Renée Miller sits in a recliner in a dimly lit room, wheezing with a nebulizer to relieve her asthma on days like this when the air is so acrid, it feels like her lungs are filled with shards of glass.
Miller lives across from a factory farm in rural eastern North Carolina, where thousands of pigs are kept and their waste is collected in open-cut ponds the size of football fields. The farmer regularly uses a high-pressure irrigation system to spray the waste as fertilizer on nearby pastures. Depending on the wind's direction, urine and waste sometimes falls on Miller's land.
“They have a sprayer over there that's on my house,” Miller said. “It's on me.”

That's a scene from “The Smell of Money,” an award-winning documentary released in 2022 that tells the story of Black residents of Duplin County living under the control of North Carolina's powerful hog farming industry. Many of the residents in the film, including Miller and Elsie Herring, sued and won in federal court, arguing that Murphy Brown and Smithfield Foods' hog farms were nuisances that damaged their quality of life.
North Carolina's factory farms are home to 9 million pigs, or nearly one for every 10 million people in the state. In addition to releasing foul odors, these farms attract swarms of flies and buzzards, contaminate groundwater, and emit air pollutants, including fine particulate matter, all of which can pose health risks to nearby residents.
The open-cut lagoons also emit methane, a potent greenhouse gas and a major contributor to climate change, contributing to the floods, hurricanes and heat waves that regularly hit eastern North Carolina.
“The Smell of Money” has screened at more than 100 events, including events for health and environmental justice experts and even EPA regional officials, so Jamie Burger, the film's producer, was excited when employees at Blue Cross Blue Shield of North Carolina, the state's largest health insurer, contacted him in January about hosting a virtual in-house screening of the film.
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The event was planned in April to coincide with National Minority Health Month and Earth Month.
“We were very excited,” Berger said, “and we wanted to show the film to health insurers. It was a great opportunity to talk to our staff and hear their opinions.”
But in mid-March, a Blue Cross North Carolina employee who was arranging the tests said the company suddenly canceled them, according to an email Burger provided to Inside Climate News.
The employee asked not to be named for fear of retaliation.
“We received unfortunate news today,” the employee wrote.[The company] “We will not be allowed to hold screenings or Q&As. Apparently the Agriculture Department is one of our clients, but due to the political situation they have been told that they have to cancel these events. We are very sorry to have to deliver this unfortunate news.”
Farm Bureau spokeswoman Linda Loveland said the organization was “not aware of the testing at Blue Cross North Carolina” and “was not consulted about the decision.”
Blue Cross North Carolina spokesperson Sarah Lang told Inside Climate News in an email that the company did not consult with an outside firm about the decision, nor did any employees represent the company as “spokespeople” in communicating with the film's producers, Lang said.
But the employee said he had discussed the screening with the insurance company's community relations director, who had seen the documentary. “By the way, she loved it and has introduced it to several executives!” the employee wrote in a January email to Berger.
According to Lang, Blue Cross North Carolina officials were concerned about employees watching the film on work time. “Like many companies, we allow a variety of employee engagement and team-building activities,” Lang wrote in Inside Climate News. “However, regardless of the content, watching the documentary is an inappropriate use of employee time and company resources.”
In an email message, the employee explained to Berger the various ways employees could watch the film: “Since the majority of our employees are remote and 15% work out of state, we are exploring the best viewing options. Not sure if we can 'live stream' during work hours. However, we could give employees a 1-2 week viewing period and do a Q&A afterwards…” the employee wrote.
After being informed the film would not be screened, a disappointed Berger reached out to Blue Cross North Carolina's entire leadership team, according to an email shared with Inside Climate News.
“There was no response,” Berger said.
Intimate Relationships
The two companies say they haven't been in contact with each other about testing, but they are closely connected. Larry Wootton, who served as North Carolina's Agriculture Commissioner for 20 years, has served on Blue Cross North Carolina's board of directors since early 2021. And a year ago, Blue Cross North Carolina announced it would become the exclusive health insurance partner for Farm Bureau Insurance, which has 621,000 members across the state as of November 2019, according to the company's website. (Separately, the agency's property and casualty insurance division is overwhelmed with claims from hurricanes and other disasters, including 22,000 claims for crop damage from Hurricane Matthew.)

The North Carolina Department of Agriculture has reason to object to a film about Concentrated Animal Feeding Operations (CAFOs) and their impact on public health. The group filed suit against the state's stringent licensing requirements for hog farms. The group supported North Carolina's Agricultural Information Leak Act, which would have imposed fines of $5,000 a day on employees who recorded suspected wrongdoing in private areas of a company and leaked that information to anyone other than their employer or law enforcement.
The Fourth Circuit ruled that the law was unconstitutional under the First Amendment.
The Farm Bureau also upheld state laws that effectively banned nuisance lawsuits against hog farms — the very type of nuisance lawsuits that Miller, Herring and the other plaintiffs in the film filed and won.
Pig farms and medical care
Given the health claims asserted by the plaintiffs, it's clear why the film would be of interest to Blue Cross North Carolina employees: With more than 2,000 hog farms in 54 of the insurer's 100 counties, some of the insurer's 4 million customers are almost certain to live near factory pig farms.
All of North Carolina's top 10 pork-producing counties have health care costs per capita that exceed the state average, according to an analysis of 2022 U.S. Department of Agriculture figures and 2019 data compiled by the Health Care Cost Institute and Duke University.
While these comparisons do not prove that pig farms directly increase health care costs, other health studies have suggested that people living near pig farms have higher rates of certain diseases.
A 2018 study by scientists at Duke University found that North Carolinians who lived near hog farms had higher death rates from all causes, including anemia, kidney disease, tuberculosis, and sepsis, than those who didn't. Infant mortality was also higher in areas near factory pig farms.
The findings were published in the North Carolina Medical Journal, run by the North Carolina Medical Institute and the Duke Foundation.
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While the scientists cautioned that the study does not establish a causal link between the diseases and the farms, they wrote that “the findings support the need for future research to identify factors that influence these outcomes and for improved testing and diagnostic strategies for these diseases in North Carolina communities adjacent to intensive swine production facilities.”
In the film, Haring sits on the screened porch of his small raspberry-colored wooden house. “It's nice to have money,” he says of his lawsuit settlement. “But what good is money if you're living in an environment that's killing you?… I can't keep breathing this air without my lungs dying.”
She died in the spring of 2021 from pancreatic cancer.
Miller is using the money he won from the nuisance lawsuit to pay off his medical bills. “I have so many medical bills,” he says in the film. “I don't have the money to go anywhere.”