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Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

Archived Blog Posts
  • Consumer Reports Releases Comprehensive, Science-Based Report Highlighting Pesticide Risks in Fruits and Vegetables

    By Thomas Green, PhD, chair, HHRA Board of Directors Consumer Reports (CR) published a cover story today on pesticides on fruits and vegetables in the US food supply. CR concluded that “20% of the 59 fruit and vegetables tested posed a high risk from pesticides.” Blueberries, green beans, watermelons, bell peppers, potatoes, kale, and mustard greens were among the 12 highest-risk foods. What’s going on here? The United States Department of Agriculture (USDA) annually publishes a report with results from pesticide residue sampling completed two years prior. In January, the USDA’s report assured consumers that 99% of more than 10,000 samples of foods collected in 2022 had pesticides at or below EPA-set legal limits. To add to the confusion, the EWG (formerly Environmental Working Group) follows up each USDA report with its “Shopper’s Guide to Pesticides in Produce” and its widely promoted Dirty Dozen and Clean 15 lists. This year, EWG “determined that 75 percent of all conventional fresh produce sampled had residues of potentially harmful pesticides.” Blueberries, green beans, bell peppers, potatoes, kale, and mustard greens made the EWG’s Dirty Dozen, but not watermelon. Grapes and peaches also made the Dirty Dozen but didn’t make CR’s list of 12 highest risk foods. Three very different perspectives, yet all three organizations use the same data source! Residue data are generated by the USDA, which collects and tests domestic and imported food samples from our food distribution system in multiple states each year. Why the discrepancy in findings? Here’s the story The USDA uses “residue tolerances” established by the US Environmental Protection Agency (EPA). Residues under the tolerance level are regarded as safe. Foods with pesticide residues over the tolerance render the food adulterated. Food declared as such is supposed to be removed from the marketplace but fresh produce rarely is. The EPA tracks total dietary exposures to a given pesticide based on all tolerances that have been approved and by law must determine that there is a “reasonable certainty of no harm” from total exposures. As reported by the USDA this year, of the 10,665 samples collected in 2022, 325 had pesticide residues exceeding the tolerance or present in the absence of a tolerance, or about 3% in total. A third of the samples with over-tolerance, presumptively unsafe residues were US-grown; two-thirds were imported foods. In 2022, 27% of samples tested had no detectable residues. The EWG uses pesticide residue detections, so regardless of the tolerance level set for a pesticide, each residue detected is counted. A food makes the Dirty Dozen list if it is among the foods with the highest number of pesticide residues. Residues of some pesticides known to pose health hazard are weighted more heavily. The EWG typically lumps US and foreign-grown food in their report. In the report released today, CR analyzed USDA data on 59 foods in more than 26,000 samples tested by the USDA over seven years (2016-2022). CR used EPA-set toxicity thresholds for most pesticides but added the full 10-fold safety factor called for in federal law to several more high-risk pesticides than the EPA does. CR scientists consider the EPA’s tolerances to be too high for some pesticides, so they developed these lower limits for “pesticides that can harm the body’s neurological system” or are suspected of interfering with human hormones. The analytical work supporting the CR report was completed by a team led by the HHRA’s founder and first executive director Chuck Benbrook, and grounded in analyses conducted using the Dietary Risk Index (DRI) system currently housed on the HHRA’s website. The DRI is also included in the Pesticide Risk Tool, developed by a team I led and housed at the IPM Institute. I co-founded the IPM Institute in 1998 where our Sustainable Food Group continues to work with food companies and supply chains to reduce pesticide risks among other initiatives. So which report wins the day? All three have value, and all three point to opportunities for improvement. Without the USDA’s highly regarded pesticide residue testing program, efforts to reduce the frequency of high-risk residues would be like shooting in the dark. Of the three analyses, the USDA’s report represents the least conservative approach to estimating risk. Yet the level of tolerance violations reported by the USDA represents hundreds of millions of presumptively unsafe servings of food in the US every year! The EWG and CR take a more conservative approach to estimating and avoiding risk. Both organizations recognize that not all potential risks have been identified or accounted for in EPA risk estimates. For example, we all ingest multiple pesticide residues daily via food and drink, but their combined risk is not taken into account by the EPA. CR’s approach is more science-based and more closely aligned with the EPA’s dietary risk assessment. CR’s methodology is driven by measured residue levels, EPA-set exposure thresholds based mostly on animal studies, and standard food serving sizes. Not all pesticide residues pose equal risk, in fact they vary by over 10,000-fold! What’s the bottom line? All three organizations recommend that everyone should eat lots of fresh fruits and vegetables. The benefits to health outweigh the risks of pesticide exposure. The EWG recommends consumers buy organic versions of its Dirty Dozen. CR recommends limiting consumption of foods they have identified as highest risk to ½ serving per day or less, and buying organic when available and affordable. A common question is, “Can I remove pesticide residues by washing?” Before testing, food samples used in these reports are at a minimum lightly washed. Additional washing may help but will not achieve anywhere near our potential to reduce risk. It’s important to highlight that US-grown conventional food samples have generated fewer tolerance violations year after year compared to imported food, and that organic foods have also consistently generated far fewer violations than conventionally grown samples. In addition, the overall pesticide risk reduction achieved for birds, bees, and people since passage of the Food Quality Protection Act in 1996 has been astounding and readily […]

  • Russell King | Executive Director Reading Science: A Guide for We Who Are Not Scientists

    By Russell K. King, HHRA Executive Director Less than a week ago, the academic publisher Sage Journals retracted studies that questioned the long-established safety record of mifepristone. In December. Nature ran a piece noting that, in 2023, more than 10,000 scientific papers–a record number–were retracted. Not understanding the data, the anti-science voices decry the retractions as proof of corruption in the research community. Misunderstanding scientific publishing is an old and common problem. Early in my career, I was editor of a peer-reviewed medical journal, and part of my job was to translate the scientific language into messages more easily understood by nonscientific readers. I offer here a guide to reading scientific papers when you’re not a scientist. This method is not the only method, and I didn’t create it, but I’ve found it useful. Before I do, however, I hasten to say that the wave of retractions last year does not indicate a wave of fraud in science. The number of journals in publication rose from 1 million in 1997 to 3 million in 2020, yet the average number of retractions per journal has remained largely flat during that time.  Half of the retractions are for reasons other than fabrication, falsification, or plagiarism. The data seem to say the scientific community has stepped up.  Scientists are pressuring journals, and, in turn, journals are improving their policing of papers after publication. Reading scientific papers Step by step: 1. read the abstract to get the general idea of what the paper is about; 2. read the figures and legends to understand the data (then look to see whether they align with the conclusions in the abstract); 3. read the discussion, where the authors summarize and interpret the data (then see whether it aligns with the data in the figures and the overview in the abstract); and 4. if it’s not your field of expertise (true for most of us, even if it’s hard to admit), read the introduction to get a feel for what the relevant literature says; 5. if you’re evaluating how they got from the data to the conclusions, read the discussion (are they using standard methods, missing controls, using a representative sample and a control group, etc.?); and 6. read through a few references to see whether they say what the authors claim they do (padding the references with papers that do not fit is often a way to build false credibility). Red flags As you’re reading, keep your eyes open for signs that should cause you to pause and question the paper’s validity. Red flags don’t necessarily mean the paper is untrustworthy, just that we should not draw conclusions without digging deeper.  Some such red flags are: 1. the author has no expertise in the subject of the paper (is their degree in a relevant field, have they worked in the field, have they previously published in the field in reputable journals?)–crossovers are not uncommon, but these will typically have a coauthor who has credible expertise; 2. the references are old, meaning fewer than six citations from the past five years; 3. the results asserted are not closely tied to the data or are not placed in context with other studies; 4. the conclusions contradict the literature or general scientific consensus–advances happen, but this should prompt us to withhold judgment until we get more information; 5. funders are not disclosed; 6. conflicts of interest are not declared; and 7. the results have not been peer reviewed. Know yourself Because science and anti-science have become such powerful forces in cultural and political differences, it’s vital that we check ourselves as we read and evaluate scientific papers. No matter how well trained we are in critical thinking, no matter how separate we think we are from the cultural and political echo chambers around us, we are still human and we are still given to myriad thinking errors. To deal with the overwhelming amount of information our brains take in, our brains seek shortcuts to lessen the burden. Sometimes these shortcuts are helpful; too often they are not. At minimum, we process information through our personal confirmation bias and a complex, overlapping, ever-changing matrix of internal filters made of everything from our DNA to what we had for lunch. We must ask ourselves–more often than is comfortable–whether our understanding of what we’re reading is being distorted by our own emotions, preferences, prejudices, assumptions, and hopes. This requires us to be honest with ourselves about our emotions, preferences, prejudices, assumptions, and hopes. Read! Science is always emerging, never static. By the moment, it grows ever broader, deeper, more beautiful, more fascinating, and more important to our lives. We depend on science to bring us new information and understanding, to correct the errors of our past and–yes–to retract papers that are erroneous. The 10,000 retractions of 2023 should enhance, not undermine, our appreciation for the men and women of science who share their work with us.  What’s happening in science is exciting, and I promise you that reading about it is more than worth the effort.    

  • Securing the Future of Science: Planned Giving for HHRA

    Planned giving is the process of donating planned gifts, also known as legacy gifts, which are contributions that are arranged in the present and allocated at a future date. Commonly donated through a will or trust, planned gifts are usually granted when a donor passes away.  If you’d like to plan a gift for to support the important work of HHRA, you may use this form.  Thank you. Tax benefits:  Donors can contribute appreciated property, like securities or real estate, receive a charitable deduction for the full market value of the asset, and pay no capital gains tax on the transfer.  Donors who establish a life-income gift receive a tax deduction for the full, fair market value of the assets contributed, minus the present value of the income interest retained; if they fund their gift with appreciated property they pay no upfront capital gains tax on the transfer.  Gifts payable to the HHRA upon the donor’s death, like a bequest or a beneficiary designation in a life insurance policy or retirement account, do not generate a lifetime income tax deduction for the donor, but they are exempt from estate tax. More information: For those who wish to make legacy gifts that are guaranteed to support their own philanthropic interests and intentions, planned or deferred gifts may be most effective. Planned gifts require more planning than most current gifts or income or equity, often including legal and accounting counsel from a donor’s trusted advisors. Because these gifts produce philanthropic benefits to recipient organizations, there may be benefits to the donors or their heirs via reductions in state or federal income, capital gains, estate, or gift taxes. There are many ways to make planned gifts, the most simple of which are life insurance policies, designated distributions from retirement funds, or bequests, where donors designate a percentage or a specific amount of their estate to the recipient charity.  Specific amounts are preferable, as they do not require a full valuation of the estate before distribution can be made. For donors over the age of 70 ½ years who are required to take minimum annual distributions from their Traditional or Roth Individual Retirement Accounts (IRAs), up to $100,000 may be directed to charitable causes, with potentially significant tax savings each year. More complex planned giving arrangements such as charitable gift annuities, charitable remainder unitrusts, charitable remainder annuity trusts, lead trusts and others may provide donors with guaranteed income for the remainder of their lives in exchange for funds transferred to charities now. The gist of most such gift vehicles involves a donor making a current gift to a charity with commensurate tax benefits, the charity paying the donor per agreed-upon terms from those funds in the years that follow, with the remainder of the funds at the donor’s death remaining with the charity in perpetuity.

  • HHRA Earns 2024 Highest Recognition for Transparency

    By Russell K. King, HHRA Executive Director I’m pleased to announce that the HHRA has once again earned the Candid Platinum Seal of Transparency (our first was in 2023)-–an achievement earned by fewer than one percent of US-based nonprofits. The Candid Platinum Seal is the highest level of recognition offered by Candid (formerly known as GuideStar) and is awarded to organizations that meet the highest standards of transparency and accountability. The Candid Platinum Seal demonstrates the HHRA’s commitment to transparency and accountability. Our board, staff, volunteers, and partners believe that by sharing our data, metrics, and strategic priorities with the public, we can build trust and confidence in our organization and our work. To earn the Candid Platinum Seal, non-profit organizations must meet a rigorous set of criteria, including providing complete and accurate information about their mission, programs, finances, and governance on the Candid website, and sharing strategic priorities and information about outcomes.

  • Russell King | Executive Director The Importance of Integrity

    By Russell K. King, HHRA Executive Director Living, as we do, during an era overwhelmed by misinformation, disinformation, mistrust, grifters, posers, and pretenders, integrity is an increasingly rare and valuable quality. For a nonprofit organization like the HHRA, integrity is essential. By funding the Heartland Study, we are seeking the answer to a controversial question:  Are there health problems for mothers and infants that correlate to higher exposure of agricultural chemicals? Why is that controversial? Because there are people who insist they already know the answer and, regardless of whether they insist it’s “yes” or “no,” they prefer we don’t ask. They have vested interests in the answers they promote and fear an unbiased scientific inquiry may produce an answer that does not support those interests. A vested interest—”a strong personal interest in something because you could get an advantage from it,” according to the Cambridge Dictionary—is deadly to integrity. We don’t know whether we’re being told the truth or being told what advances your interest, so we can’t fully believe you. Doubt will endure and undermine your message. Thankfully, the HHRA has no vested interest in the outcome of the Heartland Study. The chair of the HHRA Science Advisory Committee insists we must be “agnostic about the outcome,” and the chair of the HHRA Board of Directors insists we must not “get ahead of the data.”  The principle investigator for the Heartland Study oft reminds us to “always let the science lead.”  As the HHRA executive director, I don’t care what the answer is, but I’m certain the question must be asked. The HHRA and the scientists working on the Heartland Study are not out to prove the answer is yes or no, but to learn whether the answer is yes or no. Likewise, our donors are supporting the effort to find “the” answer not “an” answer. There are no foregone conclusions here. All of which points to the integrity of our mission and our work. Integrity is demonstrated and enhanced by transparency, which is why the HHRA makes public its IRS determination letter, audited financials, bylaws (including our conflict of interest policy), strategic plan, gift acceptance policy, volunteers and staff, and the Heartland Study’s methods paper, published in a peer-reviewed journal.  Such transparency has already earned the highest award from Candid. Integrity yields many positive results.  First, the people and foundations that support the HHRA can know that the money they donate is being used for its stated purpose.  Second, and more importantly, the people who will eventually learn of our outcomes and recommendations, if any, can know that they can trust what they’re being told. That trust will make it more likely that our work will be used in improving public health.  And that is what it’s all about.

Side Effects of Rural Living: Health Disparities in the Heartland

by Grace Koch | Nov 17th, 2021
by Grace Koch | Nov 17th, 2021
Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

Thursday November 18th, 2021 is National Rural Health Day. This year the National Organization of State Offices of Rural Health (NOSORH) is specifically highlighting health equity in rural communities. One of the goals of HHRA’s flagship project, The Heartland Study, is to analyze the impact of pesticide exposures on human health, especially on reproductive impacts, healthy pregnancies and children’s development. Our research is already documenting rising levels of herbicide use and exposures across all citizens in the Midwest and rural communities in particular.

Factors impacting the health of rural populations are often underexplored in large scale clinical research projects carried out in large urban centers. According to the U.S. Census Bureau, 97% of land in America is considered rural. Recognition of rural health disparities, and the factors driving them, is an important part of HHRA’s current and future research.

Rural Health Disparity

A whole host of compounding factors have created significant health disparities for rural communities. Rurality is generally classified as any area outside of an urban area. The Census Bureau defines rural as any population, housing, or territory NOT in an urban area. In 2020, there were approximately 57.23 million people living in rural areas in the United States, about 17% of the overall population (Source).

Rural communities are often geographically isolated from the many resources urban and suburban people take for granted. Something as simple as a yearly doctor’s appointment, or finding a healthcare specialist, can be difficult for rural families, due to long distances they may have to travel and limited transportation options. Census data of medical doctors in the US shows that rural areas only have 11 MDs per 10,000 people, compared to 31 per 10,000 in urban/metro areas. In addition, the extent and quality of healthcare services varies greatly across rural regions of the country.

Source: March of Dimes

Data from March of Dimes shows how access to hospitals in the Heartland state of Iowa are limited to only a few counties (see map). Many families in rural counties have little or no access to a nearby hospital or birth center. This distance can complicate a person’s ability to get appropriate treatment for serious health problems, especially for rural individuals who don’t have a car, money, or access to transportation.

Lack of access to healthcare resources has a direct impact on the health and quality of life of rural communities. These populations have statistically higher rates of disease and disability, pain, increased mortality, and shorter life expectancies. The top five leading causes of death (heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke) are all higher in rural populations compared to urban populations.

In the Heartland State of Indiana, for example, cancer related deaths are far higher in rural/nonmetro counties than in urban/metro counties (see chart below).

Source: RHIhub

Food insecurity is also higher among rural populations. According to the USDA Economic Research Service report in 2020, 11.6% of rural households are food insecure, compared to 10.5% for the nation as a whole. Child poverty and food insecurity is also higher in rural areas, with 16.1% of rural households with children being food insecure, compared to 14.8% overall.

Inequality and Social Determinants of Health in Rural Populations

One rural population that is particularly vulnerable to pesticide exposure is farmworkers. HHRA hopes to translate Heartland Study materials into Spanish and other languages to promote participation by farmworker communities.

Health inequalities are often exacerbated by social determinants of health. Rural Americans are more likely to be low in socioeconomic status or be unemployed, have less post-secondary education, and are less likely to have healthcare coverage by employers or through Medicaid.  In addition, rural households have less access to community social programs, foodbanks, and SNAP program benefits.

Social inequities and health disparities go hand in hand. Social determinants of health like income, education, health literacy, environmental health, gender identity, and race/ethnicity all impact an individual’s physical and mental health.

The data backs this up – adults of racial and ethnic populations, living in rural areas, face more health disparities than white adults. A 2017 CDC report showed that Indigenous, Hispanic, and Black individuals in rural areas were more likely to have higher rates of poor health, report multiple chronic conditions, and are at most risk for obesity.

Rural communities may also face more environmental challenges that can impact health. Overall access to safe drinking water, healthy food options, and stable housing is a problem for many rural communities. Hazardous materials often end up in rural areas, contaminating local environments. In farming areas, heavy use of agricultural chemicals can expose both farmers and non-farmers to toxic pesticides in air, water and dust and soil particles. These additional routes of exposure to possibly toxic chemicals are at the crux of HHRA’s scientific research on the impacts of pesticide exposure on reproductive health, pregnancy outcomes and children’s development in the Midwest. By including rurality in our research, we hope to better understand the connections between farming practices, pesticides and other toxins unique to rural areas and public health outcomes.

HHRA is committed to taking account of the impacts of the unique risk factors and unequal access to healthcare services in specific rural areas, as well as gleaning insights from rural-based clinical research. Progress in understanding these factors will help HHRA address how access to food and farming systems impact public health outcomes in the Heartland and beyond. 

We are committed to enrolling at least 30% of participants in our flagship project, The Heartland Study, from rural areas. Most clinical research on pregnancy and reproduction takes place in urban research hospitals, and the unique health challenges faced by rural women are often not explored. We want to change that.

This is why HHRA is working to build research capacity in rural hospitals and why we will be recruiting more rural hospitals into The Heartland Study. 

We are also hoping to raise adequate funding for 2022 to translate our clinical research documents into other languages. Inclusivity starts with ensuring everyone has a seat at the table, where their voice can be heard.

This #GivingNovember please help us expand our reach to rural families and healthcare providers in the Heartland.  You can do so my making a contribution, signing up for the HHRA newsletter and following us on social media.

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