Iowa is an outlier for the wrong reasons, according to several environmental advocates who spoke last week at the Harkin Institute’s annual wellness symposium, which this year focused on the future of clean water.

Speakers at the symposium, held at Drake University, noted Iowa’s cancer rates, which are the second-highest in the nation, the state’s overwhelming amounts of animal manure and its problems with polluted water.

This was the setup to launch an initiative between the Iowa Environmental Council and the Harkin Institute to explore the relationship between environmental risk factors and cancer rates in Iowa. The initiative will combine both community outreach and a “rigorous” review of academic research.

The review will result in a public report and journal article with visual data mapping to show environmental risks and cancer rates. The two organizations aim to share these reports widely across the state and hold 15 listening tours to hear and amplify Iowan’s lived experiences with cancer.

“Our goal is to give voice to Iowans — whether they’re urban or rural — give them a voice, give them the opportunity to share and document their story,” said Sarah Green, the council’s executive director.

Green said it’s now “well established” that certain factors, like tobacco use, tanning beds and alcohol consumption, contribute to cancer rates. But she questioned “what else might be at play.”

Cancer research was a priority outlined in Gov. Kim Reynold’s Condition of the State address earlier this year, when she called on the Iowa Legislature to fund a $1 million partnership between the Iowa Department of Health and Human Services and the University of Iowa to research factors contributing to Iowa cancer cases.

Adam Shriver, the director of wellness and nutrition policy at the Harkin Institute, said the partnership between Harkin and the environmental council would “address the gaps” in the conversations about cancer in the state.

“Part of what’s motivating our project is that even though there are lots of groups talking about studying the high cancer rates, there are some groups that want to limit what we’re looking at when we’re having these conversations” Shriver said.

The Harkin Institute for Public Policy & Citizen Engagement aims to facilitate public policy research and citizen engagement. Previous iterations of the symposium have featured topics like well-being in schools and healthy food.

Sue Mattison, Drake University’s provost, said the 2025 topic, the future of clean water, touches “every community, every discipline and every life.”

Mattison, who is also an epidemiologist, said she has seen “firsthand” the impact environmental factors, like water quality, can have on health outcomes.

“We know that climate change, population growth, pollution and the burden of inequitable environmental infrastructure are putting immense pressure on our water systems, and it’s clear that no single sector can change these challenges alone,” Mattison said in her opening comments at the symposium. “The problems we face require collaboration across every sector.”

The event featured speakers across disciplines who discussed the need for cleaner water through the lenses of cancer research, environmental ligation, public policy, community action and even art, with a satirical video listing the ingredients in Iowa’s “pure” drinking water.

Speakers identified industrial agriculture practices, like the overapplication of nutrients to cropland, and runoff from confined animal feeding operations, or CAFOs, as key polluters to Iowa’s water.

The most mentioned pollutant, nitrate, enters streams from manure, fertilizer, septic and sewage runoff. On its own, nitrate is not a carcinogen, but when ingested, it interacts with other compounds that can be carcinogenic, according to the National Cancer Institute.

Excessive consumption of nitrate also can cause health issues like blue baby syndrome, thyroid problems and adverse pregnancy outcomes.

Lu Liu, an assistant professor at Iowa State University, said only 4 percent of public water systems in Iowa treat drinking water for nitrates, according to a recent study.

The study — “Disparities in potential exposures to elevated nitrate in Iowa’s Public Water Systems” — was published in February and found that more than 7 percent of Iowa’s average population is exposed to drinking water with nitrate levels in excess of 5 milligrams per liter. This metric is half the U.S. Environmental Protection Agency’s limit on nitrate in drinking water, but Liu said existing research of exposure at that level has demonstrated negative health outcomes.

Jim Larew, a lawyer with the northeastern Iowa environmental group Driftless Water Defenders, said he has seen the reputation of Iowa change over the years from a state with high education rates and healthy citizens to the state with some of the highest rates of cancer in the country.

Larew, who has litigated against issues like the renewal of a water use permit for a CAFO at the head waters of a trout stream, said it would be a “misstatement” to blame all of the cancer in the state on industrial agriculture.

“But surely, when you look at the maps and incidences of cancer and where we’re doing the most intensive farming, there’s at least an association,” Larew said.

This article first appeared in the Iowa Capital Dispatch.