by Cathy Alden ome of the neighbors near the old Woolfolk Chemical Works plant have lived in their south Georgia homes for more than 50 years. They've shopped in the town. Their children have gone to the local school. They grew up playing in the pecan orchard that ran alongside the factory. Many of them even worked in the plant itself. The abandoned Woolfolk plant in Fort Valley, Georgia, has been closed for years now. After Woolfolk shut down, several other businesses continued to operate on the property, including one pesticide company that specialized in lawn and garden markets an d peach growers' needs. In 1993, Woolfolk was named a Superfund site, and the EPA began a series of clean-up actions. Despite these attempts to remedy the environmental destruction in the community, Woolfolk's neighbors remain worried. That's where Howard Frumkin comes in. Chair of the Department of Environmental and Occupational Health at the Rollins School of Public Health, Frumkin has spent his career as a physician and public health practitioner studying the harmful effects of environmental pollution on humankind. He's not content just to evaluate problems. He strives to bring environmental injustices to the atten tion of policy makers and others who can do something to remedy the damage.

Professor Howard Frumkin is working on a variety of studies, in both local and international arenas, that serve as advocacy tools for better health and a cleaner world.

t the request of members of the Woolfolk Citizens Response Group, Frumkin is conducting a clinical follow-up of the effects of pesticide exposure on workers and residents of Fort Valley. "The community, many of whom are black, was heavily exposed to pesticides, like many similar communities around the state," he says. The problem has a history. Woolfolk's destructive legacy to Peach County, Georgia, began in the 1920s when the company started manufacturing and packaging inorganic pesticides for use on the peach orchards. Production expanded during the 1950s to inclu de various organic pesticides, including DDT, lindane, toxaphene, and other chlorinated products. The EPA didn't begin its cleanup of the site and the surrounding 31 acres until 1993. One of Frumkin's current students, Na'Taki Osborne, observed Fort Valley in those days as an EPA intern. On visiting the Woolfolk plant, she saw signs warning of cont amination in ditches. She saw many homes and other areas cordoned off because of lethal soil. "Some areas were so contaminated that kids could not play there," she says. Over the next few years, the EPA went to work relocating residents, removing soil from the neighborhood, and demolishing a dioxin-ridden warehouse. Workers cleaned a drainage ditch where wastes had discharged from the plant, and they excavated pesticid e dust from eight homes surrounding the old factory. Approximately two years ago, five collaborators joined the Woolfolk project: the Public Health and Environmental Sciences Institutes at Florida A & M, LEAF (the Legal Environmental Assistance Fund), the Southern Organizing Committee (in Atlanta), and t he Atlanta chapter of Physicians for Social Responsibility. When funds became available, these groups asked Frumkin to participate in a clinical follow-up. The goal of the final phase of the clean-up is to evaluate the health of people in the community who were exposed to pesticides. Frumkin has assembled a multidisciplinary team, including students and residents in occupational and internal medicine from Emory, Fort Valley State College, and Florida A & M. They will provide dermatologic treatment, patient education, and volunteer coordination. The team will address residents' concerns about past exposures and lingering fears about contaminants that may still be present. The ultimate goal is to provide top-notch medical care based on risk profiles of those who lived and worked near the Woolfo lk site and to educate people about those risks.

In Mendota, California, in 1996, farm workers used self-made gear to protect their skin, hearing, and respiratory systems from chemical pesticide dust and noise on a mechanical tomato harvester. Photograph by Earl Dotter, used with permis sion.

ort Valley is just the kind of project that fuels Frumkin's environmental advocacy. He's deeply committed to advancing occupational health and to applying the best science where it will do the most good in s erving populations in need. But he's just as deeply committed to advocating for a cleaner world and health for everyone. Two primary means to carry out these beliefs are his leadership in Physicians for Social Responsibility (PSR) and the American Public Health Association (APHA). Frumkin co-chairs the national environment committee of PSR, an activist organization. The goal of the committee is to bring the best science to bear on advocacy that PSR pursues in environmental areas and to strongly communicate these findings to poli cy makers. Frumkin and other influential PSR members have successfully lobbied to achieve air pollution and other environmental reform legislation. "We're also working to expand the right to know about the use, release, and health effects of toxic chemica ls in peoples' communities," he says. Frumkin's chairmanship of APHA's science board has a similar purpose, to create science-based policy that public health advocates can effectively use. Frumkin says that "science and morality must come together to control hazardous exposures to people a nd the environment." Frumkin believes that public health practictioners "can't be ivory tower scientists. They must be active advocates grounded in the best science." Frumkin's fieldwork testifies to his belief. He's worked with the Newtown Florist Club in Gainesville, Georgia, to investigate an increased incidence of lupus among workers. He's evaluating the clean-up of a former Atlanta Gas Light coal gasification p lant in Waycross, Georgia. He's looking at another Georgia Superfund project, the Chevron/Marzone site in Tifton. Internationally, he's done health research on the Mexico/United States border, one of the most polluted regions on the continent. And he's be en involved in studies evaluating abnormally high levels of blood lead in women living in the slums of India. In each project, Frumkin involves students, who make site visits and prepare reports on communities and companies. He introduces them to environmental and occupational activism, allowing them to help define and respond to citizens and workers' concerns .

Occupational health student Na'Taki Osborne, a former EPA intern, works with Frumkin on the evaluation of the clean-up of a plant in Waycross, Georgia.

ast fall, Frumkin brought his message to the broader university community as a lecturer in Emory's Great Teachers series. People do not share an equal chance of getting an exposure, Frumkin said in his talk. "The environmental justice movement in this country has taught us that minority populations are disproportionately exposed to environmental hazards, such as living next to hazardous waste facilities. Studies have shown that in some cities a majority of m unicipal landfills are located in black neighborhoods. This is morally unacceptable." Frumkin sees his discipline as turning increasingly to international matters, with much greater and vaster health problems existing outside of the United States, where the rush to industrialize developing nations usually proceeds without concerns for p rotecting environments or health. People in poor countries are increasingly exposed to toxins as multinational manufacturers and operations seek competitive wages and low overhead costs. These trends are areas of grave concern in occupational and environm ental health, Frumkin says.

ake Bogotá, for example. Imagine a year-round, endless supply of delicately scented flowers, color coordinated from greenhouse to greenhouse. Colombia now exports 80% of the cut flowers that come into t he United States, including carnations, chrysanthemums, and roses. In the agricultural sector in Colombia, much of the pesticide exposure involves migrant workers, who constitute a marginalized society. Traditionally, in attempting studies on such populations, researchers have found it difficult to get even a list of workers, let alone track them down to examine their real-life settings. In Bogotá, however, an unusual opportunity has emerged. The floraculture industry has grown into a highly structured industry in Colombia. Unlike the traditional pattern, the new farms are large operations where agricultural workers can be tracked . At these farms, employees are on payroll. They come to the same workplace everyday. The farm even provides employee health care. Showing off a photo album from a recent trip to Bogotá, Frumkin explains a sign that reads Bombas de Fumigacion, which means fumigation pumps. "This is the pesticide pump area where pesticides are mixed for application and placed in drums for bulk storage." In another shot, a woman who is six months pregnant works inside a greenhouse where male coworkers in yellow raincoats are spraying pesticides on row after row of flowers. At lunchtime, she joins her fellow workers and eats outside the greenhouses near a ditch where pesticides have drained. In the afternoon, she goes back to her job of gathering flowers that have been sprayed, often just that morning. Frumkin notes that at any given time, 10% of the female workers are pregnant. This study group gives him a controlled environment in which to monitor the reproductive effects of pesticides. After measuring exposure levels and subsequently analyzing fol low-up data, his team will be better able to describe the possible hazards to an unborn child when her mother handles pesticides. With many of the workers being single moms, the farm also has child care facilities on the premises. That presents another opportunity for field workers to study the effects of pesticides on children's health. The floraculture industry in Bogotá, says Frumkin, presents "probably the best situation in the world in which to study the reproductive effects of exposures to pesticides." The Bogotá project has been two to three years in the making. Frumki n says it takes that long to build relationships and trust and to cross cultures. It represents a collaborative effort with Colombia's National Institute of Health, the trade association that represents the flower growers, Thomas Jefferson University in P hiladelphia, and two Colombian universities. Currently, the collaborators are setting up a registry to begin the process of tracking the health of the flower workers. "We don't know much about the reproductive effects of pesticides in humans," says Frumkin. "There have been virtually no epidemiologic studies. From this project, I think we can learn quite a lot about pesticides, and provide a service to the communiti es. Second, not all pesticides are alike. This study will enable us to dintinguish effects of different insecticides, herbicides, and fungicides. Third, there is nothing like local data to convince governments and others they need to act."

In Bogotá, Colombia, pesticide exposure has been difficult to track because of a migrant work force. Frumkin's project - two to three years in the making - is working with a group of payrolled employees in the floraculture industry t o document the effects of pesticides on health, particularly that of mothers and children. In 1986, Cesar Chavez spoke at a protest in New York against pesticide use in farm work as part of a national campaign to educate the public on the issue.

y the early 1800s, the transcendentalists in New England lamented the separation of humans from nature, believing it not only wrong, but unwholesome," Frumkin says. Now approaching a new millennium, Frumki n has broadened the definition of environmental health. As hunter gatherers for most of the first 2 million years of our species' history, humans maintained an intimacy with nature. "Satisfying these preferences - taking seriously our affiliation with the natural world - may be an effective way to enhance o ur well-being, as effective as some medications, not to mention cheaper and freer of side effects," he says. "If so, environmental health is a field that goes well beyond medicine, embracing urban planning, landscape architecture, interior design, forestr y, and even veterinary medicine," Frumkin says. Parks, cemeteries, and lawns - birds, mountains, and seashores - all these things matter to our society. Frumkin's vision is a healthful new century for the Earth and its inhabitants. Accomplishing the school's tripartite mission of education, research, and service, he accompanies his students around the globe, screening communities that have been exposed to hazards, assessing their risk factors, and combining public health and clinical approaches to improve situations. In the case of the Woolfolk Citizen's Response Group, such assessments may have come too late for members of the community who grew up with the chemicals and who now manifest long-term clinical effects of pesticide exposure. But with the vigilance of F rumkin and the environmental health activists who work with him, Bogotá and the rest of the world may present a different story as pesticide use is brought in concert with nature. Cathy Alden is former production coordinator in Health Sciences Publications and is now managing editor of American Journal of Human Genetics.

Public health practitioners can't be ivory tower scientists if they want to make a difference in the health of workers such as this child who labored in a Mississippi cotton field in 1978. Instead, they must take their studies to where th e workers are and their advocacy to legislators and policy makers.