2020 MacArthur Fellow Catherine Coleman Flowers's work fighting for basic sanitation addresses some of the most pressing issues of our time—public health, environmental, economic, and racial justice. It began in in her home community of Lowndes County, Alabama, a county that has a long, turbulent, and bloody history of racial injustice, and has expanded to communities across the United States. In her new book Waste: One Woman’s Fight Against America’s Dirty Secret, Flowers recounts her evolution from country girl to student civil rights organizer to environmental justice champion.

In the interview below, Flowers discusses her journey as an activist, America's dirty secret: the problem of inadequate human waste disposal, and the problems it poses to some of the most vulnerable people in this country.

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How did you first become aware of the problem of inadequate human waste disposal, which you call "America’s dirty secret?"  When did you realize this was a major environmental and racial justice issue?

Catherine Coleman Flowers: I first encountered the issue in 2002. I was working in economic development and saw people being arrested in Lowndes County for having raw sewage on the ground due to failed waste disposal systems. Even then, I didn't realize the full extent of the problem, until we conducted a house-to-house survey in Lowndes County and saw how bad things were. As we started talking about it, people began reaching out to us from other areas, from other parts of the country. That’s when we knew that it wasn't unique to Alabama, that it was prevalent in more rural communities than just ours.

We soon began hosting visitors from around the country; I’ll never forget one visit we made to a home in Lowndes, where we saw raw sewage running down the road before we even saw the home. Another time, we met with a minister who could no longer hold services at his church because they did not have a functioning septic system. In another house, both the husband and wife had been arrested for not having an adequate septic system.

Word started to get around about the situation—for example, Bob Woodson called the late Bill Raspberry, who had a column in the Washington Post, and he wrote about what was happening in Lowndes County. That's when I realized that this was a very significant, national problem.

Can you describe what is actually happening when this problem occurs?  How does waste from people’s toilets end up on their lawns, or flowing back into their homes? Is it a problem of failing systems, or systems that were never installed, or poor soil conditions?

CF: All of the above. One problem is straight piping. Straight piping is when you flush the toilet and it comes out on top of the ground or into a yard or pasture. In some cases, people have dug a pit for the waste too close to the house. Another problem is when people have septic systems that fail—especially when we have a lot of rain. When they fail, the waste can go back into their homes through the pipes. A third problem occurs when a small town’s wastewater treatment plant systems fails—which, again, is often because of rain and overly saturated ground.

How does this problem work to criminalize poverty?

CF: The problem works to criminalize poverty because the people who have been cited for dumping raw sewage have generally been poor people. They are often cited over and over and over again. To the point that it has forced a lot of them to not even talk about the problem because of fear that they can be arrested—rather than talking to someone and trying to figure out what solutions are.

What is happening now is that the regulators are involved in training the installers of the waste removal systems and choosing the equipment that can be used within the state, but they are not actually in communication with the people relying on these systems. There is a lack of accountability because there's not an independent group to make sure that these systems work accurately. The burden isn’t on those putting in the waste removal systems—it’s entirely on the families using them. And if the systems fail, and it is reported to the authorities here in Alabama, the families can be cited, brought to court or even arrested.

"It's a problem that that exists around the country—and around the world actually—but nobody expects it to happen in the U.S."

When did you discover that this was a problem not just for poor Black people in the South, but also poor white people, Latinx people and Native Americans across the nation?

CF: As time went on, it became obvious that it was impacting people around the country because they were reaching out to me. When we started getting more national press about the issue, more people were telling me about problems in their communities. No matter where I am in the U.S., every time I give a speech, somebody will come up to me and say, "You've described what I've seen all my life."

Just to give you an example—in one instance, a video was being made about the work that I do, and the filmmaker said to me, “I've seen this problem before. It was at my grandmother's house in Southern Illinois.” I actually had the opportunity to go to Virginia, a place outside of Roanoke, where people were having the same issues. These are white communities. I've seen it in Appalachia. I'm hearing about it on reservations. I've gone to places in the Central Valley in California where they’ve had these issues. I've seen it in Illinois myself, firsthand. So, it's a problem that that exists around the country—and around the world actually—but nobody expects it to happen in the U.S.

How did you become aware that inadequate waste disposal was contributing to the spread of hookworm, a parasite that had previously been considered eradicated in the United States?

CF: I became aware of this when we partnered with the Baylor College of Medicine's National School of Tropical Medicine, and I described to Dr. Peter Hotez what we were seeing in Lowndes County. I also described to him my own personal encounter, where I was bitten by mosquitoes and broke out in a rash and couldn't determine what was wrong with me.

He was the one who came up with the idea that we should do a study on hookworm, to prove what I thought existed. I didn't know what it was, I didn't have a name for it. I knew based on what people were sharing with me that something was wrong. But I didn't know exactly where to start.

That collaboration with Dr. Hotez ended up proving what we thought to be true—that hookworm was extremely prevalent in Lowndes. We collected fecal and blood samples from individuals, and we also collected soil and water samples from the county. And it was in those samples that we found the evidence.

How did your background as a Black native of Lowndes County, Alabama, and a child of parents involved in the Civil Rights movement, set you on a path as a social justice advocate?

CF: Well, there are certain learned behaviors we get from our parents and the people that we’re around. I think that my parents’ work made me listen more and have respect for local leadership. Leadership to me is not necessarily defined as elected officials. It’s also people in the community who are well-respected. My parents were like jailhouse lawyers of their communities; everybody came to them whenever they had a problem. To this day, I try to seek out the people who are like my parents—the people to whom others come with questions.

It also impacted me to grow up around people who were involved in the Civil Rights Movement and the Student Nonviolent Coordinating Committee. All of that was very inspirational and put me on the path to being a social justice advocate. Did I think I was going to end up doing this? No. And if I could have chosen something different, it would have been something more glamorous than wastewater! It just naturally evolved, and I accepted that that was my calling.

"People who are coming from urban environments have the privilege of flushing and forgetting. But if one lives or has spent time in these rural communities, it’s not the same."

How did you get the name of your high school changed so that it no longer honored a Confederate slave owner?

CF: I spent the summer—I'll be dating myself—of 1975 in in Washington, D.C. I was a Robert Kennedy Youth Fellow, and my role was to learn how Capitol Hill worked. Part of that experience involved going to visit Senator Edward Kennedy. He knew all this stuff about what I was doing as an activist, but he asked me a question that his staff could not have prepared him for. He asked me about the name of my school, and I said, “Lowndes County Training School.” And he said, “Did you know that ‘training school’ in the south denotes a school for delinquent children? And why are all the black schools ‘training schools’ and the white schools are ‘high schools?’”

It had always been that way so I didn't know any different. But when he raised the question to me, I couldn’t let go of it. When I went back home, I told my parents that I wanted to change the name of the school. I was going into my senior year, and I did not want “Training School” to be on my diploma. I didn't want people to automatically assume or perceive that I had come from a school for delinquent children.

I went with my father and another activist, Reverend Arthur Lee Knight, to present at the very first school board meeting of that year. I remember one of the school board members said to me, “You should be happy to attend a school named for William Lowndes”—a man who had been one of the leaders in the secession movement from the United States because he supported slavery.

All of that history, I understood some of it, but only as much as a 17-year-old could. I have a deeper understanding of the history now and how impactful it was on my upbringing. And I guess looking back now, you can see that petitioning for the name change was a brave move, but it was just normal for the times.

In the end, we had enough votes on the school board to change the name, and months later I graduated from Central High School.

What is your role at the Equal Justice Initiative, the organization founded by Bryan Stevenson, which was made famous in his bestselling book Just Mercy, and the movie of the same name?

CF: The reason that I've been able to do this work for so long is because of Bryan Stevenson. I had been hearing about him for a very long time, and I greatly admired his work. His team at the Equal Justice Initiative reached out to me, and I met with them and with Partners in Health about a potential collaboration in Lowndes County.

I’ll never forget the first meeting with Bryan; I was sitting there very nervous and he walked in and started telling me that he had been following my work and admired what I was doing. He said that he had grown up in a home in Delaware that had raw sewage coming back inside. Every time his sister would take a shower, he and his brother had to go and pump the septic system. That was just another validation that this is a problem beyond the Southeast.

Since that time, Bryan has been very supportive giving me the leeway to do the work that I need to do on a grassroots level to work with communities. Without his involvement, I probably wouldn’t have gone this far, because there was so much pushback. But he understood this because of his own firsthand experience, and he gave me the support that I needed to be able to get this far. He was a natural person to write the foreword for my new book, Waste.

"Even though waste is something we all produce, for some reason there's a shame associated with it. And people don't discuss it, but we need to discuss it because it impacts all of us."

Why do you think the issue of sanitation equality has received so little attention to date?

CF: I don’t think sanitation inequality gets a lot of attention because people do not want to acknowledge that it exists. The people who should be reporting on it often live in cities and don't have this problem. So unless they've actually gone and spent time in these rural communities and seen it firsthand, people don't believe in that it exists.

Just from my own experience, I remember taking a British reporter from The Guardian to Lowndes County to see it firsthand. He was shocked. He said that he had seen sewage issues like this in India, but he never expected to see that in the United States.

I guess to summarize what I'm saying—it’s because people who are coming from urban environments have the privilege of flushing and forgetting. But if one lives or has spent time in these rural communities, it’s not the same. And, as a result, unless people come and see it, they don't really realize it.

Not to mention—even though waste is something we all produce, for some reason there's a shame associated with it. And people don't discuss it, but we need to discuss it because it impacts all of us.

You’ve been called the “Erin Brockovich of Sewage” and the “Empress of Effluence.” How do you feel about these labels?

CF: They don't bother me! I have a lot of respect for Eric Brockovich. If my legacy as the “Empress of Effluence” is that I have inspired generations to be able to flush a toilet and the water comes out clean, I think it's well worth carrying those labels. These issues need to be addressed, and if we can learn how to reuse wastewater, this work could yield nutrients that bring us more in balance with Mother Earth.

Who have you taken on tours in Lowndes County to make them aware of this problem?  How have politicians and celebrities, along with journalists and filmmakers, helped to build public awareness?

CF: Yes, I think that many people need to come and see the problem firsthand and listen directly to families telling their own stories about how they deal with these conditions. I think it leaves an impact that I can never just describe. People leave our tours in Lowndes committed to bringing about the change.

The people who have come to Alabama, talked to families and seen it firsthand include Rev. Dr. William Barber, former Vice President Al Gore, Senator Bernie Sanders, Jane Fonda, Kat Taylor, among many others. These visits have been one of the best ways we've been able to share the story because people spread the word when they return home.

How is the problem of inadequate human waste disposal being made worse by climate change?

CF: Wastewater disposal technology simply was not designed to take climate change into account. There are numerous ways the problem is being made worse. First, when we have lots of rain in stalls that hold water, the systems are more likely to fail.

Second, the water tables are rising. Lowndes County had a high water table in the first place. Now, with climate change, it’s getting even higher, and the type of wastewater disposal systems that are being prescribed by the state still do not take into account climate change.

And, of course, the rising temperatures make a bad situation much worse. The combination of heat and raw sewage is encouraging diseases to take root that we’ve never seen this far north.

"The combination of heat and raw sewage is encouraging diseases to take root that we’ve never seen this far north."

What impact has COVID-19 had on the communities most affected by sanitation inequality?

CF: Two communities stand out to me. One is of course Lowndes County, which at one point had the highest per capita infection and death rate in the state of Alabama and one of the highest in the country. The other was Navajo Nation, which also had higher rates of infection and deaths as a result of COVID.

We can actually test the sewage to determine the extent of the COVID infection in a community. One scientist told me that they can see the outbreak coming at least eight days ahead of people starting to show up asking for tests or medical care. And some people are using data to isolate people who may be infected in order to prevent the spread of it.

However, there has not been the kind of research that should be done in places like Navajo Nation or Lowndes County to see what other kinds of vulnerabilities living with lack of infrastructure has created for people trying to combat this pandemic.

How have local, state, and federal governments failed to address the sewage problem?

CF: I think that part of what we see being played out is a lot of inequality in rural communities. Government officials often put money into places where they can get a lot of attention, and that's usually large cities. When people talk about infrastructure, they talk about roads and bridges. But we cannot have any sustainable economic development without having wastewater infrastructure. And that has been ignored for far too long in this country.

We need to find a way to address it. A lot of these local governments can't handle it because they don't have the funds to do it; they don't have the tax base. But we have to make sure that this is addressed, as a public health issue, an environmental justice issue, a social justice issue, an income inequality issue—all of these issues intersect at wastewater. The consequences are too great to ignore. With the sewage conditions we see, the next Spanish flu or COVID-19 could start right here in Alabama.

Are you optimistic that this problem can be corrected? What can ordinary people do about it?

CF: Yes, I'm very optimistic that the problem can be corrected. It’s like a 12-step program; now that we've acknowledged that there is a problem, we can look to the solution. We have the wherewithal to create sustainable technologies that work—green wastewater systems that they can recycle and reuse. We’re now on that path—my organization is having those discussions with technology partners.

Everyone can get involved in this issue. First, look at your own states and communities and see if wastewater problems exist. It’s not necessarily only in rural areas; it could be in the suburbs or anywhere people use their on-site systems or small treatment plants. Write your elected officials responsible for funding wastewater treatment and make sure that funding language incorporates rural communities. If policies are written to only go to towns, it excludes the unincorporated areas.

Second, let us (the Center for Rural Enterprise and Environmental Justice) know if the issue exists in your area! The government has not done a good job of collecting this information, so we have to do it. It can be helpful for us to be able to show where – outside of the Southeast – that this is problem, so that officials can no longer refuse to acknowledge it.

"We cannot have any sustainable economic development without having wastewater infrastructure. And that has been ignored for far too long in this country."

What message do you hope readers take away from your book?

CF: Well, first of all, I would like for readers to grasp the intersectionality of all these issues—of social justice, racial justice, environmental justice and rural justice. And lastly, if nothing else, I would like to inspire young people to continue to do this work.

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For more, read an excerpt from Catherine Coleman Flowers's Waste: One Woman’s Fight Against America’s Dirty Secret.