of humans, resulting in retention of vapours and gases in their respiratory system.

The extensive scientific literature on workers in hog confinement facilities (Transcript. Pip) demonstrates that workers in hog barns have unique occupational illnesses:

• organic dust syndrome caused by hog dust; • a high rate of chronic respiratory illness (asthma, chronic bronchitis);

• symptoms that directly correlate in intensity with the duration of exposure;

• respiratory or liver damage occurring over time, caused by exposure to bacterial endotoxins.

Chronic respiratory disease in 25-30% of workers inside these facilities has been reported in 25 studies world wide (Transcript. Thu). Since employment and working conditions are determinants of health, it is clear that there is significant risk to human health in large swine confinement facilities (Transcript. Ikerd, Dye, Stull, Pip, Hessel, Thu, and Paton).

Safe and Clean Physical Environments: Investigators for the United States Centre for Disease Control have found contaminants related to large-scale hog production that have serious implications for human health. These include pathogens, heavy metals, antibiotic-resistant bacteria, and parasites, all found in surrounding wells, drainage ditches, and underground water (Transcript. Dye). Both barn and meat processing waste waters are loaded with bacteria, many of which can be transmitted to humans (Transcript. Pip). Pig manure is entirely different from other mammalian manures and it ought to be regarded as a potential health hazard. It should be fermented aerobically or composted at thermophilic temperatures before being spread on the land (Transcript. Lewis, and Paton). Practices of spreading liquid manure by “broadcasting” create aerosols that can carry pathogens for miles (Transcript. Pip).

1. Pathogens: There is direct evidence that pathogens of concern to human health are surviving in manure. These pathogens are exhibiting a disturbing pattern of antibi otic resistance (Transcript. Thu). The same type of antibiotic resistant pathogens identified in liquid manure have also been found in surface and ground water near large-scale hog operations, suggesting that they have been viably transported. Five microbial contaminants that can be a hazard to human health have been found: E. coli, Enterococcus, Yersinia, Campylobacter, and Cryptosporidium. American investigators have found both Ascaris suum and Melatinium coli in intensive hog operations. The main reservoir of infection for humans by these parasites is hogs (Transcript. Pip, Lewis). One hog producer reported a personal Melatinium infection (Transcript. Neufeld). Ascaris suum is a problem in intensively-managed production systems, and the parasites can increase in such systems (Transcript. Lewis). The potential danger associated with A. suum can be reduced if pig manure is handled properly. Spreading it untreated on fields is not handling it properly, as parasite eggs may be preserved for months after they are ploughed under (Transcript. Pip, Lewis, and Paton).

2. Antibiotic Resistant Bacteria: Sub-therapeutic levels of antibiotics are used in the livestock industry to promote growth and reduce the cost of raising livestock. That use fosters antibiotic resistance in bacteria which can be transmitted to humans via the food supply or through the contact with livestock or manure (Transcript. Pip, Homme). Antibiotic treatment may be ineffective in persons infected by pathogenic, antibiotic-resistant bacteria, thereby jeopardizing their health. Sub-therapeutic use of antibiotics also leads to increased levels of antibiotic resistance in animal pathogens on the farm. That resistance endangers livestock since it makes an antibiotic less useful for treating animal infections. This leads to pressure for the approval for use on animals of antibiotics that are essential for treating human diseases. Swine manure has been shown to contain residues of amoxocillin, neomycin, oxytetracycline, chlortetracycline, and penicillin “G.” These end up not only in waste, but also in the meat (Transcript. Pip). The use of these antibiotics on farms may compromise their effectiveness in human medicine (Centre for Science in the Public Interest). Sweden banned antibiotic use in feed in 1986 (Transcript. Homme, Pip). The extent and severity of this problem has not been extensively studied, but there is evidence that antibiotics in animal feeds produces antibiotic resistance in Salmonella faecalis (Transcript. Homme).

3. Air Quality, Odour, and Health: The general realization that odour policy must be based on a sound scientific odour measurement has resulted in major developments in olfactometry and its acceptance as a legitimate environmental assessment procedure (Schultz and Vanharrenveld 1996). This means policy can no longer be based on simple nuisance. Large-scale hog operations are especially susceptible to air quality problems. A mixture of gases in animal waste creates these odours. The sources of odour are the barns, manure storage units, effluent application, and carcass disposal. The four main gases produced by the large-scale hog industry are hydrogen sulphide, carbon dioxide, ammonia, and methane. Elevated levels of these gases are toxic to many higher organisms and direct exposure to them can produce symptoms from irritation to death in humans and animals (Lorimer et al.1998). These gasses affect the lungs and irritate mucous membranes (Chapin et al. 1998). Massive hog operations reduce air quality with odour and gaseous emissions. The effects of these emissions range from health impairment among workers and nearby residents to cumulative environmental pollution. There is evidence of serious mental stress of people who live near these operations and are repeatedly exposed to emissions. Mental stress destroys health and affects the human biological system (Transcript. Ikerd). People who are exposed to these airborne emissions also experience a series of health problems at a disproportionate rate compared to people or controls who are not (Transcript. Thu, Hessel, Wing). Noxious environmental odours can trigger symptoms “by a variety of physiological mechanisms, including exacerbation of underlying medical conditions, innate odour aversion, aversive conditioning phenomena, stress induced illness, and possible pheromonal reactions” (Shusterman 1992). Similarly, the emissions from commercial hog operations affected nearby residents by causing tension, depression, anger, reduced vigour, and more confusion than a control group (Schiffman et al. 1995). In the U.S., the University of Carolina’s School of Public Health and the Centre for Disease Control of the National Centre for Environmental Health have both concluded that emissions from large-scale hog facilities constitute a public health concern.

Conclusions

The available information, when placed within the analytical framework of “health determinants” and “population health,” demonstrates conclusively that significant public health risks are associated with large-scale hog production. The fundamental biological needs for clean air, water, and healthy soil are also compromised. Therefore, human health, as defined by the World Health Organization and the governments of Canada and Manitoba, is clearly compromised by rapid expansion of large-scale hog operations. Recommendations

1. Action should be taken early to address the obvious risks to human health (as defined), created by intensive hog production and processing, even if present knowledge is insufficient to fully evaluate these risks. Since three of the key determinants of health are affected by intensified hog production and processing, further expansion of these developments must be pursued with caution in the face of uncertainty concerning environmental and health implications.

2. Human health (as defined) must be incorporated into the legislated environmental assessment process. Manitoba Health must be involved at the conceptual phase of development, not after the fact.

3. Indicators and measurables of the determinants of health which are specific to pork production and processing should be developed and applied before further expansion of pork production and processing is undertaken in Manitoba. In particular, we need better comparative data to assess the results associated with large-scale operations with comparable data from other sizes and forms of hog production.

4. Governments should ensure that agricultural uses of antibiotics do not endanger public health. Current regulations that permit the sub-therapeutic use in live-stock of antibiotics that are used in (or relate to those used in) human medicine should be rescinded. This use of antibiotics, which leads to the development of antibiotic resistance, should be halted as soon as possible.

5. Emissions, currently described as “odour,” should be considered a “health” issue rather than a “nuisance” issue in all future policy on hog production and processing.