Environmental Health Perspectives • VOLUME 110 | SUPPLEMENT 2 | April 2002 241

The environmental justice movement has

consistently challenged researchers and decision makers to acknowledge that scientific

expertise is necessary but insufficient to

address the multiple and persistent health

hazards facing the poor and people of color.

The uncertainties surrounding scientific

knowledge, such as the adverse human

health effects from exposure to multiple hazards, combined with evidence that the poor

and people of color continue to bear a disproportionate burden of the effects of environmental exposures and the associated

morbidity and mortality (1,2), have led disadvantaged communities to demand a participatory role in defining, analyzing, and

prescribing solutions to improve the conditions they face. These communities are

demanding to speak for themselves in environmental health research and decision making. In doing so, these communities often

emphasize that their experience, contextual

and local knowledge should be considered

local expertise about the multiple hazards

and chronic diseases afflicting their communities. Communities seeking environmental

justice are speaking for themselves through a

process of community-based participatory

research (CBPR). In this participatory

research process, community members act as

equal partners with scientists and potentially

other researchers in problem definition,

information collection, and data analysis—

all geared toward locally relevant action for

social change (3). I explore how one community, the Greenpoint/Williamsburg

(G/W) neighborhood of Brooklyn, New

York, has used CBPR to describe and act

upon the multiple environmental health

issues it is currently confronting. I highlight

two community-led research efforts, one targeting asthma and another health risks from

subsistence fishing, and suggest how CBPR

is helping one urban neighborhood pursue

environmental justice.

A key tenet of the environmental justice

movement is that communities of color and

the poor should have greater participation in

research and decision making that affects

their lives, partly to ensure that these

processes combine science with the social,

economic, and political realities confronting

disadvantaged populations (4,5). The

knowledge community members have about

their experience of living with multiple environmental hazards and chronic disease is one

of the fundamental assets they can contribute to environmental health research and

is often the key resource a community organizes to avoid hazardous environmental

exposures and maintain health (6–8). When

communities engage in environmental

health research, their primary concern is to

help themselves by generating usable or

actionable knowledge—information that

goes beyond description and analysis and

suggests proactive or precautionary intervention strategies (9–11). Environmental justice

activists are taking research and action into

their own hands, often partnering and collaborating with outside experts, to address

the pollution and disease disparities

confronting their communities.

I highlight the work of two G/W

community-based organizations, El Puente

and The Watchperson Project. Through indepth interviews, reviewing primary texts,

and ethnographic fieldwork, I describe the

processes each organization has used to

investigate and act upon two local health

issues: asthma and subsistence fishing. El

Puente is a community organization with a

long history of social justice organizing

among the Latino residents of Williamsburg.

I describe their health survey research

around asthma, which is aimed at addressing the causes, triggers, and management of

the disease (12). El Puente, partnering with

the nonprofit organization Community

Information and Epidemiological

Technologies (CIET), has emphasized local

ownership over the research process and the

results, all geared toward collective self-help

(12). Although some of the results of El

Puente’s work have already been published

(12,13), I emphasize the processes they have

used in their research, paying particular

attention to how they have gathered and

used community knowledge to understand

and act upon the elevated rates of asthma in

the Latino community. In a second case I

review the work of The Watchperson

Project, a neighborhood watchdog, research,

and advocacy organization. I describe how

the group partnered with the U.S.

Environmental Protection Agency (U.S.

This article is part of the monograph Advancing

Environmental Justice through Community-Based

Participatory Research.

Address correspondence to J. Corburn, Dept.

of Urban Studies and Planning, MIT, 77

Massachusetts Ave., Bldg. 9-314, Cambridge, MA

02139 USA. Telephone: (617) 253-2026. Fax:

(617) 253-7402. E-mail: jasontc@mit.edu

Received 13 August 2001; accepted 3 December

2001.

Environmental Justice

Activists in the environmental justice movement are challenging expert-driven scientific research

by taking the research process into their own hands and speaking for themselves by defining, analyzing, and prescribing solutions for the environmental health hazards confronting communities

of the poor and people of color. I highlight the work of El Puente and The Watchperson

Project—two community-based organizations in the Greenpoint/Williamsburg neighborhood in

Brooklyn, New York, that have engaged in community-based participatory research (CBPR) to

address asthma and risks from subsistence-fish diets. The CBPR process aims to engage community members as equal partners alongside scientists in problem definition, information collection,

and data analysis—all geared toward locally relevant action for social change. In the first case I

highlight how El Puente has organized residents to conduct a series of asthma health surveys and

tapped into local knowledge of the Latino population to understand potential asthma triggers and

to devise culturally relevant health interventions. In a second case I follow The Watchperson

Project and their work surveying subsistence anglers and note how the community-gathered

information contributed key data inputs for the U.S. Environmental Protection Agency

Cumulative Exposure Project in the neighborhood. In each case I review the processes each organization used to conduct CBPR, some of their findings, and the local knowledge they gathered,

all of which were crucial for understanding and addressing local environmental health issues. I

conclude with some observations about the benefits and limits of CBPR for helping scientists and

communities pursue environmental justice. Key words: asthma, community health, communitybased participatory research, cumulative exposure assessment, El Puente, environmental justice,

local knowledge, subsistence fishing, The Watchperson Project. Environ Health Perspect

110(suppl 2):241–248 (2002).

http://ehpnet1.niehs.nih.gov/docs/2002/suppl-2/241-248corburn/abstract.html

Combining Community-Based Research and Local Knowledge to Confront

Asthma and Subsistence-Fishing Hazards in Greenpoint/Williamsburg,

Brooklyn, New York

Jason Corburn

Massachusetts Institute of Technology, Department of Urban Studies and Planning, Cambridge, Massachusetts, USA
EPA) to research local subsistence-fishing

practices, and how the community group’s

research contributed key data inputs into the

U.S. EPA first community-based cumulative

exposure project (CEP). I review the community-based research process, paying particular attention to how local knowledge was

incorporated into the U.S. EPA risk assessment, and report on the assessment findings.

Through both examples, I suggest how communities living with environmental health

hazards and chronic disease can contribute

local knowledge and expertise, often overlooked or unattainable by outside

researchers, that can contribute to both

locally relevant health interventions and to

extending the work of professional scientists.

Neighborhood Exposure

Profile

The G/W neighborhood, defined by

Community Board Number One in

Brooklyn, has approximately 160,000 residents living in an area of less than 5 square

miles. These residents are some of the poorest in New York City, with 35.7% of the

G/W population living below the poverty

line (14). The median household income

for the neighborhood is $16,409 compared

with $25,684 for Brooklyn, and $29,805

for New York City generally (14). In addition to the poverty issue, only 43.7% of

adults over 24 years of age have a high

school diploma or higher level of education

compared with averages of 63.7% in

Brooklyn and 68.3% in New York City

generally (15). The ethnically diverse neighborhood is approximately 42% Latino

(mostly Puerto Rican and Dominican),

24% Hasidic Jew, 13% African American,

and 10% Polish and Slavic immigrants (14).

The neighborhood has the largest

amount of land (12%) devoted to industrial

uses than any of New York City’s 59 community districts (15). The average percentage

of industrial land use for all districts in the

city is 1.9% (15). The neighborhood houses

a disproportionate number of polluting facilities in New York City, including the

Newtown Creek sewage treatment plant; 30

solid waste transfer stations where garbage is

stored before being transported to landfill; a

radioactive waste storage facility; 30 facilities

that store extremely hazardous wastes, 17

petroleum and natural gas storage facilities;

and 96 above-ground oil storage tanks (16).

In 1987 a study by the Hunter College

Community Environmental Health Center

called “Right-to-Breathe, Right-to-Know”

revealed that Williamsburg was home to the

largest concentration of industries reporting

to the U.S. EPA Toxic Release Inventory

(TRI), many of which were not in compliance (17). Not much had changed 10 years

later. In 1997 the community housed 60

facilities storing, using, or manufacturing

10,000 pounds or more of a hazardous substance, 161 facilities reporting hazardous

substances in the citywide facility inventory

database, 21 TRI facilities, and 11 facilities

using or storing extremely hazardous materials with risk management plans (16).

These numbers rank the neighborhood first

out of all community districts in New York

City for housing the highest number of

these facilities. Residents are also exposed to

heavy vehicular traffic and mobile source

pollution from the Brooklyn–Queens

Expressway, an elevated roadway that bisects

the community. Finally, only 3.0% of the

neighborhood is shaded by trees, compared

with an average of 11.4% tree cover for all

Brooklyn neighborhoods and an average

coverage of 16.6% for all of New York

City’s neighborhoods (15).

Despite the plethora of environmental

hazards in the G/W neighborhood, few

attempts have been made to understand and

document neighborhood residents’ health.

The New York City Department of

Environmental Protection (DEP) supported

two neighborhood health studies of G/W,

focusing on rates of cancer, asthma, birth

defects, and childhood lead poisoning. These

studies found that the incidence of stomach

cancer, certain types of leukemia in men,

pancreatic cancer in women, cancers of the

central nervous system, and certain

leukemias in children were among the highest in New York City (18,19). Another study

by the DEP attempted to capture the cumulative environmental load for each census

block group in the G/W neighborhood,

called the baseline aggregate environmental

loading (BAEL) profile (20). The BAEL project was never finalized, but draft reports

gathered data on land use, demographics,

the location of toxic releases, some health

end points, and the location and number of

residents’ air and odor complaints in the

neighborhood (20). With a paucity of environmental health research being conducted

in regulatory agencies, some neighborhood

organizations decided to conduct their own

community health research.

El Puente: Asthma Research

and Action

In an effort to better understand and

improve the health of the community, El

Puente, a community learning and development institution located in Williamsburg’s

Southside, conducted a series of community

health surveys between 1995 and 2000

focusing primarily on asthma (12).

Designed, administered, and interpreted by

community residents with the assistance of

CIET, the surveys have enabled El Puente to

learn about neighborhood health, the

challenges residents face in maintaining their

health, and how to structure health interventions that resonate with and make sense in

people’s daily lives. The asthma research and

action is one part of the organization’s environmental health and justice program,

which includes issues ranging from stopping

neighborhood waste-transfer stations to creating community gardens (21). This section

reviews some of the methods El Puente used

in the CBPR process, paying particular

attention to how residents’ local knowledge

was revealed and how this knowledge

contributed to community-based healthpromoting activities.

El Puente’s health survey research “stems

from the conviction that science should be

used as an instrument for collective selfhelp” (21). The group’s work was partly

stimulated by students in the El Puente

Academy for Peace and Social Justice, a public magnet high school housed in and run by

the community organization, who were concerned with neighborhood air pollution and

alarming rates of asthma (21). The academy

had been a focal point for community health

organizing since 1988, when science class

students organized the “Toxic Avengers,” a

group of teenagers committed to education

and organizing in order to take action

against a poorly performing radioactive

waste storage and transfer facility in the

neighborhood (22). When science students

again expressed an interest in air pollution

and health issues in 1995, El Puente

enrolled CIET to help students survey the

student body, family, friends, and neighbors

about their perceptions concerning local

environmental and health issues (23). CIET

helped train students and some residents in

survey design and administration along with

the etiology of asthma. The students participating in the survey eventually organized the

Williamsburg Environmental Preservation

Activists and acted as the first team of community residents to perform El Puente’s

door-to-door health survey (24). With financial assistance from the Nathan Cummings

Foundation, 50 El Puente Academy high

school students, five teachers, and five El

Puente staff members interviewed residents

door-to-door, reaching 280 households and

1,065 individuals (25). This first survey

revealed to El Puente that residents felt there

were serious problems of air pollution and

respiratory disease in the neighborhood;

however, most residents had not taken nor

were they aware of any actions they could

take to address these conditions (25).

Although preliminary, the findings provided

the impetus to plan a series of community

health surveys and related action to combat

asthma (23).

Environmental Justice • Corburn

242 VOLUME 110 | SUPPLEMENT 2 | April 2002 • Environmental Health Perspectives
Research Philosophy

El Puente and CIET adopted a research

methodology called sentinel community surveys or service delivery surveys (26). With

these methods a mix of quantitative and

qualitative data is gathered by existing community organizations trained to conduct

questionnaires, face-to-face interviews, and

public discussions of survey design and

results—all with the intention of collective

action (26). The research philosophy is

rooted in the Latin American tradition of

participatory action research, which emphasizes that research should be understood as a

process of education, and pedagogy as a practice of social transformation (27–29). El

Puente used a form of listening research, a

technique emerging from rural appraisal in

which teams of community residents, trained

by research scientists, employ their own skills

in observation, questioning, semistructured

interviewing, and group discussions to gather

data (30). Fundamentally, the key components of El Puente’s research approach

include: a) community ownership of both

the information and the research process; b)

the premise that research will lead to action

for the benefit of the community; and c) the

weaving of research into a process of community reflection and learning (12,30).

Community Health Educators

After the 1995 survey, which was performed

mostly with high school students and volunteers, El Puente decided to employ a dedicated survey staff from the neighborhood to

obtain more detailed information and to

develop a sustained health research effort

(31). Following in the research traditions of

participatory action research, El Puente

recruited community members to act as

health promoters to administer the surveys,

lead community discussions about interpretations of results, and help residents generally manage their asthma and health (32).

According to Cecilia Iglesias-Garden, coordinator of El Puente’s health workers, the

objective was to hire community health

workers from the community who had longterm ties, commitment, and knowledge of

the neighborhood, including people who

knew about available neighborhood social

services (32). According to Iglesias-Garden,

it was also important for the organization to

recruit community members with a personal

or familial association with asthma, those

who had experience dealing with the daily

challenges of living with asthma, and residents who had a passion for improving the

health of the community (32). Eventually,

El Puente chose 10 Latinas from the community, all Puerto Ricans and Dominicans,

to be a part of their community health

educators (CHE) team.

The CHE women and CIET scientists

worked together to develop the asthma survey program: the technicians educated the

women in the science of asthma and survey

design, and the residents educated the scientists in local culture, language, and common

health practices. The women became the

centerpiece of El Puente’s community health

worker model. In this model, community

health workers are lay health advocates and

advisors who learn from and help educate

individuals and groups toward increased

well-being (33–35). The workers act as

bridge builders between residents, cultural

and folk practices, and professional providers

of clinical healthcare (33). This can be

accomplished when the women workers

offer basic disease education, screening, and

detection techniques; translate the cultural

and folk practices for unknowing healthcare

providers; and seek out professional healthcare for those who desire it (34). In New

York City’s Latino communities, the community health worker tradition dates to the

Young Lords, “barefoot doctors” of the

1960s, who worked to raise public consciousness of lead poisoning in East Harlem

(35). Community health worker models are

also increasingly used in research to help

investigators understand and treat asthma in

urban settings (36–38).

With the CHE in place, El Puente performed a second survey reaching 727

households and 2,311 individuals (31). The

increased response rate was attributed to

the presurvey organizing of the CHE and

the ability of the CHE, when at the door,

to respond credibly to the urgent health

needs they encountered. According to

Iglesias-Garden, although it was important

that the health workers could speak credibly

about asthma:

The first thing most people asked us had nothing

to do with asthma, but rather about another

medical problem they had or where they should

send their kids for school or where to get free

food to feed their family that evening. (32)

The credibility of community researchers

with other residents, which often includes

having an intimate knowledge of a place, has

been noted as one of the key factors for successful CBPR (39). The credibility of the

CHE team also contributed to widespread

community participation in focus group discussions that followed each survey.

Focus Groups and Local

Knowledge

The community research enabled El Puente

to establish, for the first time, a peerreviewed asthma rate for the Latino community in Williamsburg. El Puente calculated

an 8.5% active asthma rate generally and a

12.4% active asthma rate for children, both

more than twice the national rate of 5.4%

(13). These rates were based on the period

prevalence, or the percentage of the survey

population told by a doctor they had asthma

and who had experienced one or more

asthma symptoms in the previous 12

months. Other survey findings revealed that

residents who had been living the longest in

the neighborhood had the highest prevalence

of asthma; over half the respondents did not

have health insurance; many new immigrants avoided professional healthcare; and

residents who came directly from Latin

American or the Caribbean had half the risk

of having been diagnosed with asthma than

those who came from other areas within the

United States (13). Although these and

other findings helped El Puente begin to

take action against asthma, such as enrolling

residents in a free New York State healthcare

program, it was during a series of community

focus group dialogues that stories emerged

about why some of these phenomena might

be occurring.

The focus groups were informal community meetings where the young and old,

asthma sufferers and those without the disease, gathered to discuss interesting, surprising, or incomplete findings from the

door-to-door interviews. The meetings often

provided contextual meaning and narratives

behind the survey numbers. For example,

one survey found that women over 45 years

of age had a high prevalence of asthma similar to that found in children. This was surprising, as children, not older women, are

generally suspected as the group most vulnerable to developing asthma. During focus

group discussions, El Puente heard from

women that they typically worked in laundries, dry cleaners, hair and nail salons, and

textile factories—all occupations with potentially hazardous exposures that could exacerbate respiratory disease (21). Although the

group is working to identify more exact

explanations for the high rate of asthma in

older women, it is unlikely they would have

considered workplace exposures as a potential cause without the focus group dialogues.

The survey also revealed that many residents relied on herbal and other culturally

derived home remedies to treat asthma,

sometimes in place of physician-prescribed

medication (13). Examples of common

remedies used to treat asthma included mixtures of aloe, honey, and lemon; radish,

onion, honey, and shark oil; and snake oil

mixed with various herbs (40). However, the

survey was not able to specify why the home

remedies might be substituted for pharmaceutical medication (32). According to

Robert Ledogar, an epidemiologist with

CIET, one concern was that home remedies

Environmental Justice • Community knowledge for environmental justice

Environmental Health Perspectives • VOLUME 110 | SUPPLEMENT 2 | April 2002 243
might be toxic or exacerbating asthma

attacks; an equally important concern was to

understand the different cultural and spiritual aspects of home remedy use and how

these differed among neighborhood Latinos.

The use of herbs and home remedies is widespread in Latino cultures, especially for those

following the spiritual practices of Santeria

and Espiritismo, popular among Caribbean

Latinos from Puerto Rico, the Dominican

Republic, and Cuba (41). The focus groups

provided an opportunity to identify more

precisely the home and herbal practices that

Latinos were using, the spiritual and cultural

ties associated with the use of home remedies, and why they might be substituted for

physician-prescribed medication.

The focus group discussions about home

remedies brought youth and elders together,

along with local practitioners of herbal medicine from Puerto Rico, the Dominican

Republic, Ecuador, and other Central

American countries. Importantly, the focus

group process allowed those often marginalized in community health, particularly folk

healers, to become valued participants in the

research process. The CHE women facilitated the discussions of the home remedies.

According to Iglesias-Garden of El Puente,

the women made a conscious effort during

the focus group process not to allow other

community members or outside researchers

listening in to judge the home remedies;

instead they worked to help participants

develop a keen understanding of the practices as well as respect for their cultural and

spiritual origins. When the discussion turned

to why some residents were substituting

home remedies for prescribed asthma medications and not informing their physicians,

most residents told of being shunned and

ridiculed by their healthcare provider when

they tried to explain their cultural or spiritual practices (32). Many residents stated

that they had a hard time trusting a physician who did not understand, appreciate, or

take seriously their spiritual and traditional

practices (21). As a result, some residents did

not trust the prescribed medication and others did not visit a physician at all, preferring

their time-honored traditional practices.

Focus group dialogues also helped reveal

why Dominicans were more than twice as

likely to use home remedies than Puerto

Ricans (13.2 vs 5.3%, respectively), another

survey finding (13). Dominicans who had

more recently arrived in the neighborhood

spoke of being more disassociated from the

healthcare system than, for instance, their

Puerto Rican neighbors. According to Ana

Migdalia Flores, a member of the CHE team

and focus group discussion facilitator,

Dominicans often stated that home remedies

“helped them connect with others who could

help them integrate into the community,”

suggesting to her and El Puente that home

remedies not only represented medicinal

practices but also helped keep new immigrants connected to their social networks.

The importance of community networks for

promoting health has been noted in Mexican

American children who, despite having

higher levels of poverty, lower levels of

parental education, and more limited access

to healthcare than non-Latino White children, have unexpectedly low rates of adverse

perinatal results and prevalence of chronic

and disabling conditions (42). The focus

groups helped provide important contextual

narratives to the quantitative survey data and

revealed that, for many Latinos, maintaining

health was inseparable from the daily

rhythms of everyday life.

Knowledge for Action

Ultimately, all of El Puente’s research was

directed toward taking proactive steps to

improve the living conditions and health of

Southside residents. El Puente learned from

community expertise what types of interventions were most urgently needed and

which would most appropriately resonate

with residents’ daily lives. With the support

of the New York City Department of

Health Childhood Asthma Initiative, the

CHE women began an asthma mastery

program to enable them to train community members in developing individual and

family asthma management plans. Students

continue to be integral partners in the

asthma research by participating in interviewing and focus groups, painting community murals depicting the effects of

asthma and what to do about it, and producing an asthma awareness public service

announcement for local cable television

(21). The CHE have initiated a cultural

competency program to train local healthcare providers in Latino folk medicinal

practices (32). After learning that most residents were uninsured despite the availability of free health coverage from New York

State, El Puente organized residents to

enroll in the free insurance program. The

National Institute of Environmental Health

Sciences (NIEHS) has also recognized the

value of El Puente’s work. NIEHS recently

funded the group to continue its research

and act as the principal investigator for an

expanded 4-year asthma study, which will

include physicians from Woodhull Medical

and Mental Health Center and the

Department of Environmental Medicine of

the New York University School of

Medicine (43). El Puente’s work appears to

be paying off; not only have they educated

and enrolled hundreds of community

members in their asthma mastery program,

but asthma hospitalizations in their community district have decreased from 1,166

in 1997 to 484 in 1999 (44).

The Watchperson Project:

Cumulative Exposures and

Subsistence Fishing

A second CBPR process in the G/W neighborhood highlights not only how the process

can mobilize residents to take action, but how

community research can also contribute to

and extend the work of conventional scientific

practice. In this case, The Watchperson

Project and the U.S. EPA partnered to

develop the U.S. EPA first community CEP.

The CEP was an attempt by the U.S. EPA to

move beyond the single-source, single-hazard

approach to assessing risks and instead to recognize from the outset that some populations,

specifically the poor and people of color, are

simultaneously exposed to multiple environmental pollutants from multiple sources (45).

Cumulative assessments are intended to

differ from the traditional single-source risk

assessment approach on a number of fronts

(Table 1). First, cumulative assessments consider multiple pathways, sources, and end

points, whereas conventional risk assessments

consider only a single pathway, source, and

end point (46). For example, exposure assessment focuses on populations, not individuals,

and aggregates by population subgroups,

such as those highly exposed and highly sensitive. Highly exposed populations can be

further aggregated by specific geographic area

(i.e., neighborhoods), age, gender, race, ethnicity, and economic status. Highly sensitive

populations are also further divided by categories such as those with preexisting conditions (i.e., asthmatics), age (i.e., infants), and

Environmental Justice • Corburn

244 VOLUME 110 | SUPPLEMENT 2 | April 2002 • Environmental Health Perspectives

Table 1. Risk assessment versus cumulative exposure assessment.

Traditional risk assessment Cumulative exposure assessment

Single exposure pathway Ingestion, inhalation, dermal, and indirect

Single source Multiple sources

Single end point (carcinogenesis) Exposures not single disease

One linear dose (mostly high acute) Varied dosage (includes low chronic)

Modeling (dependent on rodent studies) Epidemiologic and no-observed-effects considered

Maximally exposed individual Actual measured exposures

Probability outcome—point or Monte Carlo Characterization by toxicity and health end points

One-size-fits-all, single stressor Case specific, holistic

Expert-dominated, centralized assessment Community-based decision making

Data from U.S. EPA (46). 
gender (i.e., pregnant women) (47).

Cumulative assessments recognize multiple

pathways, such as ingestion, inhalation, and

dermal contact, while also exploring potential

routes of population exposure, such as direct

or indirect contact, bioaccumulation, biomagnification, and vector transfers (i.e., mosquito bites) (47). A cumulative assessment

also considers a multiplicity of human health

end points, such as carcinogenic, neurotoxicologic, reproductive, developmental,

immunologic, renal, and hepatic (46).

Cumulative exposure assessment also considers the different frequencies, durations, and

intensities of exposures, such as chronic low

doses where there might not be any observable adverse effect (46). Finally, the U.S.

EPA has recognized that because some of the

necessary information for communityspecific assessments cannot be modeled solely

in a laboratory, the cumulative assessment

process departs from a one-size-fits-all centralized model of decision making and

embraces a case-specific, community-based

decision-making model (46,47).

The CEP in the G/W neighborhood

examined how much toxic contamination

residents are exposed to through air, food,

and drinking water. The study modeled the

local dispersion of 148 hazardous air pollutants and added hazardous food and water

ingestion exposures to derive a cumulative

community exposure profile (48). Here I

review only the assessment of hazards from

subsistence-fishing diets and the role that

CBPR played in this data gathering and

assessment process.

Tapping the Local Knowledge

of Subsistence Anglers

According to project manager Fred Talcott,

the U.S. EPA chose the G/W neighborhood

for its first CEP for at least three reasons: a)

the U.S. EPA suspected there were significant exposures in the neighborhood; b) the

neighborhood had an organized set of community organizations working on environmental health issues; and c) the New York

City DEP had gathered some preliminary

pollution data in the area and developed a

program—the Environmental Benefits

Program—specifically targeting the neighborhood (49). This program was an outgrowth of community organizing and a

lawsuit challenging discharges at a DEP

sewage treatment plant in the G/W neighborhood, and it was through this program

that The Watchperson Project was created

(16–20). Initially, the CEP consisted of

U.S. EPA experts trying to integrate a series

of New York City DEP and U.S. EPA data

into an established modeling methodology,

with little consultation with community

organizations (48). However, during a series

of community meetings about the CEP, the

agency heard from community residents

that their methods were missing some

potentially hazardous exposure information.

According to Samara Swanston, director of

The Watchperson Project, the U.S. EPA

methods for the dietary assessment seemed

inadequate to most residents because they

were based on a series of default “urban

diet” assumptions, which lacked any specific

information on the diets of the diverse ethnic populations and also ignored the potentially hazardous exposures from eating

locally caught fish (50). Residents suggested

during the community meetings that a large

number of local people were subsisting on a

diet of East River fish. This was the first

time the U.S. EPA had heard of this potential health hazard, and neither the U.S. EPA

nor the community had any detailed data

about subsistence fishing beyond anecdotal

evidence (49).

The Watchperson Project emphasized to

the U.S. EPA that not only were the hazards

from subsistence fishing a potentially significant dietary exposure, but also that because

many of the anglers were immigrants and

non–English speakers, they would likely be

reluctant to speak with outside researchers

about their practices (50). The community

group suggested that if there were to be an

effort to capture angler exposure data, local

people would likely be the only ones trusted

by the anglers to share information about

their fish diets (50). After considering ignoring the subsistence-fishing exposures or having community members gather this

information, the U.S. EPA agreed to help

The Watchperson Project collect information about the practices of local anglers.

According to Talcot of the U.S. EPA:

After we learned from residents that they were

eating fish from the East River, we had no choice

but to let the community groups gather the data.

For a number of reasons, including language,

cultural barriers and potential trust issues, we felt

the local people could best gather this data. This

was one situation where residents raised an issue

we hadn’t considered, defined the extent of the

problem, and provided the data for analysis. (49)

The Watchperson Project worked with

the U.S. EPA to develop a protocol to interview anglers and to identify the approximate

number of people eating fish from the river,

the amounts and frequency of fish consumption, and the types of fish anglers and their

families were eating. U.S. EPA scientists

offered the community group survey instruments used to capture similar information in

other communities, and The Watchperson

Project tailored these surveys into one appropriate for the local population (50,51). The

community group spent 3 months interviewing anglers at the India Street and the

North Seventh Street/Kent Street Piers along

the East River (48). Community members

volunteering with The Watchperson Project

visited the piers twice a day for 2 weeks during August and September and observed and

interviewed over 200 anglers. Each angler

was asked about their age, race, country of

origin; the number and age of people in

their family; and species of fish and number

regularly caught and eaten. Because the

interviewing was conducted during the summer, each interview included questions

about seasonal variability and frequency of

catches in different seasons. Finally, each

angler was asked about their fish consumption patterns and those of their family,

including the species, quantities, and preparation techniques of the fish they ate (48).

Angler Survey Findings

The information gathered by the community was divided by age and ethnicity, and

separate categories were created for Whites,

Poles, African Americans, and Latinos (48).

Almost all the anglers interviewed were

Latino or African American, although some

were Caucasian (primarily Slavic). Of the

Latinos, most had origins in Puerto Rico,

the Dominican Republic, or Ecuador

(48,50). The Watchperson Project also

found that almost all the anglers were males

between 16 and 60 years of age. The family

size of each angler ranged from 3 to 10 persons, and all anglers interviewed noted that

at least one family member was under the

age of 19 (48). The Watchperson Project

survey determined that local anglers were

catching between 40 and 75 fish per week,

averaging 57 fish per week, and that each

family member of an angler was eating

approximately 9.5 fish per week (48).

According to one angler,

Look, this is my way of feeding my family. I ain’t

got no job and this is what I did in the D.R.

[Dominican Republic]. I got to feed 5 or 6 people a night. Know what I mean? (52)

Each angler was also asked to identify

the four species they most frequently caught

and consumed. All the anglers interviewed

listed the same four species: blue crab,

American eel, bluefish, and striped bass (48).

Most anglers reported they ate whatever they

caught. One of the challenges for the interviewers was that anglers might not have been

accurately identifying the fish they caught

and ate (50). Therefore, the interviewers also

collected fish samples to confirm species

identification.

U.S. EPA analysts performed toxicologic tests on fish from the East River and

compared these data with fish contaminant

estimations from previous studies performed by the New York State Department

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Environmental Health Perspectives • VOLUME 110 | SUPPLEMENT 2 | April 2002 245
of Environmental Conservation (48,53,54).

From these data, the U.S. EPA determined

that the contaminants of concern in the

locally caught fish included cadmium, mercury, chlordane, DDT, dieldrin, dioxins,

polychlorinated biphenyls, arsenic, and lead

(48). However, arsenic was removed from the

analysis because, according to the U.S. EPA,

much of the arsenic in edible fish is present as

arsenic-containing organic compounds . . . and

these organic forms of arsenic are generally not

considered a threat to human health. (48)

In addition, because lead exposures were

going to be analyzed in a separate multimedia

study under the CEP, lead was also removed

from the fish contaminant analysis (48,49).

Using the community survey data, the

U.S. EPA generated a consumption rate for

G/W residents in grams per day, which was

consistent with U.S. EPA data from other

communities relying on subsistence fishing

(48,55). Resident exposures were then calculated on the basis of fish tissue contaminant concentrations found in actual

samples and the consumption rates. Highand low-end consumption rates for both

adults and children were calculated to

develop a range of exposure estimates (48).

The estimated exposure levels for G/W

anglers and their families exceeded U.S.

EPA oral reference doses (which generally

serve as benchmark levels for noncancer

health effects) for all contaminants except

cadmium at both low- and high-end consumption estimates (48). Exposures to

dioxins were particularly high. For example,

the U.S. EPA reference dose for dioxin is 1

× 10–9 mg/kg/day, whereas the estimated

exposure level for the average high-end

adult eating locally caught fish in the G/W

neighborhood is 8.2 × 10–8 mg/kg/day, and

for the average high-end child fish consumer the estimated exposure level is 1.5 ×

10–7 mg/kg/day (48).

Finally, the U.S. EPA calculated a lifetime cancer risk for adult subsistence anglers

in the G/W neighborhood and found that

the risk exceeded 1 in 10,000 (1 × 10–4) for

every exposure scenario. This is significant

because an acceptable cancer risk for the

U.S. EPA is one in a million (1 × 10–6). For

subsistence anglers at the high-end consumption rate, the estimated individual lifetime cancer risk across all contaminants

ranged from 8.7 × 10–2 for the singlespecies maximum contaminant concentration to 5.8 × 10–3 for the minimum

contaminant concentration. Using the

cross-species average contaminant concentration, consumer across species, the estimated individual lifetime cancer risk for the

high-end fish consumer was 4.2 × 10–2 and

6.0 × 10–3 for the low-end fish consumer

(48). Without the community-generated

information, the U.S. EPA would likely

have ignored this potentially serious health

hazard. In the final analysis the U.S. EPA

arrayed the results of each individual exposure assessment to show the range of contaminant exposures that exceeded health

benchmark levels (48).

Taking Action

Whereas the U.S. EPA spent more than 5

years completing the CEP in the G/W

neighborhood, The Watchperson Project

could not wait that long to take precautionary and preventative action. As their survey

interview data began to suggest just how

many residents were eating fish from the

river, The Watchperson Project organized a

series of “fish-in” days to educate anglers

about potential toxic contamination in the

fish they were eating and to clean up the

riverbank. The community group developed

educational materials, printed in English and

Spanish, describing possible health risks

from eating locally caught fish and suggested such things as cleaning and cooking

techniques that might reduce contaminant

intake. Because the community group was

aware that most anglers were driven to

subsistence-fish diets out of poverty and cultural tradition, “telling anglers to just stop

eating these fish, while maybe the safest

thing, wasn’t a reality for many of them”

(50). The Watchperson Project has been

working with other community organizations in the area to identify alternative

sources of food for subsistence anglers, such

as community gardens. Finally, the community organization was asked by the New

York State Department of Environmental

Conservation to share their survey findings

to assist the agency in developing culturally

sensitive practices for enforcing existing fish

advisories along the East River (50).

Discussion

The two CBPR processes in the G/W neighborhood suggest that community knowledge

is essential for understanding environmental

hazards and for developing contextually relevant interventions to eliminate the hazards

in communities experiencing environmental

injustice. Together, the two processes offer

lessons in how CBPR can most effectively

contribute to reducing health disparities facing the poor and people of color. First, each

process stressed that a lack of data should

not lead to an assumption of an absence of

hazard. Too often, disease and environmental exposure information do not exist for the

poor and communities of color, and this

ignorance leads researchers and agency decision makers to assign zero risk where little or

nothing is known. Community research is

crucial for filling the voids and gaps in health

department and environmental regulatory

agency databases (3). However, the burden

should not fall to community organizations

alone to fill gaps in existing data that agencies

and other researchers should be collecting.

A second lesson is that community

members, regardless of their level of formal

education or fluency in English, can be

equally expert as conventional scientists in

gathering information about hazards and

disease in their own communities. In the

G/W neighborhood, community members

were the only experts who could gather

information on such things as angler practices and the home remedies used by Latinos

to treat asthma. For CBPR to address environmental injustices, it must recognize that

local people have a privileged form of knowledge and expertise about the places where

they live—much like one has an intimate

understanding about certain aspects of one’s

own body. This suggests that the word

“expert” should not be conceptualized in

binary terms such as expert–lay but rather as

a fluid and heterogeneous concept where,

depending on the question asked, scientists

and community members can be equally

expert. By explicitly recognizing community

expertise, CBPR holds the potential for environmental justice communities to speak

back to the often hegemonic power of scientific expertise to define, analyze, and dictate

solutions for those most at risk.

A third lesson for CBPR is that community should be understood as both a geographic place and an identity group. El

Puente recognized that they could not be

effective administering a survey within the

entire political boundaries of the G/W

neighborhood and instead focused on the

Latino community where their organization

was based. Common symbols, language, heritage, norms, and life experiences can define

community as much or more than geography, and successful CBPR for environmental

justice must make this explicit in the

research process. The sharing of personal histories and narratives with others from similar

heritage turned out to be more important

than geography for capturing the meanings

people attached to their experiences, such as

why residents preferred home remedies or

were driven to eat fish from the East River.

Another lesson from the CBPR processes

is that to identify community, researchers

should look to organizations already established in the community (39). Part of the

success of the CBPR in the G/W neighborhood was that each project did not try to create new institutions or organizations but

built out from established groups that had

the trust and credibility of local residents. El

Puente started their survey with committed

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246 VOLUME 110 | SUPPLEMENT 2 | April 2002 • Environmental Health Perspectives
high school students and furthered the

process by organizing existing residents

committed to battling asthma. El Puente also

employed local women as a part of their

CHE team, all of whom were residents with

strong neighborhood and cultural ties. The

Watchperson Project recruited trusted and

recognized residents who could culturally

relate to the anglers and speak their language.

A fifth lesson for CBPR is that community residents should be seen as full partners

in all aspects of the research process. In El

Puente’s research, residents were involved

in all aspects of survey design, administration, and analysis. When residents are full

partners in the research process, they are

more likely to retain ownership and trust in

the process and results. Issues of research

transparency, trust, ownership, and selfdetermination continue to concern communities, especially the poor and people of

color who have either been ignored by

researchers or, when asked to participate as

subjects, are often abandoned in the end by

researchers intent on analyzing results only

for their own advancement and not for

community improvement. Local ownership

ensures that community knowledge garnered through research is used to educate

others in the community and promote wellbeing. The CBPR in the G/W neighborhood also revealed that social learning

about environmental heath issues can occur

among community residents, debunking

the notion that communities always have a

deficit of important health knowledge and

require education from outside experts in

order to act appropriately.

Local ownership also contributes to

locally generated action, perhaps one of the

most fundamental aspects of CBPR (39).

For environmental justice advocates, CBPR

must be action oriented, where contingent

interventions are developed before results are

finalized, with the understanding that community action can be fallible. El Puente

demonstrated this as they enrolled uninsured

children in New York’s free healthcare program and recruited asthma sufferers to

develop asthma management plans before

the organization completed their survey

analyses. By encouraging precautionary and

preventative action, CBPR holds the

prospect of challenging research that has

contributed to inaction over the disparate

environmental and health burdens afflicting

the poor and people of color.

To take action before results are complete and to learn from these experiences,

successful CBPR for environmental justice

must also be long-term and iterative, not a

“one-shot deal” (3). El Puente has been

working on their surveys since 1995, learning from the successes and failures of each to

reach more households, ask more specific

questions, and structure more informative

focus group discussions. Although The

Watchperson Project’s survey was more of a

one-time effort, they too have drawn from

the experience to develop a long-term commitment to educating and advocating for

local anglers. The long-term and iterative

nature of the process recognizes that the

assessment of environmental health issues

has a temporal dimension often poorly recognized by conventional science. As local

pollution concentrations, resources, and

health conditions change, so too will the

necessary actions to promote environmental

justice. CBPR is situated to capture how

new circumstances, understandings, and

identities might allow for a continual community reassessment of the proper thing to

do to address ever-changing circumstances.

Finally, the CBPR in the G/W neighborhood revealed that the process can contribute not only to local action for

improving the lives of community members, but it can also extend the work of conventional science. The angler data gathered

by The Watchperson Project greatly

expanded the dietary aspect of the U.S. EPA

CEP. The work of El Puente has revealed

the importance of local knowledge for

understanding such things as culturally

rooted medicinal practices to address

asthma. Publication of El Puente’s findings

in peer-reviewed journals and the acknowledgment of their work by the NIEHS both

suggest that conventional science is recognizing the value of their work. While the

knowledge revealed through CBPR can contribute to existing scientific understandings,

it also attempts to change the questions,

redefine problems, and increase the social

relevance of conventional science. The local

knowledge of community residents that

CBPR taps into can improve the interventions of public health professionals by making the actions relevant to lived experience,

and both cases here highlight how this is

especially important in ethnic and immigrant communities. Ultimately, although

CBPR can contribute to and extend the

work of conventional science, the environmental justice movement recognizes that

research alone may be inadequate to address

the political, economic, and social decisionmaking processes that contribute to disproportionate environmental health burdens

for the poor and people of color.

Conclusions

In the pursuit of environmental justice,

communities of color recognize that they

must begin to frame research agendas from

the outset, help define problems, and engage

with scientists in data gathering and analysis

if the research is to accurately address the

hazards and health problems they face.

Conventional science can offer a great deal

to communities that persistently bear the

burden of society’s hazards. Thus, research

and action partnerships between communities and scientists are increasingly essential

for understanding and reversing environmental injustices.

The CBPR processes in the G/W neighborhood revealed that local knowledge can

identify gaps in expert assumptions,

improve professional understanding of local

practices, and identify locally relevant

health-promoting interventions. The

processes also revealed that community residents can be “citizen scientists,” working

with conventional scientists, not in place of

them. Community knowledge helped reveal

the limits of expert assessments (such as

when residents highlighted that the U.S.

EPA missed exposures for subsistence

anglers), and if given the opportunity, can

also extend scientific understandings. As

local residents, their knowledge and experiences are meaningfully incorporated into

research processes, and when these same

populations have a chance to develop appropriate interventions, CBPR can contribute

to the pursuit of environmental justice.

CBPR is not without its limits and challenges, such as addressing the structural

issues that may be contributing to

inequitable distributions of disease and environmental hazards. By focusing on immediate health and environmental gains, CBPR

can sometimes ignore the economic, social,

and political factors that often determine

which populations have resources to resist

hazards and promote health. Additionally, I

am not suggesting that CBPR be romanticized as a panacea for ensuring that environmental health research addresses the

inequities facing the poor and people of

color. However, as CBPR must often operate with substantially less financial support

than conventional methods and under a

constant cloud of institutional skepticism, it

is difficult to assess CBPR’s full potential

and limitations.

As communities of the poor and people

of color continue to demand to speak for

themselves, CBPR remains one important

process toward environmental health justice.

Research alone will not address existing

inequalities. Political organizing and greater

democratic participation in environmental

health decision making must also accompany the prospective research paradigm shift

offered by CBPR. Further articulating the

benefits and challenges of this alternative

research approach is our imperative, for the

well-being of disadvantaged communities

may hang in the balance.

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