Solution Journalism 2022: Why Aren’t You Fixing This?

Protecting all humans (Photo creds: Klaus Nielsen)

In New Orleans, the median net income for white families is more than $63,000. In comparison, black families in New Orleans reported an annual income just below $26,000. Furthermore, African-American women living in the state of Louisiana face the worst pay gap in the entire country. Since the BIPOC in New Orleans earn 48 cents for every dollar earned by white, non-Hispanic men in the state, many residents struggle to afford rent. Additionally, as the average cost of living in New Orleans is 20% higher than the state average and 12% higher than the national average, New Orleans residents must spend a significant part of their hard-earned income on housing, especially since New Orleans housing is 41% more expensive than the US average, and healthcare is 17% higher than the national average. With these complications, many marginalized communities are forced into horrendous living conditions, including the counties closest to the DuPont-Denka Plant, a staple of Cancer Alley. 

“Cancer Alley” comprises the region from Baton Rouge to the south of New Orleans along the Mississippi River, consisting of 85 miles. Sadly, it got its name as this area used to be named the chemical corridor, as it was home to a multitude of oil refineries and chemical plants. In the late 1980s, residents living in this area noticed a significant rise in cancer cases among people living close to one another. In 1987, residents living in Jacobs Drive began to call their street “Cancer alley” after they realized fifteen people developed cancer within a two-block radius, with another seven cases just half a mile away. After doing abundant research, environmental agencies found over 50 toxic chemicals in the air in cancer alley, including benzene, formaldehyde, chloroprene, and ethylene oxide. Due to the constant exposure to hazardous substances, residents reported higher levels of cancer, including lung, stomach, and kidney cancer, and two sporadic cancers, Neuroblastoma and Rhabdomyosarcoma. 

In 2002, Louisiana had the highest death rate due to cancer in the nation. The annual carbon dioxide emission rate in the St. James parish, where St. Gabriel is located, equaled that produced by approximately 113 countries, according to the Environmental Protection Agency (EPA). Another frightening statistic which demonstrates the large abundance of cancer in cancer alley is the mean cumulative cancer risk is 45.8 per million, meaning that up to 46 individuals out of one million could potentially develop cancer over a lifetime exposure to all carcinogenic air toxics in ambient air. Compared to the national average, 30.3 per million, Louisiana residents are 33% more likely to develop cancer. These statistics are driven through systemic inequalities that have forced marginalized communities into highly polluted areas, not their health choices. 

Unlike the Uptown area surrounding Tulane University, for instance, Cancer alley is home to mainly African Americans families living in poverty as, A total of 79 census tracts in Jefferson, St. John the Baptist, East Baton Rouge, and Orleans Parishes are composed of at least 90% black residents. Most of these tracts also report exceptionally low household incomes. Furthermore, even though the reported area contains more than 136 industrial factories, unemployment is high in many communities. Most residents do not have a college education. Since many of the people living here don’t have access to education and are extremely poor, they are forced to live here as it is economically impossible for them to relocate. In a recent study by the EPA,  93 percent of the residents within a mile of the Denka plant are Black, and the Formosa plant is slated for a census tract where 90 percent of the population is Black, compared to 50 percent in the overall parish. Furthermore, in 2018, researchers collected health data from residents living within about 1.5 miles of the Denka plant and found that they had a 44% higher cancer prevalence than the national rate. With few economic opportunities, residents are trapped in a toxic wasteland through the economic inequalities of the New Orleans economy. 

A Deadly Neighbor (Photo Creds: Павел Гавриков)

The Solution: Take is from the world

Ideally, the best solution to fixing the problem of a large number of deaths from cancer due to toxic chemicals roaming the air would be to change the environment to be more similar to Finland. Finland’s air quality is the best in the world, and the level of airborne particles circulating the air is an average of six micrograms per cubic meter. However, since it is not possible for New Orleans to instantly change its air quality, New Orleans needs to implement multiple strategies to turn its environmental problems around. One example of how a region can systematically fix its environmental problems is how Thailand handled its HIV epidemic. 

In Thailand, the first HIV case reported was in 1984. By 1993, 600,000-800,000 people were estimated to be living with HIV in Thailand. In the early 2000s, the number of gay men living with HIV raised from 4.1% to 7.7%. These numbers were exceptionally high in large urban areas as well as international tourist destinations such as Bangkok, Chiang Mai, Phuket, and Pattaya. Due to these large numbers of people with HIV, the government implemented services that were free and easily accessible, allowed clients anonymity, and allowed testing to residents under the age of 18. 

Today, Thailand is recognized as a global leader in both the prevention of HIV as well as its treatment. On November 8, 1989, the Thai Red Cross AIDS Research opened Asia’s first anonymous clinic. At the beginning of the Thai government’s response to the HIV epidemic, there were many challenges. First, Thai law required hospitals to report the names of people diagnosed with HIV to the Ministry of Public Health. As a result of this, it caused an increased stigma and discrimination towards people living with HIV. As a result, the Thai Government stepped up its investment in HIV control, from just US$180,000 in 1988 to US$44.33 million in 1993. By 1996, the government allocated US $81.96 million to its response to control the spread of HIV. Prior to 2000, antiretroviral medicines, or ART, were not available through public health facilities in Thailand, and therefore many people living with HIV could not afford to buy them. As a result, in 2000, ART medications became free of charge under the Access to Care (ATC) program, drawing on the principles of equal access to HAART and service equality. This program continued to grow as by 2010, more than 150,000 patients were receiving ART. An assessment of treatment outcomes for ART among adults in Thailand showed that survival rates continue to increase. Also in 2000, Thailand launched the PMTCT program, which provides voluntary and free testing for all pregnant women, free ART to pregnant women and newborn infants, and free formula feeding for infants for the first 12 months. From 2001–2003, the transmission risk among those completing a short course of zidovudine (ZDV)-only regimen declined from 18.9–24.2% to 6.8%. By 2006, Thailand integrated its HIV services into its universal health coverage scheme, including antiretroviral therapy. In Thailand, HIV testing is free, anonymous, and adolescents who are younger than 18 do not need parental consent to get tested. 

Since 2014 Thailand has provided antiretroviral therapy for all regardless of their CD4 level, allowing readily accessible treatment at no cost for all residents. The Thai Red Cross Anonymous Clinic, located in the heart of Bangkok, provides free HIV services for 200 daily patients regardless of their socioeconomic status. Benefits include medical check-ups, HIV tests, and HIV prevention services, including condoms and pre-exposure prophylaxis (PrEP). Another program responsible for decreasing HIV cases in Thailand is the Thai Network of Youth Living with HIV. This program has effectively empowered the youth living with HIV by providing them with professional skills and mental support systems.

The Thai government has seen success through these programs as in 2018, only 6,400 people were newly infected with HIV, a 59% decrease compared to 2010. Furthermore, The public health response to HIV in Thailand has averted 5.7 million infections since 1991. If Thailand had not responded in 1991 to the HIV epidemic with free and easily accessible medical services, the country would have experienced an estimated 158,000–225,000 deaths in the 2001–2006 period. This figure would have risen to 231,000–268,924 in the 2007–2014 period. A total of 196,000 deaths were averted between 2001 and 2014. If ART scale-up had not occurred in 2001, Thailand would have experienced between 50,000 and 55,000 deaths per year in the period 2001–2006, and 31,000–46,000 annual deaths between 2007 and 2014. With such success, New Orleans should adopt Thailand’s strategy of implementing free medical services that are easily accessible to all residents regardless of age, income, or living status. 

While this program has been highly successful in Thailand, there have been some limitations. First, the AIDS mortality rate is still not as low as previously wanted by the Thai government. In 2020, Thailand had an estimated 500,000 people living with HIV, and 12,000 died of AIDS-related causes. Additionally, this program has a few main limitations, all of which involve early detection. First and most importantly, studies show that people living with HIV who developed opportunistic infections such as tuberculosis, cryptococcal meningitis, and pneumocystis pneumonia had a doubled risk of death. A way for this vast problem to be solved is for HIV to be diagnosed earlier, so people know that their immune system is deteriorating. Another challenge was that people who are newly diagnosed with HIV may not always start antiretroviral therapy right away or switch treatments. For example, researchers were able to conclude that changing treatments indicates a failure of first-line treatment, and people may have had to wait before being able to switch. 

Implementation: Adding the good to NOLA

The strategies proposed by the Thailand Government to help combat the HIV epidemic can be implemented in New Orleans in order to help lower cancer mortality rates in cancer alley. First, both New Orleans and Thailand are comparable, as both regions have high levels of poverty. While HIV and cancer are incredibly different medical issues, they both have the same essential element to boost survival rates; early detection. To follow Thailand’s strategies, New Orleans should implement free services that are easily accessible to residents in the most at-risk areas. A possible solution to Cancer Alley could be implemented through a three-step process. 

The first stage would consist of early detection. Part of this stage would be to open up free clinics in accessible places, just like Thailand did. Additionally, these clinics should be available for all ages and should permit testing to children under 18 without parental consent. This would be extremely helpful since most of the population living in cancer alley, especially the places with the highest cancer rates, did not graduate high school, and many of them are illiterate. By lowering the age of parental consent, children who are educated and learn about the clinics in school will be more inclined to get tested as they will be taught the critical importance in early detection. Furthermore, since these clinics will be in easily accessible areas throughout cancer alley, they will be accessible to people who may not own a car. These clinics will be filled with volunteers, mentors, doctors, and nurses who all strive to help the people living in cancer alley. In this stage, signs will be hung up as well as children in schools will be taught and take home papers that this screening is accessible to everyone despite their insurance status. 

The second stage of this plan will be to provide free treatment. This stage will be immediately after the screening stage. These clinics must strive to have patients start their treatment right after they are diagnosed. In this stage, people will be provided with support from doctors, nurses, and volunteers. Each patient will be given a personalized treatment plan free of charge, regardless of insurance status. As a result, more residents will seek medical help and continue their recommended treatments at no cost to patients. 

The last stage will be for city officials to follow up with patients past their treatment. Just because someone is cured in the second stage, their cancer could return through their inability to relocate out of cancer alley. Part of this step includes the clinics providing check-ins with the patients after their treatments to ensure that their cancer does not return. If it does, patients will have access to early prevention services and further medical treatment free of cost. This plan would also pose as a base for research about cancer treatments, and since the treatments would be done through the same program, it would be easy to track the success of the programs. 

If this complex plan was to be implemented, there could be many difficulties. The first and most difficult challenge would be government funding. Currently, the New Orleans city government needs more funding to build new facilities, hire hundreds of medical professionals, and provide intensive services at no cost. The city would require a large amount of federal and state funding, which is rarely available. Another challenge will be choosing the location of the clinics, as cancer alley includes 85 miles of New Orleans. Additionally, as many residents do not have access to transportation, any clinic location would also require transportation services. Lastly, having people know about the clinics and get screened may be challenging. For example, many people living in cancer alley are uneducated and may not be aware that they are living in a place that puts them at such a high risk for cancer. Also, it will be hard to get people to come in for follow-ups as they may think after their treatment is done, they won’t continue to be monitored. Despite the challenges, if New Orleans is able to implement free medical services that are easily accessible to residents of Cancer Alley, the city may be able to correct the damages their immoral actions have created.