In the 1990s industrial-scale hog farming exploded across Eastern North Carolina, a high-poverty and environmentally sensitive region, making the state the second-largest pork producer in the country. The growth of large hog operations has now been slowed, but the environmental effects persist. For Steve Wing, the region provides a case study in the public-health challenges of poor communities.

Lack of access to clinical services makes it harder to document health problems; powerful interests threaten researchers and access needed for research; and the prospect of reprisals or intimidation discourages workers and residents from participating in studies designed to document exposures and their health effects. Wing and his colleagues have combined old-fashioned community organizing with novel and high-tech methods for doing epidemiology in this daunting environment.