THE POLITICS OF PVC by LORA ELIZABETH VESS A DISSERTATION Presented to the Department of Sociology and the Graduate School ofthe University of Oregon in partial fulfillment of the requirements for the degree of Doctor of Philosophy December 2007 11 "The Politics of PVC," a dissertation prepared by Lora Elizabeth Vess in partial fulfillment of the requirements for the Doctor ofPhilosophy degree in the Department of Sociology. This dissertation has been approved and accepted by: Greg McLauchlan~ Chair of the E~ari~i~gCo~~ittee~----~- -- -­ /f/tJl0 ~I, ?-t»7 Date Committee in Charge: Dr. Greg McLauchlan, Chair Dr. Richard Yark Dr. John Bellamy Foster Steven Hecker, M.S.P.H Accepted by: Dean of the Graduate School III © 2007 Lora Elizabeth Vess lV An Abstract of the Dissertation of Lora Elizabeth Vess for the degree of Doctor of Philosophy in the Department of Sociology to be taken December 2007 Title: THE POLITICS OF PVC Approved: _ Dr. Gregory McLauchlan This dissertation examines the political, scientific, social, environmental, and health debates surrounding the use ofpolyvinyl chloride (commonly called vinyl), a plastic many public health advocates and activists contend has a toxic lifecycle with deleterious human and ecological impacts at every stage. Using extensive documentary research and in-depth interviews, I answer a basic question: how and why have major stakeholders politicized PVC in recent decades? I find the strength of the anti-PVC movement lies largely in its broad based constituency: it includes professionals within the health care and green building industries, as well as labor unions and environmental health advocates. However, I raise critical questions about the movement's strategy of situating itself as a market-based movement where limited analysis is given to the greater environmental and health impacts of the health care and building industries as a whole. v CURRICULUM VITAE NAME OF AUTHOR: Lora Elizabeth Vess PLACE OF BIRTH: Franklin, Virginia DATE OF BIRTH: 6/12/1972 GRADUATE AND UNDERGRADUATE SCHOOLS ATTENDED: University of Oregon, Eugene Oregon Northern Arizona University, Flagstaff, Arizona Virginia Polytechnic Institute and State University, Blacksburg, Virginia DEGREES AWARDED: Doctor of Philosophy, Sociology, 2007, University ofOregon Master of Arts, Applied Sociology, 1999, Northern Arizona University Bachelor of Arts, 1994, Virginia Polytechnic Institute and State University AREAS OF SPECIAL INTEREST: Sociology of Health Environmental Sociology Social Inequality PROFESSIONAL EXPERIENCE: Graduate Teaching Fellow, University of Oregon, 1999-2007 Graduate Assistant, Northern Arizona University, 1997-1999 Vi GRANTS, AWARDS AND HONORS: $6000, Wasby-Johnson Sociology Dissertation Research Award, 2006 Central Lane County Labor Council Emerging Leader of the Year, 2006 PUBLICATIONS: Vess, Lora. 2006. "Environmental Justice." Pp. 111-119 in Sociological Inquiry, edited by K. M. Mahmoudi and B. W. Parley. Dubuque,IA: Kendall/Hunt Publishing Company. Vess, Lora. 2000. "Fury for the Sound: The Women ofClayoquot." Organization & Environment 13:266-267. Vll ACKNOWLEDGMENTS There are many people who have supported me and aided me throughout the process of formulating, researching, and writing my dissertation. I wish to express my sincere appreciation to my advisor and committee chair Dr. Greg McLauchlan for his strong support of my work. Special thanks are owed to my committee, Dr. John Bellamy Foster, Steven Hecker, M.S.P.H, and Dr. Richard York. Thanks too, to the wonderful staff at the science library. This research was supported in part by the University of Oregon, Department of Sociology Wasby-Johnson Research Grant. lowe a debt of gratitude to my incredible cohort, with whom I entered this program. I am particularly thankful to Laura Earles and Dan Wilson who have both supported me emotionally and stimulated me intellectually. As my 'unofficial advisor' Brett Clark deserves a special nod of acknowledgement for his encouragement and skill in helping to make sense ofjumbled ideas. I'd like to thank the members ofmy current and previous dissertation workgroups: Sarah Cribbs, Lara Skinner, Joel Schoening, and especially Katie Rodgers. I thank Sandra Ezquerra and Courtney Smith with a hearty round of applause for being such awesome dissertation-writing cheerleaders. And finally, my deepest thanks goes to Keith Appleby, for being there with me during the toughest times, the late nights, and the moments of achievement. I am grateful for the commitment and resolve of the activists and advocates interviewed for this project and part of this movement as a whole. I am thankful for their efforts to help create an environmentally healthier world in which to live, work, and play. Vlll To that end, I am hopeful that my nephews and their generation are more cognizant and active in addressing the human impact on our health and the environment than many of us have been. Last, but certainly not least, I thank my family for their continued support and love. IX For my father, H Douglas Vess x TABLE OF CONTENTS Chapter Page I. THE POLITICIZATION OF PVC . The Politicization of PVC... 4 Chapter Outline.............................................................................................. 6 Methods.......................................................................................................... 8 II. WHY PVC? SOCIOLOGICAL & ECOLOGICAL SIGNIFICANCE................ 10 Environmental Justice 13 Linking Environmental Health and Justice with Workplaces................... 14 Contested Illness and Scientific Debates.................................................. 15 Stakeholders and Social Movements............................................................. 18 The History of PVC: Political and Economic Context................................. 21 A Lifecyc1e of Harm: Toxicity and Health Threats 25 Production................................................................................................. 25 Use 29 Disposal..................................................................................................... 31 Contemporary Position of Government Agencies 33 III. PUSHING THE BOUNDARIES OF HEALTH AND SOCIAL MOVEMENT THEORY: THE ANTI-PVC MOVEMENT 36 Target of the Movement................................................................................. 37 Actors in the Movement................................................................................. 41 Scientific and Medical Activism................................................................ 43 Xl Chapter Page Advocacy Organizations............................................................................ 46 Health Social Movements.............................................................................. 48 The Public Interest Health Movement 49 Relation to the Problem 51 Power to Address the Problem.................................................................. 53 Working Within the System...................................................................... 55 Contested Illness 58 Summary 61 IV. FRAMES, COUNTERFRAMES, AND MOVEMENT FORMATION 63 Framing 65 Emergence and Overview of the Anti-PVC Movement History ~......... 70 Wave One.................................................................................................. 70 Wave Two................................................................................................. 73 Environmental Justice..... 76 EPA Draft Dioxin Reassessment 78 Movement Growth...... 79 The Center for Health, Environment, and Justice..... 82 Regulation and Phthalates......................................................................... 85 Proposition 65 85 World Health Organization & International Agency for Research on Cancer 86 Scientific Experts & Industry Influence.. 87 Counterframing and Counter Strategies........ 91 Counterframe: PVC Serves a Public Good............................................... 92 Counterframe: Non-Problem 93 Scientific Counterframing......................................................................... 95 Counterframe: Marginalization..................................... 102 Counterframe: Economic Harm................................................................ 107 XlI Chapter Page Conclusion 108 V. FIRST, DO NO HARM? PVC IN HEALTH CARE 111 Relation to the Problem _ ".............. 114 Framing of Concerns.................................................... 114 Frame: Children's Health.......................................................................... 115 Ethics Frame: Right Thing to Do 118 Resonance................................................................................................. 121 Why Nurses? 122 Portland, OR (PDX-Portland Intl.)Power to Address 127 Barriers in Health Care............................................................................. 131 Unions 132 The International Association of Fire Fighters 132 Working Within the System........................................................................... 136 Tactics 136 Outward Tactic (Market) 137 Outward Tactic (Government Relations).................................................. 141 Inward Tactic (Education)......................................................................... 145 Type III Contested Illnesses............................................................. 148 VI. BUILDING POLITICAL OPPOSITION TO PVC: THE U.S. GREEN BUILDING COUNCIL AND BEYOND 155 U.S. Green Building History.......................................................................... 156 United States Green Building CounciL.............................................. 157 The USGBC and Political Opportunity.................... 159 Trade Associations and the USGBC..... 161 Xlll Chapter Page Consensus-Based Decision-Making 163 Leadership in Energy and Environmental Design (LEED).. 167 LEED, PVC, and Controversy.................................................................. 168 Discussion................................................................................................. 172 End-of-life Debates 174 Recyclability 174 Landfill Fires and Open Burning 175 TSAC Methodology - Life Cycle Analysis and Risk Assessment...... 176 Precautionary Principle............................................................................. 179 Precedent Setting?..................................................................................... 180 Influence ofUSGBC's Decision............................................................... 181 Market Transformation 183 Green Building Beyond the USGBC 186 Green Building Meets the Movement to Green Health Care 189 VII. CONCLUSION: THE POLITICS OF TOXICS: TOWARD NEW MOVEMENTS AND NEW ALLIANCES....................... 196 A Precautionary Approach............................................................................. 197 Ecological Modernization................................................. 202 Treadmill of Production 204 Comparisons Between the Health Care and Green Building Arms ofthe Movement................................................................................................. 213 The Vinyl Institute and Opponents................................................................ 219 Directions for the Future. 227 Frame Bridging and Continuing the Coalition Model.. 227 Concluding Thoughts................................................................................ 230 APPENDICES A. METHODS 232 XIV Chapter Page B. IN-DEPTH INTERVIEW OUTLINE 241 C. CHRONOLOGY OF EVENTS........................................................................ 247 D. PVC REPORT TIMELINE 249 E. INDEX OF ACRONYMS AND ABBREVIATIONS...................................... 250 REFERE1\TCES 252 xv LIST OF TABLES Table Page 1. Summary of TSAC Findings......................................................................... 171 1 CHAPTER I THE POLITICIZATION OF PVC "I just want to say one word to you, Ben-just one word." "Are you listening?" "Yes I am," says Ben. "Plastics. " The Graduate (1967) Every day, a typical resident ofthe United States encounters and uses countless plastic products and materials. Plastics have dramatically altered almost every aspect of our lives, from how we grow, shop for, and prepare our food, to how we travel. They affect how we communicate and interact with others, whether we are using a cell phone or hosting a party. The American Chemistry Council assures us that ''plastics are helping to create a better planet and a safer world" (www.americanchemistry.com). Since the development of the first synthetic plastic in 1909, plastics have expanded the array of conveniences and products that are conceivably beneficial in certain realms. However, in light of the unintended consequences that accompany plastics, "better" and "safer" are disputable terms. While innovations in plastic development may have improved the human condition-think of child safety seats or medical devices-the ascendancy of plastics has also spawned a multitude of products that directly create health, ecological, and social concerns. This research is the story of one of those plastics, polyvinyl chloride (PVC)l, and how its use came to be challenged and politicized because ofthe environmental, social, and health risks associated with PVC's toxic lifecycle. I investigate the major stakeholders in current PVC debates, focusing on the strategies and tactics employed by organizations, businesses, and activists who draw attention to the hazards associated with PVC or seek to eliminate its use. How do both PVC proponents and opponents frame the issues and respond to one another's actions? Who is more successful in their approach lSome forms of PVC are also commonly referred to as vinyl. The two terms are used interchangeably in this study. 2 and why? For opponents, what are the major barriers they confront? In sum, the purpose ofthis research is to answer how and why stakeholders have politicized PVC by examining the political, scientific, social, environmental, and health debates that surround its use. Among the plastics, PVC is the second most common, with more than 14 billion pounds of vinyl produced annually in North America (www.vinylinfo.org). The chemical and plastics industries have successfully introduced PVC products into almost every sphere of our lives. However, environmental and health hazards associated with PVC have led some environmental health researchers and academics to regard PVC as one of the worst offenders for environmental damage (Thornton 2000; Markowitz and Rosner 2002). Of all the plastics, PVC is the most persistent, or least likely to break down, in the environment (Markowitz and Rosner 2002). Other chemicals, including some suspected carcinogens, are commonly added to vinyl to make the plastic soft and flexible, and can leach from the plastic. PVC production requires large amounts of chlorine, thus contributing significantly to the formation of dioxin, a known carcinogen? PVC's toxic lifecycle has human and ecological impacts at every stage - in production, use, and disposal. The combined impact of these three stages has led biologist Joe Thornton, author ofPandora's Poison: Chlorine, Health, and a New Environmental Strategy (2002) to assert "The plastic [PVC] that is all around us, and expanding its role in our lives all the time, turns out to be one of the most hazardous materials on earth...." (p. 318). In the early 1990s Greenpeace became the first national environmental organization to raise concerns about PVC, and began to specifically target U.S. chemical companies that manufacture the key chemicals used in PVC production (Costner 1995). Subsequently, an anti-PVC movement has emerged on several fronts. Two industries­ healthcare and green building---emerged as prominent in this movement because of the predominance of PVC use in medicine and construction.3 Vinyl is the most widely used 2 Dioxin belongs to a family of 419 chemicals with related properties and toxicity, but the tenn 'dioxin' is often used to refer to the 29 that have similar very high levels of toxicity. The most toxic fom of dioxin is 2,3,7,8, tetrachlorodibenzo-p-dioxin or TCDD. 3 Green building is the process of designing and constructing buildings with a smaller ecological footprint than traditional non-green buildings. Defining what counts as a green building can bedifficult. Some 3 plastic in healthcare, and more than 75 % of the PVC manufactured is used in construction and building, by both traditional as well as some green builders. PVC plastic constitutes almost 25 % of health care products and packaging currently in use (Shaner and Botter 2003). Within these two industries, a variety of stakeholders approach this issue from different fronts and with different objectives. Much of the movement towards phasing out or eliminating PVC has emerged internally, with professionals in these industries emerging as key leaders of the movement. In this sense, the anti-PVC movement is largely occupationally-driven. However, because of the predominance of PVC use in healthcare and building, PVC has also been targeted by broader-based environmental, health and other public-interest organizations. The missions of the health care and the green building industries involve protecting and promoting human and environmental health, thus as professionals and leaders in these fields learn of the known and suspected health and environmental risks of PVC, they push for greener healthcare and for sustainable design and construction. While PVC is prevalent in the healthcare and building industries, it is also ubiquitous in our homes and the built environment. PVC is relatively inexpensive to produce, durable, and becomes more adaptable and versatile with the addition of plasticizers (used to change the hard, raw PVC into a soft polymer) and other additives or stabilizers (heavy metals such as lead or cadmium and fungicides and other toxic chemicals).4 Because of these characteristics, it has become a widely used replacement for woods, metal, glass, rubber, ceramic, and even other plastics. Dozens of items that we use or encounter daily contain PVC plastic: children's toys, automobile parts, medical equipment, electronic applications (e.g., keyboards, electrical cords, computers, etc.), packaging material, piping, siding, windows, furniture, flooring, office supplies, builders incorporate green features (energy-efficient lightbulbs, low-flow toilets, low VOC paints, recycled wood, etc.) while others use integrative design processes to develop a much more comprehensive sustainable facility. Overall, the objective is to create healthy and sustainable buildings in which to live and work. 4 Phthalates are the dominant group of plasticizers and are known animal carcinogens. In laboratory animals, they have been found to damage the reproductive system, caUling infertility, testicular damage, reduced sperm counts, and suppressed ovulation (Thornton 2002). Phthalate concerns will be discussed in greater detail elsewhere. 4 window blinds, shower curtains and more. As Architecture Week notes "Chances are good that you are within arm's length of vinyl at this moment" (Cockram 2006:E1.1). In what follows, I examine efforts to politicize PVC use, particularly in the health care and green building industries, and the ensuing socio-political struggles.s Within the medical community, an array of stakeholders - businesses, manufacturers, healthcare providers and facilities, unions, professional associations, and environmental health organizations6 - are involved to in efforts to limit or phase out PVC use in healthcare. Similarly, among green builders, sometimes referred to as "sustainable" or eco-builders," there are architects, designers, developers, and general contractors dedicated to using environmentally responsible building strategies who seek to reduce PVC use. The Politicization of PVC Politicizing PVC entails the ways activists or stakeholders work to frame issues and mobilize support for their cause. Understanding the process of politicization involves an in-depth examination of how PVC has emerged as a focus of activists, professionals, and others within the healthcare and green building industries. Politicization involves the interplay between these groups and others, such as vinyl­ related industries and trade associations that resist challenges to PVC use and work to promote a positive public perception of PVC. While stakeholders vie to control public discourse surrounding PVC and to influence decision-making bodies or market direction, this struggle is not a clear-cut story of opponents versus proponents. The relation of each stakeholder group to the PVC product - whether as producers, users, workers, or contesters-ereates a complexity of interests among various stakeholders. The political and economic context that led to the rise of PVC begins with the expansion of the petrochemical industry and plastics development during World War II. The conditions that led to the development of PVC-rapid economic growth, the development of new technologies, a shift in industrial practices from supporting the 5 Hereafter, unless otherwise indicated, reference to PVC's health and environmental cmcems should be understood to include all aspects of the PVC lifecycle. 6 Environmental health organizations examine the intersection of public health and environmental damage and seek to remedy the health problems and injustices that result from the intractions between humans and their environment. Environmental health activists generally start from the standpoint that humans are largely responsible for the environmental problems that led to health issues. 5 military to appealing to consumers-also led to the development and production of a myriad of chemicals, materials, and products that have their own set of health and environmental problems. In our society, we are exposed to a plethora oftoxics daily. It is not possible to investigate each of these toxics; however, given PVC's status as the most contentiously plastic, perhaps this research may yield insight into understanding existing or potential social movements surrounding environmental health concerns within the same political and economic context. Environmental and public health advocates contend that government regulation or monitoring of these chemicals is limited, relies heavily on industry-supplied data, and does little to protect the environment and human health. However, in the face of growing environmental health problems, scientists, academics, business leaders, and activists are mobilizing. This contingency of advocates recognizes the interconnections between human actions and environmental change. They seek application of a more precautionary, or cradle-to-cradle, approach to our use of these chemicals and materials. In order to understand the politicization of PVC within the healthcare and green building industries, I focus on two sets of interrelated questions: I) Why have green building and healthcare professionals and their allies become involved in politicizing PVC? Within these two industries, who are the major stakeholders? What is the political and economic context that led to the politicization of PVC in general, and more specifically in these two industries? What major events or debates occurred within these two industries to bring PVC to the forefront of action? How have these debates played out? 2) How have PVC opponents mobilized around their cause and, concurrently, how have PVC proponents responded? What complications or disputes have PVC opponents encountered from vinyl interests, or from within their own movement? What aspects of PVC's lifecyc1e are opponents contesting? How does this vary by organization, profession, occupational power, unionization status, and gender? What are opponents' different objectives in regard to PVC, and what methods do they use to achieve these? Are stakeholders able to make convincing claims as to the verity of their position? What are the targets of opponents' mobilization? Do opponents direct their actions within the 6 within the healthcare industry or within the green building profession? Or is action directed towards shaping public perception and consumption habits? Chapter Outline In Chapter 2, Why PVC? Sociological Significance, I address how research on the politicization of this particular plastic can inform the social movement, public health, sociology of science, environmental sociology, and sociological health and medicine literatures, thus demonstrating the sociological significance of my study. I introduce the major stakeholders and advocacy organizations involved in PVC's politicization and I present a brief historical overview of PVC's development to contextualize current debates. I then answer the question "Why PVC?" from an ecological and health perspective in order to show differences in how PVC concerns are framed and then acted upon by challengers to its use. Finally, I outline the role that government agencies and policies have played in shaping this movement and the debates central to it. It should be noted that while the environmental, occupational, and human health problems linked to PVC are not bound by national borders, the organizations and individuals in this study are based in the United States. In Chapter 3, Pushing the Boundaries ofHealth and Social Movement Theory: The Anti-PVC Movement, I use the social movement literature to provide a theoretical examination of the anti-PVC movement. I argue that the anti-PVC movement is largely an occupationally driven movement within the health care and green building industries of the economy. The primary goals of the movement are market transformation (development and purchasing of non-PVC products) and the education of professionals or businesses within both these industries of PVC harms. Next, I examine the anti-PVC movement within the health care community as a health social movement (HSM). Phil Brown and colleagues (2004) have developed a typology ofHSMs; I add to this typology with a fourth ideal type, the 'Public Interest Health Movement,' or PIHM. I discuss the role that professional advocates play in PIHMs and how their class position impacts strategies, tactics, and goals of the movement. Chapter 4, Frames, Counterframes, and Movement Formation, provides an historical overview of the anti-PVC movement, including primary debates between 7 movement adherents and opponents. I focus on the emergence of the movement, specifically its framing concerns and countermobilization tactics. I introduce and examine some of the initial and key framing strategies employed by various stakeholders. I argue that there have been three waves of PVC activism, beginning in the 1970s with occupational health and fire safety concerns, followed by the second wave in the early 1990s with Greenpeace's chlorine chemistry campaign, leading to the current third wave of the anti-PVC movement found predominately in the health care and green building industries. I also consider the use of scientific arguments in shaping the politicization of the health and environmental hazards of PVC. Finally, I examine the arguments and strategies that the vinyl industry employs to refute challengers and delegitimize activists. In Chapter 5, First, Do No Harm? PVC in Health Care, and Chapter 6, Building Political Opposition to PVC: The Us. Green Building Council and Beyond, I take an in­ depth look at the politicization process first within the medical and health care community and then within the green building community. In each case I examine how stakeholders frame their concerns and establish their objectives, and how these decisions influence their tactics and strategies. The health care industry responds most significantly to PVC problems framed as patient health or ethical concerns. Activists in the green building community draw attention to end-of-life problems with PVC disposal. In chapters five and six, I also assess the relationship between stakeholders' strategies and their ability to influence PVC use. I find that stakeholders in the health care branch of the anti-PVC movement more successfully use their economic clout to shift the marketplace towards PVC alternatives. I conclude that vinyl industry interests have been able to influence the green building industry to a greater degree than occurs in the health care industry. In the final chapter, The Politics o/Toxics: Toward New Movements and New Alliances, I examine the story of PVC as an example of the social conflict that arises when profits are valued over human and ecological health. I evaluate the solutions offered by those who politicize PVC, and using the treadmill of production literature, I argue that their recommendations propose few structural changes that would address the causes of environmental and health risks. Many proposed solutions tend toward the 8 ecological modernization perspective, whereby new technologies or reformist market changes are claimed to resolve the problems associated with PVC. Rather than demanding increased government regulation of chemicals and potentially toxic products, or proposing a shift away from excessive consumption and convenience, the emphasis is placed on market change and increasing awareness about toxic threats among professionals in the field and consumers. I compare the approach of the health and green building movements in terms of framing of the problems, objectives, tactics, and their interactions with the vinyl, chemical, and plastics industries. Finally, I discuss why this matters; what lessons have been learned and what does an analysis of PVC politicization tell us about environmental health movements and the contested nature ofhealth problems that are environmentally and economically induced. Methods This dissertation relies on documentary research and in-depth interviews with a non-probability sample of individuals and representatives of organizations involved in phasing out PVC or active in PVC campaigns and the politicization of PVC. A detailed methods section is found in Appendix A. Documentary research was used to examine written accounts of the socio-political history of PVC, current debates surrounding PVC use, and the positions, objectives, and actions of stakeholders. This material included scientific reports, government documents, research studies, books, papers, and articles, as well as the websites, press releases, newsletters, and position papers of various organizations. Twenty in-depth interviews (including four follow-up interviews) were conducted, each lasting approximately forty-five minutes to one hour and forty-five minutes, as well as two shorter interviews. I also attended several green building seminars and a Habitat for Humanity event. The research allowed me to create a list of the major and minor stakeholders and activists involved in the PVC debates. I determined that there are essentially three categories of organizations and websites involved in debates about PVC. To borrow terminology from world systems theory, these can be referred to as the core, semi­ periphery, and periphery. Core protagonists of the movement include organizations that are actively engaged in the debates. The semi-periphery-the largest category-includes 9 groups or websites that are participants in the movement and which may educate others, but are not as directly involved. The periphery includes organizations whose involvement is limited or intermittent. As part of my efforts to understand and follow the debates surrounding PVC, I regularly checked websites of these organizations in addition to others that cover environmental health, green building, and vinyl industry interests. Information gathered from print and Internet sources was supplemented with interviews with representatives from all the organizations in the core, as well as some in the semi-periphery. Interviewees were contacted using a combination of snowball and purposive sampling. All respondents, except the vinyl industry representatives and a medical supplies representative, waived confidentiality.7 Interviews were voluntary, semi-structured and open-ended, and geared toward discovering how stakeholders work to politicize and remedy the problems associated with PVC use, or to discover the perspectives of PVC proponents and how they engage in the debates. The interviews covered the framing of PVC concerns, organizational structure and activism (including objectives, strategies, perceived solutions, coalition formation, etc.), influence of actors on (or perceived influence) corporate decision-making and government policy, barriers to movement success (from within and outside of the movement), and environmental and occupational health training, if appropriate (see Appendix. B for an interview guideline). I adjusted each interview guide to accurately reflect the type of organization (i.e., business, union, environmental health) the interviewee represented. I digitally recorded all interviews, downloaded the audio onto my password-protected computer and subsequently transcribed and coded the interviews. 7 I formally met with two vinyl representatives during my in-person interview; however, one of them rarely spoke. My interview had been scheduled with the other person and her presence was never explained to me. Pseudonyms are used for the vinyl representatives throughout the dissertation. 10 CHAPTER II WHY PVC? SOCIOLOGICAL & ECOLOGICAL SIGNIFICANCE PVC opponents have called PVC the "poison plastic," "a toxic nightmare," and "the dirtiest plastic from creation to death" (Walsh 2005e; CHEJ 2006; Conrad 2006). No other plastic is denounced or singled-out to the same degree as PVC. The seriousness of the claims made by the anti-PVC movement and the shift away from PVC use by a multitude of companies highlights the importance of understanding this movement. The anti-PVC movement is allied with unions, environmental justice groups, sustainability advocates, and healthcare activists. Social movement literature on environmental and environmental justice movements, health social movements, and the labor movement helps to inform the anti-PVC movement and contextualize it sociologically. In addition to social movement literature, my dissertation draws upon the theoretical and empirical work from the sociology of health and medical sociology, environmental sociology, sociology of science, and labor studies. Sociological interest in the relationship between the environment and human health has led researchers to explore the political debates and scientific disagreements concerning environmental illnesses and health risks, as well as public participation in the construction of an illness or an environmental health problem. As a politicized toxic threat, PVC controversies are similar to other contested environmentally-induced health problems. Disagreement arises first over whether PVC (in any or all stages of its lifecycle) is a source of environmental and human harm. Secondly, ifall stakeholders concede this point, disagreement arises over the degree to which PVC is deemed harmful and whether those risks are "acceptable."l Thirdly, conflict arises over decisions regarding what, if any, actions should be taken. The sociological tradition of investigating the environmental and social roots of illnesses began with Marxist theorists in the mid-nineteenth century. In the 1840s, I Inherent in risk assessment, the traditional model for assessing risks, is that some risk is acceptable. However, this is a political rather than scientific judgment (Clark 1989). 11 Friedrich Engels documented occupational and environmental conditions that caused illness and early death as a consequence of the organization of economic production and the social environment ([1845] 1973). Continuing this tradition, social medicine pioneer Rudolf Virchow (1821-1902) and former Marxist Chilean president Salvador Allende (1908-1973) analyzed the social origins of illness, emphasizing how inequalities are rooted in the distribution and consumption of social resources and underdevelopment and imperialism respectively (Waitzkin 1981). According to Waitzkin, all three of these scholars determined that disease was not simply a matter of an infectious agent or pathophysiologic disturbance, but an outcome of multifactorial causation, including malnutrition, economic insecurity, occupational risks, bad housing, and lack of political power. The historical contributions of Engels, Virchow, and Allende provide a foundation for examining the social causes of disease, and as Waitzkin contends, the social pathologies that distressed these men - inequalities of class, exploitation of workers, and conditions of capitalist production - continue to cause illness and disease. As Waitzkin (1981) and his predecessors note, without systematic and structural changes that alter the relationship between capital, the environment, and workers, environmentally-induced health problems will continue to rise. A number of social movements have formed have in reaction to such health inequalities. According to Phil Brown et al. (2004), social movements organizing around health issues can be traced back at least to concerns with occupational health during the Industrial Revolution. Since then, health social movements have emerged in response to issues including: women's health, breast cancer, patients' rights, general health access, disability rights, mental health rights, AIDS, tobacco control, and occupational health and safety. These movements are well-deserving of study, as are environmental health movements. However, most research in this area tends toward examining either environmental movements or health movements. When environment and health are studied in conjunction with one another, the focus is almost exclusively on environmental justice.2 Environmental justice scholarship is an extremely important area of research, but one that does not encapsulate all environmental health movements. Environmental and 2 An important exception is Phil Brown and colleagues whose work is used extensively here. 12 occupational health social movements have played a significant, if sociologically understudied, role in U.S. public health history. As Gottlieb (1993) has documented, public health and anti-pollution activists have long struggled to reform the institutions contributing to social inequalities in health and environmental equity. This activism has an historical and current gendered dynamic to it. In the early decades of the twentieth century, the problems of industrial disease were frequently ignored, attributed to poor worker hygiene, or unstudied. Though not commonly known, the era was marked by a number of influential women active in community and occupational health. Alice Hamilton, "the mother of American occupational and community health," was instrumental in investigating and documenting hazardous industries and substances. Gottlieb (1993) describes Hamilton becoming "the country's most powerful and effective voice for exploring the environmental consequences of industrial activity" by the 1920s (p. 10,51). Florence Kelley served as a strong advocate for workplace and community reform for women and children. Kelly led the National Consumers League, linking the problems of degraded environments with workplace issues and drawing national attention to hazardous workplace conditions. In recent decades, women have emerged as committed leaders within the environmental justice movement. The dedication of women to community environmental health and well-being continues into the anti-PVC movement. For example, under the leadership of Lois Gibbs,3 the Center for Health, Environment and Justice has prioritized dioxin and PVC health and environmental concerns. In the health care industry, nurses are becoming increasingly involved in campaigns to make their workplaces safer for patients and the environment through efforts to rid their facilities of PVC and other harmful toxics. In this way, PVC activism is a return to, or perhaps a continuation of, the intersection of environment and health as expressed by women.4 3 Lois Gibbs is widely regarded as being an instrumental leader in organizing and working with her neighbors in Love Canal, New York. In 1981, she founded the Center for Health, Environment and Justice, a non-profit organization, providing assistance to grassroots commmity organizations. The Center's Be Safe/Anti-PVC campaign establishes its position as a 'core' organization. Gibbs is also the author ofDying from Dioxin: A citizen's Guide to Reclaiming Our Health and Rebuilding Democracy (1995). 4 There are many factors that account for women's involvement these movements that are beyond the scope of this project to examine. However, for clarity, I am not suggesting an essential argument, whereby 13 Environmental Justice Although the anti-PVC movement as it is manifested within the health care and green building industries is not an explicit illustration of an environmental justice (EJ) movement, the relationship between environmental justice and PVC health and environmental concerns is unquestionable. The EJ movement is principally concerned with "the relationship between environmental degradation and social and economic injustice, particularly in relation to race, gender, and class oppression" and attends to the intersection of health, the environment, and politics (Foster 1994:137). Even though EJ did not emerge as a central frame for some of the activists and stakeholders interviewed, PVC's pervasiveness as a toxic hazard for humans and the environment situates PVC's continued use as an EJ issue. The omission by activists likely speaks more to their own class position and may symbolize the inattention to the classed and racialized health inequalities that EJ activists have criticized mainstream environmental organizations for Ignonng. Environmental justice seeks to encompass "both the racial and the class aspects of the political economy at work in communities that face toxic assault" (Cole and Foster 2001: 15). The siting of viny1manufacturing facilities and incinerators and the myriad of associated toxic problems (particularly exposure to dioxin), are structured along race, class, and gender lines. In the United States, vinyl production predominates along the Mississippi River corridor, or "Cancer Alley," a region infamously renown for the dominance of petrochemical facilities and other polluting industries that straddle the river and the nearby predominately low-income parishes and communities of color. Eliminating dioxin, a byproduct of PVC incineration, has long been a goal ofEJ activists, as documented through a history of organization and activism concerning the location of incineration facilities and hazardous waste dumps (see Gibbs 1995,2002). The environmental and health injustices experienced by these fence-line communities in Texas and along Louisiana's chemical corridor substantiate the charge made by the grassroots EJ movement that people and communities of color are women are viewed closer to nature and thus more aware of environmentalconcerns. Instead, I contend, the structured dimensions of their lives and gendered divisions oflabor account for a predominance of women activists, as is particularly evident within the nursing profession. 14 systematically exposed to environmental hazards, with the unequal exposure to pollution most significantly experienced by groups marginalized by gender, age, class, race/ethnicity, and geographic location (Bryant and Mohai 1992; Bullard 1994a; Bryant 1995). Exposure to environmental hazards and case studies of resistance and mobilization against such threats have been well documented by EJ researchers and writers (see Bryant and Mohai 1992; Gottlieb 1993; Bullard 1994a, 1994b, 2002). Environmental justice activists are correct in pointing out the inequalities of exposure and of government response and regulation. Yet even with acknowledgement of such disparities, no one is safe, no community nor body free from toxics or the environmental and health risks associated with PVC's lifecycle. Examining how anti-PVC advocates prioritize health and environmental concerns and express understanding for the EJ implications of the PVC lifecycle aids in discovering both why and how PVC opponents engage in PVC politicization and current debates. Linking Environmental Health and Justice with Workplaces Environmental justice focuses on environmental health, yet a lesser-studied component of this research involves the interconnection of environmental and occupational health as a social and EJ issue. As previously mentioned, the controversies that surround PVC as a politicized toxic involve whether PVC is a source of environmental and human harm. Examined from the viewpoint of a production worker in a vinyl chloride monomer plant will yield not only a different set of concerns than from the perspective of someone with a different relation to the site of production, but also a different prioritization of those concerns. Where one is situated along what Orbach (1999) calls the economic-environmental nexus influences the answer to the question of harm and, similarly, their perception of degree of harm. Many scholars have emphasized the importance of examining the point of production for understanding environmental health and justice struggles (Levenstein and Wooding 2000; Pellow and Park 2002). These researchers draw a link between the toxic exposures in workplaces and environmental justice by contending, "What is produced at the point of manufacture ultimately becomes the potential source of environmental hazard" (Levenstein and Wooding 2000:14). I agree; however, anti-PVC activists and - --- ----- 15 -----------------~--- environmental health advocates do not always recognize or prioritize these links. Professionals in the healthcare and green building industries who are active in the movement, and clearly far from the point of production, mobilize to address the hazard of PVC as it travels throughout its lifecycle. However, the workplace does emerge as a central feature of PVC's politicization. It is not the factory floor, likely envisioned by Levenstein and Wooding, but rather more often a hospital neonatal intensive care unit or a green building conference. As Smith (1981) clarifies in her work on black lung, the workplace should not simply be understood as the physical characteristics of the site, but also as the social relations (including technologies, work organizations, and industrial/labor relations) that shape and are part of the workplace. Given that PVC is challenged most often by professionals within the field, it follows that the workplace, as both a physical place and site of social relations, influences these debates. Sociological attention is lacking on the emergence of different sites of activism downstream, where manufacturing and community health concerns, if not expressed overtly, will nonetheless likely be impacted in some way by the mobilization of stakeholders along various points in the stages of PVC's lifecycle. For better or worse, in the case of PVC, the main concerns and debates are not expressed or centered on occupational exposure. However, by investigating the concerns, tactics, and objectives of a range of stakeholders, we gain a broader understanding of the multiple levels of activism that occur around toxic substances and other human-created environmental harms. Contested Illness and Scientific Debates One of the struggles facing activists and stakeholders in these movements involves "proving" a scientific relationship between environmental toxics and health. Disagreements over environmental and health risks associated with PVC have constituted key controversies in the disputes surrounding this plastic. On the one hand, PVC opponents contend that there is enough evidence indicating PVC's harm, while on the other hand, the vinyl industry insists that the connections between PVC and 'alleged' health and environmental problems are either unsubstantiated or that risks are not elevated to a point necessitating action. Stakeholders turn to different models for 16 assessing risk and framing the problems. Industry tends to favor traditional models, which ask, "How much harm is acceptable?" rather than aiming to prevent harm in the first place (Montague 2004). Risk assessment models are favored by government agencies and certain industries because they suggest (but do not provide) objective, rational science and allow government agencies to avoid political trouble (O'Brien 2000). PVC opponents and critics of the traditional reliance on risk assessment models for determining harm challenge this approach and reframe the debate, often by advocating use of the precautionary principle.5 One's approach to evaluating risk significantly influences how stakeholders frame and steer debates. Disputes are further intensified and complicated by the contested nature of environmental and occupationally induced illnesses and health problems. 'Contested' and controversial illnesses tend to be environmental or occupational in origin and call into question the biomedical model of disease (see Brown, Kroll-Smith and Gunter 2000).6 Environmentally induced illnesses may be caused or affected by synergistic effects of chemicals, intervening variables between exposure and effect, or chemical accumulation, thus complicating confirmation of a causal link between a chemical and a health outcome (Krimsky 2000). Defined by Brown et al. (2003), these are illnesses, diseases, or conditions "that engender major scientific disputes and extensive public debates over environmental causes" (p. 214). Environmental illnesses are marked by the absence of certainty of knowledge, often leading to social and political citizen activism (Brown et al. 2000). They may manifest as cancer as well as chemically induced reproductive, neurophysiological, and developmental effects. 5 Discussed in greater detail in chapters four and five, the most commonly referred to definition of the precautionary principle is defined in the 1998 Wingspread Statement, "when an activity raises threats of harm to human health or the environment, precautionary measures should be taken, even if Iilme cause and effect relationships are not fully established scientifically" (cited in Tickner, Kriebel and Wright 2003: 489). 6 Mishler (1981) defines the biomedical model as assuming that disease is a deviation from normal biological functioning, that diseases have specific causes that can be located in the ill person's body, that diseases have the same symptoms and process in any historical period and in different cultures and societies, and that medicine is a socially neutral science. 17 I have determined that there are at least three types of contested illnesses. The first type includes those illnesses such as multiple-chemical sensitivity and Gulf War­ related illness, where the legitimacy of the actual illness or environmentally induced health problems is contested.7 In the second case, illnesses are recognized and not contested, but the environmental source or sources are disputed, particularly by the medical establishment or industries that may be responsible for contributing to or causing the health problems. Examples would include asthma, breast cancer, black and brown lung, and silicosis.8 In such cases, the link between health and environmental exposure is strongly suspected, but there is no definitive scientific support for an environmental causation hypothesis (see Eisenstein 2001; Klawiter 2003; and McCormick, Brown and Zavestoski 2003). In the third type, the environmental source is a known toxic, but the relationship between it and an environmental or occupational health problem or illness is complicated because a scientific link has not been definitively established (or if so, the degree that it is harmful remains contested), or because of the difficulty in attributing the health problem or illness to a specific toxic source. As an example, phthalates, a common PVC additive, are known endocrine disruptors; however, should a person develop endocrine-related problems, establishing a link between phthalate exposure and a person's health problems is nearly impossible. Similarly, dioxin is a known carcinogen; however, it is extremely difficult, if not also impossible, to prove one's cancer arose from dioxin exposure from a particular source. As Krimsky (2000) states, "Science always favors strong causality 7 Illnesses that are initially contested do not necessarily retain this status indefinitely. Multiple chemical sensitivity is one of the many names given to "those chronic conditions that appear to have been brought on by exposure to low doses of ubiquitous environmettal toxicants at levels" presumed safe in the past. Symptoms may include nausea, confusion, difficulty concentrating, metallic taste sensations, moderate rhinitis, tinnitus, increased and irregular heartbeat, various paraesthesias, ocular disorders, memoryloss, asthma, and reactive airway disease (Kerns 2001: 1-3, 11,27). Gulf War illnesses include nausea, loss of concentration, blurred vision, fatigue, lack of muscle control and coordination, irritable bowels, headaches, rashes, and other ailments experienced by Gulf War veterans following their service in the Gulf (Brown et al. 2003). 8 Brown lung, or byssinosis, is a progressive, potentially fatal occupational disease of textile (particularly cotton mill) workers which causes chest tightness, shortne$ of breath, coughing and wheezing (Levenstein et al. 2002). Similar to brown lung, black lung is also a progressive, potentially fatal occupational disease. The symptoms for coal miners include persistent, severe cough and sputum, breathlessness, and ch5t pain (Smith 1987). In the mid-nineteenth century, black lung was differentiated from silicosis, another chronic respiratory disorder, occupational in origin (Derickson 1998). 18 over weak causal associations, but in reality the standard of strong causality for the biological effects of chemicals on humans is rarely achievable" (p. 117). Because of the uncertainty in establishing links between toxics and health problems, this type is open to heavy politicization. For PVC, because so many of the health problems associated with its lifecycle fall into this third category of contested illnesses, vinyl interests are able to point to deficiencies or gaps in data and lack of government legislation or regulation to support their position of minimal risks from PVC lifecycle. These three categories of contested illness should be regarded as ideal types; environmental and occupationally induced health problems may shift from one category to another at different stages of politicization as new scientific data emerges or stakeholders influence the debates. Stakeholders and Social Movements As stated, PVC is politicized most widely within two primary industries: healthcare and green building. Chapter 2, Pushing the Boundaries ofHealth and Social Movement Theory: The Anti-PVC Movement, is dedicated to a theoretical examination of the anti-PVC movement. Before further discussing the debates and controversies surrounding PVC it may be helpful to introduce the major stakeholders, the majority of whom are anti-PVC. Organizations that fall within the core (or those actively engaged in debates, as described in Appendix A: Methods) for the health care industry include Health Care Without Harm (HCWH), Kaiser Permanente, and Catholic Healthcare West (CHW). The Healthy Building Network (HBN) and the U.S. Green Building Council (USGBC) emerge as the core organizations in the green building industry. The Center for Health, Environment, and Justice (CHEJ) and Greenpeace are core movement stakeholders that do not fall within either industry. The Vinyl Institute is the primary stakeholder involved representing the vinyl interests. Health Care Without Harm, a coalition of 443 organizations in 52 countries, is one of the principal players in the anti-PVC movement and arguably the main organization involved in the health care industry. Its mission is "to transform the health care industry worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment" (www.noharm.org). The inclusion of Kaiser Permanente and Catholic 19 Healthcare West may appear unusual; however, as large healthcare providers, their decisions regarding PVC use in medical supplies and healthcare facilities have had a substantial impact. Their actions have further politicized the PVC issue within healthcare, helping to raise awareness of the concerns, impacting medical product suppliers, and aiding in institutionalizing the debates. Kaiser Permanente is an integrated health care organization, comprised of health plans (representing 8.5 million people in eight states and Washington D.C.), hospitals, medical groups, and an affiliation with the Seattle-based Group Health Cooperative. Catholic Healthcare West is the nation's eighth largest hospital system, serving 22 million people at 42 hospitals. Kaiser's health plans and hospitals are nonprofit, as are those of CHW.9 The comparator organization to HCWH within the green building industry is the Healthy Building Network (HBN), "a national network of green building professionals, environmental and health activists, socially responsible investment advocates and others who are interested in promoting healthier building materials as a means of improving public health and preserving the global environment" (www.healthybuilding.net). The U.S. Green Building Council (USGBC), the preeminent green building industry coalition, plays a significant role in the politicization of PVC. In Chapter 5, Building Political Opposition to PVC: Case Study, Green Building and PVC, I discuss how the organization's decisions are at times the center of controversy. The USGBC is a nonprofit organization representing over 10,000 member organizations and comprised of 75 regional chapters. The organization's objective is "to transform the building marketplace to sustainability" (www.usgbc.org). The politicization of PVC is not limited to the healthcare and green building industries. Greenpeace has been at the core of the movement since the early 1990s. Its involvement has been foundational and tremendously significant. For this reason, it is included as a core organization even though its current involvement in the movement is somewhat limited. Along with Health Care Without Harm and the Healthy Building Network, the Center for Health, Environment and Justice (CHEJ) works through partnerships and coalition building. CHEJ has been involved in "works to build healthy 9 Kaiser's medical groups (partnerships or professional corporations) are the exception. 20 communities, with social justice, economic well-being, and democratic governance" (www.chej.org). Unlike other core organizations, CHEJ is not an occupational-based organization, nor is it oriented towards professionals in a particular field. Founded by Lois Gibbs following her grassroots activism at Love Canal, CHEJ has evolved into a national environmental justice organization, dedicating much of its resources to providing scientific and organizing assistance to community groups. In this vein, CHEJ should be regarded as being part of the anti-PVC movement by expanding the issue beyond the healthcare or green building industries. Center for Health, Environment, and Justice's seemingly outlier position does not detract from the movement's dominance within these two industries. To a certain extent, CHEJ's efforts coincide with those ofHBN and HCWH. The Center for Health, Environment, and Justice is not the only organization of its type involved in the movement, but it is the only one that has prioritized the current politicization of PVC to such a high degree. The Vinyl Institute is a U.S.-based trade association representing the leading manufacturers of vinyl, vinyl chloride monomer, vinyl additives and modifiers, and vinyl packaging materials. Its mission is "to advocate the responsible manufacture of vinyI resins; life cycle management of vinyl products; and promotion of the value of vinyl to society" (www.vinylinfo.org). The Vinyl Institute represents 8 full members and 14 supporting members, and interacts regularly with other related trade associations, particularly the American Chemistry Council, which represents the Plastics Division and the Chlorine Chemistry Council. Categorizing these organizations and businesses as the core groups should not be interpreted as a dismissal of the other organizations and public interest groups represented in the periphery and semi-periphery of the movement. These core organizations have the advantage of size and resources, providing them with greater visibility and ability to act. Moreover, all of these except Kaiser Permanente and Catholic Healthcare West, are coalitions or represent multiple parties. Thus, the core groups should be regarded not as single organizations but as representatives of many. It should also be noted that healthcare and green building professionals often act 21 individually within their respective worksites. As such, their actions towards deselecting or challenging PVC's use often go undocumented. The History of PVC: Political and Economic Context Two scientists, British chemist Alexander Parks and American chemist Leo Baeke1and, are credited with developing the first human-made plastic and the first truly synthetic plastic in 1862 and 1909 respectively (Wilson and Yost 2001). PVC was first produced in a laboratory in 1872 but not commercially produced until 1933 by Union Carbide. Plastics production and use increased substantially in the 1920s and 1930s when a commercial replacement for rubber became needed. The manufacture of PVC accelerated in the U.S., Japan, and Germany during World War II with the expansion of the petrochemical industry and plastics development. The technological boom that followed WWII aided in developing techniques for mixing PVC with plasticizers, creating various applications (Malin and Wilson 1994). An extensive public relations campaign followed soon after, promoting plastics as materials "that would transform the lives of Americans" and "Better Things for Better Living ... through chemistry" (Markowitz and Rosner 2002:139, 140). The American public "opened their arms to the wonders of chemistry" and the "magic of plastics," where scientists were able to turn monomers into polymers (Trade Secrets 2001; interview, Benson). From 1940 to about 2000, the U.S. production of synthetic organic chemicals grew more than thirty-fold (Thornton 2000). The production of PVC alone has doubled over the last 20 years, with 27 million tons of PVC currently produced worldwide each year. Depending upon whom you ask, the history of vinyl is wrought with suppression of information, cover-ups, and disregard for occupational and public health. In their book, Deceit and Denial: The Deadly Politics ofIndustrial Pollution, historian Gerald Markowitz and historian of public health David Rosner (2002) contend that the plastics and chemical industry misled its workers, the American public, and the federal government about the dangers of vinyl chloride. 1O Markowitz and Rosner reviewed thousands of chemical industry documents prior to writing their expose on corporate 10 Vinyl chloride is commonly referred to as VCM (vinyl chloride monomer) in the industry. 22 misbehavior. They contend that the industry (represented by the Manufacturing Chemists' Association) had learned of a link between vinyl chloride and a previously undefined degenerative bone condition, called acroosteolysis or AOL, in the mid-1960s, yet kept this knowledge from the American people for several years. They further discovered that additional research had been conducted on behalf of European chemical manufacturers at this time on the toxicity of vinyI chloride, confirming its carcinogenicity. Along with European vinyl manufacturers, the American chemical industry entered into secrecy agreements aimed at preventing public disclosure of these findings. According to Markowitz and Rosner, this was due primarily to two reasons. First, the Food Additives Amendment's (1958) Delaney clause banned the use of any suspected carcinogen in any food product. And second, the industry viewed the U.S. political climate ripe for "industrial upheaval via new laws or strict interpretation of pollution and occupational health laws" (p. 182).11 The late 1960s and early 1970s were marked by growth in federal occupational and environmental regulation. This growth accompanied the rise of public environmental awareness stemming, in part, from the 1962 publication of Rachel Carson's Silent Spring. 12 While chemical industry representatives maintain that Markowitz misrepresented the Delaney clause (Scranton 2004) in this cultural environment of growing labor, civil rights, and environmental activism, it seems reasonable to expect that the plastics and chemical industries wished to avoid such public scrutiny and associated ramifications, potentially, at all costs. Describing the industry position, Markowitz and Rosner write: When cancer became an issue, the industry took more extreme and potentially explosive actions to cover up the danger. ...the industry was largely successful in hiding its information about cancer from the government and in deflecting national attention away II A Manufacturing Chemists' Association document revealed significant concern over bad publicity and appeals to undertake any necessary efforts "to avoid exposes like Silent Spring and Unsafe at Any Speed' (Markowitz and Rosner 2002: 175). 12 During this time major government agencies and legislation were established and passed; including: Coal Mine Safety and Health Act (1969), National Environmental PolicyAct (1969), Environmental Protection Agency (1970), Occupational Safety and Health Administration (1970), National Institute for Occupational Safety and Health (1970), Clean Air Act (1970), Water Pollution Control Act (1972), Pesticides Act (1973) and the Endangered Species Act (1973). 23 from the potential hazards of thousands of mostly untested new chemicals and of vinyl chloride in particular (p. 178). Cancer concerns materialized in 1974 when the American public learned that four PVC workers exposed to vinyl chloride died from angiosarcoma (ASL), a rare form of cancer of the liver. According to Markowitz and Rosner (2002), this cancer was "identical to that seen in the European rat feeding studies" conducted in Italy that linked VCM to cancer and about which the industry had failed to inform the National Institute for Occupational Safety and Health (1\TIOSH) (p. 192). As Markowitz and Rosner see it, the sole aim of industry secrecy agreements "was to avoid a public relations and legal nightmare" (p. 183). Public knowledge regarding a link between vinyl chloride monomer and cancer could result in a significant market effect. While workers' compensation laws generally insulated the industry from severe financial loss from workers, the possibility of consumer lawsuits was of great concern. In particular, prior to 1974, vinyl chloride had seen widespread use as an aerosol propellant for drugs, pesticides, paints, and hairspray. However, rather than risk liability and inform consumers about the dangers of vinyl chloride, manufacturers began quietly replacing vinyl chloride in its aerosol propellants. And, instead of complying with a NIOSH request for information, the industry decided to minimize the seriousness of occupational and public health risks from viny1chloride exposure. They did not tell NIOSH about the Italian studies, and they did not tell them about their data indicating that the threshold limit should be dramatically reduced. Markowitz and Rosner's (2002) account is greatly disputed by the vinyl and chemical industries - particularly the question of what they knew and when they knew it. The controversy over publication of their book and subsequent appearance on a PBS documentary, Trade Secrets (2001) with Bill Moyers, will be discussed in greater detail in chapter four. The vinyl representatives I interviewed would not comment extensively on the industry's history, but what they did disclose contrasts significantly with Markowitz and Rosner's account. In my interview, the representatives acknowledged that this was a sad chapter in their industry's history, but maintained that vinyl chloride 24 was considered innocuous at the time and not harmful. As of July 4, 2007, the Vinyl Institute's website states: There also is a commitment to responsible manufacturing practices and a determination to make sure that vinyl is appropriate and safe for the products in which it is used. This commitment is perhaps best exemplified by the effort the industry undertook in the early 1970s, when it was discovered that workers in vinyl polymerization plants who had prolonged, extremely high exposures to vinyl chloride monomer, the raw material used to make viny I, were at risk for developing angiosarcoma of the liver, a rare form of cancer [emphasis, mine]. On the other hand, Markowitz and Rosner cite B.F. Goodrich and Union Carbide documents dating from 1959 that indicate otherwise: ... We feel quite confident that 500 parts per million is going to produce rather appreciable injury when inhaled 7 hours a day, five days a week for an extended injury ....and. ...Vinyl chloride monomer is more toxic than has been believed (B.F. Goodrich document and Union Carbide document, Trade Secrets).13 As described to me by the vinyl representatives, during polymerization of vinyl chloride, big vats would "cake up" but there were no acute health effects. A medical doctor out ofB.F. Goodrich in Kentucky recognized the link between vinyl chloride and angiosarcoma. 14 In our interview, one of the vinyl industry representatives made a point of mentioning both that ASL does occur naturally (although adding "rarely" as a clarifier), and that high doses of vinyl chloride are required for an exposed worker to develop the disease. Once this link was realized, the OSHA responded and lowered vinyl chloride workplace Permissible Exposure Limits from 500 parts per million to 1 part per million. Within eighteen months, industry realized they had to change how they did business and they began sharing information worldwide (although primarily with Europe), to lower exposure to vinyl chloride monomer. However, OSHA imposed this decision and employer compliance was legally required. But, as the interviewee asked, "Why would you want to fight that? No one with a conscience would expose workers to cancer." He recognized that threshold level values were a point of debate, with some stakeholders maintaining that there is no safe level for exposure. However, he emphasized, "regulators think you can create safe levels." By implying that there is no 13 At the time, workers were regularly exposed to 500 parts per million of vinyl chloride (Trade Secrets). 25 need for concern, he added, "Everybody in industry"-before clarifying-"in general, everyone can sleep soundly at night [he] hopes." A Lifecycle of Harm: Toxicity and Health Threats The degree to which (or even if) PVC is harmful is at the heart of the debates surrounding its continued use. Some of the health and environmental problems are associated with a particular stage in the lifecycle, while others are potentially problematic at multiple points, such as during production and disposal. Arguably, PVC first emerged in the socio-politicallimelight several decades ago w4en production workers were exposed to excessively high levels of vinyl chloride and became ill and/or died. In the U.S., documentation of certain occupational related illnesses have dropped along with vinyl chloride monomer threshold limit values (now one part per million). As the political economic climate has shifted, so have the debates. Some problems may have diminished, but others have emerged. To understand current debates, it is useful to identify the occupational and environmental health problems as they relate to the history of industry and current use of PVc. Outlining the most prominent health and environmental problems helps set the stage for understanding how different stakeholders define and frame their concerns. This is particularly useful, given that different stakeholders politicize different aspects of PVC. Production The manufacture of PVC accounts for the production of many unintended, toxic byproducts. Like the majority of plastics, fossil fuels are the primary feedstocks necessary for production. PVC is the least consumptive mainstream plastic of fossil fuels; however, this is because approximately 40% of its content is derived from chlorine, a natural element accounting for much of the contention surrounding PVC's use. PVC manufacture would not be possible without chlorine chemistry. At each stage of PVC production, organochlorines (carbon-based chemicals) are formed and released into the 14 A private practice physician who conducted physical exams ofthe Goodrich's employees did discover acroosteolysis in workers, but not angiosarcoma. While this may have been an honest error on the part of the interviewee, it is noteworthy that the industry's representatives did not accurately remember the industry's history. 26 environment (Thornton 2000). Organochlorines are toxic, persistent in the environment, bioaccumulative (concentrate in the fatty tissues of organisms), and contaminate "absolutely every inch of the planet" (Thornton 2000:5,25).15 Organochlorine exposure is increasingly being linked to different kinds of cancer, immune suppression, infertility, and development problems. Because over lO,OOO organochlorines are produced by the chemical industry, the impacts of PVC as an organochlorine-containing material become magnified and contribute to one of the greatest threats to environmental and human health. PVC's heavy reliance on chlorine for production positions it not only as the only major plastic that contains chlorine, but also as the largest user of chlorine in the world (Thornton 2000). The generation of dioxin, a persistent, carcinogenic chemical, is an unintended but unavoidable by-product whenever chlorine-based chemicals are produced, used, or burned, as in the manufacture and the disposal of PVC. Dioxins have been linked to breast cancer, lower sperm counts, and reproductive-related birth defects in men. According to Greenpeace, throughout its entire lifecycle, "PVC is responsible for a greater share of the nation's annual dioxin burden than any other industrial product" (www.greenpeaceusa.org). Because dioxin bioaccumulates, traveling up the food chain, the food supply is the major source of contamination. Human exposure to dioxin through the food supply appears relatively consistent throughout the population, except for locally caught or harvested foods in especially contaminated regions (Institute of Medicine 2003). Most significantly, this impacts subsistence fishers, American Indian, and Alaska Native tribes who rely on fish and wildlife in greater quantities than the general population. The health and development of children are also at risk, as will be discussed further below. Dioxin is able to travel long distances. As an example, even animals in the arctic, particularly at the top of the food chain, are at a significantly high risk for contamination. Before dioxin makes its way into the fatty tissues of a polar bear, it must first be 'produced' where it is part of a process that potentially causes a multitude of health 15 Those organochlorines that do breakdown in the environment often result in other, more persistent and potentially more toxic byproducts (Thornton 2000). 27 problems for humans. As of2007, there remained eight chior-alkali facilities in the United States that relied on mercury to produce the chlorine needed for PVC production, releasing an unaccounted for level of mercury emissions each year (www.nrdc.org). PVC is produced by the conversion of ethylene dichloride (EDC) into vinyl chloride monomer (VCM), which is then polymerized to form Pvc. 16 The conversion of EDC to vinyl chloride generates hydrochloric acid, a by-product with corrosive properties causing irritation and burns, or potentially more serious health problems if exposure is more severe (ASTDR 2007). While EDC is not particularly persistent, large quantities of persistent bioaccumulative by-products are produced by the synthesis of EDC and VCM (Thornton 2000). This synthesis generates a substantial amount of chemical waste, PCBs, dioxins, and furans. As one of the best-studied chemicals (Kielhorn et al. 2000), vinyl chloride's hazards are well documented. Vinyl chloride is listed as a known carcinogen by the U.S. Department of Health and Human Services and the World Health Organization's International Agency for Research on Cancer (IARC). Even short-term exposure to VCM involves a fatal risk if levels are high enough. 17 Vinyl chloride has been found in at least 616 of the 1,662 National Priority List sites identified by the Environmental Protection Agency (EPA) (ASTDR 2006). Ninety-eight percent of the vinyl chloride produced is used to make PVC. Human health risks from vinyl chloride are mostly occupational; however public health risks are greatest for communities in close proximity 16The polymerization process occurs through four stages: First, salt (sodium chlorine) is broken down through an electrolytic process to release chlorine as a greenish gas ... .In the second stage, chlorine, is combined with a variety of hydrocarbons to produce vinyl chloride monomer. .. .In the third stage, the monomer is formed into a polyvinyl chloride resin. In the fourth stage, it is fabricated irto finished products (Markowitz and Rosner 2002: 169-170). 17According to the U.S. Agency for Toxic Substances and Disease Registry (ASTDR), among the risks associated with breathing high levels of vinyl chloride for short periods of time include; dizziness, sleepiness, and unconsciousness. Breathing vinyl chloride for long periods of time involves the same risks (including death) but can result in permanent liver damage, immune reactions, nerve damage, and liver cancer. Studies in workers who have breathed vinyl chloride over many years showed an increased risk of liver, brain, lung cancer, and some cancers of the blood have also been observed in workers. Animal studies have shown that long-term exposure to vinyl chloride can damage the sperm and testes. (Thpartment of Health and Human Services, ASTDR, ToxFAQs for Vinyl Chloride, July 2006). 28 to vinyl chloride production facilities and in the vicinity of hazardous waste sites and municipal landfills. Tobacco smoke also contains a low level of vinyl chloride (ATSDR 2006). The route of exposure may be air or soil where it is "highly mobile" and as a consequence is sometimes detected at levels higher than EPA standards for groundwater and drinking water (ASTDR 2006). Until the early 1990s, traces of vinyl chloride remained in PVC, leaching the carcinogen into food and water from PVC containers. This risk remains included on the ASTDR's latest Vinyl Chloride Toxicological Profile (2006). In the United States, PVC plants are mainly located in Louisiana and Texas, where the petrochemical industry enjoys prominence. These plants are located in largely African-American and low-income communities where there is risk from air pollution and contamination of their groundwater from the vinyl production facilities. Large-scale releases of vinyl chloride may occur from operator error or whenever a power failure requires immediate termination of the polymerization process (Malin and Wilson 1994). In the 1980s the groundwater of the small African-American town of Reveilletown, Louisiana, was contaminated and ultimately relocated after a plume of vinyl chloride was inadvertently released from the nearby Georgia-Gulf PVC plant. Major vinyl chloride spills have occurred elsewhere in Louisiana, as well as in Pennsylvania and Texas. Mossville, Calcasieu Parish, Louisiana may be among the most notable examples of environmental injustice. This parish is home to a total of 14 industrial facilities, including chemical companies, an oil refinery, a coal-fired power plant, and more vinyl manufacturers than any other in the United States (Mossville Environmental Action Now, Inc. et al. N.d.). In 2005, the public-interest law firm Advocates for Environmental Human Rights took the novel approach of filing a petition on behalf of Mossville residents with the Inter-American Commission on Human Rights of the Organization of American States, charging that the environmental situation interferes "with fundamental human rights to: life, health and a clean and ecologically secure environment; privacy as it relates to the inviolability of the home; equality; and freedom from discrimination" (Walsh 2005c). 29 Occupational health risks for PVC production workers are relatively well documented (Lee et al. 1988; Cheng et al. 1999; Langard et al. 2000; Mundt et al. 2000; Yadav and Chhillar 2001; Lewis et al. 2003). The point of production is among the most hazardous for workers, but as the first stage of the PVC lifecycle only marks the beginning of opportunities for public health risks. During production, exposure to PVC has been known to cause acroosteolysis (absorption of bone of the terminal joints of the hands and circulatory changes), Raynaud's phenomenon, and angiosarcoma of the liver (ASL) among workers. Lowered Permissible Exposure Limits (PELs) for vinyl chloride have greatly reduced the number of new cases of ASL; however, given ASL's latency period of approximately 20 years, new cases of ASL caused by viny1chloride exposure may continue to emerge among former workers or their children. This may be a particular risk for workers exposed to vinyl chloride in countries where the manufacturing process is outdated or vinyl chloride is not regulated (Kielhorn 2000). For instance, in 2004, Taiwanese researchers found that there was an increased risk of developing liver fibrosis in PVC workers who had high exposure to vinyl chloride monomer (Telemedecine Week 2004). Use PVC production generates concern in its own right; however, PVC resin alone is not very useful; additives and stabilizers are added to the plastic during the production process (compounding) to create the desired properties. PVC end-products are commonly comprised of only about 70% PVC resin, and sometimes as little as 35% or 40% (Malin and Wilson 1994). These additives create additional health risks and contribute to the risks associated with the middle stage of PVC's lifecycle. The most common additives are plasticizers, chemicals used to give PVC its flexibility. Plasticizers reduce PVC's inherent (chlorine-based) fire resistance, making it necessary to add fire-retardants as well (Malin and Wilson 1994). Stabilizers are added to PVC to reduce degradation caused primarily from heat or ultraviolet light (Malin and Wilson 1994). Heavy metals, such as cadmium and lead, have traditionally been used as PVC stabilizers. While their use has been declining in the U.S., there are some applications where alternative materials are either not available or not preferable. In recent years, 30 imported vinyl products, including children's lunchboxes and miniblinds, have been found to contain potentially hazardous levels of lead. The plasticizers or added stabilizers can leach, causing brittleness, or outgas, from the PVC, thus inhibiting performance and risking contamination (particularly of concern when used in medical products). In current PVC debates, because of additive and stabilizer concerns, the use stage of PVC has emerged as much more controversial than the production stage, especially within the health care branch of the movement. Phthalates are the most common plasticizer and are used in the manufacture of household, consumer, and medical products. Phthalates are a family of industrial chemicals used as softeners in PVC plastic (toys, vinyl shower curtains, car seats, wallpaper, etc.) and as solvents in cosmetics and other products (www.hcwh.org). Phthalates have been linked to birth defects, organ damage, infertility, cancer, and liver, lung, and kidney damage (Ecologist 2003). The most used, studied, and politicized, phthalate is di(2-ethylhexyl) phthalate (DEHP). 18 DEHP is added to medical devices, including intravenous (IV) bags, tubing, and catheters to soften the PVC and make the plastic more pliable. Plasticizers are not covalently bound to the polymer and factors such as temperature, pressure, storage time, contact with fluids, and flow rates can influence the leakage ofDEHP from PVC into fluids such as blood and saline solution (Danschutter et al. 2007). Since DEHP is not chemically bound to PVC, concerns of leakage from intravenous and other medical bags and devices surround its use. DEHP is the only plasticizer approved by the FDA for medical use (Danschutter et al. 2007). DEHP is a reproductive toxicant, and animal studies have linked DEHP with reproductive and developmental toxicity (Shea and Committee on Public Health 2003). The most vulnerable populations include infants and toddlers, particularly males, pregnant and lactating women, and patients undergoing certain medical procedures. According to the Department of Health & Human Services, Food and Drug Administration (2002), the male fetus, male neonate, and peripubertal males appear to be the highest-risk groups of 18 DEHP is a colorless oil used in high concentrations (20% to 50%) in medical devices to soften PVC (Danschutter et a1. 2007). 31 patients. 19 Animal studies indicate that DEHP may adversely affect male reproductive tract development, particularly the developing testes (Shaner and Botter 2003).1° Male neonates treated in neonatal intensive care units (NICUs) are especially at risk for reproductive development problems. They may spend several weeks or more in an NICU, where they absorb high doses ofDEHP via ingestion, intravenous, and dermal absorption (Calafat et al. 2004). Because risk to humans must be extrapolated from animal studies, DEHP has emerged as one of main controversies surrounding PVC's use within the medical community (Shea and Committee on Public Health 2003). There may be additional reasons for concern. A 2007 study in a pediatrics intensive care unit suggested that there may be a relationship between DEHP plasticized PVC intravenous tubing sets and deep venous thrombosis (DVT), a rare, but potentially dangerous medical condition in children (Danschutter et al. 2007). The researchers' experiments "strongly suggest" that an appreciable number of patients, both in the pediatric intensive care unit and throughout the hospital, to be intravenously injected with DEHP plasticized particles. These same researchers observe, "It is also remarkable that since plasticized products became ubiquitous in the developed world, asthma and allergies evolved to the status of major health problems. Evidence now reveals that, besides lifestyle and demographic factors, asthma and certain allergies can reflect a biological response to phthalates and especially DEHP" (p. e751). Disposal At the end of its lifecycle, PVC is dumped into a landfill, incinerated or otherwise burned, or recycled. PVC products that wind up in landfills contribute to the contamination of groundwater through the leaching of toxic fluids. Communities may be harmed not only by PVC contamination of groundwater, soil, aquifers, and wells, but also 19 The Department of Health & Human Services lists the following as posing the highest risk of exposure to DEHP: exchange transfusion in neonates, extracorporeal membrane oxygenation (ECMO) in neonates, total Parenteral Nutrition in neonates (with lipids in PVC bag), multiple procedures in sickneonates (high cumulative exposure), hemodialsysis in peripubertal males, hemodialysis in pregnant or lactating women, entemal nutrition in neonates and adults, heart transplantation or coronary artery bypass graft surgery, massive infusion of blood into a trauma patient, and transfusion in adults undergoing ECMO (2002). 20 In Europe, where the use ofphthalates is more controversial, the market for DEHP has fallen since 2000 (Waldman 2005). 32 by the emission of toxics into the atmosphere. The most notable of the numerous health and environmental problems associated with PVC disposal is dioxin, released through the burning of PVC products. As previously indicated, dioxin is not safe at any level, "disrupting biological reproduction, development, and immunity" even at miniscule exposures (Hoffman 2003:135). The EPA has determined that incineration of municipal and medical wastes are the dominant known sources of dioxin in the United States (Thornton 2000). In addition to dioxin, other additives, including lead are also released. Lead cannot be destroyed by incineration, leading Thornton to conclude that vinyl is a major cause oflead pollution (Thornton 2000). Beyond what is purposively incinerated, one of the major PVC controversies concerns how much PVC is burned and its potential toxicity. In particular, disputes center around the frequency and toxicity of open or backyard burning and landfill fires. These conflicts and their significance are discussed in greater detail in Chapter 5, Building Political Opposition to PVC: Case Study, Green Building and Pvc. As an occupational group, firefighters likely face the most significant occupational hazards as a result of the predominance of PVC in construction and the household, and the well-documented risks associated with burning it. Any fire may be potentially dangerous to firefighters; however, exposure to carcinogenic chemicals increases the risk of various cancers, respiratory problems, and other health concerns. At low temperatures, even before PVC ignites, it releases deadly gases, such as hydrogen chloride. As reported in Environmental Building News (1994), "No one disputes that hydrochloric acid and a wide range of other toxics are released when PVC burns. Just how much hydrochloric acid humans can breathe without injury is hotly debated, however" (Malin and Wilson 1994). At high temperatures, benzene, toluene, formaldehyde, chloroform, chlorinated biphenyls, dioxins and dibenzofurans are released (Wallace 1990: 12). According to Deborah Wallace (1990), author of In the Mouth ofthe Dragon: Toxic Fires in the Age ofPlastics, the emission of carcinogens appear to explain the high frequencies of leukemia, laryngeal, colon, and soft tissue cancers diagnosed in many young firefighters. 33 The widespread use of synthetic plastics and PVC in building materials and interior furnishings contributes to hotter burning fires and denser smoke (Giarrizzo 1990). According to Giarrizzo, there are 43 known or suspected carcinogens in smoke from synthetic plastic alone. Many of these hazardous chemicals remain at fire scenes even after a fire has been extinguished and the area has cooled (Winney 1996). Firefighters may inhale, absorb, and ingest carcinogenic agents. Their gear may inefficiently protect them from exposure, particularly to hazardous materials. The expense of special suits designed for toxic chemical spills prohibits many municipalities from providing them for their firefighters. Moreover, anyone (or anything) who comes in contact with the gear worn by firefighters becomes exposed to these toxics, creating cross-contamination. Recycling PVC is difficult, or even impossible according to some opponents. PVC opponents argue that recycling poses additional end-of-life health and environmental concerns. PVC bums at much lower temperatures than other commonly recycled plastics (particularly polyethylene terephthalate [PET]), often ruining recycling batches and risking equipment damage (Malin and Wilson 1994). The additives used in different combinations for various applications also complicate PVC recycling. For this reason, recycled PVC products may be more accurately called 'downcycled' products, since the new PVC product is always oflower quality than the original material (Thornton 2000). Thornton thus surmises that "downcycling does not reduce the amount of PVC produced each year or the total quantity of PVC building up on the planet" (p. 316). Contemporary Position of Government Agencies "Improving the health and well-being ofAmerica" (U.S. Department of Health & Human Services slogan) Despite a growing body of evidence, including some of their own reports, the response of the federal government agencies has been to issue warnings, resolutions, and public health notifications. While many of these suggest and encourage avoidance of certain PVC products or the development of alternative products, none of these require change; they only encourage voluntary compliance for manufacturers and hospitals. Multiple factors influence the decisions and actions taken by government agencies; 34 budget uncertainty, agenda changes based on who is in office, and stakeholder pressure to name a few. Of key concern to occupational and environmental health advocates is well-funded, organized industry opposition to their issues. The role of the state is to regulate; however, industry and economic influences over state decisions have serious health and environmental consequences. In their discussion of the political economy of the work environment, Levenstein and Tuminaro (1997) point out that "limits to regulation are imposed ... by the imperatives of the capitalist firm," adding that it is unclear how far those limits can be pushed (p. 14). Part of the problem is also the compartmentalization and fragmentation of government oversight. There are numerous federal, state, and local agencies that deal with environmental, occupational, and public health protection, regulation, and enforcement. And within these there may be multiple separate and distinct bodies or offices responsible for addressing problems that are interrelated, such as water quality, air pollution, and waste management. If just considering federal agencies that address some aspect of PVC production, use, or disposal, at minimum, you would have to include; Occupational Safety and Health Administration, Consumer Products Safety Commission, the Environmental Protection Agency, and the Department of Health and Human Services (including the Agency for Toxic Substances and Disease Registry, and the Food and Drug Administration). In Toxic Deception, Fagin and Lavelle (1994) explain that chemicals are not screened for safety before they go on the market because "for the most part ... the chemical industry was a firmly entrenched economic and political force by the time Congress was moved to do something to protect the public from hazardous compounds in the 1970s" (p. 10). Consequently, industry economic interests were able to greatly influence and weaken environmental protection laws. As an important example, this influence became even further entrenched in law with the passage of the Toxic Substances Control Act in 1976 (TSCA). According to Fagin and Lavelle, in effect TSCA established a policy whereby chemicals were treated as safe until they were are a 'proven' risk and thus allowed to stay on the market. TSAC's language favored industry by requiring that the EPA weigh potential costs to industry against the benefits of its 35 decisions. When combined with the EPA's reliance on chemical manufacturers' studies for data, and allowance for protection of 'trade secrets,' the cards certainly seem stacked against public safety. In the early 1970s, following the establishment of the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health O\JIOSH), and the Environmental Protection Agency (EPA), national awareness regarding public and occupational health and industrial hygiene was high. However, the vinyl industry was vigilant in its efforts to avoid public disclosure ofthe hazards of vinyl chloride (YC). Although evidence suggests these hazards were already well known within the industry by this time, the vinyl industry worked diligently to protect its image and market (see Markowitz and Rosner 2002). The public relations arm of the industry remains at work. The dominant strategy appears to revolve around confronting directed assaults, although during the last two decades, the plastics and chemical industries have mounted several large public campaigns. There appears to be a general lack of public of awareness regarding the hazards ofPYC. However, this is not the case for activists and advocates in the health care community and green building industry. In the next chapter I examine the social movements that have emerged to challenge PYC's use. 36 CHAPTER III PUSHING THE BOUNDARIES OF HEALTH AND SOCIAL MOVEMENT THEORY: THE ANTI-PVC MOVEMENT The anti-PVC movement is a norm-oriented social movement (Smelser 1962) in that concerns are directed towards producing limited, but specific changes such as identifying and using PVC alternatives, rather than seeking value-driven transformative societal change that is more revolutionary in scope. The anti-PVC movement does not adhere to the "prevailing definition of movements as political phenomena [which] has led scholars to focus primarily on a movement's political environment" (Taylor 2000b:221). Instead, as Taylor suggests, we should think in broader terms for understanding how power is exercised and protested in complex societies where the "sites of collective action have expanded beyond the state... " (p. 224). While the anti-PVC movement shares some of the characteristics common to traditional understandings of social movements, such as collective or joint action, change-oriented goals, some degree of organization, temporal continuity, and some extra-institutional collective action and institutional activity (McAdam and Snow 1997), for the most part, the anti-PVC movement is not a 'traditional' protest movement, lacking such hallmarks as direct action, mass mobilization, or even moderate politicallobbying.\ On first glance, the anti-PVC movement may be more appropriately regarded as a "new social movement" as it is dominated by a professional middle-class of 'non-self­ interested actors' (Rose 1997:469). However, New Social Movement (NSM) theorists contend that these movements are a response to new developments in the organization of capital. This characteristic ofNSMs is not shared by the anti-PVC movement, which actually seeks to address concerns about PVC through use ofthe capitalist system (specifically, by promoting market change) rather than pose any direct challenge to the capitalist system itself. Moreover, while the anti-PVC movement is clearly shaped by the 1 The health care industry is more likely than the green building industry to engage in political activity. 37 class position of its participants, the movement cannot accurately be described by New Class theories (see Rose 1997; Scambler and Kelleher 2006) either, in that the anti-PVC movement is not emphasizing the advancement or pursuit of class interests. Instead, the anti-PVC movement should be regarded as a primarily occupationally-driven movement, largely comprised of architects, builders, environmental health activists, nurses, and other healthcare professionals. Calling for the phase-out or elimination of PVC can be understood as major, but specific objectives within other, broader social movements. Issues related to the use of PVC have emerged within the context ofthe green building movement and'also as part of a health social movement. In this sense, there are two main branches ofthe anti-PVC movement.2 These branches share at least two traits that impart an element of distinctiveness to the anti-PVC movement, particularly when they are considered in conjunction with one another. One, anti-PVC activists seek change by working within the health care and green building industries through targeting decision-making leaders, manufacturers, suppliers, and other professionals. Two; the protagonists, individuals and organizations that either support or benefit from the movement in the both branches of the movement are predominately either professionals within these industries or advocacy organizations with strong ties to health care and green building. These two traits are developed in the following sections. Target of the Movement Unlike many other social movements, the anti-PVC movement is not specifically directed at the state or its policies and most ofthose who are involved in the movement do not "conceive of themselves as outside of and opposed to institutions" (Tarrow 1994:25). The involvement of both health care and green building businesses establishes the movement as within the system rather than mobilizing against the system. These organizations do not seek to challenge the political (or economic) system through protest or disruption. Instead, the approach within both the green building and healthcare sector 2 Unless I specify otherwise, when I refer to the ant~PVC movement I am referring to both the healthcare and green building branches of the movement. Similarly, any references to 'the movement' should be understood to mean the anti-PVC movement. 38 is two-fold: promoting market change and education about PVC within their respective industries. With regard to the former, activism by these organizations within the core is primarily aimed at transforming the market via pressure on the consumers, users, sellers, and producers of PVC products, towards the use and production of alternative materials. Part of this emphasis on market change involves dimensions ofwhat Hess (2005) terms technology-oriented and product-oriented movements (TPMs). TPMs "are mobilizations of civil society organizations that generally are also linked to the activity of private-sector firms, for which the target of social change is support for an alternative technology and/or product as well as the policies with which they are associated" (p. 516).3 One strategy of the anti-PVC movement, particularly manifest in the health care industry, is the push for alternatives to DEHP containing PVC IV bags. According to Hess, while TPMs are distinct in their means of social change, they may nonetheless occur in conjunction within broader social movements. Like the anti-PVC movement, TPMs include nonprofit and advocacy organizations, and networks of occupational, research or industrial organizations. The applicability of Hess's conceptualization of TPMs to the anti-PVC movement is strongest in his first of three hypotheses of processes, the "private-sector symbiosis," where a "cooperative relationship emerges between advocacy organizations that support the alternative technologies/products and private­ sector firms that develop and market alternative technologies" (p. 516). As I discuss elsewhere in this chapter, Health Care Without Harm and Catholic Healthcare West formed a cooperative relationship to encourage Baxter, one of the largest medical device producers, to develop a non-PVC IV bag. Baxter initially consented to the challenge but ultimately the company reneged on its commitment. Instead, B. Braun, a much smaller medical supplies producer, met CHW's PVC/DEHP-free IV bag needs. According to Hess's second hypothesis, "incorporation 3 Hess distinguishes 'technology' from 'products' with the former meaning "material objects that are intentionally used to modify the social and/or material world" and the latter defined as "capital or consumer goods that are sold in markets" (p. 518). In my application ofHess's TPMs to the anti-PVC movement, I am largely concerned with PVC products rather than techndogies as that reflects the primary concerns of those in the movement. 39 and transformation," typically, established industries will tend to subsume the innovations of the TPMs, redesigning the technologies and products such that they are "more consistent with existing technologies and with corporate profitability concerns" (p. 516). Predictably, when they could no longer afford to ignore the demand for alternatives, the two largest medical supply producers, Baxter and Hospira, introduced their own lines ofPVC/DEHP free IV lines. However, incorporation and transformation is ofless concern to the anti-PVC movement than Hess found to be the case for other social movements. Activists are not mounting epistemic challenges to medical knowledge; however, as the movement to green health care develops, it is possible that market battles that play out among medical suppliers will influence the direction of the movement. Within green building, it is feared that the vinyl industry has coopted not the innovations of the TPM current of the anti-PVC movement, but taken their argument about PVC environmental and health safety concerns and flipped it to argue precisely for the "greenness" of the product. In other words, the vinyl industry maintains that vinyl products are environmentally friendly and there is no need to develop alternative products to them. According to Hess's third hypothesis of "object conflicts," product diversification follows the process of incorporation and transformation, leading to conflicts among various movement stakeholders. Hess states, "the design choices between different variations of similar objects [e.g., PVC IV bags or other PVC products] become sites for conflict among the range of organizational and individual actors that develop from SMs to established industries" (p. 520). The PVC free lines produced and marketed by both Baxter and Hospira are limited; thus object conflicts have not yet emerged as central to the PVC debates in health care. Both companies have not fully committing to phasing out PVC medical products. They continue to produce PVC IV bags, rather than coopting the design ofB. Braun's product line. Instead, they produce a niche product to respond to the anti-PVC movement's successful demands for a market shift. Within green building, there is tremendous debate regarding which materials (if any) have been established as safe and would serve as acceptable alternatives to the PVC materials 40 currently used in building construction and design. Disputes have been especially contentious with regard to a possible PVC avoidance credit in green construction through the U.S. Green Building Council's green rating system, as will be discussed in detail in chapter six. Educational objectives serve as the second target of the movement. The focus of the anti-PVC movement is not on generating broad public awareness or recruiting members, rather it is to share information among green builders and healthcare workers. Reflecting the professional or class status of the movement participants, activists work to convince others in their field of the ecological or health importance and cost of deselecting or not using PVC.4 Hence, the protagonists and adherents in the green building and health care branches of the movement direct their educational efforts primarily within their respective industries. Adherents are most active in the movement and represent the core protagonists (McAdam and Snow 1997). As Rose (1997) noted in his class-cultural theory of social movements, professional middle-class social movements "tend to see change as a process of education about values" (p. 478). This accurately describes anti-PVC green builders who seek to influence other professionals, such as architects and developers to deselect PVC, as well as anti-PVC health care activists who try to persuade and educate nurses, hospitals, and suppliers to either use or offer PVC-free medical devices. The main exception on both accounts is the Center for Environment, Health, and Justice and to a currently less-involved degree, Greenpeace, whose anti-PVC campaigns reach out to a broader base of support. Like some environmental and public health movements, the health beneficiaries of the movement are not the actors themselves, but are an unknown population. As previously stated, certain populations are at greater risk for dioxin contamination, but no individual or community is protected from dioxin exposure. Movement participants are acting on behalf of a perceived threat rather than on behalf of or as part of a particular at­ risk constituency. These 'conscience adherents' (McCarthy and Zald 1977) are supportive of the movement but will not be direct beneficiaries if the movement 4 In health care, the cost between PVC IV bags and non-PVC IV bags are roughly equivalent. In green building, non-PVC materials are substantially more affordable for some applications. 41 succeeds. In the case of intravenous DEHP exposure, anti-PVC health adherents are acting on behalf of those populations most vulnerable to harm; however, such action arises out of a collective concern for these larger groups at risk, rather than out of concern for a specifically known patient population. In other words, no contingency of parents of male neonates, pregnant or lactating women, or others identified as the highest risk groups have emerged either as an exposed group seeking redress or as calling for PVC/DEHP IV phase-outs. Thus, there is no experiential knowledge base from which to draw. As such, the individual beneficiaries of the movement remain largely unknown to the movement adherents. In contrast, it is important to note that those businesses involved in the anti-PVC movement are very likely to be a beneficiary constituency. By being able to promote themselves as "green" (both for builders and healthcare organizations), these organizations and businesses will potentially profit from the positive economic returns associated with favorable press and public opinion. However, not all hospitals and healthcare facilities promote the fact that they have eliminated some PVC products even after they have done so. Moreover, "green" can be, and is, described in various ways by different stakeholders. It is not a certainty that being PVC-free will resonate in importance with the public. If economic interests were the sole motivator for these businesses, it may make more sense for them to advance a "green image" using a less controversial and less elusive environment and health problem, or to wait until the contentiousness of some of the debates had subsided before electing to phase-out PVC. This is not to dismiss the argument that these interest groups are involved for their own self-interest; however, in my asking the question, "Why has PVC become politicized?" I sought to determine the manifest reasons that these organizations gave in addition to latent reasons that might also be true. Actors in the Movement Social movement literature inadequately examines social movements sharing similar characteristics to the anti-PVC movement with regard to movement targets and professionals as protagonists. By 'professionals' I mean members of occupational 42 groups, generally middle-class, characterized by a high level of technical and intellectual expertise, and autonomy in recruitment and discipline (see Friedson 1970, chap. 9). Rose (1997) describes the professional middle class as "distinguished by higher education and broad flexibility in the work process, while still lacking control over the products oflabor" (p. 477). This section addresses the role of professionals as actors in the anti-PVC movement, professionals as scientific and medical activists, and the role of coalitions and advocacy organizations in the movement. Research has been conducted on the professionalization of movements (see McCarthy and Zald 1977; Piven and Cloward 1977; Staggenborg 1988), but less on professionals in movements, excepting those movements theorized within the framework of New Social Movements. This makes sense, of course, given that social movements often emerge to represent those with fewer financial resources and political opportunities. Professionals are more accurately regarded as those in decision-making positions and as part of the dominant power structure, rather than as a disadvantaged group seeking to rectifY an injustice. However, there is increasing activism on the part of professionals, particularly scientists, who have joined as supporters and participants in environmental health and justice struggles. The influence of these "scientific advocates" or "expert­ activists" may have important implications for policymaking, community health, or environmental impacts. Increasing literature on boundary movements, lay-scientific interactions (particularly within the breast cancer movement) and even science-oriented organizations helps to document the collaboration between professionals and lay people, citizen-scientists, or community organizations (see McCormick, Brown, and Zavestoski 2003; Frickell 2004). This research is relevant, but not adequate, for understanding the involvement of 'professional advocates' in the anti-PVC movement. Scholarly examination of 'the professional' is almost exclusively located within the ecological and environmental health science disciplines (Frickell 2004). Focus is primarily on activist scientists challenging the prevailing use or interpretation of science, giving voice to scientists, or assisting or advising community organizations. 43 Scientific and Medical Activism In Frickell' s (2004) examination of scientific activism in the U.S. environmental justice movement, he identifies four science-oriented organization types; environmental boundary organizations, scientific associations, public interest science organizations, and grassroots support organizations. All four have relevance for the anti-PVC movement, particularly public interest science organizations (e.g., Physicians for Social Responsibility) and grassroots support organizations (e.g., Center for Health, Environment, and Justice). However, overall, the anti-PVC movement is comprised ofa wide range of professionals not represented in the scientific activism literature. They may serve similar roles to grassroots support organizations (GSOs) as described by Frickel!. GSOs are staffed by professional activists and volunteers, not professional scientists, and connect citizens' groups to the broader movement infrastructure. However, unlike GSOs, the anti-PVC protagonists' goals are not about contesting the credibility of industry and government claims over "maintaining the credibility of science" or addressing the "extreme imbalances of power" (p. 462). In fact, many of the professionals in the anti-PVC movement do not overtly challenge government claims or attend to the hierarchy of power relations between those most at risk from PVC related environmental health threats, themselves, and government or industry. The involvement of scientists varies from organization to organization within the anti-PVC movement, but nonetheless tends to follow the pattern Frickell (2004) describes as "intermittent and tailored to specific context-dependent task[s]" (p. 463). Generally, these contributions have included writing or technical assistance for reports and/or submitting comments (such as for the United States Green Building Council) or providing technical advisement at roundtables or conference presentations (e.g., Health Care Without Harm, Oregon Center for Environmental Health). Frickell's research is an important starting point for understanding scientific professional activism, but with its focus on scientists only, it is limited in its ability to explain the professional activism of those non-scientists who are also distinguished by professional credibility, technical skills, and expert knowledge. 44 Other writers have looked more specifically at the role of healthcare professionals as public health advocates. The medical profession has a varied and at times contradictory history in terms of working for the public good (see Stevens 2001). At least in terms of the contributions of the health care community, McCally's (2002) examination of medical activism is more directly relevant to the anti-PVC movement. According to McCally, physicians, like other scientists engaged in environmental health debates, use their expertise to respond to scientific uncertainty surrounding policy questions. For example, in recent years, physician activists have participated in debates regarding precautionary principle development. The precautionary principle "requires that when potential of harm is present, but the evidence is incomplete, public policy ought to err on the side of caution-do no harm" (p. 152).5 However, such activism is limited, often viewed with suspicion by the professional mainstream, and not encouraged within the institution. Undergraduate and graduate level medical students are exposed to very few examples of medical activism. Student chapters of national medical organizations are a rare exception, but social responsibility, environmental health, and medical activism are generally neglected from the medical school literature, curriculum, and priorities of medical associations (McCally 2002). Further, much of physician activism is motivated by self-interest and consequently fails to produce solidarity with other social movements or other groups on larger social, human rights, or environment issues (p. 153). Despite these barriers, activist physicians do regularly engage in environment, peace, health care reform, and human rights movements (p. 149). Physicians have been involved directly in the anti-PVC campaign, most notably as members of Physicians for Social Responsibility (PSR) and Health Care Without Harm (HCWH). For example, McCally is the current Executive Director for PSR, having served as President in 2004, and on the Board of Directors for many years. He is also active in the American Public Health Association, one ofthe first medical societies to take a position on PVC in 5 Widespread adoption of the precautionary principle by U.S. environmentalists, academics, and some policymakers followed from a small conference in 1998 at Wingspread, the Johnson Foundation's conference center in Racine, Wisconsin (Myers 2006). 45 medicine. In the mid-1990s, as an activist with PSR, McCally worked with public health advocate and physician of occupational medicine Peter Orris, and Greenpeace activists Joe Thornton and Jack Weinberg to write the first Public Health Reports article about PVC's role in medical waste incinerators, the effect on human health, and the call for the public health community to reduce the use of vinyl (interview, Thornton). Not all the activists in the anti-PVC movement are professionals, but with few, albeit important exceptions, the individuals who work for core organizations in the movement are. Many of the movement protagonists who are not distinguished by their professional status, per se, nonetheless work with professionals. There are also participants in the movement such as Bill Walsh, the founder and national coordinator for the Healthy Building Network, who have atypical professional backgrounds for their current occupation. Despite the focus of his work, Walsh's background is not in building or architecture, but rather as a licensed attorney. The Center for Health, Environment, and Justice (CHEJ) represents the most important exception to this categorization. CHEJ exhibits membership traits common to traditional social movement organizations, whereby members are recruited (in this case, outside of the healthcare or green building industries). Finally, the actors in the anti-PVC movement are a coalition of professionals, labor unions, and environmental health activists. Instead of a contentious relationship among these groups, they have come together, largely under the leadership of Health Care Without Harm (HCWH), to address the PVC issue in the health care industry. In turn, HCWH interacts with other core organizations, including those representing green building interests. A cooperative arrangement allows different stakeholders to stay informed of each other's concerns and activities and to coordinate efforts when necessary or desired. As Orbach (1999) has noted, a coalition between organized labor and the environmental movement, two of the most powerful social movement sectors in the United States, has the potential to "present a strong force in favor of a just and ecologically sustainable economy" (p. 46). 46 As an example, in California, an alliance of unions, environmental organizations, and public interests groups joined together to form the Coalition for Safe Building Materials to fight changes in the California Plumbing Code allowing the widespread use ofCPVC (chlorinated PVC) pipes in housing.6 While the coalition was ultimately unsuccessful, the labor/environmental alliance illustrates that commonalities do exist and can be addressed by the groups collaboratively. I argue however that at present, labor's involvement within the movement is growing, but it is still fairly limited. By and large, within labor/environmental/professional coalitions, labor is not doing a great deal of problem framing and strategizing. The movement could be strengthened if efforts to involve labor were increased and if labor were to take on a more involved role in the movement.7 Advocacy Organizations There is a wide and diverse range of stakeholders involved in the politicization of PVC that prevents easy categorization of the different organizations. Represented just within the healthcare and green building branches of the anti-PVC movement are conventional social movement organizations (SMOs), interest groups, business interests, and nonprofit organizations. However, the line between these categories is not easily demarcated. It is not the purpose of this research to compare the varying tactics, strategies, or objectives by organizational type, but to understand how these various groups have come together to politicize PVC. Having said this, it is still useful to describe the different types of advocacy organizations in order to better understand the distinctions among stakeholders. Andrews and Edwards (2004) seek to clarify the differences among advocacy organizations such as interest groups, public interest groups, social movement organizations, and nonprofit organizations involved in the political process. They employ 'advocacy organizations' as a broad umbrella term to describe organizations that "make public interest claims either promoting or resisting social change that, if 6 CPVC is controversial in part because of the extra chlorine required for manufacture. 7 Any interactions between labor and managerial representatives are issue and situation specific and are not meant to comment on greater worker/employer relations. 47 implemented, would conflict with the social, cultural, political, or economic interests or values of other constituencies or groups" (p. 481). Interest groups are defined broadly as "voluntary associations independent of the political system that attempt to influence the government," whereas public interest groups seek "a collective good, the achievement of which will not selectively and materially benefit the membership or activists of the organization" (p. 481). Businesses and associations can be characterized as interest groups, although Andrews and Edwards' definition should be expanded to include action that attempts to influence important non-governmental entities as well. SMOs are a bit trickier to define as evidenced in numerous debates among social movement scholars regarding participation, membership, level of institutionalization, tactics, identity, moral and ideological claims, organization form, and goals (p. 482-483). Della Porta and Diani (1999) define social movements as "informal networks based on shared beliefs and solidarity which mobilize around conflictual issues and deploy frequent and varying forms ofprotest" (p.16). And finally, the anti-PVC movement is also comprised of nonprofit organizations. Referring specifically to advocacy nonprofit organizations, 0 'Neill (1989) defines these groups as "primarily involved with lobbying or disseminating information directed toward broad societal objectives or collective goods rather than outcomes of benefit to their own members" (p. 10 cited in Andrews and Edwards 2004:484). The broadness of this definition indicates overlap between nonprofits and SMOs; however, nonprofit organizations can further be differentiated by their 501(c)(3) tax status, which prevents them from participating in political campaigns and restricts their lobbying activities. The various stakeholders involved in the PVC debates are representative of a range of advocacy organizations. However, in the sense that all of these are 'organizations,' this term is used throughout this dissertation to refer to the collective of groups involved in the anti-PVC movement. When referring to activists and participants on all sides of the debates, including vinyl industry interests, the term 'stakeholders' is used instead. My point is not to dismiss the importance of understanding the different characteristics of these organizations; thus, where necessary, these groups are further 48 differentiated by their status as businesses, interest groups, public interest groups, SMOs, and nonprofits. 8 A further distinction lies in the movements 'participants' and 'activists.' All individuals and organizations involved in the anti-PVC movement are participants, but not all are activists. For example, Keith Callahan, Catholic Healthcare West's vice president for supply chain management is a participant, whereas Mike Schade, Coordinator ofCHEJ's PVC Campaign is an activist. Health Social Movements The anti-PVC movement has branches within both green building and the healthcare industry. This section explores the anti-PVC movement within the healthcare industry. Over the last several decades health social movements have been primarily concerned with problems of patient care including: access to and quality of healthcare, health inequalities based on race, ethnicity, gender, class and/or sexuality, disability, research funding concerns, disease or illness experience, and contested illnesses (Brown et al. 2004; Kolker 2004). Important research has documented citizens taking "their health care into their own hands" (Morgen 2002, see also Bullard 1994, Epstein 1996). Public interest and concern with healthcare access in particular has been fairly well reported in the media, but few scholars have devoted much attention to health social movements (HSMs) (Keefe et al. 2006). Moreover, according to Brown et al. (2004), "researchers studying HSMs typically have not adopted social movement perspectives; in fact, much of the research on HSMs has not been conducted by sociologists" (p. 52). As health social movement scholars, Phil Brown and colleagues' (2004) work on HSMs is applicable here. Brown et al. (2004) build on Della Porta and Diani's (1999) definition of social movements to define HSMs as "collective challenges to medical policy, public health policy and politics, belief systems, research and practice that include an array offormal and informal organizations, supporters, networks of cooperation, and media" (p. 679). They hold that HSMs challenge political power, professional authority, and personal collective identity (Brown et al. 2004). Keefe, Lane, and Swarts (2006) add that HSMs are comprised of those affected by the issue and whose actions challenge the 8 Please see Appendix A: Methods for a listing of where core organizations fall categorically. 49 scientific and medical establishments. By emphasizing 'personal collective identity' and 'those affected,' both of these definitions suggest that what medical sociologists refer to as the 'illness experience' is central for the key actors involved in HSMs. However, as I discuss in the previous section, my intent is to expand that conception of HSM stakeholders to include those participants who are not necessarily directly impacted by the issue they are contesting, but who have elected to mobilize around a certain issue, in this case, contesting the use of PVC. Brown et al. (2004) divide HSMs into three categories: health access movements, constituency-based movements, and embodied health movements. Health access movements are self-explanatory; these are movements seeking equitable access to healthcare and improved healthcare services. Constituency-based health movements seek to redress the inequalities within the healthcare system based on race, ethnicity, disability, gender, class and/or sexuality. Embodied health movements "address disease, disability, or illness experience by challenging science on etiology, diagnosis, treatment, and prevention" (p. 52). As ideal types, some movements may share characteristics of more than one category within Brown et aI.' s typology. As an example, the environmental justice movement overlaps between the constituency and embodied health movements with its focus on the disproportionate burden ofpolluting facilities in communities of color and the illnesses that may arise from exposure (p. 53). By framing their organizing efforts and critique of the system through their personal awareness and illness experience, environmental justice (EJ) activists exhibit what Brown et al. consider key about the embodied nature ofthis movement. Additionally, EJ activists seek to address "disproportionate outcomes and oversight by the scientific community and/or weak science" (p. 53). Thus the EJ movement also has similarities with constituency-based health movements. The Public Interest Health Movement Lacking from Brown et al. 's (2004) typology is a fourth ideal type that would include the characteristics of the anti-PVC movement, particularly as it manifests within 50 the healthcare community. Like the £J movement, the anti-PVC movement shares some characteristics of more than one HSM ideal type; however, it does not sufficiently resemble any of the three categories within the typology to be regarded as a good fit. While Brown et al.'s definition ofHSMs is inclusive enough to encompass the anti-PVC movement, their typology presumes social movement action is taken on behalf of or by a specific constituency, such as a particular demographic group, or a group characterized by their relationship to or with a particular illness, disability, or disease. In large part, Brown et al. 's categories can be regarded as primarily addressing the concerns of patients or potential patient populations by organizations and activists outside of the healthcare industry. While this is not always the case, particularly in embodied health movements (e.g., scientists working with breast cancer activists), the objectives of these movements tend not to either originate or be promoted (or both) within and by the healthcare community. Such an interpretation does not adequately encompass activism or mobilization among healthcare workers and organizations nor does it accommodate those movements that combine labor and/or union interests with public health and patient concerns. There is no clear category for activists within the healthcare industry and their allies seeking to green the profession and medical facilities. A fourth ideal type, Public Interest Health Movement (PIHM) would recognize the intersection between labor, public health, and the environment. Like HSMs, scholars have largely neglected those medical social movements comprised solely of physicians and their organizations and associations as well (McCally 2002). Creation of a fourth category establishes a way to differentiate those movements comprised of both health and medical organizations. This is not a new movement; but it is one that is absent from Brown et al.'s typology. McCally (2002) and others have commented that today's environmental health movement "draws on older public health concepts of sanitation and population health and newer notions of ecosystem health" (p. 146). As indicated in chapter two, the history of public health has long, if inconsistently, attended to the link between the environment and public health concerns. As progressive healthcare organizations and facilities move towards what they regard as environmental 51 sustainability, this may be a return to addressing some of these earlier concerns while at the same time broadening the scope. PVC can be regarded as just one aspect of this trend within healthcare, which also includes efforts towards improving food health, greening facilities, mercury elimination, environmentally-preferred purchasing, and green chemical policies. A public interest health movement thus emerges in response to the pressing issues of the day and as a result, there is no constant designated constituency. Unlike other HSMs, PIHMs are not trying to redefine a personal trouble into a public issue. Members of the movement and their allies are predominately within the industry and not directly affected. Ifwe compare this ideal type with Brown et al. 's (2004) typology, it becomes evident that a fourth category is warranted. There are four characteristics that distinguish PIHMs from other HSM's; '1) their relation to the problem, 2) their power to address the problem, 3), they work within the system; and 4) they address type three (see chapter one) contested illnesses that have diffuse or hard to establish causes. Individually, not all SMOs, interest groups, or nonprofits involved in the PVC debates meet these criteria; however, collectively they form the basis of what a PIHM would look like. Examining the characteristics of PIHMs furthers our understanding of how these characteristics come together to shape PVC framing concerns and the politicization of PVC. Below I discuss each of the four characteristics ofPIHMs in detail, using PVC to illustrate. However, as an ideal type, these traits can apply to other politicized environmental health or healthcare related concerns as well. Relation to the Problem By relation to the problem, I mean the movement participant's position in the class structure and their relationship to the means of production. Unlike many activists represented in Brown et aI's (2004) typology, those in fue anti-PVC movement in healthcare are professionals within the industry rather than private citizens. This also includes businesses in the anti-PVC movement (i.e. Kaiser Permanente and Catholic Healthcare West) that have been highly effective in their efforts to deselect PVC. The organizations involved in the movement do not represent workers employed in the 52 manufacturing or production aspects of vinyl chloride and PVC products. This 'separation' from the means of production introduces an element of detachment and alienation for the majority of the movement's participants. While the anti-PVC movement is occupationally driven, concerns about PVC are predominately directed at the use stage. Problems are framed in terms of consumption, rather than in terms of occupational health and safety. In PIHMs, since the movement participants are not materially dependent upon the particular forms of production practices for these items of consumption-whether they are intravenous bags made of PVC or mercury thermometers-they are uninhibited from challenging the continued use of these products. In this sense, there are no real economic risks for PIHM participants. No evidence indicates that attempts by nurses or other health care professionals to influence purchasing decisions has led to any form of disciplinary action. Similarly, those involved do not directly represent those affected or perceive themselves at risk. Thus, PIHMs do not necessarily share the same sense of urgency as EHM activists who may be ill or have limited access to health services (Brown et al. 2004). Just as the movement is influenced by PIHM participants' relation to the means of production, their class position as professionals and white collar workers is reflected in organizational values, decision-making, tactics, and goals. For example, the decision making of the Oregon Center for Environmental Health, a Portland-based nonprofit organization "dedicated to reducing and eliminating toxic chemicals," is influenced by a Board of Directors comprised of all professionals-ranging from a chemical engineer, to a marketer, to lawyers, and professors specializing in public health and air toxics. Large health care systems are able to pressure medical supply companies to provide PVC alternatives under the rubric of environmental health and patient safety, but production concerns are not emphasized in their framing of the problems. In my interview with a representative with B. Braun, a major producer ofPVC/DEHP free IV bags, I asked if the company had a problem with how PVC was manufactured. The interviewee responded, "It wasn't manufacturing, it was more of the clinical issues with patients and a secondary to that, the environment." Concerns for PVC production workers are largely off the radar 53 of many in the current movement and are thus not reflected in their decision-making, framing ofthe problems, or goals. Much of the research on medical professionals focuses on physicians and the American Medical Association or other specialists and their societies, rather than nurses or professional nursing associations (Stevens 2001; Light 2000). While the PIHM accommodates activism among physicians, it explicitly incorporates space for activism among non-physicians and activists in non-authority positions. While health professionals are the core ofthe PIHM, a PIHM includes coalitions with unions, public interest groups, and health-based occupational groups. Coalition formation with organizations with non-professionals and organizations with different relation to the means of production may occur. PIHMs benefit from the involvement of allies, who at times may even serve as leaders in the movement, as is the case with the anti-PVC movement and HCWH. However, PIHM allies work with those receptive members of the healthcare industry rather than directing their efforts to challenging those resistant to change.9 Medical and healthcare professionals may network with other organizations outside of the industry, but generally, those other organizations are not integral to the movement within the healthcare industry. Power to Address the Problem The occupational status of those involved in the movement lends credibility, legitimacy, and a 'professional voice' to PIHMs. Doctors and nurses consistently rank among the top most prestigious occupations in public opinion polls (Harris Interactive 2006). Professional organizations' fundraising and mobilization of resources falls along different patterns than may be experienced by other SMOs. In part, because many of the stakeholders are healthcare facilities or businesses, financial constraints are less of an issue. However, while this is an asset to PIHMs, it may also impede movement growth. Individuals who are not part ofthe established movement may have trouble accessing some of the information whether due to high conference costs or due to limited access to information, as in the case of member-only websites. Also, because these groups tend to 9 This is not to imply that there are no challenges for activists with these relationships. 54 work within the system, they may be able to secure funding from sources that more confrontational or controversial groups would not be able to access. 10 As an example, the Oregon Center for Environmental Health (OCEH), receives U.S. Environmental Protection Agency support and funding for select OCEH programs. Social movement theorist Diani (2000) states, "Collective action requires long term commitments and the willingness to engage in projects which rely upon the contribution of all the parties involved for their success" (p. 391). In other words, social movements succeed in part because of the 'staying power' of their participants. Thus, because those organizations most involved are institutionalized within the political and economic system, they are unlikely to dissolve when goals are reached. Earl and Schussman (2003) point to two advantages of organizational longevity for social movement organizations (SMOs): "the ability of SMOs to employ activists, thus ensuring the livelihood of professional activists, and the ability of SMOs to retain organizational experience and learning" (p. 179). The core anti-PVC organizations are firmly established with a range of founding dates from 1945 (Kaiser Permanente) to 2000 (the Healthy Building Network).ll The power to address the problem is also evinced by the fact that PVC concerns have largely become institutionalized values, adopted by major health care systems. While there are challenges within the health care system to phasing out PVC, much ofthe resistance to doing so does not come from health care providers, but from interests outside the industry. The early leaders in the anti-PVC movement established a framework for addressing health and environmental concerns, thus positioning the movement to progress as well as broaden to include associated or similar concerns. Coalition formation and networking has helped root the movement within the health care community, For example, Hospitals for a Healthy Environment (H2E), a not-for-profit 10 In the anti-PVC movement, CHEJ is an exception, seeking membership dues fom both individuals and organizations. However, while CHEJ is allied with the healthcare branch of the anti-PVC movement, it is not part of it. 11 Founding dates for the rest: Center for Health, Environment, and Justice: 1981 (then called Citizens Clearinghouse for Hazardous Waste), Vinyl Institute: 1982, Catholic Healthcare West: 1986, Health Care Without Harm: 1996, and the U.S. Green Building Council: 1993. 55 organization "creating a national movement for environmental sustainability in health care" was jointly founded by the American Nurses Association, the American Hospital Association, the Environmental Protection Agency, and Health Care Without Harm. H2e now has almost 1,400 partners representing over 7,50 health care facilities (www.h2e­ online.org). While H2E's objectives are far-reaching, because of the high percentage of PVC used in health care the organization specifically targets dioxin elimination. Given the size and composition of the organization, H2E illustrates how efforts at phasing out PVC in the health care industry have become embedded and institutionalized within the industry. Working Within the System PIHMs seek to change the system from within rather than trying to challenge and push for change from outside the system. Participants in the anti-PVC movement are healthcare professionals and businesses within the industry pursuing a market driven movement rather than a policy change movement, although such an objective remains a possibility. A range of participants have coalesced around an expressed concern related to health care and environmental stewardship. In this regard, PIHMs are quite different from Brown et aI's (2004) HSM categories. As noted in the H2E example, the organization perceives itself explicitly as contributing to a national social movement. The types of organizations that H2E partner with are extensive and include: health care facilities, health systems, group purchasing organizations (GPOs), health care professional or trade associations, vendors, manufacturers, consultants, and other service providers, local, state or regional environmental agencies, and member or community­ based organizations working with health care facilities. By targeting professionals and working within the health care system, H2E typifies the PIHM ideal type. Reform movements that work within the system may seem contrary to the notion of more radical social movements which are limited in their institutional access. The professional legitimacy and authority of those involved and even their size, as in the case of organizations such as Kaiser Permanente or Catholic Healthcare West, potentially translates into significant power to regulate PVC and/or the power to influence the 56 market. There may be little direct action, but direct action is often unnecessary. PIHMs adopt less traditional but more reformist approaches to action. Monopsonistic, or more accurately oligopsonistic, purchasing power enabled Kaiser Permanente to pressure Collins and Aikman (C&A) one of the nation's largest manufacturers of PVC-backed carpet to develop an entirely new line of PVC-free carpet. As one activist in the industry described Kaiser's market power: ... they've done a ton of work just trying to figure out what's in the product that they buy. They'll send very extensive questionnaires to vendors asking them 'what's in the products they are buying, how are they manufactured, how are they disposed of?' a whole series of questions that many of these vendors have never even thought about before. 'What do you mean you want to know all this stuff? We don't know.' Kaiser will write them back and say well, you have to find out if you want to do business with us. In 2005, Catholic Healthcare West (CHW) awarded a $70 million contract to B. Braun Medical Inc. for supplying its hospitals with PVC-free and DEHP-free intravenous (IV) bags, solutions, and tubing. CHW's previous contract had been with Baxter, a global medical supply company and the largest manufacturer onv lines in the United States. CHW and HCWH had approached Baxter in 1998 or 1999 requesting development of a PVC-free IV bag; however Baxter failed to follow through. According to Sister Mary Ellen Leciejewski, CHW's Ecology Program Coordinator, "things kept getting pushed back and pushed back and things weren't happening." As CHW's Kathy Kudzia, Director of Supply Chain Management, explains, "I think that was the message we sent to Baxter. We had gone out there, Sister Mary Ellen, myself and really kind of laid it on the line for them that as an organization if they didn't have products available on the market ready to go by February of2006 then we would make the change." Baxter ultimately addressed CHW's demands in April 2006, when the company introduced AVIVA, a non-PVC and non-DEHP IV solutions line available on a limited basis to pilot center sites. In a churlish telephone conversation with a Baxter representative, I stated I was researching trends in medicine and asked if the product line was developed to meet market demand for non-DEHP IV bags. In contrast to a B. Braun representative, the Baxter representative did not agree that the move towards a PVC-free and DEHP-free IV line was a trend and was quite resistant to acknowledging health 57 concerns associated with DEHP. Clearly, there remains disagreement within the industry regarding the health risks associated with PVC and DEHP. However, should the majority of hospitals and healthcare facilities move away from PVC devices, manufacturers that do not respond to market demands may suffer economically. Additionally, these companies jeopardize their reputations if they concede DEHP leakage occurs and is harmful, yet they continue to produce and sell a PVC IV line plasticized with DEHP. Thus, when professionals and healthcare organizations 'work within the system,' the relation to production must be considered. However, as in the case with Baxter, while not all in the health care industry are part ofthe anti-PVC movement, they still must compete economically. Even if these companies do not accept that there are problems with PVC, if they wish to remain viable, they still eventually respond, as Baxter did with AVIVA. PIHMs also work within the system because they accept the legitimacy of the state and do not overtly challenge state authority. As professionals, many of them are likely to see government officials and bureaucrats as their colleagues. They do not take issue with the state's role as a protector of economic interests. As expressed by many interviewees and advocated throughout healthcare literature and promotional material, the development and use of alternatives to PVC are regarded as the primary solution to the problems associated with PVC. The anti-PVC movement focuses largely on the use stage of the PVC lifecyc1e, particularly in health care where the primary concern is DEHP leakage. There is nothing inherent in the movement's framing that proposes major political modification, such as greater regulation of chemicals, or challenges to economic growth. As a movement that relies on the market for social change, challenges to the economic system are not expected. 12 While representatives of some organizations I interviewed expressed disappointment with different government actions (and inaction) in protecting public health on this issue, they did not respond with any significant challenges to governmental authority. 12 In chapter 7, I discuss this "treadmill of production" in greater detail. 58 In particular, the Food and Drug Administration and the Consumer Product Safety Commission were cited as government agencies that should be more proactive in monitoring and regulation consumer products. Anti-PVC protagonists-particularly unions such as the American Nurses Association (ANA) and the International Fire Fighters Association (IAFF)-do use lobbyists to advocate on behalf of their interests, but this political activity is not likely to include significant attention to PVC concerns. The IAFF also partners with a number of government agencies, including the National Institute of Occupational Safety and Health's National Personal and Protective Technologies Laboratory (NPPTL), the National Aeronautics and Space Administration (NASA), the National Institution of Science and Technology (NIST), as well as the military to investigate fatalities, research fire fighter exposures, test personal protective gear, and transfer military technology to civilian uses. Brown et al. (2004) present HSMs as along a continuum of strategies and agendas. At one end, are direct-action organizations that challenge current scientific and medical paradigms largely from outside the system. At the other end of the continuum are advocacy organizations, such as those predominately found within the anti-PVC movement. These groups are described as "work[ing] within the existing system and biomedical model, us[ing] tactics other than direct, disruptive action (e.g., education), and tend[ing] not to push for lay knowledge to be inserted into expert knowledge systems" (p. 53). This approach is representative ofPIHMs more generally. While their professional positions within the system affects their strategies, as Brown et al. (2004) point out, it also influences the lens through which they approach medical problems. Contested Illness The final PIHM characteristic concerns the contested nature of PIHM health concerns. By this I mean that those issues PIHMs address are environmentally or occupationally-induced and are the subject of scientific, political, or public debate over the cause of the health problem. As described in chapter one, in the third type of contested illness, a link may be recognized between environmental or occupational exposure and a health risk, but the degree (or even if) that exposure leads to harm is 59 greatly contested. The environmental source of the health problem is a known toxic, as in the case ofvinyl chloride, dioxin, or DEHP, but disputes arise because a scientific link has not been definitively established (or if so, the degree that it is harmful remains contested), and/or because of the difficulty in attributing the health problem or illness to a specific toxic source. PVC is particularly open to politicization because health problems are associated with all stages of its lifecycle. Activists and participants involved in PIHMs must decide what solutions they believe are acceptable among interest groups and are achievable. On the other hand, vinyl supporters work to minimize or altogether dismiss the risks associated with PVC. In the case ofDEHP, there is definitive evidence that the phthalate leaches from PVC IV bags (U.S. Food and Drug Administration 2002). However, the controversy centers on what level ofDEHP exposure is harmful for humans and in particular, which patient populations? Dr. Ted Schettler (2006), Science Director of the Science and Environmental Health Network and science advisor for HCWH, asks, "When do we know enough to act to protect people from unnecessary and potentially harmful exposures?" (p. 9). With contested illnesses and health problems, different sides of the debates often employ the same research or government reports to bolster their own position. For example, while PVC opponents point to what they consider an overwhelming amount of evidence of DEHP' s toxicity and associated harm, PVC supporters argue that evidence on the deleterious effects of DEHP is inconclusive in humans. Further, in a case of backward logic, PVC supporters point to the lack of governmental regulation on PVC products as an obvious confirmation of the safety of the material. A Plastics News (2002) editorial, "Politics Shouldn't Determine PVC's Fate," argued that even though some government studies have found problems with phthalate exposure, "numerous scientific studies and government agencies do not see merit in widespread phasing out of PVC, either to cut down on dioxin emissions or to reduce phthalate exposure" (p. 6). In part, type three contested illnesses remain contested as an outcome of the fragmented approach ofthe biomedical model and the compartmentalization of 60 government regulation due to a multitude of government agencies. For example, phthalates are widely used in consumer products and phthalate exposure is not limited to IV bag leakage. As Schettler (2006) points out, "there is virtually no attempt to look at the bigger picture. The focus is generally on one source or one product at a time" (p. 3). With DEHP, much of the activism in health care is aimed specifically at discontinuing use ofPVC/DEHP IV bags in the NICU, given the known vulnerability of male neonates. Thus, even some movement participants fail to take a holistic or integrated approach to environmental and human health problems associated with PVC use at large. Health care professionals may be motivated to respond to contested health problems as an outcome of training that emphasizes prevention, as is the case for many health care professionals in the anti-PVC movement. However, training may also be an impediment if potential activists are committed to the idea that the authority of science is incontrovertible, where uncertainty then leads to inaction, rather than action. Health care and medical professionals receive little training in environmental and occupational exposure and health. Because all three factors may influence PIHM participants, the tendency may be for these social movements to take a more conservative approach to contested or environmentally-induced illnesses and health problems. In these situations, PIHMs may differ from other HSMs as described by Brown and colleagues (2004) in that they not only address contested illnesses, but how they remain contested. In their approach to contested health problems, many participants in PIHMs are part of what Brown et al. (2004) term the dominant epidemiological paradigm (DEP). The DEP is "the codification of belief about disease and its causation by science, government, and the private sector. It includes established institutions entrusted with the diagnosis, treatment and care of disease sufferers, as well as journals, media, universities, medical philanthropies, and government officials" (Brown et al. 2004 :61). As members of the DEP, many health care professionals are unwilling, or even unable, to challenge the conventional approach to medicine or the basic assumptions of modern science. In this sense, PIHMs are unlikely to take on the most controversial and politicized 61 environmentally-induced illnesses. Or, at the very least, they will not do so until enough research has been generated within the DEP for their comfort level. Summary The interrelation of these four characteristics-relation to problem, power to address the problem, working within system, and contested illness-serves to engender a particular type of HSM that has not previously been identified in the literature. Emerging public health movements may be a return to historical roots of medicine where occupational and public health concerns played a larger role in medicine's approach to prevention and healing. As a PIHM, the anti-PVC movement goes beyond traditional notions of public health, with work taken on by individual 'champions' in hospitals and health care facilities and by industry leaders. PIHMs' emphasis on social change recognizes the intersections among health, occupation, and the environment. However, their approach is largely determined by their class status as professionals and far distanced from PVC production. Approaching health and environmental concerns from within the system may introduce a particular set of challenges or barriers. As possible with all social movements, some within the social movement may hide their self-serving objectives under an umbrella of claims for improving public welfare. Professionals may be reluctant to expand the scope of their involvement either beyond their paid positions or beyond their own profession. Professionals may be unwilling to engage in what McCormick, Brown, and Zavestoski (2003) term 'boundary movements' where the line between experts and laypeople is blurred and one movement crosses into other social movements. Those within the system may have a hard time working with those working outside the system. As an example, Rebecca Berg (2005), editor of the National Environmental Health Association's (NEHA) Journal of Environmental Health, examined some of the tensions between the environmental movement and the environmental health profession. She found that environmentalists tend to perceive, "that environmental health as a profession is neither able nor willing to address controversial manmade threats to human 62 health, particularly those associated with industry activity" (p. 41). Environmental health practitioners disagreed, although one acknowledged that, "government is slow and clumsy and it takes us 15 or 20 years to change our mind on anything" (p. 42). Participants within movements do not necessarily share the same concerns or tactical approaches for achieving their objectives. In this chapter I argued that within the anti-PVC movement is largely an occupationally-driven movement within the health care and green building industries of the economy. I noted the important exception of two activist organizations in particular, Greenpeace and the Center for Environment and Health. The anti-PVC movement's primary targets are market change and education within both health care and green building. Actions are not generally directed at state authority, although some actions are designed to change specific government agency policies. In the next chapter I examine the formation of the anti-PVC movement, exploring the debates and points of contention that have contributed to the current course of the anti-PVC movement. 63 CHAPTER IV FRAMES, COUNTERFRAMES, AND MOVEMENT FORMATION "Doubt Grows with Knowledge" Goethe. Chapter three, Pushing the Boundaries ofHealth and Social Movement Theory: The Anti-PVC Movement, theoretically examines the anti-PVC movement and introduces a fourth ideal type of HSM, the Public Interest Health Movement, to build on Brown and colleagues (2004) typology ofHSMs. I argued that the anti-PVC movement is largely an occupationally-driven movement within the health care and green building industries of the economy. I noted the important exception of two activist organizations in particular, Greenpeace and the Center for Health, Environment, and Justice. The anti-PVC movement's primary strategies are promoting both market change and education within the health care and green building industries. I emphasized the role professional advocates play in PIHMs and how their position within the class system influences strategies, tactics, and goals for the movement. Coalitions and collaboration between interest groups, social movement organizations, and other advocacy organizations serve as a strength of the movement, although I argued the movement would benefit from more extensive involvement by labor unions. In this chapter I provide a brief historical overview of the development of the anti­ PVC movement since the early1970s, including primary debates and issues of contention and conflict to better understand the current movement. I use collective action frames and framing processes to understand the dynamics of the anti-PVC movement. The current framing of concerns, strategies of movement members, and counterstrategies of the plastics and chemical industries have been markedly influenced by past controversies and conflicts. Some of the framing strategies employed by various stakeholders in the current movement are the same or similar to those used by organizations earlier in the movement, but even those strategies that are different should be recognized and examined for their influence in shaping the movement. 64 My initial objective for this project was an investigation and analysis of current PVC politicization and the debates surrounding its use. However, as I learned more about why and how different stakeholders in health care and green building challenge PVC's use, I realized that full understanding of the politicization of PVC required a more in-depth historical examination of how PVC first became problematized and contested. In comparison with the early anti-PVC movement, today's movement is most prevalent in the health care and green building industries; however, the actions and responses of various stakeholders have significantly been shaped by social, political, economic, scientific, and health debates that have both preceded and occurred outside of these two industries. The context and foundation of today's anti-PVC movement can be understood by examining three different factors for their influence on the current anti-PVC movement in health care and green building: 1) earlier challenges and mobilization around PVC, 2) politicization that has occurred outside of health care and green building which has been influential on the movement, and 3) countermobilization tactics employed by the chemical and plastics industry. These countermobilization tactics are designed to refute the challenges of movement protagonists or otherwise aim to delegitimize activists and their work. These tactics include, use of counterrhetorics, non-problematizing, use of scientific arguments, credibility arguments, and direct action. In particular, the use of scientific arguments and appealing to experts is consistently used by a number of stakeholders in PVC debates. However, there are significant differences in the political and economic power of organizations such as the Vinyl Institute, the PVC trade association representing over twenty multinational corporations, compared with anti-PVC organizations like the Oregon Toxics Alliance, a nonprofit environmental health organization with one paid staff member. I determined that prior to the involvement of the health care and green building industries there were at least three major issues of contention surrounding PVC use and two major waves of the movement. Two of these issues of contention concern worker health and are very much interconnected. As addressed in chapter one, the history of PVC production is laden with controversies and accusations of industry deceitfulness in 65 its failure to protect the occupational health of workers. The occupational health of production workers emerged as the first source of conflict in the 1970's. The second major concern also emerged in the 1970's and centered on the risks of burning PVC. At this time, although the Manufacturing Chemists' Association was doing its best to project a positive public image in the face of emerging cases of angiosarcoma and acroosteolysis, the industry was also being criticized and challenged for PVC' s culpability in fire related fatalities and injuries. Together, mobilization around occupational and fire fighter health concerns represent the first wave. The second, and more recent point of contention prior to today's movement began with Greenpeace's chlorine chemistry campaign of the early 1990's. This campaign was instrumental in bringing PVC to the forefront as an issue of contention. All three of these issues fall under the rubric of PVC environmental and health safety concerns. This chapter is divided into three sections. I begin the chapter with an introduction to and discussion of the concept of framing as it relates to the anti-PVC movement. In the following section, I provide an historical overview of the anti-PVC movement, highlighting some of the major points of contention, while interweaving an analysis of the movement's use of framing. I focus largely on the debates and issues of contention that have emerged after the commencement of Greenpeace' s seminal anti­ PVC campaign. While the characteristics of an anti-PVC public interest health movement, as discussed in the previous chapter, begin to emerge, health care organizations and activists are not as deeply involved in these early stages. In the final section I examine the counterframing and counter strategies of the plastics and chemical industries as they respond to the politicization of PVC. Framing In the process of politicizing PVC, actors in the movement or in various organizations, must reach some sort of consensus about what aspect(s) of PVC are of most concern. In other words, before collective action is taken, movement members must determine and agree upon the problem. As I discuss below, for the first wave of the movement, concern was expressed largely with regard to occupational health for production workers and fire fighters as well as fire safety. As a response, vinyl chloride 66 exposure levels were lowered and more stringent fire safety protections were implemented. The second wave of the movement began with Greenpeace's chlorine chemistry campaign, a campaign that ultimately shifted and more specifically targeted Pvc. In the third wave, or current anti-PVC movement, many organizations and activists express serious concern with the health and environmental problems associated with the entire PVC lifecycle. However, this is not necessarily tme for all members of the movement. Those that are more likely to be participants rather than activists are often concerned with only one or several specific PVC related risks. As an example, and I discuss in the following chapter, for some health care movement participants concern about PVC lies primarily with DEHP exposure. In any movement, once the primary concerns are identified, movement participants must determine solutions and persuade others their concern is worthy of action. Through this process of collective action framing, "activists identify problems, diagnose their causes, propose solutions, and give reasons for collective action" (Reese and Newcombe 2003 :294). Framing is an active process whereby those involved possess agency to shape the movement (Benford and Snow 2000). The concept of 'frames" stems from the work of Goffman (1974) "to denote 'schemata of interpretation' that enable individuals to 'locate, perceive, identify, and label' occurrences within their life space and the world at large" (Goffman, p. 21 cited in Benford and Snow 2000:614). In other words, frames represent different versions of reality and are used to espouse or defend a person's, an organization's, or a social movement's definition of the situation (Shriver, White, and Kebede 1998). In this sense, "Frames organize experiences and guide the actions of the individual or the group" (Taylor 2000a:51 1). During the course of the anti-PVC movement, the concerns of movement participants have been formulated or framed, reevaluated, and reframed. Thus they change and shift the focus of action and the accompanying debates based on new evidence, the vinyl industry's counterframes, or in response to a new opportunity for mobilization. Framing analysis generally tends to assume that movements engage in oppositional framing or activities designed to 'demobilize antagonists' (Pellow 1999). In these situations, opponents respond to each other's frames through reframing their initial 67 frame and then by counterframing. While framing emphasizes shared understanding of ideas and meanings, framing processes occur within a specific political, social, and economic context. Frames represent more than just a different understanding and construction of a problem; they are reflective of the political and economic power of different stakeholders who draw not only on 'cultural stock' (Zald 1996) for frame construction or organizational tactics, but also their structural power. Opponents of the anti-PVC movement often organize and respond through trade associations. Jasper and Poulson (1996) observe that the use of professional or trade associations as countermovement organizations serve to aid targeted individuals and institutions, coordinate their responses, and share information about effective strategies. Domhoff (1998:33) has further noted the role of trade associations in advancing the goals and values, "especially the profit motive" of the corporate community. Representing all the major businesses in a specific industry or economic industry, trade associations are part of a corporate network joined for the purposes of relating to one another and the government. Understanding the frames used in the anti-PVC movement is important for four reasons. First, over the course of the movement, different environmental or health problems associated with PVC have been identified and emphasized. Second, the current anti-PVC movement spans two distinct economic sectors. There is substantial overlap between the health care and green building industries with respect to concerns over the broader PVC lifecycle. The industries also overlap with regards to some more specific concerns related to PVC, such as dioxin. However, different problems, such as the problem ofDEHP and the problem of landfilling PVC, are more salient to the professionals within health care and green building respectively, and thus emphasized. In this way, frames function to enhance the resonance for a particular audience. Resonance reflects the effectiveness or mobilizing potency for potential movement adherents (Benford and Snow 2000). Knowing their intended targets, health care activists are more likely to frame their concerns around problems of use and consumption (i.e., health risks from DEHP), whereas green building activists are more likely to frame concerns around disposal or fire safety. Similarly, adherents recognize that the anti-PVC movement in 68 both industries is embedded within a larger movement to green health care and the green building movement as a whole. Third, understanding the frames used in the anti­ PVC movement is important because there are some social movement organizations, such as Greenpeace and CHEJ, whose work interconnects and overlaps with the health care and green building industries, but nonetheless direct their efforts at different targets. Fourth, understanding the movement's framing is important for understanding the counterframing strategies of the plastics and chemical industries. In light of the political and economic strength of the plastics and chemical industries, this chapter focuses extensively on their counter strategies. Snow and Benford (1988) note that the process of creating collective action frames involves three core framing tasks: diagnostic framing, prognostic framing, and motivational framing. Together, these three tasks enable social movement actors to identifY the problem, attribute blame, and mobilize action (Benford and Snow 2000). The first task, diagnostic framing, involves locating the origin of the problem and attributing blame or responsibility to some source. Gamson (1992) refers to this as "injustice framing." In the early 1990s, when Greenpeace sought to address concerns regarding hazardous chemicals, they realized that the solutions lied in changing things at the input level, with the production technologies. According to an interview with Joe Thornton, a former Greenpeace activist, "there weren't many concrete issues at the time to focus on in terms of the front end, so the chlorine chemistry was really our effort to make concrete the campaign to change production processes." Thus, Greenpeace diagnosed the problem as 'chlorine chemistry.' Benford and Snow (2000) observe that the task of attributing blame may be complicated by disagreement among and within different social movement organizations. In this case, as the only SMO involved with this campaign, Greenpeace experienced no external competition in defining the situation. Next, having identified the problem, SMOs and activists must propose solutions and determine the tactics and strategies to be used to achieve those objectives. This second task, prognostic framing, has been referred to as both "consensus mobilization" (Klandermans 1984) and the "agency component" of framing (Gamson 1992). Prognosis framing entails deciding what to do about the problem. The clear 69 prognosis demanded by Greenpeace was a chlorine sunset, "the gradual phase-out of the production and use of chlorine and organochlorines and the phase in of safer, chlorine-free alternatives" (Thornton 2000: 13). According to Benford and Snow (2000), it is at this point where activists are likely to encounter oppositional or 'counterframing' activity, which may instigate defensiveness or require elaboration of prognoses or movement reframing. Unsurprisingly, the chemical industry did not respond favorably to Greenpeace's prognoses and engaged in countermobilization strategies, which will be discussed further in the final section of this chapter. The third and final core framing task is referred to as motivational framing (Benford and Snow 2000) and provides a "call to arms" or rationale for engaging in collective action. Motivational framing appeals to agency, a sense of efficacy or empowerment felt by movement activists and organizations. Also labeled 'identity framing,' this third task entails activists defining "who they are, usually as 'we,' typically in opposition to some 'they' who have different interests and values" (Pellow 1999:662). Gamson (1992) notes, "Without an adversarial opponent, the potential target of collective action is likely to remain an abstraction," such as hunger, poverty or war (p. 7). Thus, "to sustain collective action, the targets identified by the frame must successfully bridge abstract and concrete" (Gamson 1992:33). By targeting 'chlorine chemistry' Greenpeace connected their concern, 'hazardous chemicals', with a concrete and appropriate source for action. Together, diagnostic, prognostic, and motivational framing are necessary for social movements to mobilize resources and challenge opponents. Collective action frames reflect an organization's core norms, values, and beliefs, and as Gamson notes, "are the outcome of negotiated shared meaning" (Reese and Newcombe 2003; Gamson 1992: Ill). Resonance, as mentioned above, reflects the consistency of a SMOs collection action frame with the interpretative frame of individual participants (Snow, et al. 1986). The greater the resonance or the believability of a particular frame for a targeted audience, the more likely SMOs will be able to motivate and mobilize those social actors to action. Resonance is also linked with the credibility of frame articulators. As Benford and Snow (2000) suggest, the greater the status and/or perceived expertise of the frame articulator and/or the organization they represent, the 70 greater the frame resonance. Various stakeholders in the PVC debates tactically adopt credibility strategies, aiming to either increase their own credibility, often through appealing to experts, and/or decrease the credibility of the opposition in the same manner or through more outright attacks. Emergence and Overview of the Anti-PVC Movement History Wave One Mobilization around PVC concerns began predominately over occupational health concerns. These concerns emerged in 1975 when the American public first became aware of the deaths of four PVC workers due to angiosarcoma of the liver caused by vinyl chloride exposure in PVC production facilities. In the mid 1970s, concerns also mounted around occupational health risks for fire fighters exposed to burning PVC. At this time, fire fighters and their allies mobilized around growing fire safety concerns. Between 1975 and 1982, there were at least four major fires that exposed fire fighters to severely high levels of burning PVC. In 1975, 699 firefighters fought the New York Telephone Company fire, consuming clouds of toxic smoke from burning PVC insulation, leading some of them to develop respiratory diseases, cancers of the throat and larynx, and causing many others to retire on disability pensions. Referred to as the worst fire in the department's modern history, the firefighters union and their allies mobilized to change New York toxic exposure laws as well as institutionalize new measures for protecting and monitoring the health of firefighters (Lee and Singleton 1982). In 1982, the International Association of Fire Chiefs adopted resolution number four, which resolved, That the IAFC strongly recommends that the issue of combustion toxicity be examined when considering national, state, and local building and fire codes and that scientific studies be undertaken to further claritY the role that such burning synthetics as pvc. .. play in firefighters' short and long term mortality rates (Greenberg N.d.). Three major fire tragedies-the 1977 Beverly Hills Supper Club fire in Southgate, Kentucky, the 1978 Younkers Department store fire in Des Moines, Iowa, and the 1982 MGM Grand Hotel fire in Las Vegas-had occurred within a five year span in which the toxicity of the smoke from smoldering and decomposing plastics, PVC in particular, were responsible for the majority of fatalities (Greenberg). In a lawsuit filed after the Supper 71 Club fire, the plaintiffs' attorneys argued that the PVC wire insulation in the electrical system created toxic gases. Both the local utility company and PVC manufacturers settled before going to trial. The MGM fire was the most controversial. According to Deborah Wallace (1990), a specialist on the impact of burning plastic on public health, "All parties involved in the litigation agreed that the fire originated in the electrical system in the back wall of kitchen" (p. 102). However, agreement ends there. Wallace describes an unusual burn damage pattern, ... most of the objects in that room [the kitchen] only had smoke damage. Paper announcements hanging on the walls showed no char at all. .. The major path of the fire ... led up the wall to the plenum by way of the electrical installation. The plastic pipes in the plenum, as well as the electrical insulation, then carried the flames across the plenum! (Pp. 102-103). The MGM Grand was twenty-six stories tall; of the eighty-five fatalities, sixty-one occurred on the top seven floors of the hotel, where the fire never reached. According to Wallace's account, toxic smoke from burning plastics, and PVC in particular, on the ground-floor casino spread throughout the air handling system, the elevator shafts, the seismic joints, the fire stairs, the electrical and plumbing systems, and even broken windows. The MGM fire remains a source of contention between anti-PVC activists and industry and continues to reverberate and influence PVC's politicization. As reported to me by a leading representative of the vinyl industry, the industry continues to strongly disagree with the 'allegation' that vinyl was the cause of the fire. However, at the time, the mere charge that vinyl was a fire hazard caused enough concern in the industry to serve as a catalyst for the formation of the 'Vinyl Group' (now the Vinyl Institute), a trade association representing major manufacturers of vinyl, vinyl chloride monomer, vinyl additives, and vinyl packaging materials. My vinyl industry contact remembers that it was following the MGM fire that anti-PVC activists began to emerge. Indeed, in the early 1980s, PVC's politicization became national in scope. For example, the California legislature passed a resolution 1 A plenum is "an air-filled space in a structure; especially: one that receives air from a blower for distribution (as in a ventilation system)" (www.meriam-webster.com). 72 requiring the establishment of tests to determine the fire-gas toxicity and combustibility of materials used in building construction. Prior to this, the California Supreme Court ordered that the 1982 building code could not be distributed without including a warning about the health hazards of plastic pipe. In Chicago, after hearing testimony from toxicologists, the City Council voted to ban PVC as an approved building code material. And in New York, the Transit Authority decided to heed the warnings of health officials regarding the dangers of burning plastic and to discontinue the use of PVC electrical tubing in subway stations (Greenberg N.d.). This period of politicizing the occupational and fire safety risks of PVC can be regarded as the first wave of the anti-PVC movement. For both of these sets of workers, vinyl production workers and fire fighters, mobilization emerged following a precipitating event. For production workers and their allies, the public discovery of the link between vinyl chloride exposure and cancer and other health problems prompted action. Fire fighters mobilized in response to a series of high profile fires in which fire fighters died and others were seriously injured from toxic exposure to burning PVC. Assuredly, the actions taken during this time have not been lost to history; however, in the current anti-PVC movement, concerns over occupational health are not given regular or prominent attention. At least for production workers, this is likely attributable to the OSHA imposed reduction in acceptable levels for vinyl chloride exposure. Some organizations, such as the Center for Health, Environment, and Justice, the Healthy Building Network, and Health Care Without Harm have supported and joined with community groups over environmental justice concerns where hazardous facilities (e.g., PVC production facilities or incinerators) are located, but this mobilization and support is not the primary purpose of their organization's anti-PVC campaigns. Fire fighters continue to be highly concerned about the hazards of PVC, but as a reflection of the current anti-PVC campaign's focus on market reform and education, fire fighters are not prioritized in these campaigns, much like vinyl production workers. Collectively, fire fighters are represented by a strong union, the International Association of Fire Fighters (IAFF), which prioritizes the occupational health of its members, but in general is not active in any coalitions of SMOs working to phase out or eliminate PVC. In essence, 73 while activists and participants in today's anti-PVC movement stress that the entire PVC lifecycle is marked by environmental and health problems, in actuality, it is the problems associated with the use and disposal stages that receive the most attention. Wave Two Following the events of the early 1980s there was a lull in the national anti-PVC movement. Concerns over PVC resurfaced in the early 1990s with the onset of Greenpeace's chlorine chemistry campaign. This second wave of the anti-PVC movement led directly into today's movement. In contrast to the earlier period of activism, Greenpeace framed PVC concerns primarily around issues associated with chlorine, a primary component of PVC. Greenpeace had expanded its toxics and organochlorine campaigns to focus on the whole field of chlorine chemistry. Organochlorines are a class of chemicals that contain one or more chlorine atoms with serious environmental and health implications. Rather than focus on one particular chemical, Greenpeace reasoned that because there were both known and suspected problems with all organochlorines, it made the most sense to ban all uses of chlorine. With over 11,000 chlorine-based chemicals in production, a study of the health and environmental impact of each chemical would take over 15 to 20 years to complete, making such a task impractical and ultimately unworkable. According to Joe Thornton, a Greenpeace research analyst and research coordinator for the U.S. toxics campaign and the international chlorine campaign at the time, Greenpeace's goal was to stop the expansion of the hazardous waste incineration industry (interview). Greenpeace recognized that all forms of chlorine disposal would result in the release of toxic substances into the environment, thus their focus should be directed at the front end, at the production technologies that are reliant on hazardous chemicals. As noted above, framing the concerns around chlorine chemistry functioned to address production processes, use of toxic substances, and disposal concerns. As Thornton describes in an interview, chlorine chemistry was recognized as the sector of the chemical economy: ... that is responsible for the most hazardous, most persistent, most bioaccumulative set of pollutants. So, if we could deal with chlorine chemistry, we would deal in one fell swoop, with dioxins and PCBs and CFCs destroying the ozone layer and a huge number of pesticides that were a problem, and chlorinated solvents which were hazardous in the 74 workplace, so, that was the intent. It was a way of creating a concrete, but vastly sort of ambitious campaign focused on the production and use of toxic substances. Greenpeace's campaign sought to frame production and disposal processes as environmental and public health problems. Thornton was involved in the strategic development of the campaign and was the first person in North America to author a report on the topic of problems associated with organochlorines (interview, Thornton). In 1991, Greenpeace published The Product is Poison: The Case for a Chlorine Phase-Out, thus beginning the debate over chlorine chemistry in North America. (For a complete chronology of events, please see Appendix C.) According to Thornton, much of Greenpeace's work centered on the Great Lakes "where the effects of persistent organochlorines on wildlife and human health was becoming a major issue." Greenpeace partnered with activist organizations in the region around the decision-making of the International Joint Commission, an independent binational organization established in 1909 to "prevent and resolve disputes relating to the use and quality of boundary waters" between Canada and the U.S. (www.ijc.org). Thornton recollects, "[this] lead to the IJC in 1993 saying that chlorine chemistry ought to be phased out and that became sort of springboard for continuing that campaign at a national scale in the U.S. and also in Canada as well." Greenpeace, along with the IJC's support, created a cohesive frame for their issue closely mirroring the "framing tasks" framework laid out by Benson and Snow (2000). Together, the IJC and Greenpeace diagnosed the problem as chlorine and chlorine­ containing compounds and sought a chlorine phase-out and an ultimate ban on chlorine as a prognosis. Greenpeace rationalized this by citing the IJC's recommendation to the U.S. and Canadian governments "to sunset chlorine-based chemical processes-including PVC manufacture-because of the threat to human health and the environment...." (Environmental Building News 1993). The IJC's recommendation provided greater credibility to Greenpeace's argument. In part, Greenpeace redefined what had previously been presented as primarily an occupational and fire safety problem into a problem that potentially affects the greater public. Their collective action frame linked environmental 75 health with human health, a connection that has continued with the framing used in the current anti-PVC movement. As Greenpeace's campaign matured, the organization politicized PVC as a centerpiece of its larger chlorine chemistry campaign. Thornton explains, "we recognized that vinyl is the largest single use of chlorine ... so it was a pretty obvious step that if you are an activist organization and you want to be campaigning on chlorine chemistry, vinyl has to be an important focus." This focus did not alter their attribution of what is to blame-chlorine chemistry-but by concentrating on PVC, they modified their tactics and targets. Their prognoses expanded; they recommended the EPA impose a moratorium on permits for new vinyl facilities, for expansion of facilities, and for new incinerators; modify permits at existing plants to require lowered dioxin emissions; phase-out medical and municipal solid waste incinerations, and begin rapid phase-outs of some PVC uses, including short-life PVC products (Duchin 1997). This change in their prognosis framing helped make a broad or intangible concern one that was publicly accessible and potentially more manageable, thus increasing the likelihood of a sense of efficacy among movement actors. By focusing on PVC, activists could direct their efforts to different stages of the PVC lifecycle and used the rhetoric2 of endangerment to do. This rhetorical idiom presumes that "individuals have the right to be safe from harm, to have good health, and to be shielded from preventable or reducible types of bodily risk (Ibarra and Kitsuse 1993 :35, emphasis in original). Greenpeace's use of endangerment rhetoric becomes apparent with the publication of their 1997 report, Dioxin From Cradle to Grave, where they introduced terms into the PVC discourse with loaded language, such as, 'toxic burden,' 'poison plastic,' and 'toxic lifecycle'. Greenpeace strengthened its framing by using another tactic that would become a mainstay of both vinyl opponents and supporters. Benford and Snow (2000) note that the credibility of any framing is affected by the credibility of the frame articulatOls (2000). In this case, the call to phase out chlorine chemistry had become embraced by a larger constituency. Other organizations and community groups joined with Greenpeace in their efforts to politicize PVC. Physicians and public health activists also joined with 2 "Rhetoric", here, refers to the deliberate use of language to persuade others (Taylor 2000a:5 I0). 76 Greenpeace to bring the issue to the attention to the American Public Health Association where, in 1994, the APHA passed Resolution 9304 advocating the phase out of chlorinated chemicals in most applications, except for water disinfection and pharmaceuticals (Cap 1996). Religious organizations, cities, and city councils passed also passed resolutions. As Benford and Snow (2000) suggest, the greater the status and/or perceived expertise of the frame articulator, the greater the credibility of organization's framing. The passage of resolutions by religious organizations and medical associations helped to convey a sense of legitimacy and also lend some authority to the credibility of Greenpeace's claims. According to Starr (1982) authority "signifies the possession of some status, quality, or claim that compels trust or obedience" (p. 9). The use of authority relies on 'legitimacy' and 'dependency' as sources of effective control. Legitimacy and dependency also serve as reserves of persuasion when authority fails. Physicians and other professionals are able to claim cultural authority, whereby their authority is granted "not as individuals, but as members of a community that has objectively validated their competence" (Starr 1982: 12). Physician involvement thus lent authority to Greenpeace's health arguments. Environmental Justice Greenpeace also began working in the Gulf Coast in Louisiana and Texas with those communities most immediately affected by vinyl production feed stocks. Greenpeace was then able to tap into an existing grassroots network of local organizations. Incorporating an environmental justice component was an astute tactical decision for the organization. In her work on the framing processes of the environmental justice movement, Taylor (2000a) observes that because the movement is multiracial, it has been able to avoid some of the "divide-and-conquer" strategies of countermobilizations (p. 562). As a largely middle-class and white environmental organization, had Greenpeace's decision to politicize PVC emphasized only the health of the environment and not the health of people, the organization would have been susceptible to external criticisms as promoting an elitist environmental agenda (see Bullard 1994b; Taylor 2000a). The degree to which Greenpeace truly addressed environmental inequality is debatable; however, what is important is that Greenpeace 77 projected a message that the vinyI industry "is a glaring example of environmental racism and injustice" (Duchin 1997), thus encouraging their opponents to perceive the movement as broad-based and human-centered. Efforts towards politicizing PVC began to have visible successes. In 1997, Greenpeace was still active in the movement when Shintech, the u.s. PVC subsidiary of Shin-Etsu, the world's largest PVC producer, sought to build a new PVC plant in St. James Parish, Louisiana. In an "unprecedented decision", the EPA decided to overturn a permit allowing the company to build the facility (Tremblay 2002: 19). Claiming environmental racism, community activists organized St. James Citizens for Jobs and the Environment and joined with other local and regional organizations to challenge the siting of the new PVC plant. Expansion of its coalition base was an effective strategy for gaining national attention to the issue and legitimizing the cause (Hines 2001). On behalf of 19 organizations, Greenpeace and the Tulane University Environmental Law Clinic filed both a federal claim and a state lawsuit contending the facility would violate the "disparate impact" clause of Title VI of the Civil Rights Act and would also violate the Clean Air Act. Title VI bars racial discrimination by entities receiving federal funds. The complaint stated that a permit issued to Shintech would be racially discriminatory under Title VI. Activists and their supporters framed the case as setting a national precedent for the environmental justice movement. The broadness, inclusivity, flexibility, and cultural resonance of the "environmental justice" frame, positions it as a master frame, and thus contributes to the mobilizing potential of SMOs (Benford and Snow 2000). Collective action frames with broad interpretative scope, appeal, and utility for at least two distinct social movements can sometimes become master frames. 'Environmental justice' has emerged as a master frame for activists seeking to link racism, injustice, and environmentalism in one frame (Taylor 2000a). By using the EJ master frame, grievances were not solely directed at Shintech, but at a larger institutionalized system of racism and environmental injustice. Pointing to the predominance of chemical facilities and refineries already in the area, the clear prognosis for activists was to prevent the construction of the facility. Residents mobilized out of concern regarding increased 78 threats to their health. Shintech rejected these charges and ultimately "sidestepped the activists," deciding to build its new PVC facility in Addis, Louisiana, where Dow Chemical supplied the needed vinyl chloride (Tremblay 2002). While the company chose not to engage in a drawn out framing contest, Shintech CEO, Chihiro Kanagawa, responded to the EPA decision by dismissing the credibility of the activists' framing, asserting, ''It was politics, nothing but politics ... The state of Louisiana, the local government, gave us full support. They issued the permits" (Tremblay 2002: 19). EPA Draft Dioxin Reassessment A key turning point for the movement occurred in 1994 when the U.S. Environmental Protection Agency released a draft Dioxin Reassessment identifYing medical waste as the single largest source of dioxin air pollution. The draft consisted of two documents, each over 1,000 pages long, on the health effects of dioxin, the sources of dioxin, and the levels to which the population has been exposed (Gibbs 1995). At this time, there were over 6,000 medical incinerators in use in the United States. The EPA Reassessment provoked a firestorm of activity over the course of the next several years. In 1995, Citizens Clearinghouse for Hazardous Waste (now CHEJ), led by Lois Gibbs, kicked off their Stop Dioxin Exposure Campaign. Forty citizen activists, scientists, and representatives of national organizations gathered in April to plan the national campaign with the goal of "a sustainable society in which there is no dioxin in our food or breast milk because there is no dioxin formation, discharge, or exposure" (Gibbs 1995:xix). In Dyingfrom Dioxin: A Citizen's Guide to Reclaiming Our Health and Rebuilding Democracy, Gibbs encouraged activist coalitions to engage in targeted consumer boycotts of PVC and other chlorine-based products. The organization has revisited these strategies in its current PVC campaign. In the mid 1990s, Greenpeace experienced the beginnings of a restructuring and by 1997; $8 million was cut from its budget (Chemical Week 1997). According to Joe Thornton, "Greenpeace went through a financial and political crisis," thus leading Greenpeace to deemphasize its work against chlorine chemistry. The downsizing at Greenpeace coincided with the formation of Health Care Without Harm, currently a core movement adherent. To some extent, HCWH filled the gap in toxics work left by 79 Greenpeace. Specifically, HCWH formed in response to the EPA Dioxin Reassessment draft, organizing to directly address the problem of medical waste incineration. HCWH recognized that the incineration of vinyl plastics was one of the reasons medical waste incinerators were such high dioxin producers, and thus took a two­ pronged approach. According to HCWH's Communications Director, Stacy Malkan, "we [HCWH] started with the waste and then looked upstream, how can we first of all, stop hospitals from burning so much waste. And second of all, [HCWH aimed to] reduce the toxicity of the waste. So that they are not disposing of highly toxic chemicals." Having diagnosed the problem as the incineration of medical waste, the organization's clear prognoses involved shutting down these incinerators, while emphasizing that this goal should not be met by simply transferring the problem to other locations or countries. As HCWH became incorporated into the anti-PVC movement, a shift in the framing of PVC lifecycle concerns occurred which emphasized the role of the health care industry in contributing to these problems. HCWH was able to build on Greenpeace's close work with physicians to create their initiative on PVC. In this sense, even though Greenpeace's involvement in the movement dramatically decreased over time, their efforts continued to influence the movement. Movement Growth The mid- to late 1990's were the formative years of the anti-PVC movement. Thus, there was a greater degree of consciousness raising and public position taking during this time than is prevalent in the movement today. The passage of resolutions or taking formal positions on dioxin or PVC use in health care continued as a way to express commitment or support for the concerns of the movement. In 1996, the American Public Health Association followed up its 1994 resolution on chlorinated chemicals, with the passage of Resolution 9607, calling for the phase out or elimination of PVC in healthcare. Other city and state medical associations and societies followed suit. At this time, several sizable and notable medical societies passed resolutions or took formal positions against PVc. The American Nurses Association House of Delegates passed a resolution for the "Reduction of Health Care Production of Toxic Pollution," targeting medical waste. The International Council of Nurses released a position statement on "Medical Waste: Role of 80 Nurses, and Nursing" (1998), and the American Medical Women's Association passed a resolution called "Dioxins and Medical Waste Incineration" in November 1999. Additional religious organizations, cities and city councils passed official resolutions against PVC, further building momentum and increasingly the credibility and resonance of the movement. The additions of reputable medical societies and religious organizations to the anti-PVC movement complicated the countermobilization efforts of the vinyl industry. First, the greater the degree of prestige or legitimacy of social movement organizations or activists, the more risky any counteraction becomes for the opposition. Jasper and Poulson (1997) note that in the range of strategies a targeted entity may deploy in response to public criticism, should it "blunder," the organization's "reputation for competence, honesty, or benevolence" may be weakened (p. 398). In this case, if the viny1and chemical industry appeared to be attacking physicians, nurses, or religious organizations, their strategy may backfire and help to create sympathy for the movement. The vinyl industry must carefully avoid "blundering" as it argues for the safety of PVC against professionals whose jobs rests on their knowledge of health. By the late 1990s, the anti-PVC movement began to more closely resemble the movement as it stands today. At this time, health care professionals had become more involved, phthalate concerns had fully merged with PVC concerns, and HCWH had begun to playa greater role in the framing process. In 1998, HCWH released a study concluding that phthalates could harm multiple organs and interfere with sperm production. In November 1998 the Canadian government's health service, Health Canada, issued a parental advisory on PVC toys containing the plasticizer diisononyl phthalate (DINP). Over the course of the next 12 months, many countries imposed restrictions on phthalate containing PVC toys, including Austria, Canada, Denmark, Finland, Mexico, Norway, the Philippines, Germany, France, Greece, and Sweden. Meanwhile, in the U.S., Greenpeace and eleven other consumer, public health, environmental and religious organizations petitioned the U.S. Consumer Product Safety Commission (CPSC) to ban all vinyl toys for children under the age of five. On December 2, 1998, the CPSC issued a voluntary ban on young children's teethers and 81 rattles made of PVC plastic containing phthalates such as DINP, the primary plasticizer in PVC toys. More than a decade earlier, in 1986, at the bequest of the CPSC, the toy industry voluntarily consented to limit their use of the phthalate DEHP. At this time, phthalates had clearly emerged as part of the PVC problem. By spring of 1999, Greenpeace had teamed up with Health Care Without Harm and began switching their focus from PVC toys to PVC medical devices. Phthalate risks remained central to the debates and were reflected in activists' diagnostic framing. The two organizations drew attention to the potential risks to patients from DEHP leaching out of medical bags. Their framing was challenged in 1999, when former U.S. Surgeon General C. Everett Koop led an American Council on Science and Health (ACSH) scientific panel reviewing the safety of phthalate plasticizers. The non-peer reviewed report, "A Scientific Evaluation of Health Effects of Two Plasticizers Used in Medical Devices and Toys" (1999) contradicted the results of a study released the previous summer by HCWH. The ACSH report reviewed DEHP and DINP and stated that there was no scientific evidence that either is harmful to adults or children, thus concluding that both vinyl toys and IV bags containing these phthalates were safe. The ACSH committee's conclusions were highly controversial. HCWH's Stacy Malkan states the panel's findings have subsequently been "discredited and debunked". Although, the Vinyl Institute, "certainly bandied it about and still do." Critics questioned the legitimacy of the panel's findings, given ACSH's strong financial ties to industry. ACSH receives 76% of its funding from corporations, including chemical manufacturers (Sissel 1999a). In the past, the organization's leanings towards industry have included: discrediting concerns about lead poisoning, claiming dry cleaning agents are not a health threat, and opposing stricter EPA air pollution standards (Environmental Building News 1999). Indicating its industry leanings, Elizabeth M. Whelan, ACSH president, recently condemned the cereal maker Kellogg for acknowledging the nutritional deficiencies of their popular sugar cereals. Whelan censured corporations, like Kellogg, for "acting more politically correct than ever, joining whenever they can with their harshest critics. They 82 are appeasing their foes -- and abandoning science in the process" (www.asch.org)? Whelan's comments point to two commonalities of contested environmental health problems evident in the PVC debates: charges of questionable science and the mixing science of and politics. Agin (2006) calls this 'junk science,' " ... extensively corrupted science, science corrupted in objectivity and/or method, the corruption either deliberate or involving sloppy methods or due to ignorance of what science is about" (p. 4). In HCWH's review of the ACSH panel's analysis ofDEHP's toxicity, they charge ACSH with both questionable scientific integrity and questionable "intellectual rigor and honesty" for a selective and misleading review of the literature, misrepresenting evidence, and for claiming a cited study reports a finding that the study does not address or report in the published manuscript (Schettler 1999:1-2). In the same way that 'experts' are used to strengthen the claims or arguments of movement stakeholders, they may also be used to discount the claims of opponents or disparage the other sides' 'experts.' The Center for Health, Environment, and Justice Meanwhile, CHEJ continued with its Stop Dioxin Campaign. In a chemical industry expose, Behind Closed Doors (2001), CHEJ documents their account of a pattern of counter mobilization by the chemical industry. They accused the Chlorine Chemistry Council (CCC), the American Chemistry Council (ACC), and the Vinyl Institute (VI) of attempting to block resolutions against dioxin in San Francisco and Oakland, contending these actions were part of a larger "attack to gut any report or policy that would eliminate dioxin or adopt a precautionary approach" (CHEJ 2001). In addition to targeting local resolutions like those in the Bay area, CHEJ maintains the industry's prime target has been the U.S. EPA's dioxin reassessment. CHEJ holds the chemical industry and the CCC in particular, responsible for the delay of the 3 For a survey of what ACSH considers 'junk science,' their Top 10 list of unfounded health scares