René Miller rests in a recliner in a darkened room, gasping through a nebulizer to ease her asthma. On days like this, the air smells so acrid it feels like her lungs are filled with shards of glass.

Miller lives across the road from a factory farm in rural eastern North Carolina that raises thousands of hogs, and whose waste fills an open-pit lagoon that is as large as a football field. The farmer routinely sprays the waste as fertilizer using a high-pressure irrigation system onto nearby pasture. Depending on how the wind blows, sometimes it rains urine and feces on Miller’s property.

“That sprayer over there—it comes on my house,” Miller said. “It comes on me.”

This is a scene from “The Smell of Money,” an award-winning documentary released in 2022, that tells the story of Black residents in Duplin County who live under the thumb of North Carolina’s powerful hog industry. Many of the residents in the film, including Miller and Elsie Herring, successfully sued Murphy-Brown and Smithfield Foods in federal court, arguing the companies’ hog farms constituted a nuisance that harmed their quality of life.

There are 9 million hogs being raised on factory farms in North Carolina, nearly one for each of the state’s 10 million residents. Not only do these farms stink, but they also attract swarms of flies and buzzards, pollute the groundwater and emit air pollutants, including fine particulate matter, all of which can harm neighbors’ health.

The open-pit lagoons also emit methane, a potent greenhouse gas and major contributor to climate change, which drives the flooding, hurricanes and heat waves that routinely pummel eastern North Carolina.

“The Smell of Money” has screened at more than 100 events, including those tailored to health and environmental justice professionals and even to EPA regional staff. So the film’s producer, Jamie Berger, was thrilled when an employee with BlueCross BlueShield of North Carolina, the state’s largest health insurer, contacted her in January about hosting a virtual company screening of the film. 

The event was planned for April to coincide with National Minority Health Month and Earth Month.

“I was so excited,” Berger said. “I’ve wanted to show the film to health insurance providers. It was a wonderful opportunity to speak with staff and hear from them.”

But in mid-March, a Blue Cross North Carolina employee who had arranged the screening said the company abruptly canceled it, according to emails Berger provided to Inside Climate News.

The employee asked not to be named out of fears of retaliation.

“We received some disappointing news today,” wrote the employee. “[The company] will not allow us to host a screening or a Q&A with you. Apparently, the Farm Bureau is one of our clients, and due to the political climate, we were told we have to cancel these events. I am so sorry to be the messenger of this rather unfortunate news.”

Farm Bureau spokesperson Lynda Loveland said the group “was not aware of any screening” at Blue Cross North Carolina, “nor were we consulted on their decision.”

Blue Cross North Carolina spokesperson Sara Lang told Inside Climate News via email that no outside companies were consulted about the decision. Nor was the employee representing the company as “a spokesperson” when communicating with the film’s producer, Lang said.

However, the employee indicated that she had spoken with the insurer’s community relations director, who also had seen the documentary, about the screening. “She loved it, by the way, and shared it with some executives!” the employee wrote to Berger in an email in January.

Blue Cross North Carolina officials were concerned that employees would view the film during work hours, according to Lang. “Like many companies, we allow a variety of employee engagement and team-building activities,” Lang wrote to Inside Climate News. “However, regardless of the content, watching documentaries is an inappropriate use of employee time or company resources.”

In the email messages, the employee described for Berger various ways in which employees might watch the film. “Since most of our workforce is remote and 15% works out of state—we are trying to figure out the best way to view. We are not sure that we can ‘livestream’ it during the workday. However, we could give employees 1-2 weeks to watch and then have the Q&A .…” the employee wrote.

After being notified the film would not screen, a disappointed Berger contacted the entire Blue Cross North Carolina leadership team, according to emails shared with Inside Climate News. 

“There was no response,” Berger said.

A Close Relationship

Although both companies say they did not communicate with each other about the screening, they do have a close relationship. Larry Wooten, who served as North Carolina Farm Bureau president for 20 years, has sat on Blue Cross North Carolina’s board of directors since early 2021. And a year ago, Blue Cross North Carolina announced it would be the exclusive health insurance partner for Farm Bureau Insurance, which has 621,000 members across the state, according to its website. (Separately, the bureau’s property and casualty branch has been overwhelmed with claims from hurricanes and other disasters—22,000 claims for crop damage during Hurricane Matthew alone.)

There are reasons the North Carolina Farm Bureau might take exception to the film’s depiction of concentrated animal feeding operations (CAFOs) and their impacts on public health. The group has sued to oppose the state’s stronger permitting requirements for hog farms. It supported North Carolina’s ag-gag law, which would have imposed fines of $5,000 a day on company employees who documented alleged wrongdoing at non-public areas of a business, and then passed that information to anyone besides the employer or law enforcement. 

The Fourth Court of Appeals ruled the law was unconstitutional on First Amendment grounds.

The Farm Bureau also supported state legislation that all but outlawed the filing of nuisance lawsuits against hog farms—the very types of nuisance suits filed and won by Miller, Herring and the other plaintiffs featured in the film.

Hog Farms and Health Care

Given the health claims advanced by the plaintiffs, there are obvious reasons why Blue Cross North Carolina employees could be interested in the film. With 2,000-plus hog farms in 54 of 100 counties, it’s nearly certain that some of the insurer’s 4 million customers live near a factory hog farm.

All of the top 10 hog-producing counties in North Carolina report per-person health care costs above the state average, according to an analysis of 2022 USDA figures and 2019 data compiled by the Health Care Cost Institute and Duke University.

While those comparisons don’t prove that hog farms directly increase health care costs, other health studies have suggested people who live near these operations have higher rates of some diseases.

A 2018 study conducted by Duke University scientists found that North Carolinians who lived near these hog farms had higher death rates from all causes, including anemia, kidney disease, tuberculosis and septicemia, than people who did not reside near them. Infant mortality rates were also higher in neighborhoods near factory hog farms. 

The findings were published in the North Carolina Medical Journal, operated by the North Carolina Institute of Medicine and the Duke Endowment. 

Although the scientists cautioned that the study didn’t establish causation between the diseases and the farms, “the findings support the need for future studies to determine factors that influence these outcomes, as well as the need to improve screening and diagnostic strategies for these diseases in North Carolina communities adjacent to hog CAFOs,” the scientists wrote.

In the film, Herring is shown sitting on her screened-in porch in a small wooden house the color of a raspberry. “It’s good to have the money,” Herring says, referring to the settlement from the lawsuit. “But what good is money if you’re still living in an environment that’s killing you? … You can’t continue breathing this air without it messing up your lungs.”

She died of pancreatic cancer in the spring of 2021.

Miller is using the money she won in the nuisance lawsuit to pay down her medical debt. “I have too many medical bills,” she said in the film. “I can’t afford to go nowhere.”