“Health Care With Harm”

A Study of the Initiative To Shut Down Henry Ford Hospital’s Medical Waste Incinerator in Detroit, Michigan

by Leslie Lott
Table of Contents

Max Ortiz/ Detroit News 9/22/00

PROBLEM
BACKGROUND
KEY ACTORS
DEMOGRAPHICS
STRATEGIES
SOLUTIONS
RECOMMENDATIONS
REFERENCES
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Problem

The effects of incineration have plagued both Virginia Park, as well as other Detroit residents for years.  Wayne County’s reliance on incineration for medical and municipal waste is evident in the location of three incinerators within an area of less than three miles of each other: Henry Ford Medical Waste Incinerator, Detroit Municipal Incinerator, and Hamtramck Medical Waste Incinerator.  Many citizens have referred to this area as Wayne County’s “toxic triangle of incineration”( Pers. Comm. Cedar 2000). The Henry Ford Medical Waste Incinerator is located on the premises of Henry Ford Hospital in a mixed business and residential area on West Grand Boulevard in Detroit, Michigan.

Public Health

            Since the incinerator’s inception in 1980, citizens have made repeated complaints because of foul smells and thick black smoke, which penetrate the Virginia Park neighborhood on a daily basis    (Bates-Rudd “Hospital to Close” 1999).  The United States Environmental Protection Agency (USEPA) states that medical waste incinerators have been some of Michigan’s largest polluters, for burning waste sends tons of lead, dioxins, and other toxins into the atmosphere (http://www.ecocenter.org/). 

For years, Virginia Park Residents, particularly children and the elderly, have been suffering from respiratory illnesses and other related heart conditions (http://www.essential.org/cchw/campaign/Profiles.html). Residents have been plagued with nausea and headaches that miraculously disappeared when the incinerator was closed for maintenance reasons in late 1999.  David Josar reports that, Michelle Gertz, 44, is becoming increasingly convinced that the incinerator in her neighborhood is not so safe.  Her children, Brian, 10, and Brittany, 8, have chronic headaches and stomachaches which she suspects are caused by the toxins and respiratory irritants that permeate into the environment from the incinerator’s smokestacks (“Incinerator Worries” 1999).  “There have been twenty-one recorded deaths related to respiratory and other health problems on Poe Street, located directly across the street from the incinerator" (http://www.essential.org/).

Environmental Justice

            Since the mid- 1980’s it has become increasingly apparent that there is a disproportionate impact of environmental toxins and pollution on individuals who reside in poor and minority communities than those who live in other areas. A study conducted by the United Church of Christ concluded that in communities with two or more commercial hazardous waste facilities, the number of minorities was three times higher than in communities without hazardous waste facilities (Bryant 2000).  Many believe that the disproportionate impact of hazardous waste facilities on people of color may be due to environmental racism.  Environmental racism is the deliberate targeting of people of color communities for toxic waste facilities and the official sanctioning of a life threatening presence of poisons and pollutants in people of color communities (Bryant 2000). 

Henry Ford Hospital is located in an area where people of color make up ninety-one percent of the population, with African-Americans making up the largest number of that percentage (http://www.uscensus.gov).  The Henry Ford Health System that operates Henry Ford’s Hospital has two other hospitals in predominately Caucasian suburbs.  Currently, these suburban hospitals do not incinerate their medical waste, but send it to an autoclave in Toledo, Ohio, where it is steam sterilized    ( Simmons 1999).  Donele Wilkens of Detroiters Working For Environmental Justice asserts, “Detroit residents are already exposed to more harmful pollutants than their suburban neighbors (Seigel 1999).”  To neighbors, community leaders, and environmental groups, this is clearly an issue of environmental racism and injustice.  However, in January 2000, in response to a letter written by the Coalition to Shut Down Henry Ford’s Medical Waste Incinerator, Steve Velick, the Chief Executive Officer of the hospital at the time denied this as being an environmental justice issue.  He states, “Cottage and Wyandotte [two of the hospitals located in the suburbs] stopped incinerating waste because their facilities did not generate enough waste to justify the costly incinerator upgrades required to meet the EPA’s newest standards” (2000). “Nevertheless, community leaders want to know why the hospital chooses one method in a white, suburban community and a different one in an African-American community (Holden and Simmons 1999).”

Role Of Health Care

Health care professionals and their institutions pledge to provide services that defend human beings against illness.  Furthermore, health systems serve to incorporate vital public health principles in the daily operations of their facilities, including taking an active role in disease prevention (Michigan Environmental Justice Coalition 1999).  The Health Care Without Harm Organization(HCWH) explains, “ [y]et, unknown to many of us, the purchasing and waste disposal practices of health care institutions often undermine their own purpose, and our expectations of them, by contributing to sickness (HCWH 1999).”  Further, health professionals have taken the Hippocratic Oath of ‘first, do no harm,’ and practices such as incineration are directly inflicting harm on communities that health care providers claim they strive to protect (http://www.ecocenter.org).

Alternatives to Incineration

            Community leaders maintain that there are affordable, safe and more efficient alternatives that are now being used by an increasing number of hospitals. However, relying on incineration for the disposal of medical waste from hospitals is slowly becoming a rarity in southeast Michigan, particularly Wayne County.  A 1998 survey of twenty-five Wayne County hospitals found that Henry Ford Hospital is the only one still burning their waste in an incinerator on-site.  One third of these hospitals send their waste a steam based autoclave in Toledo (Seigel 1999). Various technologies, such as autoclaving, both sterilize and reduce the volume of medical waste without incineration.   Currently, autoclaves are the most common treatment alternative in the United States.  An autoclave destroys infectious agents through a process of steam sterilization. However this process does not burn waste, thereby reducing the risk of dioxin production (HCWH 1999).

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Background

The Henry Ford Health Care System was founded in 1915 to “provide comprehensive health care for residents of Detroit and southeast Michigan (Velick 2000).”  Henry Ford Hospital has 900 beds and an education and research complex on site.  The incinerator, to burn the hospital’s medical waste, was installed in 1980.  Until recently, Henry Ford Hospital incinerator burned approximately 600 million pounds of medical and solid waste annually.  While the waste stream includes used surgical dressings, latex gloves, old medicines, and amputated body parts, it is mainly comprised of discarded paper and plastics that could be recycled or disposed as ordinary hospital waste (Pers. Comm. Holden 2000).   The Center For Disease Control (CDC) estimates that only six percent of the waste stream is infectious and only two percent of the hospital medical waste stream is any significant threat to human and should be burned in a crematorium or other incinerator. The rest of the waste or more than ninety percent can be handled in the same way solid waste is handled by reducing, reusing, and recycling (http://www.ecocenter.org/health.html).  Excessive burning of plastics, paper, and other non-infectious wastes results in the emission of dioxins, furans, arsenic, lead, mercury, cadmium, carbon monoxide, acid gases, and toxic particulates (HCWH 1999).

The USEPA states in their draft of the Dioxin Reassessment that hospital incinerators are one of the three largest sources of dioxins to the environment.  Their research findings show that dioxins not only cause cancer, but may lead to developmental and immune system problems to those who are exposed to these toxins over an extended period of time.  Additionally, the EPA asserts that medical waste incinerators are the second leading source of mercury, which is a neurotoxin. Incinerators also emit pollutants and particulates that are respiratory irritants that can exacerbate  problems for asthma sufferers ( HCWH 1999).

            The citizens whom inhabit the area surrounding the incinerator can attest that they have seen the effects of these toxins on themselves, their family, and the community at large.  A 1998 Wayne State University Report found that Michigan residents living near pollution sources, such as incinerators, have lower birth rates and higher rates of cancer.  A five year Michigan Department of Community Health study shows that the rate of children hospitalized for asthma is at least three times higher in a cluster of inner city zip codes surrounding Henry Ford Hospital than in Wayne County, outside of Detroit.  Additionally, the report asserts that asthma rates among African-American children are increasing.  For further evidence, a report commissioned by the New York University Research Program focused on Ambulatory Care Sensitive Conditions in Michigan from 1983 through 1994 sites that in the four zip codes surrounding the incinerator, the average number of hospital emissions of children aged zero through four are at numbers four times the state average (1998).

Community Organization                    

Although the incinerator has been criticized since its inception, a neighborhood residents of the Virginia Park District’s Council did not start actively working on this campaign until late 1996, early 1997 when the facility failed an opacity test, which was the only restriction on particulate air emissions for medical waste incinerators in Michigan at that time (Pers. Comm. Holden 2000).  Opacity measures and limits the amount of particulate content of what is coming out of a smokestack and provides no limitations on toxin levels.  Failure of this test brought some community attention to the incinerator and provided an opportune time for community leaders to begin a dialogue with the Health System (Pers. Comm. Doyle 2000).

In August 1997, the EPA released the first federal standards and guidelines (the MCAT rule) regulating hospital and medical waste incinerators.  Existing facilities will have three to five years to comply with these rules (HCWH 1999).  At the time of the release of these guidelines, Henry Ford’s incinerator did not comply with the new federal standards for emissions.    Wayne County granted a consent order approving the renewal of their permit contingent on reducing pollution to levels acceptable to the USEPA.  The Consent Order includes limits on final emissions and stack testing to confirm that the incinerator is operating in compliance. Waste changing rate has been reduced from 1800 pounds per hour to 1000 pounds per hour.  Additionally, certain pollutants will be monitored by a Continuous Emissions Monitoring System (Wayne County Dept. of the Environment 2000).   

Community members, and other environmental organizations realized that HFHS would be making critical decisions during the next few months, which would decide how the incinerator would operate in the future.  The Sierra Club and the Ecology Center, in particular, were unwilling to approve letting the incinerator continue to operate at these Federal levels.  Both groups believe that Federal guidelines compromised with environmental safety by not providing adequate protection of the health of the community by allowing tons of toxins to be released into the environment each year. These groups felt that complying just to these standards was not doing enough.  Employing a waste reduction program,  phasing out  mercury based products and attempting to reuse and recycle many of the products thrown into the waste stream quickly were placed on the agenda as well.  Community members claim that the “hospital has an obligation not only to live up to the letter of the law(and whatever loopholes may be in it) but to live up to the Hippocratic Oath” (Seigel 1999). So, community health and environmental organizations from around the greater Detroit Area decided that forming a coalition would be the best tactic to ensure efficient use of community resources in the area to lobby for the shutdown of the incinerator and drastic changes in waste management practices of Henry Ford Hospital (Pers. Comm. Doyle 2000). 

The hospital, despite hearing the Coalition’s demand for HFHS to shut down the incinerator decided that spending $2.1 million dollars on upgrading the incinerator to comply with new Fed Regulations was the best option (Bates-Rudd “Hospital Claims” 1999).  Mike Whelan, Henry Ford Hospital’s Vice President of Support Services, claimed the “hospital did a very extensive study evaluating fifty-two alternatives….[and] they claimed that other methods of dealing with medical waste would have raised expenses and health costs or would have required the waste to be transported through residential areas, creating safety problems for the community (Seigel 1999).”

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Key Actors

Henry Ford Hospital

Henry Ford Hospital has been operating an on site medical waste incinerator since 1980.  The board of executives, including Nancy Schlicting have always maintained that the “all scientific and technical standard indicate that incinerator is safe to operate and the WCDEQ has confirmed it meets all air quality standards”(Schlicting 2000).  They cite examples that show their attempt to be a “good corporate citizen” such as spending two million dollars to upgrade the incinerator to meet USEPA “stringent” air quality standards.      Further, issues of potential environmental injustices have been repeatedly denied.  However, the hospital executive’s became very responsive and open to meeting with the coalition to discuss their concerns and questions about the operating of the incinerator (Pers. Comm. Doyle).   

 James Williams, VPCC member Photo by Daniel Mears/ Detroit News 5/7/00

Virginia Park Citizen’s Council(VPCC)

Virginia Park Citizens Council is a local neighborhood council that has actively opposed an incinerator being located in their community since 1996. One of the most vocal members of this organization is resident James Williams who was incensed by the unequal treatment of residents in his area as compared to suburban residents. He also has become increasingly convinced that the incinerator located across the street from his home may be causing some of his health problems.  “I want to be a good neighbor to the hospital, not a patient in it (Barry 2000).”  Williams and other council members have been a liaison between the neighborhood residents and the coalition at large.  VPCC helps to educate their neighbors of the potential health effects of incinerator and encourage them to attend town meetings and rallies to ensure that their voices would be heard by the HFHC.  Also, they organized the usage of yard signs which said “Shut It Down, HENRY FORD” and encouraged the community to come to public hearings and rallies (Pers. Comm. Holden 2000). 

Coalition To Shut Down Henry Ford Medical Waste Incinerator

This coalition was established over four years ago and involves over thirteen community, public health, and environmental organizations including: Virginia Park Citizen’s District Council; Detroiters Working For Environmental Justice; Southeast Michigan Group of the Sierra Club; the Ecology Center; the Sugar Law Center for Economic and Social Justice; the National Wildlife Federation; and the Michigan Chapter of the American Lung Association.  Additionally two local grassroots community groups focusing on shutting down incinerators in their own communities, Hamtramck Environmental Action Team and Clean Air Please! Of Madison Heights, offered support as well.  The coalitions received political endorsement from two local governmental officials: Wayne County Commissioner Jewel Ware and State Representative Hansen Clarke. The primary goals of the coalition are to (1) shut down the medical waste incinerator, (2) prevent HFHS from sending their waste to a commercial incinerator (i.e. Hamtramck Commercial Medical Waste Incinerator), (3) reduce the waste stream and its toxicity and (4) start a extensive recycling program on site (Pers. Comm. Doyle 2000)

 Southeast Branch of the Sierra Club

Anna Holden, who is the chair of the Southeast Branch, is the lead member and spokeswomen for the Coalition.  Anna has been an active part of both the civil rights and environmental movements since the early 1960’s.  In 1999, she published two articles about the campaign to shut down the incinerator in an attempt to raise even more national public awareness of health and environmental justices issues.  Both her dedication and experience with similar campaigns makes her a valuable asset to this struggle.  Finally, as an organization, the Sierra Club provided financial resources and a well renowned name, adding legitimacy to the cause.

  Detroiters Working For Environmental Justice (DWFEJ)

DWEFEJ has emphasized the apparent environmental injustice occurring in the Virginia Park neighborhood.  Donele Wilkens, director of DWEFEJ, has become the “face of the coalition” due to her eloquent and powerful speaking ability.  She explains, “Environmental racism is real.  In neighborhoods across Detroit and around the nation, it is destroying the health of our people” (Wilkens and  Sullivan 2000).  Through the effort DWEJ, the Coalition has received national attention through hosting a press conference in Detroit   “declaring a national state of emergency on environmental racism and economic injustice” that focused on local environmental injustices, including Henry Ford’s Incinerator.  The keynote speaker for this event was Damu Smith of Greenpeace USA, who was instrumental in the struggle to prevent the Shintech Corporation from placing a hazardous waste facility in a predominately African-American neighborhood in Louisiana.   This press conference enabled the Coalition began to publicize their concerns and efforts under the umbrella of the national environmental justice movement.

Jewel Ware, Wayne County Commissioner

Jewel Ware joined the coalition in 1998 when she was informed of the health threats that community members in her district were experiencing due to location of Henry Ford’s incinerator in their neighborhood.   As a prominent local official, she has the respect of many local community leaders and   enlisted local ministers to endorse a series of advertisements in local newspapers, demanding that Henry Ford shut down its incinerator.  Also in 1999, Ware sponsored several town meetings that helped to facilitate an active dialogue between that addressed the questions and concerns of citizens in the area.  Ware stated in September 1999, “Henry Ford Hospital likes to boast about its leadership in medicine.  [Failure to comply with opacity and cadmium] tests show that Henry Ford also leads as a polluter.  As a health care provider, it ought to be ashamed that its incinerator poses such a serious health hazard to the public” (Josar “Environmentalists” 1999).

 

The Ecology Center

The Center’s Environmental Health Project has focused on a medical waste project that promotes environmentally responsible health care and provides technical assistance to community and local officials.  Specifically, this project attempts to educate the community of the harmful health effects of incineration and advocates the shut down of all incinerators in the southeast Michigan area. Their activism brought much needed resources into the campaign including experts on public health, researchers, and past experience in campaigns to shut down incinerators.  The Ecology Center’s staff members who focus on their medical waste project, Tracey Easthope and Mary Beth Doyle were also instrumental in shutting down the University Of Michigan’s medical incinerator while the Henry Ford campaign was beginning to become more aggressive.    Additionally Tracey Easthope is an important member of the campaign for she is a scientific expert on incineration and its potential effects on public health.   With the Center’s connections to the national Health Care Without Harm Organization, Health System officials experienced national public relations embarrassment as being a health care provider that is inflicting harm on the very individuals it strives to keep healthy.

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Demographics

            In order to somewhat accurately portray the demographics of the area, the four zip

codes (48202, 48206, 48208, 48201) located around the Henry Ford Hospital were chosen for analysis. The population of these four zip codes combined is 93, 962.  Of these individuals, 85, 868 are people of color who are largely African-American.  Thus, the percentage of people of color in this area is ninety-one percent of the total population.  Additionally, sixty percent of the families that live within a two and a half mile radius of the incinerator are at or near the poverty level (about $15,000 per year for a family of four) (http://www.essential.org/cchw/campaign/Profiles.html).        

            The following table represents a summary of information based on 1990 Census data for all four zip codes.

 

Zip Codes

Total Population

% of People of Color in Pop.

% of   Households >$15,000/year

 

48202

24,565

91%

58%

48201

16, 221

75%

79%

48206

38, 035

99%

56%

48208

14, 925

92%

65%

Source:  1990 U.S. Census Data

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Strategies

Coalition Building

            Establishing a coalition in 1998 provided a strong and threatening presence that demanded the opinions and concerns about incineration be heard.  Connecting individuals from diverse backgrounds and resources provided a variety of perspectives and a significant amount of human resources that are needed for this campaign to be a success.

Drawing Support From National Non-Government Organizations

            Making connections with nationally known organizations such as Sierra Club, Health Care Without Harm, Detroiters Working For Environmental Justice and Greenpeace provided national attention, resources, and legitimacy to this campaign.

Civil Disobedience

            Nonviolent rallies have been one of the primary methods used by the coalition to gain public awareness of the harmful effects of the incinerator on the residents of the community.  Although these four rallies received little media attention, they became a public relations embarrassment to HFHS.  

Constant Community Pressure

            In the beginning of the campaign the coalition target of influence was the board of executives and the public relations department in a broad sense.  When letters and phone calls to the board were not causing executives to desire to meet with coalition members to discuss their concerns, the community decided it needed to formulate a different, more effective approach.  Eventually it was decided that they would target a specific executive within HFHS who possessed power within the health system, would respond to pressure, and had the insight and conscience to realize it was in the hospitals best interest to shut down the incinerator.  This woman was Nancy Schlicting, Senior Vice President of the Henry Ford Health System.  Citizens demanded that their opinion be heard by making hundreds of phones calls and supplying a daily shipment of postcards to her office.  Additionally, Virginia Park Citizen’s Council began to solicit bold, red yard signs stating “Shut it Down, Henry Ford” which were prominently placed in lawns around the facility. 

Media Attention

            The coalition had limited coverage by the mainstream media, so leafleting, direct contact with citizens, town meetings and speakers at community meetings helped spread to the community at large.  Postcards were distributed and signed by neighbors and other concerned South Eastern Residents urging HFHS to shut down its incinerator.  In November 18,the same day as the “Great American Smokeout” protesters received some media attention when they demanded that Henry Ford “Stop Smoking” (Seigel 1999).     Coalition members also placed a huge banner on the front of a church across the street from the incinerator that stated “Henry Ford, Stop Smoking” which remained in that same position on the church for months.  By in large, most of the publicity came from public radio, alternative community newspapers, and radio/television stations targeting African-American communities (Simmons and Holden 1999).

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Solutions

            On February 4, 2000, Henry Ford Health System officially announced that it was “committed to phasing out incineration over a reasonable period of time (Schlicting 2000).”  The Coalition to Shut Down Henry Ford Incinerator congratulated Henry Ford but plan to “press for a definitive and expeditious time line to achieve the shutdown”.  In less than four years, the Coalition was successful in achieving their main goal.  This type of outcome is unprecedented but Coalition members and HFHS admit that community pressure and acute knowledge of the science and technology of medical waste incinerators was what eventually caused Nancy Schlicting, executive Vice President to make this decision (Doyle “Cleaner Air” 2000).  Schlicting states herself in a letter to the Michigan Environmental Justice Coalition that “[u]fortunately we have to deal with negative news coverage and community concerns about it.  This is taking time away from our core mission.  We are concerned about our reputation and relationship to the community we are dedicated to serve (Schlicting 2000).”   Mary Beth Doyle, a representative of the Ecology center stated in an interview “when you drive to work every day seeing more and more signs on neighbors lawns and a huge banner that is demanding the health system that you are an executive vice president for to ‘stop smoking’ I believe it would tend to wear on your nerves (Pers. Comm 2000).” 

            The most incredible victory of this battle was that Henry Ford did not have to shut down their incinerator at all.  In 1998, the hospital spent 2.1 million dollars in improving pollution control that included a monitoring system and an air scrubber designed to remove chemicals from smoke.  This retrofit was commissioned in response to the EPA’s MCAT rule.  Additionally, in 1999 reported incinerator emissions were ten times better than the Environmental Protection Safety Standards required by law. The incinerator, at the time of its decided closure, was under compliance of all laws regulating hospital and medical waste incinerators (Schlicting 2000).  

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Recommendations

The community members involved in the effort to shut down Henry Ford’s Medical Waste incinerator have been successful in achieving their main goal.  At this point, Henry Ford Health System has committed to ceasing operation of their incineration facility on June 30, 2001.  However, many of the members of the coalition believe that this is not the end of the struggle.  In particular the Ecology Center, Sierra Club, and the National Wildlife Federation want to ensure that the Health System will begin to make an effort to significantly decrease the amount of their waste stream and its levels of toxicity.  Additionally, much emphasis has been made on helping the hospital set up extensive recycling programs.  As part of the discussion at the time when Henry Ford announced that they were going to phase out incineration in February 2000, they also proposed building a recycling center, along with the autoclave on the site where the incinerator used to be.  However, after hiring an environmental consulting firm that many in the coalition believe to be pro-incineration, HFHS decided that the facility would be too costly. 

            This new update has been a minor defeat, but the Coalition has responded by encouraging HFHS to hire Resource Recovery Systems, a firm that focuses on planning for large scale recycling programs within industries.  However, this firm has little experience working with hospitals, which may become a problem in the later months.  Additionally, the National Wildlife Fund is pushing the hospital to commit to a mercury abatement plan.  Currently, HFHS has decided that it may consider replacing its incinerator with an onsite autoclave ( Pers. Comm. Holden 2000).

            The struggle to shut down Henry Ford’s Medical Waste Incinerator provides hope and a model for all communities struggling to shut down a hazardous waste facility in their own neighborhood.  It is a reminder that citizens themselves are advocates and that are able persuade industry to commit to ending many of the environmental and economic injustices of the world. 

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References

 

Personal Communications

Cedar, Rob. Hamtramck Environmental Action Team.  Personal Communication on 16 October 2000. 

Doyle, Mary Beth.  The Ecology Center.  Personal Communication on 18 October 2000. 

Holden, Anna.  Southeast Branch of the Sierra Club.  Personal Communication on 21 November 2000.

Journals, Magazines, Books and Newspapers

Barry, John B.  “Unjust Burden: Sierra Club Joins Growing Movement For Environmental Justice.”  The Planet  June 2000.

Bates-Rudd, Rhonda.  “Henry Ford to Shut Down Incinerator.”  Detroit News  23 Feb.  2000.  Metro.

Bates-Rudd, Rhonda.  “Hospital Claims Its Air is Cleaner.”  Detroit News 15 December 1999.  Metro.

Bates-Rudd, Rhonda.  “Hospital to Close Incinerator After Neighbors Complain.” Detroit News 

               29 Mar. 2000.  Metro.

Bryant, Bunyan.  Environmental Advocacy: Working For Economic and Environmental Justice.  An Unpublished  book. 2000.

Doyle, Mary Beth.  “Cleaner Air Coming To Detroit.” From the Ground Up.  April/ May 2000.

Holden, Anna, and Charles E. Simmons.  “Community Health and Environmental Justice: Burning Issues in Detroit.”  Everyone’s Backyard: Journal of the Grassroots Movement for Environmental Justice.”  Fall 1999.    

Josar, David.  “Environmentalists: Close Waste Incinerator.”  Detroit News  22 Sept. 1999.  Metro.

Josar, David.  “Incinerator worries neighbors.”  Detroit News  26 July 1999.  Metro.

Seigel, Ron.  “Demonstrators Charge Medical Waste Incinerator Causes Secondhand Smoke.”  Michigan Citizen  28 Nov.-4 Dec. 1999.

Simmons, Charles E.  “Environmental Justice and Human Rights.”  Michigan Citizen  26 Sept.-2 Oct. 1999.

Letters

Michigan Environmental Justice Coalition.  Letter to Walter Douglas, Vice Chair Public Responsibility Committee, Henry Ford Health System.  15 June 1999.

Schlicting, Nancy M.  Letter to Alison Horton, Michigan Environmental Justice Coalition.  18 February 2000. 

Velick, Steven.  Letter to Honorable Jewel Ware, Wayne County Commissioner.  19 Jan.  2000.

 

Pamphlets and Press Releases

Health Care Without Harm.  Health Care Without Harm: The Campaign For Environmentally

Responsible  Health Care.  Falls Church.  1999.

Wayne County Department of Environment.  Air Quality Management Division.  Community Bulletin.

Detroit.  2000.

Wilkens, Donele and Quita Sullivan.  “Local Groups Join In Issuing A Declaration.”  Press Release.

            18 Jan. 2000.

World Wide Web Resources

Unknown.  <http://www.essential.org/cchw/campaign/Profiles.html >   (19 Sept. 2000).

 Unknown. “The Ecology Center’s Medical Waste Project.”  The Ecology Center < <http://www.ecocenter.org/health.html >    ( 24 Sept. 2000).

United States. U.S. Census Bureau.  http://www.census.gov (19 Sept. 2000)

 

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