Correcting failing sanitation in vulnerable communities

A conversation between environmental health activist Catherine Coleman Flowers and Dean Lloyd Minor

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In a recent Minor Consult podcast, Lloyd Minor, MD, dean of the Stanford School of Medicine, welcomed environmental activist and author Catherine Coleman Flowers for a conversation about widespread failures of public sanitation in the United States and the health and economic impacts on vulnerable communities.

Flowers, founder of the Center for Rural Enterprise and Environmental Justice, has brought national attention to wastewater inequality in the United States, particularly for marginalized, rural communities.

Her persistent activism has earned her a MacArthur Fellowship “genius grant,” a voice in guiding national policy as vice chair of the White House Environmental Justice Advisory Council and, most recently, a place among Time magazine’s 100 Most Influential People of 2023.

Minor and Flowers explored root causes of systemic infrastructure lapses, the increasing threat of climate change, and how her research and advocacy have expanded across the country.

Parts of the conversation are represented in this Q&A, which is edited for brevity and clarity.

Online extra:

Lloyd Minor: Many leaders I’ve spoken to for this podcast have drawn inspiration from their families, and I understand that
you’re no exception. Tell us about your parents, their activism
in the Civil Rights Movement, and how their passion
for social justice influenced you.

Catherine Coleman Flowers: I called my parents the jailhouse lawyers of our community because everyone in the community would go to them when they had a problem, and they would try to figure it out.

Now I look back and realize how smart my parents were, and how much trust they had built over the years from people in the community because of their activism. It has had a great influence on me.

They also felt that you have to give voice to the needs of the community. I feel that every step that I make, I’m walking in their shadow.

Minor: You grew up in Lowndes County, Alabama, and though your life journey took you away for several decades, you returned in 2000. You were working as an economic development consultant when you become aware of the county’s lack of adequate sanitation. What did you find out about the problem and the reasons behind it?

Flowers: In 2002, when I was working with Robert Woodson, the founder of the National Center for Neighborhood Enterprise [a nonprofit that empowers community-based leaders to promote solutions to problems in underserved communities], a county commissioner invited me to visit a couple who were arrested because their septic tank was failing and sewage was running onto a plot of land where several family members lived.

People started coming forward to share their own struggles, and a house-to-house survey showed that many septic tank systems were failing. The problem was much larger and more complex than we had been told by the state officials.

Minor: What are some of the dangers of living in these

“… Who would want to wash dishes in a sink where sewage is coming back into it? Children are in a lot of these communities, and you don’t want them playing around raw sewage.”

Environmental activist Catherine Coleman Flowers

Flowers: The National School of Tropical Medicine at Baylor College of Medicine worked with me and the Equal Justice Initiative on a 2017 study that found high rates of hookworm in Lowndes County and other rural areas of the country — especially where septic systems are failing.

A lot of people still complain about septic failures. I mean, who would want to wash dishes in a sink where sewage is coming back into it? Children are in a lot of these communities, and you don’t want them playing around raw sewage. Also, during the height of the pandemic, Lowndes County had the highest per capita death rate from COVID-19 in Alabama.

I have to believe that some of it was because people living around raw sewage are vulnerable. Some of the worst epidemics in the world have come from the improper treatment of sewage.

Minor: Your research showed inequalities in sanitation and
clean water access across rural U.S. communities, which you’ve so aptly called America’s dirty secret. How extensive is the
problem and who is most affected?

Flowers: I’ve been surprised at the number of people who have told me this exists in places I didn’t expect.

In California’s Central Valley, we found places where people don’t have adequate or working sanitation. We’ve found it in places where it rains a lot. There have been a lot of storms in California recently. I’m sure a lot of communities that are on septic tanks have been experiencing failures.

In areas where sea levels are rising and water tables are already high, septic systems are more vulnerable. In Miami-Dade County, Florida, for example, officials are expected to spend billions of dollars to convert people away from septic. Sewage from failing systems in these areas leach into water, causing problems such as algae blooms and fish kills.

And it’s not just in places that are on septic. Hawaii and Puerto Rico have problems. Alaska is having failures because of melting permafrost. We are finding it in all 50 states.

Minor: Why do septic systems fail, and how do you
combat failures?

Flowers: They tend to fail when they are full of water or the ground is saturated. We were told by one engineer that a lot of the septic systems are made from the most degraded form of cement. So we think that there should be a move to redesign how septic systems are made.

“When I came back to Lowndes County and saw that a lot of things had not changed, I guess it was the spirit of my parents that propelled me to do something.”

Miami-Dade County officials are moving to a more centralized system, but that may not work everywhere, so we need to come up with a better way to treat wastewater. And I think we have the means to do it.

In the Huntsville area — where the Marshall Space Flight Center is — they are able to take urine and turn it into drinking water. Just imagine if we were to take some of that technology and come up with a new way to treat wastewater.

With climate change, it is more imperative than ever that we use innovation to come up with real, resilient solutions.

Minor: What drove you to take on such a daunting problem
with no clear path to resolution, and what’s kept you motivated in moments of discouragement?

Flowers: If I didn’t take the lead, my grandson was going to have to keep fighting that same fight. When I came back to Lowndes County and saw that a lot of things had not changed, I guess it was the spirit of my parents that propelled me to do something.

My faith also directs me. I can’t pretend it’s not existing and look the other way and not hold people accountable.

Minor: I want to end with two questions that I ask all
my guests. What do you think are the most important qualities
for a leader today?

Flowers: Listen to the people. Oftentimes we feel we know all the answers and assume that if people don’t have the degrees, they don’t know. But if I hadn’t listened to the people living in those Lowndes County communities, I wouldn’t be where I am today.

Minor: And what gives you hope for the future?

Flowers: When I ask my 7-year-old grandson, “What do you want to be when you grow up?” He says, “A scientist or an astronaut.” That gives me hope for the future.