Brian Mayer

“A Lab of Our Own” Environmental Causation of Breast Cancer and Challenges to the Dominant Epidemiological Paradigm

There are challenges to the dominant research paradigm in breast cancer science. In the United States, science and social activism create paradigmatic shifts. Using interviews, ethnographic observations, and an extensive review of the literature, we create a three-dimensional model to situate changes in scientific controversy concerning environmental causes of breast cancer. We identify three paradigm challenges posed by activists and some scientists: (1) to move debates about causation upstream to address causes; (2) to shift emphasis from individual to modifiable societal-level factors beyond an individual’s control; and (3) to allow direct lay involvement in research, which may raise new questions and change how questions are approached, the methods used, and the standards of proof. We use our model to examine controversies about doing scientific research, interpreting scientific results, and acting on science. Ultimately, we aim to understand what impedes construction of new methodologies and knowledge about environmental factors in human disease.

The Resilience Activation Framework: a conceptual model of how access to social resources promotes adaptation and rapid recovery in post-disaster settings

A number of governmental agencies have called for enhancing citizens’ resilience as a means of preparing populations in advance of disasters, and as a counterbalance to social and individual vulnerabilities. This increasing scholarly, policy, and programmatic interest in promoting individual and communal resilience presents a challenge to the research and practice communities: to develop a translational framework that can accommodate multidisciplinary scientific perspectives into a single, applied model. The Resilience Activation Framework provides a basis for testing how access to social resources, such as formal and informal social support and help, promotes positive adaptation or reduced psychopathology among individuals and communities exposed to the acute collective stressors associated with disasters, whether human-made, natural, or technological in origin. Articulating the mechanisms by which access to social resources activate and sustain resilience capacities for optimal mental health outcomes post-disaster can lead to the development of effective preventive and early intervention programs.

Assessing the Relationship Between Social Vulnerability and Community Resilience to Hazards

This article contributes to the disaster literature by measuring and connecting two concepts that are highly related but whose relationship is rarely empirically evaluated: social vulnerability and community resilience. To do so, we measure community resilience and social vulnerability in counties across the United States and find a correlation between high levels of vulnerability and low levels of resilience, indicating that the most vulnerable counties also tend to be the least resilient. We also find regional differences in the distribution of community resilience and social vulnerability, with the West being particularly vulnerable while the Southeast is prone to low levels of resilience. By looking at both social vulnerability and community resilience, we are able to map communities’ social risks for harm from threats as well as their capacities for recovering and adapting in the aftermath of hazards. This provides a more complete portrait of the communities that might need the most assistance in emergency planning and response, as well as whether such interventions will need to be tailored toward reducing damage or finding the path to recovery.

Science, Policy, Activism, and War: Defining the Health of Gulf War Veterans:

Many servicemen and women began suffering from a variety of symptoms and illnesses soon after the 1991 Gulf War. Some veterans believe that their illnesses are related to toxic exposures during their service, though scientific research has been largely unable to demonstrate any link. Disputes over the definition, etiology, and treatment of Gulf War-related illnesses (GWRIs) continue. The authors examine the roles of science, policy, and veteran activism in developing an understanding of GWRIs. They argue that the government’s stress-based explanation of GWRIs and its insistence on a scientific link between service in the gulf and veteran illnesses forced veterans to shift from pleas for care, treatment, and compensation on moral grounds to engagement in the scientific process and debates over the interpretation of scientific findings. The authors compare the experiences of veterans to those of breast cancer activists to explain the stages of illness contestation in general.

Clearing the air and breathing freely: The health politics of air pollution and asthma

This study examines the growing debate around environmental causes of asthma in the context of federal regulatory disputes, scientific controversy, and environmental justice activism. A multifaceted form of social discovery of the effect of air pollution on asthma has resulted from multipartner and multiorganizational approaches and from intersectoral policy that deals with social inequality and environmental justice. Scientists, activists, health voluntary organizations, and some government agencies and officials have identified various elements of the asthma and air pollution connection. To tackle these issues, they have worked through a variety of collaborations and across different sectors of environmental regulation, public health, health services, housing, transportation, and community development. The authors examine the role of activist groups in discovering the increased rates of asthma and framing it as a social and environmental issue; give an overview of the current knowledge base on air pollution and asthma, and the controversies within science; and situate that science in the regulatory debate, discussing the many challenges to the air quality researchers. They then examine the implications of the scientific and regulatory controversies over linking air pollution to increases in asthma. The article concludes with a discussion of how alliances between activists and scientists lead to new research strategies and innovations.

Policy Issues in Environmental Health Disputes

This article compares the state of policies concerning three different diseases/conditions with putative environmental factors: asthma, breast cancer, and Gulf War-related illnesses. By comparing the state of four different types of policies--research funding, regulations, compensation/treatment, and citizen participation--the authors demonstrate the dynamic relationship between policies and health social movements. They identify four factors that shape policy for these three diseases: the science base supporting the environmental causation hypothesis, prevalence and perception of risk, the sources of support for the environmental causation hypothesis, and the strength of health social movements. All four factors contribute to policy outcomes, but they find the strength of health social movements to be particularly important for the three diseases they examine. In some cases, social movement activity can be more important than the strength of the science base in terms of policy outcome success.

School custodians and green cleaners: New approaches to labor-environment coalitions

Coalitions between labor unions and environmental organizations often dissolve in class tensions that appear to force unions to choose between job security and occupational or environmental health. This article examines a successful blue—green coalition that worked to substitute cleaning products used in Boston public schools with safer alternatives. The coalition succeeded in part through the role of bridge builders, who unified a diverse group of stakeholders, including community and environmental health advocates, labor activists and labor unionists, and school administrators, to discuss their individual and common interests in eliminating toxic chemicals from the school environment. This article also explores the framing strategies used by the coalition partners, especially the logic of the precautionary principle in bridging the concerns of the environmental activists with the safety and health concerns of the union. This case raises questions of how coalition strategies and tactics may bear on the success of blue—green coalitions.

EMBODIED HEALTH MOVEMENTS AND CHALLENGES TO THE DOMINANT EPIDEMIOLOGICAL PARADIGM

Health social movements address several issues: (a) access to, or provision of, health care services; (b) disease, illness experience, disability and contested illness; and/or (c) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality. These movements have challenged a variety of authority structures in society, resulting in massive changes in the health care system. While many other social movements challenge medical authority, a rapidly growing type of health social movement, “embodied health movements” (EHMs), challenge both medical and scientific authority. Embodied health movements do this in three ways: (1) they make the body central to social movements, especially with regard to the embodied experience of people with the disease; (2) they typically include challenges to existing medical/scientific knowledge and practice; and (3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research, and expanded funding. We present a conceptual framework for understanding embodied health movements as simultaneously challenging authority structures and allying with them, and offer the environmental breast cancer movement as an exemplar case.

Health Social Movements: Advancing Traditional Medical Sociology Concepts

Over the last decade, a growing number of social scientists have turned their attention to the study of activism around health issues. Health social movements (HSMs) have pressed the institution of medicine to change in dramatic ways, embracing new modes of healthcare delivery and organization. Health activists have also pushed medicine to evolve by connecting their health concerns to other substantive issues such as social and environmental justice, poverty, and occupational or environmentally induced diseases. HSMs therefore serve as an important bridge, connecting the institution of medicine to other social institutions. In similar fashion, the study of HSMs has motivated medical sociology to develop new tools and theoretical perspectives to understand these alterations in the medical landscape. Medical sociologists stand to learn a great deal about the institution of medicine by observing it as it comes into conflict with patients and activists around issues of health care delivery, science and policy, and regulatory action. This broad sweep of interests must be systematized, which is our project here.

School Custodians and Green Cleaners

Coalitions between labor unions and environmental organizations often dissolve in class tensions that appear to force unions to choose between job security and occupational or environmental health. This article examines a successful blue—green coalition that worked to substitute cleaning products used in Boston public schools with safer alternatives. The coalition succeeded in part through the role of bridge builders, who unified a diverse group of stakeholders, including community and environmental health advocates, labor activists and labor unionists, and school administrators, to discuss their individual and common interests in eliminating toxic chemicals from the school environment. This article also explores the framing strategies used by the coalition partners, especially the logic of the precautionary principle in bridging the concerns of the environmental activists with the safety and health concerns of the union. This case raises questions of how coalition strategies and tactics may bear on the success of blue—green coalitions.