1. Urban Brownfields and Health Policy

Health takes place within specific embodied spatial and temporal contexts. It is altered by geographies of power that condition relationships and institutions. It is “an outcome of the physical and social geographies that shape and determine those social determinants [of health] and health care systems.”1 Research and policy increasingly address social determinants of health and the colonial structures of violence that endure in health care access and equity. Yet a lack of attention to the role of land and property means crucial aspects of colonialism remain unknown and thus taken for granted—namely that “enduring colonial structures like private property, land dispossession, and racism . . . define and shape health outcomes immeasurably.”2 Medicine in the United States extends settler colonialism and racial capitalism through the legacies of property and industrial contamination, even as health care aims to ameliorate the embodied harms of those systemic legacies.3 This chapter seeks to denaturalize the land practices that support health care within the political economy of urban redevelopment. Rejecting the biomedical model of health that inoculates medical institutions from the ways they colonize space and expand the frontier operations of urban renewal, I take up the specific policy of brownfield redevelopment to open a conversation about the colonial power relations of property and pollution and their necropolitical operations on Black, Indigenous, and people of color (BIPOC) communities. Brownfields give us insight into the settler-colonial property frontier and its “toxic disregard for life”—that is, racialized processes of spatial production that rely on dehumanization, exclusion/privilege, and acceptance of conditions that expose certain populations to health risks, injury, disease susceptibility, and death.4 The discussion seeks to foreground land pedagogy and practices, including, first, the moral geographies of improving unproductive (wasteful) land that anchor the settler-colonial state; second, discourses of blight that blame BIPOC communities for their intimate proximity with waste in order to justify land grabs; and third, a vast extension of eminent domain under the auspices of eliminating so-called noxious influences for the public good.5 Brownfields bring into view the ways that social groups have different capacities to make land into property as a result of regimes of value tied to waste and race.6 Indeed, this is central to health colonialism, which is actively maintained by existing governmental and political-economic structures, urban land redevelopment, and waste management.

Industrial practices have left widespread contamination affecting land, water, air, and human and nonhuman bodies.7 Dealing with contaminated land has necessitated mechanisms of land conversion that serve as the foundation for development projects. Land conversions involve complex shifts in meanings, investment structures, policy proposals, institutions, and physical arrangement. It includes legislation aimed at liability for site remediation as well as financial instruments and international agreements that parlay land redevelopment risk between private and public agencies. Over the last few decades, local, state, federal, and transnational policies have promoted the redevelopment of contaminated land using voluntary and market-based policy instruments. Brownfields have emerged as a widespread and prominent mechanism of land conversion in the United States. The term “brownfields” refers to abandoned or underutilized industrial and commercial sites that are, or are perceived to be, physically, chemically, or biologically contaminated. They comprise reused land or property complicated by the (potential) presence of a hazardous substance, pollutant, or contaminant. Such land is often what remains of former industrial and/or military work, but the term is used more broadly to include idle, abandoned, derelict, damaged, vacant, underused land or buildings with poor ground conditions. The term “brownfields” therefore may refer to land with known documented and perceived pollutants and hazardous wastes, or to land that is not being used to the potential of its perceived or imagined value. For advocates, brownfield policies offer not only environmental cleanup but also locally driven land recycling and health improvement, “with the promise to transform distressed sites across the United States from blight to valuable economic and environmental resources.”8

In the early 1990s, big-city mayors and legislators from urban industrial states pressured Congress and the U.S. Environmental Protection Agency (EPA) to start a pilot program to redevelop underutilized and/or damaged land in highly desirable urban infill areas.9 These brownfields, which were often cheaper than comparable nonpolluted properties, became sites of promise for reusing a struggling city’s vacant or depleted land—as a “green investment” to conserve greenfields (unused land) by redeveloping brownfields. Such properties could become new factories, businesses, housing, and other revenue-creating endeavors. Brownfields may involve more risk, but they offer the prospect of higher rates of return. They usually require special financing as well as risk-transfer mechanisms that enable developers to limit environmental and financial liability. The central premise of most brownfield redevelopment programs is that regulatory flexibility is needed in order to bring contaminated properties back onto the tax rolls—that is, brownfield strategies eschew punitive regulatory models of environmental protection to pursue “cooperative approaches” that encourage voluntary environmental improvements via market-oriented property development.10 To that end, the EPA first launched a pilot brownfields program in 1995 to support the agency’s land revitalization goals of reusing contaminated properties to reinvigorate communities, thus preventing sprawl, preserving green space, and protecting the environment.11 The program was given statutory footing by the 2002 Small Business Liability Relief and Brownfields Revitalization Act. This act provided the EPA pilot with a congressional mandate, clarified liability issues to make redevelopment more attractive, and adopted new tools to promote land conversion; funding was increased to $250 million per year.12

In contrast to federal programs that rely predominantly on liability and enforcement to initiate cleanups, brownfield voluntary programs permit site owners and developers to approach the state to identify potentially valuable sites, especially within inner cities. Numerous states have enacted their own brownfields programs, with different mixes of incentives, regulatory pressure, information provision, and public involvement. These programs typically limit cleanup costs and responsibility for adverse consequences of land conversion; they also imply that there will be job creation in economically distressed areas, along with improvements in environmental health. Cities and other planning authorities draw on federal seed funding and state programs to apply advanced appraisal techniques to prospective brownfield site projects, including spatial demarcation and accounting in GIS databases and other parcel/property listings. This technological work subsidizes private industry’s acquisition, remediation, and adaptive reuse of brownfield sites by optimizing data production for effective capital planning. Brownfield developers can also qualify for a range of subsidies, including tax increment financing (TIF), revolving funds (loans), trust funds (tax- or fee-based accounts), real estate trusts (private investments), tax credits and deferrals, or state grants. The 1997 Federal Taxpayer Relief Act enables developers to immediately reduce their taxable income by the cost of their eligible cleanup expenses. The law allows the costs of environmental cleanup to become fully deductible in the year they are incurred, thus helping offset short-term cleanup costs.13 To receive this incentive, the property earmarked for redevelopment must be located in a census tract area where more than 20 percent of the population resides below the mean poverty level and where 75 percent or more of the area’s land is zoned for commercial or industrial use. Because these areas are often located within cities experiencing industrial manufacturing decline and devaluation, developers reap the benefits of reusing inexpensive, contaminated urban land to enjoy limited liability and high resale value.14

Such brownfield property redevelopment relies on assumptions about waste as a quantifiable and measurable object that can be separated and removed from land, or kept in place and contained to levels of risk deemed safe enough for a particular postcleanup end use. This way of thinking about waste maintains the illusion of a border between contamination and social life—a border on which capitalism’s constant expansion and revival depends. Brownfield redevelopers strive to limit and contain their liability via property redevelopment schemes that rest on an underlying binary of waste/society to establish the “conditions for a revival of profitability,” predicated on a racialized logic of improvement.15 Private developers are invited to invest in brownfields as an opportunity to turn a profit on converting economically unproductive land to public use. Brownfields deepen private sector engagement through amenities that boost private investment while immunizing investors from financial risk and biopolitical consequences. This process builds on long-standing practices that made—and maintained—environmentally degraded, economically divested, and racially marked lands.

Geographer Lindsey Dillon argues that the intimate proximity between environmental hazards and racialized bodies reveals that waste is one of the central modalities through which race has been lived in the twentieth century.16 In turn, race has been and remains pivotal to signifying the “waste-ability of urban space.”17 As environmental justice activists and scholars across a range of fields attuned to critical studies of race have shown, race and waste have been articulated in specific geographical ways, leading to racialized health inequities and other disparities. Unequal social formations reproduce racial difference through spatial (de)valuation connected to the material presence of waste, as well as perceptions of “who” and “where” are unproductive and wastable. Property value is not the neutral measure of the worth of a particular piece of real estate but may be “better understood as the result of social and economic relations among places.”18 Jenna Loyd further explains that existing property systems, as well as the federal legislation, various authorities, and funding that support them, “build racial differentiation, class, and normative gender and sexual relations into the landscape.”19 Historically, for example, white single-family residential neighborhoods received low-interest loans for mortgages and high ratings in terms of their security value. Conversely, nonwhite land—often mixed use and adjacent to industry—was frequently redlined and considered an investment risk, subject to the racialized labels of “nuisance” and “blight.” Couched in the supposedly impartial language of public health and planning, exclusionary zoning sequestered nonwhite people to contaminated, vulnerable, and less desirable locations in an effort to protect white health and secure the value of whiteness as property.20

Brownfield redevelopments extend the legacy of property as an operation of racial capitalism and of pollution as colonialism.21 Brownfield programs essentially maintain and expand practices that invested in public health for white communities and sanctioned contamination as part of historical racial segregation and disinvestment. They facilitate site conversions and cleanup remedies that minimize investor liability, thus often ensuring that contamination remains. Moreover, they facilitate land grabs and transfers through repossession, or “accumulation by degradation,” where land is lost and gained because of its contamination.22 Max Liboiron explains that “pollution is not only an exercise of colonial domination, it can also be part of its imperial expansion.”23 Scholars have warned that brownfield programs risk further entrenching “environmental apartheid” by implementing separate and unequal environmental standards across regions, particularly between inner cities and wealthier suburbs.24 Grassroots activists and national environmental organizations have argued that “differential cleanup standards at brownfield sites could lead to a dangerous double standard and to a concentration of redeveloped sites in the inner cities where contamination has not been removed but rather contained on site” to buffer life elsewhere.25 Furthermore, brownfields can serve as a technocratic instrument to determine whose bodies and communities can be wasted. Brownfields facilitate contingent determinations of value about whose lives and whose health matter and whose racially marked bodies and futures do not.

Brownfield programs pose significant problems for public participation, intensifying the ongoing racial ordering of land and territorial control as well as further curtailing minority participation in governance. Heightened reliance on private investments and private property controls to address residual site hazards results in decisions about future land use that increasingly depend on proprietary information that is unavailable to the public. Private investors who encourage brownfield redevelopments may seek to curtail or eliminate public input in order to limit liability and facilitate faster turnover of the site, even as citizen groups demand a say in the recycling of land. Deed restrictions enshrine private ownership of property, leaving the public at risk, all while brownfield projects avow goals of improving environmental health. The economic calculus of brownfield redevelopment restricts, even obstructs, a knowing and involved public. Brownfield developers receive state-certified liability releases for cleanups in the form of covenants not to sue after cleanup, no-further-action agreements, gag order clauses in property sales documents, and so forth. In addition to freeing developers from any further responsibility for adverse environmental and biopolitical effects, the state agrees that it will not require or impose additional cleanup requirements at a later date if acceptable cleanup standards are implemented.

Such standards are tied to a risk-based understanding of anticipated land use that extends waste colonialism. Because different end uses of the site require distinct tiers of remediation standards, land recycling efforts enlist remediation options that range from minor remediation needed for limited human contact, such as future use as a parking lot, to widespread waste removal from the site or on-site underground waste containment. Developers typically remove the upper level of soil and replace it with clean soil placed atop an impervious cap meant to prevent exposure to arsenic, lead, chromium, or any other remaining contamination capable of reaching the surface. In some cases, engineered systems may be constructed to pump out contaminated groundwater or to capture noxious odors. Governance of the remaining on-site contamination hinges on what are considered safe levels of risk according to the type of land reuse and ongoing hazards. The process essentially locks communities into a future of permissible contamination tied to a specific site use with little to no public discussion. Moreover, local governments often have little incentive to restrict land use and impose controls, few resources, and limited financial capacity to monitor or enforce controls; in many cases, they face strong political pressure for unrestricted use of a site.26 The overall managerial ontology at work fosters some futures and eclipses others by assimilating what la paperson characterizes as “the life worlds of land, air, water, plants and animals, and Indigenous peoples [that] are reconfigured into natural resources, chattel, and waste: statuses whose capitalist ‘value’ does not depend on whether they are living or dead but only on their fungibility and disposability.”27

Brownfield programs wed environmental risk reduction to economic development as part of the broader integration of economic priorities in federal hazardous waste policy and the cycle of land dispossession/repossession that characterizes racial capitalism and ongoing U.S. settler-colonial property governance. This raises equity issues. Many brownfield sites lie in minority communities, where lower-income people have been relocated to devalued land or left underserved for decades. Yet studies have found “negative correlations between the proportions of local populations that are nonwhite or low-income and the likelihood of receiving an award” for brownfield redevelopment.28 Contrary to the EPA’s explicit commitments to equity with respect to land revitalization, applicants from localities with higher concentrations of poverty and higher numbers of self-identified nonwhites have been historically less likely to receive an EPA brownfields award.29 The brownfield framework assembles a property frontier that aggregates and homogenizes a diverse array of land types labeled “underutilized potential”—a category akin to the settler-colonial ideology of terra nullius (empty land).30 This process renders such lands commensurable, marking them as available for redevelopment projects with the potential to generate a high return thanks to financial subsidies and liability caps. To revive conditions of profitability, each brownfield site is treated as discrete territory, regardless of regional patterns of disinvestment and environmental decline.31 For cities or regions under conditions of austerity, brownfields become part of the austerity policy arsenal directed at distressed areas for environmental violations that are the result of larger-scale processes of wasting and devaluing. The spatial fetishism of the brownfield enables city officials and developers to target and intervene in delineated properties, and in doing so, they negate current site uses and even blame existing communities for having underutilized or environmentally degraded the land.

Brownfield programs support the racialized operations of the private property system by justifying land dispossession of areas of actual or perceived contamination and uncertain environmental hazards in terms of risks to health. The symptoms of a neighborhood’s systemic neglect, including degraded infrastructure, environmental hazards, and racialized health inequities, can serve as justification for exercising eminent domain based on the argument that it is a public necessity. Under the proviso of public improvement, cities and their favored developers can point to the legacies of structural-institutional-environmental racism and any number of conditions resulting from the nexus of race, waste, and space—from sewer floodplain hazards and high quantities of lead in water systems to asthma rates linked to industrial pollution—as a rationale for the removal of low-income residents and communities of color from land, homes, and the ability to secure safe, stable living.

The brownfield framework draws on the long-standing policy discourse of “blight” as racially marked land that legitimates eminent domain and seizure in the name of public use. Definitions of what constitutes public use have typically been left to each state, and the U.S. Supreme Court has made increasingly broader determinations over the years.32 In 2005, the Supreme Court ruled that cities may legally seize private property for “economic development” even if that property is not blighted, essentially sanctioning any city seizure of private land that could receive higher property tax revenues with a new or different public use. The ruling supports urban renewal practices that have, over decades, tied the laudable objective of creating healthy cities and affordable housing to the amorphous discourse of blight and its racialized stigma. For example, the Housing Act of 1949 provided the legislative basis for the American urban renewal program that was tasked with supplying an adequate living environment for every American family. Instead, it became tethered to the objective of removing urban blight. Urban renewal advocates enlisted metaphors of plant pathology and medical disease to provide a scientific basis for blight. By elevating blight into a destructive and contagious urban disease, renewal advocates stretched the application of public use as a requirement of eminent domain, with property rights reconceptualized so that so-called blighted properties “were considered less worthy of the full bundle of rights recognized by American law.”33 Blight served as a useful rhetorical device to reorganize property ownership according to productive and unproductive land uses. Although it was purportedly a neutral, scientific understanding of urban decline, it was used to warrant the removal of Black and other minority residents from parts of the city.34 Determinations of blight sanctioned massive land clearance and removal of BIPOC populations from land deemed to be deteriorated, dysfunctional, poor, and unproductive. Federal resources underwrote the redevelopment costs. In Rachel Weber’s depiction, “like teams of surgeons, city government removed the concentrations of blight while the federal government assumed the role of the insurance company, absorbing the costs of demolition and land preparation.”35

Brownfields extend this genealogy of subsidized land appropriation and redevelopment. Local and state governments use the power to take private property based on blight—amplified by the ambiguous, elastic definitions of public use found in brownfield programs—to accelerate the gentrification and displacement already affecting low-income BIPOC communities. Cities are designating property as blighted not necessarily because it exhibits conditions of toxicity but rather because the city views the property as unproductive from a tax revenue perspective.36 The preemptive exercise of eminent domain to reorganize urban land—whether to eliminate potential pollution or to support public use in cases where environmental health is not even a primary concern—takes on the logic of providing a public benefit for the “good of the city.”37 This expansion of eminent domain legalizes the condemnation of property and its transfer to private parties under the public use clause, where assessments of the state of urban infrastructure determine that “this land is too good for these people” and could be put to a better use.38 Municipalities and local governments can opportunistically define blight according to their own city or regional planning interests, especially to generate fast revenue through commercial and retail projects.39

Scenarios wherein an urban renewal authority or city agency attempts to declare eminent domain on a property in order to attract big box stores have grown rapidly in areas that are experiencing economic decline. The home improvement chain Home Depot actively seeks to develop store locations on urban brownfield sites, receiving tax breaks and remediating contaminated sites to lay vast parking lots in cities as disparate as Honolulu and Pittsburgh. Walmart similarly pursues brownfield redevelopment: the Denver Urban Renewal Authority targeted the largest pan-Asian grocery store in the city, along with a strip mall of popular Asian restaurants, to grant Walmart $10 million in tax subsidies to redevelop the site.40 The city’s eviction and redevelopment plan was only thwarted after a lengthy community petition process. In the case of Emeryville, California, the city took control of a hallowed shell mound of the Ohlone people through eminent domain proceedings that considered the site merely as postindustrial urban wasteland and taxable city property.41 Emeryville, dubbed a poster child for brownfield redevelopment, conducted urban renewal of this sacred ground by digging into the massive human-made mound of shells, tools, bowls, animal bones, and human burials created over the course of 2,500 years to construct the Bay Street retail and entertainment complex. The shell mound, which once stood more than thirty feet high and three hundred feet long, had been desecrated by earlier land conversions, including the occupation of the site by an amusement park and dance hall, followed by heavy industry in the 1920s that left vats of toxic chemicals and polluted soils from a defunct pigment plant.42 Emeryville’s redevelopment agency subsequently stripped the ground of toxic dirt and hired a developer to create the Main Street commercial village that is now hailed nationally as a model of urban land reclamation. On Black Fridays, Ohlone activists and protestors converge near the intersection of Shellmound Street and Ohlone Way to honor the site’s significance, demand land rematriation, and remind shoppers that they are standing on a living cemetery—a cemetery where reportedly one hundred human burials were taken from the metered parking lot behind Victoria’s Secret, and several other hundred were reburied on site in an unmarked grave anchoring the mixed-use development.43

While the EPA now acknowledges that brownfields may be Tribal lands, it remains unclear whether brownfield programs will conduct land reparations for Native communities and descendants. The productivity imperative of the property system—and the broader functioning of property law as a U.S. settler-colonial technology, with all of the knowledge and financial institutions that support it44—actively organizes and maintains the social death of land to the extent that in Emeryville, a strip mall now contains ancestral burials and toxic waste in a still-active cycle of repudiation and erasure.45 Essentially, brownfield policy and financial instruments create an ad hoc property frontier of “wastelands.” As a result of the uncertain presence of waste, contaminated land is always potential in terms of economic viability; it provides an opportunity for future surplus value production.46 Brownfields promise higher returns thanks to their higher stakes—as long as measures and rewards are in place to mitigate investor risk related to the unknown extent of contamination.

This utility for economic productivity is a colonial way of understanding contaminated land as a wasteland with potential. It works within the structural context of U.S. settler colonialism and racial capitalism—namely “the systematic extraction of value organized through racial hierarchy” and its accompanying racialization of space.47 Physical contamination of land articulates with colonial notions of improvement and productivity to delineate the brownfield as a new enclosure: postindustrial land with (real or perceived) contamination available for development projects and property renewal.48 Historically, land uses that procured maximum economic value were considered proper to civilization; conversely, land or wilderness that had not yet been drawn into colonial or national development capitalist relations were perceived as wasteful or as waste.49 Settler-colonial enclosure sought to reframe land as a resource by enacting a way of seeing the world based on a logic of expropriation and the economic right “to realize the maximum productive potential of all things, at all times, and in all ways.”50 Extending this morality of economic use and its opposite as waste, brownfields policy converts pollution’s stubborn presence/excess into mere financial, legal, and technical matters that support the settler-colonial logic of “public reuse” of land and facilitate the racialized targeting of BIPOC spaces through an ongoing cycle of toxicity.

Brownfield conversions often orchestrate a violent feedback loop of land repossession as dispossession that reenacts frontier logics—or, as Sharon Stein explains, “The U.S. state’s genocidal efforts to conquer the literal frontier helped to solidify a colonial template of state-facilitated capital accumulation that is premised on the conquest of a perpetual frontier.”51 Waste frontier offers blank space to facilitate land grabs and extraction. It might be a state’s takeover of land as new territory, or it might be using land as a containment space “to externalize the toxic burdens.”52 Spatial demarcation and GIS-based accounting of land supports private redevelopment within the property market by producing surfaces of transfer, seizure, and exchange that allow for the burial, monitoring, and forgetting of waste. Such an approach makes ambiguous the technical inventorying of land with predatory targeting of marginalized communities; such an approach also facilitates the ongoing denial of the environmental harms perpetrated by settler-colonial, racialized land practices and occupation of space. By affixing contamination on site and treating space as unrelational and accounted for in database entries and GIS-layered renderings, brownfield programs disembed the land market from material conditions of waste and its racialized geographies. Because brownfield programs make contamination legible as a frontier for high returns with limited liability for uncertain toxicity, there is no incentive to inventory the history of site hazards and waste as a ruin of racist disinvestment and uneven geographies of wealth and poverty. Instead, brownfields maintain internal colonization territorially and fiscally through conquest of devalued landscapes seen to have potential—a determination that enables settlers to know city space as theirs, with them as the managers and rightful inhabitants of public or civilized space.53 With the entire property system built on stolen Native land, this brownfield frontier supports renewed rounds of forced removal, occupation, and erasure of BIPOC inhabitants in the name of redevelopment, thereby amplifying the need to address brownfields as a deeply historical, spatial, and cross-generational racial justice issue.

While brownfield policy remains invested in the property system, the redevelopment methodology is not wholly determined by such frontier logics. Indeed, it has been instrumentalized to foster more community sovereignty and land reciprocity in response to pollution, devaluation, and other social determinants of health that become the pretext for displacement. Brownfield projects that reframe land revitalization in terms of health equity and environmental stewardship, for example, represent the potential to advance goals of enhancing care for BIPOC communities and rearranging historical geographies of segregation and disinvestment.54 Both the EPA and the Agency for Toxic Substances and Disease Registry recognize an important aspect of land reuse for public health improvement beyond economic development.55 A form of brownfield project called healthfields holds the promise of reframing land revitalization as an ongoing public health effort involving community stewardship of bodies of land and human health. This U.S. land reuse policy also seeks to ameliorate medical scarcity in underserved BIPOC communities and to work across the U.S. biomedical divide that separates bodily health and clinic-based acute care from environmental conditions.

Healthfields are brownfields ostensibly used for health purposes, such as health care centers, grocery stores, farmers markets, green spaces, and in some cases affordable housing. The “EPA Brownfields to Healthfields” website defines healthfields as an “economic development strategy that has served lower income families living in environmentally overburdened neighborhoods.”56 An EPA story map detailing healthfields through visual media and textual narrative shows that healthfields increase local access to health care and community clinics, parks and open space, food access, and housing—all through cleanup and reuse of former brownfield sites.57 The term “healthfield” first cropped up around the year 2014 in Florida, and it has since been popularized by Miles Ballogg, the director for brownfields and economic development for Cardno TBE, an engineering consulting firm self-described as a professional infrastructure and environmental services company. Ballogg and Cardno have been leaders of healthfield projects and advocacy in Florida, but there are also prominent examples in places like McComb, Mississippi, and Los Angeles, California.58 The EPA report “Improving Public Health in Brownfields Communities” details the benefits of healthfield redevelopment: “In addition to the restoration of blighted, idle land and the removal of contamination, residents now have improved access to health care, new jobs, and local economic engines that leverage additional improvements and enhance quality of life.”59 The literature on healthfields emphasizes that brownfield law provides local governments and brownfield communities with the opportunity to link land revitalization with public health through provisions that allow local governments to spend up to 10 percent of their grants to conduct health monitoring of populations in sites where people may be exposed to hazardous substances and what is termed “legacy contamination.” Frequently cited healthfield projects range from asthma surveillance mapping of children linked to school-based health programs to the conversion of defunct gas stations into parks, farmers markets, and health services centers.

The healthfield program debuted with the Willa Carson Health and Wellness Center in Clearwater, Florida. This case was driven by Willa Carson herself, who had already been operating a community health care center and wanted to raise enough money to open a more permanent facility for a free clinic to service residents of the city’s North Greenwood community. A derelict gas station was deemed an ideal place for the health center thanks to its central community location. Using EPA and state brownfield program funds, four underground storage tanks and 450 tons of contaminated soil were removed from the property. The city then leased the property to the nonprofit clinic—which Carson had previously operated out of two refurbished apartments—for thirty years at the rate of $1 per year.60 Opening in 2001, the Willa Carson Health Resource Center provides free health care predominantly to the surrounding African American community and is operated on donations and grants with the help of a volunteer workforce.61

Another brownfield conversion that fulfills critical needs and greatly improved medical access for local residents is the Johnnie Ruth Clarke Health Center at the historic Mercy Hospital in St. Petersburg, Florida. Beset with petroleum contamination from a former cab company as well as hazardous waste from the African American hospital that operated on the grounds for over forty years, this healthfield project sought to install a new community-run health services center in the tradition of Jim Crow–era African American medical activism, providing residents with immediate access to health care and an economic anchor for further neighborhood redevelopment. Funded with a $3.75 million U.S. Department of Health and Human Services grant and $463,000 U.S. Housing and Urban Development Community Development Block Grant funds, the center’s construction began in 2003 and included the preservation of the 1923 historic hospital building and a new museum dedicated to the history of African American medicine in Pinellas County.62 The Johnnie Ruth Clarke Health Center foregrounds the potential of healthfields to convert legacies of health disparities tied to racial segregation into geographies of justice based on community-driven health services and land revitalization. The site is a brownfield partly because of the past lack of infrastructure for medical waste removal—what an EPA Brownfields conference presentation described as “abandoned historic African American Hospital environmental issues.”63

The development of the health center at this Jim Crow–era hospital brings more community health services to an underserved area, but it does not significantly alter the spatialization of waste and racial inequity. The emphasis of brownfield programs, and by extension healthfields, on environmental cleanup standards and land futures allied to property productivity potentially means that significant but uncertain contamination remains. In this sense, healthfields represent a contradiction: such programs may offer badly needed health services, but they risk reentrenching health disparities stemming from historic segregation, environmental racism, and waste colonialism. Healthfields may only superficially address the land’s hazards, thus ensuring exposure to contamination continues. This negative outcome of healthfields may be further intensified by the type of healthfield developed: the broad definition includes corporate packaged-food box stores, for-profit health service chains (often referred to as Medicaid mills), or pharmaceutical manufacturing, the latter being an especially well-known polluting industry. Healthfields may also support the growth of nonprofit philanthrocapitalist medical surveillance, as well as the installation of high-end hospital zones that exploit devalued land and the poor communities that live there while receiving tax breaks for their provision of humanitarian services. Even as healthfields create an opportunity to bring health care to underserved areas and rearrange historical geographies of hospital locations that arose along lines of segregation rather than epidemiological need, they also potentially serve as “Jim Crow tax shelters” that thrive on blight renewal—what la paperson refers to as the “ghetto land pedagogy” of settler colonialism.64

Thus, while healthfields to some degree show that “land can be polluted and still foster good land relations,”65 the continued prioritizing of property values and an environmentally inequitable and extractive logic incentivizes development projects that target vulnerable populations; it justifies ongoing land grabs under the banner of environmental health. Planting parks, farmers markets, or other environmental amenities as trickle-down benefits to local health-stricken communities can intensify gentrification and entrench geographies of waste and race by “greenwashing” displacement. Healthfield projects tether the reuse of brownfield sites to health purposes—namely local access to health care clinics—yet can function to greenwash austerity, poverty, and contamination. In so doing, healthfields can perpetuate ill health. The initiative offers tax breaks and lowers cleanup standards and liability to health projects that remedy toxic blight: even as healthfield programs create an opportunity for community-oriented land remedies, they also spur the growth of extractive development projects that exploit devalued land and do not necessarily give local communities a seat at the table of economic planning and governance.

This critical speculation on healthfields underscores how brownfield policy organizes a new waste frontier that expands the rationale for and application of eminent domain to the racialized logics of blight. Brownfield site conversions generate value through contingent determinations of productivity and public use; they implement waste remediation and land renewal in ways that intensify the everyday environmental degradation, disinvestment, displacement, and poverty experienced by BIPOC communities. The example of healthfields raises further questions about the targeting of contaminated land located in BIPOC communities who suffer from the presence of waste and who are underserved by health care providers. The healthfields initiative aims to convert targeted areas into hospitals, wellness centers, and grocery stores, offering tax breaks that invite “green health” projects. Brownfields/healthfields promise an ad hoc postindustrial frontier that makes contaminated land available for cleanup and revitalization, and that can serve as an important means for generating liquidity in cash-strapped urban areas with small tax bases.66 The attendant discourse of blight claims that brownfield redevelopment enhances public health; in practice, however, such redevelopment is structured to lower cleanup standards and reduce liability. The two cases of brownfield and healthfield—and their respective goals of boosting the economy and improving public health—show how blight designation can be used to gentrify inner-city areas or arbitrarily secure more profitable site usage, and how health service installations may paradoxically entrench health inequities, economic injustices, and environmental hazards stemming from segregation and previous rounds of land seizure.

Examining this policy environment and set of practices provides important context for the health sector’s formal role in land valuation and perpetuating racial inequities in health. Brownfields provide insights on the U.S. property frontier—its articulations of waste and race tied to determinations of productive versus unproductive land use—and liberal regimes of value, such as the moralistic discourse of blight, that justify land grabs and displacement as environmental improvement and public health benefit. In the next chapter, I utilize this framework to critically review the land development policies and practices of large nonprofit hospitals, excavating the policy terrain known as Eds and Meds. The discussion considers how these nonprofit institutions actively foster medical brownfields: they maintain the toxic open door of the property system and racially uneven urban regional health care; facilitate eminent domain in territorial and fiscal ways while declaring community benefits, local development, sustainability, and even racial justice; and build urban biomedical complexes by extracting from the environmental and economic livelihoods of BIPOC communities.