Human beings have recognized the embodied effects of lead exposure for centuries, even if those effects were not always medicalized. As Daniel Renfrew explains in the introduction to Life without Lead, this ancient substance was “reinvented and transformed” in the industrial age, working its way into paints, fuels, household products, and pipes (p. 4). In Uruguay, as in other parts of Latin America, this reinvention and transformation was driven by “import substitution industrialization” (ISI) policies. Under ISI, governments worked to reduce their dependence on northern goods by subsidizing or single-handedly building up heavy industries, particularly petrochemical ones.
Renfrew’s book charts how environmental justice activists in the Montevideo neighborhood of La Teja positioned lead at the center of their response to the neoliberal unraveling of ISI in the late 20th and early 21st centuries. As Montevideo’s factories and refineries started to decay, close, or become privatized, the classic signs of lead poisoning (most notably cognitive and behavioral disorders in children) began to appear in La Teja and other working-class sections of the city. The book recounts the attempts of activists to link this epidemiological crisis to the economic crisis of austerity. Blending theory from the political ecology of disasters with ideas from anthropology about medical and biological citizenship, Renfrew profiles more than a decade of work by an advocacy group called the Comisión Vivir Sin Plomo (CVSP, or “Live without Lead Commission”). Doing so, he adds an important Latin American case study to an environmental justice literature in which U.S.-based research remains dominant.
Renfrew’s argument, however, is not just that scholars should pay more attention to toxic exposures in the Global South. Rather, he suggests that CVSP’s activism was most effective when it found ways to turn lead poisoning from a tragic case of social suffering into a solidarity-generating public event. For CVSP, lead catalyzed a hopeful movement for improved housing and public services, and for a turn away from austerity and back to a more inclusive welfare state.
CVSP’s collective idealism is captured in the organization’s very name. As Renfrew himself notes—and as countless medical experts and industry leaders never tired of telling him and his CVSP comrades—it is practically impossible to live a life “without” lead. Lead can be partially expunged from a poisoned body, or remediated from tainted ground, but like other industrial toxicants, it persists at some level in bones and soils. The question to which Renfrew and the activists return over and over again is, “Whose bodies and whose environments will bear this burden?”
When news of the lead poisonings first emerged, around the turn of this century, many in Uruguay suspected tetraethyl leaded (TEL) gasoline, which was still prominent in cars and machinery. State and industry leaders agreed that TEL should be eliminated, in line with WHO recommendations, but they also suggested that if leaded gasoline was the culprit, then the burden of lead must be a shared one, evenly dispersed by the winds across the city’s rich and poor sectors. CVSP activists rejected this explanation. Given decades of brazen toxic dumping by a variety of industries into waterways and working-class neighborhoods, the elimination of one single source of lead would not suffice. Eventually, the state and industry settled on what Renfrew calls an “Official Protocol” regarding lead. The Official Protocol conceded that poor neighborhoods were more burdened with lead than wealthier ones, but even as it did this, it placed the blame for exposure on the urban poor themselves. Doctors, industry leaders, and politicians began to imply that if children were being poisoned, then their parents were not being careful enough to protect them.
None of these official explanations stopped activists from asking questions. In Chapters 3 and 4, Renfrew traces CVSP’s lead-related activities to a history of militancy among Montevideo’s working class. CVSP’s charismatic leader, Carlos Pilo, was both a former trade unionist and a former political dissident. With Pilo at the helm, CVSP cultivated a nostalgia for an era of full employment and working-class solidarity. To do this, it strategically deployed familiar cultural forms like the carnivalesque musical genre of murga and revived direct action tactics forged during Uruguay’s period of military dictatorship (1973–1985). In 2003 and 2004, calls for the privatization of the state-owned oil refinery that employed many of La Teja’s residents ran headlong into calls for the phase-out of leaded gasoline. Pilo and others found themselves in the tricky position of being both supportive of continued public ownership of the refinery, with its promises of better wages and strong unions, and critical of the industry’s willful blindness to the lead issue.
Much of CVSP’s struggle, however, was undertaken on behalf of residents who likely had no direct connection to either La Teja’s trade unions or its pro-democracy movement. Perhaps the most vivid ethnographic section of the book is Chapter 5, which recounts the relocation of a pair of squatter settlements situated in areas known to harbor high levels of residual lead. In response to the threat of lead poisoning, the government demolished these settlements and moved their residents—many of them Afro-Uruguayans—to new housing projects on the outskirts of the city. Instead of dismissing the relocation project as a cynical attempt at biopolitical exclusion, Renfrew highlights its ambivalence. On the one hand, relocation provided hope for a previously ignored group of people. On the other hand, the provision of new and supposedly safer housing gave the state another chance to push the Official Protocol on lead poisoning. Whether the children of the new settlements would continue to receive monitoring for blood lead levels, or treatment for acute poisonings, was anything but clear.
Medical anthropologists might be most drawn to Chapter 6, in which Renfrew profiles the efforts of doctors and scientists in Uruguay’s national lead poisoning clinic to produce legible evidence about the issue. Renfrew shows how quantitative measures of lead exposure were consistently subjected to second guessing. What to make of sudden spikes in blood or soil lead levels? Were they outliers, or confirmation of something poor patients had suspected all along? Should Uruguayan bodies, as health ministry leaders insisted for years, be expected to tolerate higher blood-lead levels than North American bodies? Amid such debates, doctors and patients began questioning their own sense of the truth. Most profoundly, the chapter illustrates how, when toxicity moves from the streets to the clinic, experts are forced to reconcile that which is socially significant with that which is statistically significant.
Though Renfrew perhaps misses an opportunity to engage with the extensive literature in medical and environmental anthropology on the subject, I read Life without Lead as a book about ignorance. Whether dealing with working-class nostalgia, urban planning, corporate transparency, or biomedical science, Renfrew underscores the crucial role that un-knowing and non-knowledge play in stories of toxic disaster. As an ethnographer whose fieldwork turned him into a fellow activist, he makes a strong case for seeing exposure as a vehicle for hope and social transformation. Finishing the book, I began to wonder how hope and ignorance might be related. The fact that Renfrew’s work raises such questions indicates that Life without Lead will be a provocative and informative text for scholars and students at the ever more crowded intersection of medical anthropology, disaster studies, and the ethnography of toxic worlds.