The Alabama Center for Rural Enterprise (ACRE), the predecessor to the Center for Rural Enterprise and Environmental Justice (CREEJ), evolved as an effort to address the root causes of poverty in Alabama. This led to the need to create a model that could be replicated in rural communities across the United States. Efforts to address the problems revealed a complex set of issues that needed multidisciplinary, grassroots-led solutions. One central issue that continued to surface was the lack of infrastructure, particularly wastewater infrastructure, necessary for sustainable economic development.

A house to house survey confirmed that more than half of the households in the county were either straight-piping raw sewage onto the ground or had failing septic systems that sometimes pushed the sewage back into their homes through bathtubs. This was the first-time people could discuss the flaws in onsite treatment or the lack of it without the fear of arrest. The Alabama Public Health Department used the threat of incarceration as a tool to punish families with failing or no septic systems. This tactic forced people to hide instead of disclosing the issues that resulted in significant health impacts, including evidence of hookworm in Lowndes County. The national attention led to the revelation of wastewater issues in areas throughout the United States.

The founder of CREEJ and then director of ACRE Catherine Flowers, a Lowndes County native, had her own encounter with raw sewage and mosquitoes that lead her to contact Dr. Peter Hotez - the founding Dean of the National School of Tropical Medicine at Baylor’s College of Medicine. Flowers experienced a strange outbreak on her skin and doctors could not identify the cause. She wrote Dr. Hotez in search of answers posing the question, is it possible there could be some diseases related to exposure to raw sewage that American doctors are not trained to diagnose? The study revealed the presence of tropical parasites that are endemic to developing countries. Several parasites were identified including hookworm.

From members of Congress to the United Nations Special Rapporteur on Extreme Poverty, individuals who learn of the Hookworm study are shocked by the severity of the study’s conclusions. This is not a partisan issue or a bi-partisan issue, it is a human rights issue and marginalized rural communities are at the frontlines.