SOCIAL THOUGHT & COMMENTARY

Beyond Global Warming:

Interacting Ecocrises and the
Critical Anthropology of Health
Merrill Singer
University of Connecticut

Abstract
Human health is at growing risk due to the multiple climatic effects of global
warming. More importantly, it is becoming evident that individual ecocrises
are not independent phenomenon but are entwined with and contribute to the
intensification of other environmental predicaments. In light of a range of
imagined futures that share a narrative about global warming that posits the
existence of global “winners and losers” (regions that will benefit from and
those that will suffer from global warming), this paper examines two specific
cases—Midwestern flooding during the summer of 2008 and the accelerating
degradation of the Sacramento Delta. These examples, expressions of conver-
gent ecocrises, here termed pluralea interactions, suggest that going beyond
global warming reveals the folly of “winner and loser” thinking. The paper
concludes with a discussion of the implications of the health impacts of inter-
secting ecocrises for directions in medical anthropology. [Keywords: global
warming, anthropology of health, imagined futures, pluralea]

Anthropological Quarterly, Vol. 82, No. 3, pp. 795–820, ISSN 0003-549. © 2009 by the Institute for Ethnographic
Research (IFER) a part of the George Washington University. All rights reserved.

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Beyond Global Warming: Interacting Ecocrises and the Critical Anthropology of Health

“Our future…is like that of the passengers on a small pleasure boat

sailing quietly above the Niagara Falls, not knowing that the engines
are about to fail” (James Lovelock, quoted in Goodell 2007).

Not Just Global Warming

Vernon (1993) argues that a country’s willingness to participate in global
environmental protection agreements is conditioned by the structure of
the state and its relationship to what he calls “polluting elites.” One sign
of how these elites have responded to global warming, which a growing
number of climate, health, and social scientists see as one of the gravest
contemporary and future threats to human health and safety, observes
Begley (2007:1), is that “Individual companies and industry associations—
representing petroleum, steel, autos and utilities—[have] formed lobbying
groups [to mobilize] greenhouse doubters to ‘reposition global warming as
theory rather than fact,’ and to sow doubt about climate research just as
cigarette makers had about smoking research.” More recently, some corpo-
rations have “gone green” and begun to support limited action on global
warming (while nonetheless still promoting expanded production and con-
sumption). These two alternative responses reflect contrastive imaginings
of the future. Even with growing awareness of the potential risks of global
warming, there has been little support for the development of a broader
biosocial environmental focus that recognizes that global warming and the
multiple and diverse health risks it entails (Baer and Singer 2009) are only
part of a far larger environmental crisis involving a set of convergent and
potentially interacting anthropogenic threats to the environment and to
human health.
As Spratt and Sutton (2008:xi) stress, global climate change constitutes
only the exposed “tip of [a] broader global-sustainability iceberg,” that
includes a litany of environmental degradations that are now “converging
rapidly in a manner not previously experienced.” At the same time that
climate change is disrupting the planet’s geophysical feedback mecha-
nisms that sustain inhabitable environments, Earth is also beset by multi-
ple other ecocrises set in motion by human socioeconomic activities (Smil
2008). Among these are nuclear dumping, acid rain, disappearance of
wetlands, pesticide and other chemical pollution, air pollution, soil con-
tamination and salinization, a global potable water crisis, ocean acidifica-

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tion, deforestation, soil depletion, plastic pollution, depletion of edible

sea life from the oceans, and a general loss of biodiversity through extinc-
tions. All of these threats are connected to the transformation of the
Earth’s biomass into an ever growing human population (Speth 2008).
These diverse threats, which Foster et al. (2008) label the “ environ-
ment problem,” have momentous health implications for humans. As,
Pimentel et al. (1998) indicate, “ Based on the increase in air, water, and
soil pollutants worldwide, we estimate that 40% of human deaths each
year result from exposure to environmental pollutants and malnutri-
tion.” This recognition has led to the development of the concept of
“ health-based environmental indicators,” which are measures designed
to describe the status of human health as a result of environmental con-
ditions (Vassilev et al. 2001).
Even more significant than the number of health-related degradations
that comprise the environment problem is the issue of ecocrises interac-
tion. Rather than seeing the various environmental calamities we face
and their respective configurations of health-based indicators as stand-
alone threats to human well-being—the conventional but limited out-
look that leads to fragmented and even competitive mitigation efforts—
it is argued here that adverse human impacts on the environment
intersect; that the resulting interactions significantly exacerbate the
overall human (and plant and animal) health consequences; and these
interacting ecocrises create the potential for catastrophic outcomes (Rees
2003). In this light, the purpose of this paper is to draw attention to the
nature and health implications of convergent and intersecting ecocrises,
a phenomenon here termed “ pluralea interactions” (derived from the
Latin words plur, meaning “ many” and alea, meaning risks or hazards)—
and to discuss the implications for medical anthropology. I illustrate the
biosocial and geoclimatic complexities of pluralea processes using two
examples: the Midwestern Floods of 2008 and the dire condition of the
Sacramento Delta area. While pluralea phenomena are occurring world-
wide, these two examples are used to emphasize the point that, contrary
to the assertion made by some imagined futures narratives, North
America is not likely to be a “ winner” in the time of global warming and
is no less at risk from interacting ecocrises than other parts of the plan-
et. Finally, it is argued, understanding pluralea provides a new agenda
for directions in 21st century medical anthropology.

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Winners, Losers, and Imagined Futures Narratives

in a Changing World
At the individual level, it is possible and common to imagine one’s future
life some distance ahead in time; in the West, in fact, being asked to pon-
der questions about our imagined personal future has become institu-
tionalized in employment interviews and psychological assessments.
Citing a pivotal incident from Rohinton Mistry’s (1996) novel, A Fine
Balance, Mackenzie (2008:122) writes, “ in deliberating, planning, and in
working out how to carry out our personal [life plans], we imaginatively
project ourselves into the future. Such imaginings usually encompass not
only our own future actions and their consequences but also the imag-
ined actions and reactions of others.” Moreover, Mackenzie stresses,
imaginings of this sort can help prepare for future events or they can
“ provide opportunities for self-deception, self-indulgence, wishful think-
ing, and other failures of agency leading us to make decisions that we
later regret” (Mackenzie 2008:123).
From an anthropological perspective, of course, imagining the future
is understood not simply as an idiosyncratic and individual activity, but
rather as a social process involving the narrative construction of shared
cultural meanings. Narrative, defined as “a discourse featuring human
adventures and sufferings connecting motives, acts, and consequences in
causal chains” (Mattingly 1998:275), is characterized by contextually
grounded actions that lead to socially meaningful outcomes. In Laurie
Price’s apt phrase (1987:315), hearing a narrative augments a listener’s
“fund of cultural knowledge” with which to confront future life chal-
lenges. In this sense, as Fisher (1984) affirms, the referent of narration is
not the fictive world of entertainment (i.e., storytelling for the sake of
amusement or distraction); rather it is the construction of taken as truth-
ful world understandings. Futures imaginings in narrative form, in effect,
are cultural theories “of symbolic actions, words, and/or deeds, that have
sequence and meaning for those who live, create, and interpret them”
(Fisher 1984:2). Additionally, as Fisher (1985) points out, to be embraced,
an imagined futures narrative must be characterized by “probability,”
that is, a coherence and consistency that harmonizes with existing cultur-
al knowledge. Such narratives “ring true” to a population of listeners.
Within the realm of imagined environmental futures, author/activist
Shaun Chamberlin (2009:21) argues that people embrace cultural narra-
tives that “tell ourselves about life…that allow us to make sense of the

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bewildering array of sensory experiences and the wider evidence we

encounter. They tell us what is important, and they shape our perceptions
and thoughts.” With regard to global warming, Chamberlin has identified
four competing cultural narratives that have identifiable elite and/or pop-
ular constituencies. The first of these, which he labels “Denial,” is an
understanding of the future that is characterized by a business as usual
perspective. In this cultural story, climate change is a minor affair and
does not play much if any role in the shaping of coming events. The future
is envisioned as being similar to the present, but with more material
wealth because of steady economic “progress.” As suggested in the intro-
duction, this scenario has been embraced and promoted by various cor-
porate funders of a global warming denial discourse. Witnessed climatic
changes are dismissed as cyclical weather patterns or the product of other
conventional causes.
The second cultural story Chamberlin calls “ Hitting the Wall.”
Accepting global warming as a significant threat, those who embrace it
envision a future in which we have effectively responded to this danger
with free market mechanisms (e.g., Green Capitalism, trading of green-
house gas allowances) that permit continued expansion of production and
consumption. Thus, this can be characterized as a “business almost as
usual” perspective.
The third alternative he labels the “Impossible Dream.” It visualizes a
future in which a science-based techno-fix saves the planet and its inhab-
itants. In this future, rooted in stalwart conviction about our endless abil-
ity to invent our way out of problems and to achieve thereby a new envi-
ronmental equilibrium, there will emerge exotic new technologies
designed to reflect solar energy away from the earth and eliminate
mounting stratospheric carbon.
Chamberlin’s perspective on these three collective futures narratives, as
his labels suggest, parallel Mackenzie’s discussion of individual narratives,
they are characterized by deception, indulgence, and wishful thinking. Thus,
a theme that cross-cuts these first three scenarios (including the denial per-
spective, which sometimes incorporates it as a back-up narrative) is the
notion of winners and losers in the time of global warming. As Leichenko
and O’Brien (2006:113) explain: “Under a binary approach, nations, regions,
and populations are…categorized as either winners or losers based on a
series of biophysical measures such as changes in mean temperatures and
rainfall amounts…” While it is generally recognized by those who foresee a

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future of winners and losers that people in much of sub-Saharan Africa and
on small island nations will be losers, they assert that people in what are
generally low-density populated areas, such as much of North America,
northern Europe, Siberia, Tasmania, and New Zealand, will be among the
winners in terms of longer growing seasons and increasingly habitable lands.
In other words, as Coreil (2004:3) notes, “Whether a particular impact is per-
ceived as negative or positive depends on one’s interests.”
The final scenario in Chamberlin’s scheme involves a future character-
ized by a broad transformative response to environmental threat. In this
imagined world, we achieve the mitigation of global warming through the
adoption of alternative planet-friendly lifestyles and green energy
approaches. Inevitably, as indicated below in the conclusion, achieve-
ment of such a future requires a commitment to environmental justice.

Confronting Pluralea
It is the argument of this paper that all of Chamberlin’s futures narratives,
especially those that incorporate an acceptance of winners and losers, fail
to fully engage the issue of pluralea interactions and the threat they pose
for human health and well-being. Of considerable importance in the
study of pluraleal phenomena are their proximate and ultimate causes,
and especially, from the anthropological standpoint, the precise role of
human social and economic systems in generating health damaging envi-
ronmental stresses and the intertwined ecocrises that result. Also critical
to the pluralea perspective is the development of an understanding of the
pathways and mechanisms through which two or more ecocrises interact
to produce synergistic, magnified environmental and health impacts.
No less than the alternatives discussed by Chamberlin, the pluralea
perspective is a product of imaginings about the future; most directly, it
is a descendent of a lineage of evidence-based calculations of the health
and environmental costs of societal pursuit of “natural resources.” One of
the earliest published examinations of this issue was The Challenge of
Man’s Future by journalist Harrison Brown (1954). In this seminal volume,
Brown (1954) argued that if all nations of the world were to achieve the
level of development of the West there would eventually be a collapse of
the natural resource base on which developed countries depend. While
Brown’s warning had little impact when it was published, 18 years later,
in 1972, the Club of Rome issued a similar book, entitled The Limits to

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Growth, that did attract attention from the media, researchers, and poli-
cy-makers. Initiated in 1968, the Club of Rome was born of a conference
designed to discuss the costs of short-term thinking in international
affairs, especially the human penalties of promoting unlimited resource
consumption in an increasingly interdependent world. Reflecting the
efforts of an international and multidisciplinary team of experts who had
access to a wide range of data bases on world population, agricultural and
industrial production, resource depletion, and pollution, the book pro-
jected a global economic collapse some time before 2100 AD. The cause
of the collapse was explained as the calculable limits of the environment
to both provide the massive quantities of resources needed to meet rising
levels of consumption worldwide and to endure the anthropogenic pollu-
tion borne of ever-expanding production (Club of Rome 1972). While com-
mitted to market-based economics, the authors of The Limits to Growth
recognized the threat that industrial capitalism presents for maintaining
the fragile ecosystems on which all life depends.
Subsequently, in 1983, the United Nations General Assembly passed a res-
olution creating the World Commission on Environment and Development.
The Brundtland Commission, as it came to be known, first met in October
1984 and published its report, Our Common Future, 900 days later, in April
1987. Over the 900 days that the Commission was in session, signs of the omi-
nous health-related impact of human activity on the environment regularly
made front page headlines around the world. These included:

• A drought-triggered, environment-development crisis in Africa that

put 36 million people at risk of starvation, killing perhaps a million.
• A leak in a pesticides factory in Bhopal, India that killed more than
2,000 people and blinded and injured over 200,000 more.
• A liquid gas tank explosion in Mexico City that killed 1,000 and left
thousands more homeless.
• The Chernobyl nuclear reactor explosion that sent a radioactive
cloud across Belarus, Ukraine, Russia, Western Europe and other sec-
tors of the Western Hemisphere and exposed hundreds of thousands
of people to radioactive iodine-131.
• Agricultural chemicals, solvents, and mercury flowed into the Rhine
River during a warehouse fire in Switzerland, killing millions of fish
and threatening drinking water in the Federal Republic of Germany
and the Netherlands.

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• An estimated 60 million people died of diarrheal diseases related to

unsafe drinking water and malnutrition; mostly children.

Meanwhile, although it did not capture the attention of the writers of

Our Common Future, the greenhouse gases that propel global warming were
continuing to build in the earth’s atmosphere, and here and there around
the globe, climate, glacial, oceanic and other scientists began to record
signs of a significant shift in the Earth’s temperature. Early in the new cen-
tury, a study by the World Health Organization (2002) concluded that over
150,000 people a year were already dying from the effects of global warm-
ing and predicted a doubling of this number by 2020, if not earlier.
Stressing the need for a shift in focus from individual environmental
problems to interlocked environmental (and other) emergencies, the
Brundtland Commission (1987) concluded that “The deepening and widen-
ing environmental crisis presents a threat to national security—and even
survival…” The potential for reaching such a dangerous state is not with-
out precedent on Earth. The Permian-Triassic (P-T) Mass Extinction of
approximately 250 million years ago wiped out 95% of all marine species
and 85% of land dwelling species. Its cause appears to have been the build
up of planet-warming CO2 in the atmosphere (and a resulting rise in tem-
perature of 10 to 30 degrees Celsius ), caused by massive lava outflows in
Siberia. Atmospheric CO2 ultimately reached 1,000-1,500 parts per million
(i.e., as much as 1,500 carbon dioxide molecules for every one million total
molecules in the atmosphere) (Kiehl and Shields 2005). While current lev-
els of CO2 are far lower (in the range of 385 parts per million), they are still
the highest they have been for over 400,000 years and are rising at a faster
rate—2 parts per million per year with an expected jump to 3 parts per
million in the near future—than at any time in the past 20,000 years. At
this pace, by the end of the next century levels could reach those that
occurred with such catastrophic results during the Permian-Triassic.
Most environmental approaches to gaining insight about human health
historically have focused on the identification of one-on-one relationships
between specific human health indicators and particular environmental
factors (e.g., the impact of second-hand smoke exposure on rates of can-
cer). Because of the complexity of the relationships between human soci-
eties and environments, the simple observation of cause and effect con-
sequences in hierarchical, interlocking systems generally has proved
insufficient to provide a complete picture of the nature and extent of the

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adverse human influence on the health of both ecosystems and the

human beings who inhabit them. Missing has been a critical biosocial
framework for comprehending how particular interactions occur (e.g.,
social factors that influence the production, sales, and use patterns of a
pesticide like dioxin, its distribution in the environment, and its direct
and indirect health effects) (Roberts et al. 2003). Building on anthropolog-
ical studies of societies in environmental context (e.g., Cole and Wolf
1974, Wolf 1972), the multidisciplinary perspective of political ecology
(Blaikie and Brookfield 1987, Foster 1994, Roberts and Grimes 2002)
offers medical anthropology a starting point for developing such an
understanding. This is achieved by integrating “spatially heterogeneous
processes and actors within a framework of ecological, social, and politi-
cal relations that links inquiry across scales of analysis” (Bury 2008:307).
This approach is united with critical perspectives in the health and social
sciences (Baer, Singer, and Susser 2003; Krieger 2003; Singer 2009) to form
a political ecology of health. The resulting theoretical framework lends
itself to broader research agendas in medical anthropology on the ways
that political, economic, and structural factors shape the interface among
society, health, and the environment (Baer and Singer 2009).
In light of this perspective on health and the environment, the remain-
der of this paper presents two examples of contemporary interlocked
ecocrises and examines the diverse components and kinds of interaction
that comprise these health-threatening expressions of pluralea phenome-
na. The implications of these developments for medical anthropology are
discussed in the conclusion.

Case 1 Flooding the Heartland

The Midwest is often described as the most quintessentially “American” of
the nation’s several regions. First recognized as having a distinct cultural
tradition in the early part of the 20th century, Midwestern “character” and
accompanying values are known to have exerted considerable influence on
the American self-conception and identity. As described by Sisson, Zacher
and Cayton (2007:12), in the popular imagination Midwesterners are
“thought of as hard-working, thrifty, devoted to family values, strong in
character, comfortable with normalcy, rather sedate and cautious about
change.” Yet, with reference to the environment, the Midwest is, in fact, a
place of extensive and rapid change, much of it as the result of intended

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and unintended human action. Exemplary are the environmental transfor-

mations that contributed to the extreme weather events, including mass
flooding, that staggered the Midwest during the early summer of 2008.
The Midwestern location of the weather events in question is notewor-
thy because an influential component of contemporary climate change
discourse has focused on the issue of “winners and losers,” namely the
assertion that while some regions and some countries will suffer signifi-
cant health and social consequences of global warming others will bene-
fit and life there will get better. Among the commonly cited winners is the
American Midwest, whose corn, soybean, and wheat belts, some commen-
tators have claimed, will expand profitably in the coming, warmer, years
ahead. As Easterbrook (2007) asserts,

Rising world temperatures might throw Indonesia, Mexico, Nigeria,

and other low-latitude nations into generations of misery, while
causing Canada, Greenland, and Scandinavia to experience a rip-
roarin’ economic boom…. In North America, spring comes ever ear-
lier—in recent years, trees have flowered in Washington, D.C.,
almost a week earlier on average than a generation ago. People may
find this creepy, but earlier springs and milder winters can have eco-
nomic value to agriculture—and lest we forget, all modern soci-
eties, including the United States, are grounded in agriculture.

The folly of such thinking is suggested by the scale of the storms that inun-
dated the Midwest during the months of May and June of 2008, and the
implications they have for the alleged rosy future of the region. As graph-
ically reported in USA Today (Keen 2008:1):

“Nightmare” was the only word Joe Russell could come up with
Sunday to describe the ordeal his family has been through in the past
week. Five days after a tornado tore the roof off their one-story
home on the banks of the Big Blue River in Indiana, a deluge of rain
poured into the remnants, soaking everything…“We’ve about had
it,” [Russell] said…“People are really stressed out.”…Hundreds of
thousands of customers lacked power across the region. Gov. Mitch
Daniels [of Indiana]…declared 13 counties as disaster areas, raising
the total to 23. Jane Jankowski, a spokeswoman for Daniels, said
more than 1,200 people were staying in shelters. “This thing came on

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fast with such a radical deluge of water that people were describing
going from a feeling of security to waist-deep water in a matter or 15
or 20 minutes,” Daniels said.

In Iowa, the result was extensive flooding involving most of the rivers
in the eastern part of the state beginning around June 8th. The flood stage
(i.e., the point at which a body of water floods surrounding areas and
causes damage) of the Cedar River at Cedar Rapids is12 feet. The previous
record flood occurred about 80 years ago in 1929, when the Cedar River
rose to 20 feet. In 2008, the Cedar reached 20 feet and kept rising, with
weather experts reporting that they expected the waterway to crest at 22
feet. Later they changed this estimate to 24 feet. In fact, the river finally
crested at 31.3 feet, breaking the previous record by more than 11 feet.
Cities like Cedar Rapids and Iowa City were hit hard by the storm’s flood
waters. In Cedar Rapids, for example, the downtown flooded and a rail-
road bridge collapsed, spilling railroad cars filled with rock into the river.
As a result, some Iowans began using the phrase “Iowa‘s Katrina” to refer
to their experience.
Across the region, the economic costs (from flooded fields that could
not be harvested to damaged infrastructure, commercial districts, and
dwellings) are massive (and include potential impacts on fuel prices
because of the loss of corn fields central to the burgeoning biofuel indus-
try, the growth of which has contributed significantly to the expansion of
cornfields into previous buffer zones).
While heavy rains at this time of year are not unusual in the Midwest;
rainfall and other storms of the magnitude seen in 2008 are quite unusu-
al. In all, nine rivers in Iowa hit record flood levels. Iowa’s Governor, Chet
Culver, declared 83 of the state’s 99 counties disaster areas. As one insur-
ance company official (quoted in Burns 2008) noted, “I’ve been in the
business for 30 years, and I can’t remember a couple of weeks following
Memorial Day that had this many storms one right after another.” His
company logged 11,000 claims in Iowa, Minnesota, Wisconsin and
Missouri, nearly double its average number of claims in previous years.
From a climate cycle point of view, flooding of the kind that sub-
merged the Midwest is expected to occur once every 500 years (which
means that hyrologists, those who study the properties, distribution, and
circulation of water on Earth, believe that a flood of this enormity has a
0.2% of occurring in a specific year in a given location). This is the second

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massive flooding of the region to occur since 1993, however. In the earli-
er deluge, known as the Great Flood of 1993, 47 people died, 10,000
homes were destroyed, 75 towns were engulfed in flood waters, and the
region suffered $15 billion in damages, making it one of the most devas-
tating storms in modern US history (although far less than the $41 billion,
or more, in damages caused by Hurricane Katrina or the approximate
combined $25 billion in damages wrought by the back-to-back Gulf Coast
Hurricanes Gustov and Ike in 2008) (Larson 1996; EQECAT 2008a, 2008b).
Moreover, during the last 35 years, there have been four floods in the
Mississippi River basin area that based on their magnitude would have
been characterized as 100-year floods, while relatively large Midwestern
storms that used to occur approximately every 20 years now arrive every
four to six years (Zabarenko 2008).
This emergent pattern of larger, more frequent Midwest flooding has
led some climate scientists to investigate the role of global warming in
changing weather patterns because air warmed by the presence of the
greenhouse gases that now blanket the earth can carry far more water
than cooler air. An analysis of weather data conducted by a group of envi-
ronmental organizations from across the country concluded that there has
been a marked increase in the frequency of heavy rainstorms, with the fre-
quency of “extreme rainfall” increasing by 24% between 1948 and 2006. In
the Midwest, the frequency of extreme rainfall events has increased by
20% since the late 1960s, while the number of days per year that see pre-
cipitation greater than four inches has gone up by 50% over the last centu-
ry (National Wildlife Federation 2008). Additionally, there has been a
steady increase in temperature, streamflow and high streamflow across the
United States during the 20th century (Groisman et al. 2002). Over the last
50 years, hydrologists have recorded increases in rates of evaporation;
near-surface humidity; total, low, convective cloudiness (Groisman et al.
2001a, Sun et al. 2001); and early snow cover retreat (Groisman et al.
2001b), as well as an earlier onset of both spring- and summer-like weath-
er conditions, and a rise in thunderstorm activity (Changnon 2001). In
short, there have been multiple indicators of warmer, wetter conditions
that form the context for and fuel increases in damaging flooding events.
While existing science does not yet allow close calibration of specific envi-
ronmental events and broad trends like global warming, as the
Intergovernmental Panel on Climate Change (2007:714) points out,
“Significant increases in observed extreme precipitation have been report-

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ed over some parts of the world, for example over the USA, where the
increase is similar to changes expected under greenhouse warming.”
Further, Kamyar Enshayan, director of an environmental center at the
University of Northern Iowa, has pointed out that the disaster was not
“natural” in the sense that the heavy rains fell on a landscape that had
been radically reengineered by humans. Notes Enshayan (quoted in
Achenbach 2008:A1), “We’ve done numerous things to the landscape that
took away [its] water-absorbing functions.” The changes Enshayan refers
to include: a) the replacement of tall grass prairies (which have now all
but disappeared) with plowed fields of corn and soybeans that, unlike
prairie grasses, have shallow roots that do not hinder the flow of water
run-off as do prairie grasses; b) the thorough draining of developed fields
through the installation of underground pipes; c) the straightening of
streams and creeks, which has reduced the size of their banks while
increasing their rates of water flow; d) the filling in and development of
flood plains; e) the extension of cultivated land ever closer to creeks and
rivers, eliminating the buffer zones that used to hold back rainfall from
moving rapidly from plowed fields to surface water; and f) the biofuel-
motivated removal, between 2007 and 2008, of over 100,000 acres of
land from the Conservation Reserve Program, which pays farmers not to
cultivate tracts of potential farmland, thereby reducing the fallow
acreage with deep roots in the soil.
As a result of these unrestrained efforts to expand food and biofuel
production and human occupation, approximately 90% of the wetlands in
Iowa have disappeared. This loss is noteworthy because wetlands play a
critical role in reducing the frequency and intensity of floods by acting as
natural defenses that slow water flows, absorb great quantities of water,
and store water in the ground. Wetlands, in short, have an integral role in
limiting the health, economic, and social costs of flooding, which is the
most common “natural” hazard in the United States. As a result, wetlands
(and their loss) have a direct impact on human health. The primary
health-based environmental indicators associated with flooding, besides
drowning (which claimed the lives of 16 people in the Midwest deluge),
are infections caused by waterborne pathogens and water-based disease
vectors; contact with polluted water that contains the outflow of over-
whelmed sewage systems, petroleum products, toxins from built environ-
ments, uncollected garbage, and dead animals; and respiratory and neu-
rological diseases caused by mold that forms in damp structures.

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In the aftermath of the Midwest floods, public health officials expressed

particular concern about several waterborne pathogens, including E. coli,
giardia, and cryptosporidosis. Cryptosporidium parvum, for example,
became a major health hazard after the 1993 Mississippi flooding of
Milwaukee (Epstein 2005). During a two week period, 25% of Milwaukee res-
idents were infected. Victims suffered from painful stomach cramps, severe
diarrhea, high fever, and dehydration, and over 100 people, especially eld-
erly individuals and those suffering from immune conditions, died.
Given the tendency of flooding to form pools of stationary water,
another health threat faced by the Midwest was the potential for mosqui-
to-borne infections. The Siouxland District Health Department in Iowa, for
example, reported that after the storms ended, the Sioux City area was
covered in mosquito-friendly pools of stationary water. In Indiana, health
official reported trapping a number of mosquitoes infected with West Nile
virus (Johnson 2008). The primary carriers of West Nile Virus are Culex
mosquitoes, a species that prefers to breed in artificial containers such as
old tires, buckets, wading pools and clogged rain gutters, but will also lay
eggs in pooled water after flooding. The severity of West Nile infection
varies greatly, with some sufferers developing encephalitis and others
experiencing no apparent symptoms at all. Among the reported human
West Nile cases in Iowa in 2008, the most common symptoms were:
fatigue (100%), fever (83%), muscle aches (83%), joint pain (83%), headache
(67%), and nausea (67%) (Iowa Department of Public Health 2008).
There is a special risk of chemical exposure in areas near flooded struc-
tures that contain hazardous materials, include asbestos, propane, chem-
icals, gas and oil, and pesticides. In Cedar Falls, Iowa, for example, a
maintenance building that contained 2,4,5-trichlorophenoxyacetic acid, a
powerful herbicide found in the defoliant Agent Orange, was overrun by
the Cedar River, and some of the chemical spilled into the floodwaters
(Johnson 2008).
Another consequence of the flooding of structures is the subsequent
growth of mold, which is known to be the source of severe allergic reac-
tions and potentially fatal respiratory seizures. Particularly dangerous are
molds that produce mycotoxins. People can be exposed to mycotoxins
through skin contact, inhalation, or ingestion. Symptoms and diseases
caused by exposure include wheezing, memory and hearing loss, chronic
bronchitis, hypersensitivity pneumonitis, learning disabilities, mental
deficiencies, heart problems, multiple sclerosis, chronic fatigue, lupus,

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fibromyalgia, rheumatoid arthritis, and bleeding lungs. Mycotoxins can

also cause suppression of immune system function, putting sufferers at
grave risk for a wide range of other health conditions, and some mycotox-
ins are carcinogenic (Brandt et al. 2006).
In sum, global warming is not likely to bring wealthier and certainly
not healthier times to the Midwest because, contrary to the premises of
the “winners and losers” perspective, climate change is not an isolated
event. Rather, because of interaction with other adverse anthropogenic
eco-changes in the region, as seen in the flooding of 2008, many if not
most Midwesterners will be climate change “losers” in the absence of far
reaching mitigation efforts.

Case 2 Collapse of the Sacramento Delta

“ For all its value and beauty…. the delta is also on the verge of
collapse” (Yeoman 2008:29-30).

The collapse referenced by Yeoman is affirmed by John Paul Woodley, Jr.,

the assistant secretary of the army for civil works, who asserted at the
“Still Battling the Inland Sea” conference held in Sacramento in July 2007:
“If I had been asked prior to August of 2005 which of the two great cities,
New Orleans or Sacramento, was in the most danger of catastrophic inun-
dation, my answer would not have been New Orleans, my answer would
have been Sacramento” (ASCE News 2007). The reason for Woodley’s
assessment is the current state of the Sacramento-San Joaquin River Delta,
one of the 60 largest river deltas in the world and the largest on the west
coast of the United States. Situated east of San Francisco on the western
edge of the Central Valley of California, it is one of the few inverted river
deltas in the world. In this type of formation, the narrow end of the
branching fan of land patches and waterways faces the ocean while the
wide end is turned inland to catch water runoff from the western flank of
the Sierra Nevada Mountains and the south portion of the Cascades, as
well as part of the coastal range. It is a vast watershed that captures more
than half of California’s rainfall and snowmelt, which drains through the
rivers and other waterways of the Delta on its way through the Carquinez
Strait into San Francisco Bay and ultimately the Pacific Ocean. As a result,
in the past the Delta flooded over with each spring’s snow melt, forming

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a giant estuary that was once called the Everglades of the West. Given the
endangered state of the Everglades, and the causes of its decline, the
comparison is now frighteningly accurate.
The making of the modern Delta is the story of California. In 1846,
Edwin Bryant (1848), a Kentucky journalist, visited the area and recorded
a description of the Delta in his journal, which, following the discovery of
gold in California (an event that made the state’s name a household word
throughout the nation), was published and became a best seller:

The Sacramento and San Joaquin Rivers empty into the Bay of San
Francisco at the same point, about sixty miles from the Pacific, and
by numerous mouths or sloughs as they are here called. These
sloughs wind through an immense timbered swamp, and constitute
a terraqueous labyrinth of such intricacy, that unskilful [sic] and
inexperienced navigators have been lost for many days in it, and
some, I have been told, have perished, never finding their way out.

With the support of Congress (which in 1850 passed the Swamp and
Overflow Land Act conveying ownership of the Delta to the State of
California), settlers arrived and began to drain the marshes. In the late
19th century, levees, comprised of parallel walls of sun-dried peat bricks,
were built by thousands of Chinese laborers brought in to help control
flooding and create what soon became an archipelago of 70 highly fertile
“peat-dirt” islands (some of which are now 15-20 feet below sea level and
sinking at a pace of about three inches a year) surrounded by 700 miles of
waterways. With its naturally spreading water controlled, the Delta grew
into the pear capital of the world and at one time produced nearly 90% of
the asparagus grown on the planet. Other Delta crops include cherries,
corn, wheat, tomatoes, and wine grapes. Because of its plentiful water
(which now serves the domestic consumption needs of two out of three
Californians, or approximately 23 million people) and agricultural produc-
tivity (yielding a harvest valued at $2 billion a year from just over 300,000
acres of land), the Delta became pivotal to the fast-growing economy of a
rapidly populating and politically powerful state.
From early on, there were fortunes to be made in Delta farming, and
men like Louis Meyers, an orchard magnate—whose four-story 58-room
Italian Renaissance villa with five marble fireplaces, inlaid parquet floors,
rare handmade tile work, and imported wood paneling, on the Delta’s

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Grand Island, still stands—were among the promoters and benefactors of

the re-shaped Delta ecosystem.
Today, however, the fortunes of the Delta seem far less favorable.
While its well publicized “Thousand Miles of Waterways” have made recre-
ational fishing an important tourist attraction in the Delta—at one time,
long time residents report, stripped bass were so plentiful they could be
scooped from local waters with a hand net—native fish populations of
salmon, steelhead, sturgeon, smelt, and striped bass are declining at an
alarming rate, suggesting that the entire Delta ecosystem is seriously out
of balance. Some species, like the delta smelt, verge on extinction. Loss of
this tiny fish is dangerous because it has long served as a primary food
source for larger fish. Alien plants and animals (introduced by ships that
travel the Stockton Deep Water Ship Channel that was dredged through
the Delta in the 1930s to link Sacramento to the ocean) now thrive in the
altered environment. One invader, the overbite clam, is an aggressive
competitor for estuary plankton, another critical food source for native
fish species. Intertwined agricultural threats to the water species of the
Delta include nitrogen fertilizers and pesticides run-off.
Data collected by researchers at the University of California, Davis
reveal 57 different pesticides in the waters and soils of the San Joaquin
River system (Jahagirdar 2006). At almost half of the testing stations set
up by researchers along the river system, pesticide levels exceeded the
environmental safety and public health standards implemented by the
Central Valley Water Board. Moreover, most of the chemicals identified in
the water system have been linked to health problems ranging from can-
cer to brain damage. Over the last 35 years, there has been a continual
pattern of “pesticide substitution” as each class of agricultural pest killer
is found to be harmful and is replaced by a new set of powerful chemicals
that initially are touted as being free of the negative consequences of
their predecessors, only in time to be found to be as dangerous or even
more dangerous to the environment than the pesticides they replaced.
Thus, when DDT was banned in 1973, after its deadly effects on wildlife
became known, it was replaced by the organophosphates. As the harm
caused by these substances was documented, they, in turn, were replaced
by the pyrethroids. Current research indicates that pyrethroid pesticides
may be even more toxic to fish than their predecessors. Notably research
on the San Joaquin River found pollution by all three of these classes of
pesticide (Jahagirdar 2006).

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Beyond Global Warming: Interacting Ecocrises and the Critical Anthropology of Health

The river was also found to contain deadly heavy metals, such as sele-
nium (which has been responsible for bird kills at Kesterson Reservoir in
California’s Central Valley) and mercury, salts like boron, and other chem-
icals that feed rampant algae growth that uses up the oxygen needed by
other aquatic wildlife. Many of these chemicals derive from fertilizers,
which are high in nitrogen and phosphorous. Nitrate compounds that
form from the nitrogen in fertilizer are a health hazard that at sufficient
levels can cause a fatal condition in young children called “blue baby syn-
drome” (i.e., cyanosis).
There is another toxin in the waters of the Delta that is a direct prod-
uct of the growing human population in the region. The toxin, ammonia,
is a common byproduct of human urine and feces. Studies show that the
Sacramento region sewage treatment plant—which discharges treated
wastewater produced by almost one and a half million residents (without
removing ammonia), is the largest single source of ammonia in the Delta.
The ammonia load in the wastewater produced by the residents of
Sacramento has more than doubled since 1985 as a result of rapid urban
growth (Weiser 2008). Moreover, Environmental Protection Agency data
released by the California Sportfishing Protection Alliance (2007) indicate
that the city of Stockton violated its wastewater discharge permit 50 times
in 2005, allowing ammonia to exceed allowed levels per occasion by 23 to
1,245%. In the assessment of Bill Jennings, the executive director of the
Alliance, which sued the city:

Stockton’s wastewater control system is a public health and environ-

mental hazard…The City’s failure to provide adequate facilities and
acceptable levels of maintenance for wastewater control indicates
an outrageous and egregious disregard for the health of Stockton’s
residents and poses a clear threat to the integrity and survival of the
Delta’s fish and wildlife resources…

Richard Dugdale and colleagues (2007) at the San Francisco State

University’s Romberg Tiburon Center have investigated the impact of
ammonia on the food chain of the Delta. They report that ammonia kills
diatom, an algae that also forms part of the Delta food chain. Larval smelt
are also believed to be particularly sensitive to the rising ammonia levels.
Further, nuisance algal blooms that have begun clogging Delta waterways
have been traced to rising ammonia levels.

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 MERRILL SINGER

These changes, however, are not the only ecocidal forces pushing the
Delta toward crisis. The earthen levees that keep the farmlands of the
Delta artificially dry are fragile and subject to collapse. On June 3, 2004,
for example, a 350 foot section of the levee 10 miles west of Stockton
crumbled, flooding 12,000 acres of Upper Jones Tract Island and causing
$90 million in damage. Six months were needed to pump the water out of
the area. Over the last 100 years, there have been over 165 levee failures,
and, given the ever present threat of earthquakes in California, the poten-
tial for widespread levee breach is great.
Global warming, which is causing more frequent extreme weather events
and pushing sea levels ever higher (estimated to rise two feet on the
California coast by the end of the century), is another growing threat to
levee integrity (Logan 1990). In addition to causing an increase in mean
water surface, which puts direct pressure on the levees, “sea level rise will
increase the frequency and duration of extreme high water events from the
co-occurrence of high tidal elevations, El Niño–like disturbances, low pres-
sure systems, and high inflows” (Lund et al. 2008:10). The result will be a
considerable boost in the length of time levees are stressed by high water,
significantly raising the likelihood of levee failure. Even without damage to
the levees, a rising ocean will steadily increase the salinity of Delta water.
Ironically, farming the Delta has itself contributed to global warming by
releasing a considerable amount of CO2 from the local peat soil into the
atmosphere. A study completed in 2005 by a team led by Jeffrey Mount,
director of the Center for Watershed Sciences at the University of California,
Davis (Mount et al. 2006) projected a 64% chance that up to 20 levees will
fail simultaneously at some point within the next 50 years.
Also threatening the levees, and the rapidly declining fish populations,
is the massive pumping of water out of the Delta. The water goes both to
feed the sprawling, highly profitable, farmlands of the San Joaquin Valley—
a center of US vegetable and fruit production that could not sustain such
high-yield farming based on local rainfall and natural stream flow—and to
provide drinking water to many California residents. Massive pumps, built
at two locations, are capable of drawing out millions of cubic feet of water
per hour and pushing the precious liquid into a series of aqueducts, canals,
and reservoirs. One pumping station moves water into a canal that travels
over a hundred miles to bring water to the fields of the San Joaquin Valley,
allowing the production of $20 billion worth of tomatoes, peppers, cotton,
and other crops. The other pump, part of a system known as the State Water

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Beyond Global Warming: Interacting Ecocrises and the Critical Anthropology of Health

Project, one of the largest artificial water-distribution initiatives on the

planet, diverts water from Northern California and the Central Valley to 150
cities in Southern California, providing them with at least a portion of their
potable water. Together, during rainy years, the two pump systems divert
enough water from the Delta “to flood a 1,000 football fields more than a
mile deep” (Yeoman 2008:31).
The consequence of these various interacting anthropogenic forces is
summarized in a report issued by the Public Policy Institute of California
(Lund et al. 2008:7-8), which points out that

Natural systems that have been heavily influenced by human activi-

ties—of which the Delta is a prime example—are vulnerable to sig-
nificant change from two distinct sources… First, external factors
(such as climate change) can dramatically alter conditions. Second,
the way human activities interact with natural processes can create
additional pressures. As these systems lose their resiliency, they
become vulnerable to dramatic and potentially abrupt shifts in phys-
ical and biological conditions… These changes are often associated
with thresholds or tipping points where change is…irreversible….
The Delta is at a tipping point.

Without massive, costly intervention (which, because of the magnitude

of the forces involved cannot insure success), dramatic changes in the
Delta, that have momentous health and social consequences for
Californians and the nation, lie ahead.

Conclusions: Moment of Danger, Moment of Truth

As Bodley (2008:49) indicates, “The basic cause of environmental crisis is
humans making too many demands on nature.” These demands take three
primary forms: 1) reaching rates of resource depletion in the process of
commodity production and consumption that exceeds rates of resource
production through biological and other natural processes; 2) restructur-
ing and simplifying environmental systems in ways that upset ecological
balances and trigger climatic and other disruptive environmental events;
and 3) discarding vast quantities of waste that interfere with natural recy-
cling processes. While all human systems through time have put demands
on their local environments, and even caused some degree of environmen-

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tal restructuring and degradation, species extinction, or even various

forms of local societal collapse (Diamond 2005), the rise of the global cap-
italist system, with its fossil-fuel driven technology, emphasis on ever
expanding consumption, and truly worldwide impact has increased the
likelihood of triggering a cascade of interacting and life-threatening
ecocrises to a level never seen before in human history. Pluralea interac-
tions of this sort undercut narratives of regional “winners and losers” of
climatic or other environmental change. Instead, they imperil—although
not necessarily in quite the same ways nor always to the same degree—the
health and social well-being of all human populations and magnify the
critical need for meaningful mitigation efforts and wider societal transfor-
mations. Further, the occurrence of pluralea interactions clarify that our
dominant approaches to the environment, reflected in the first three of
Chamberlin’s imagined futures, have put us in perilous times.
Over its relative short history as a named subdiscipline, the field of
medical anthropology (while a diverse field) has moved from an early
focus on environment and health issues towards an orientation that priv-
ileges cultural and social structural factors over environmental ones.
Greater unification of these approaches—such as examination of the
interplay of cultural narratives and environmental experiences—and the
development of an environmentally conscious critical anthropology of
health (or alternatively, an anthropologically informed political ecology
of health [Greenberg and Park 1994]), offers an important direction for
medical anthropology in the 21st century. In this regard, one of the
strongest contributions medical anthropology can make to the study of
pluralea phenomenon, in addition to calling attention to their growing
importance in global health, is the careful on-the-ground analysis—very
likely often as members of multidisciplinary teams—of the nature of
local and regional ecocrises interactions, their social determinants, and
community responses to these adverse events. Additionally, given the
grave nature of the issues involved, the tremendous disparities in the dis-
tribution of the human consequences of pluralea phenomena, the
inequalities in the distribution of political and economic power that
underlies anthropogenic environmental changes, and the growing emer-
gence of local and social movements for change, there is a need for an
engaged medical anthropology, one that seeks, in collaboration with the
communities it studies and activist movements, to apply its insights to
amelioration. In short, in light of recognition of pluralea interactions as

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Beyond Global Warming: Interacting Ecocrises and the Critical Anthropology of Health

representing grave threats to all human futures, there is a critical need for
a new applied narrative of environmental health equity and action.

ACKNOWLEDGMENTS
I want to thank Hans Baer and Pamela Erickson for reading and providing comments
on an earlier draft of this paper.

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