Racial and Economic Disparities and Environmental Health
(Originally published in the Townsend Letter July 2021)
Introduction
The health effects of exposure to air pollution, water pollution, and other environmental factors is well known and researched. It is also widely documented that many environmental hazards are disproportionally found in areas of concentrated racial and ethnic minorities and in lower income neighborhoods. Physicians and health care providers need to be aware of the racial disparities of environmental health and how it may impact a segment of patients. Two areas for providers to understand is how race and income play a role in exposure to environmental toxicants and why some groups and communities experience greater environmental illness and disease compared to other groups.
Disparities in toxicants exposure and health
In recent years many environmental organizations, cities, states, and other groups have investigated whether communities of color and lower income communities have more exposure to environmental toxicants than white communities and higher income communities. Terms such as environmental racism and environmental justice have come to the forefront to bring awareness to the fact that exposure to chemicals, that affect our health, based on race, national origin and income are a reality in the United States. Everyone should have access to clean air, water, and food regardless of race, income, or geography. According to the American Public Health Association, environmental racism is any policy or practice that affects individuals, groups or communities based on race or color. Environmental justice is the fair treatment and involvement of people regardless of race, national origin, or income with respect to the environmental laws, regulations, and policy. 1,2 Health care providers should be aware of these terms and the fact that a portion of their patients may be exposed to more toxicants and experiencing more health effects of toxicant exposure simply based on their skin color, income, or area where they live.
In the United States we know that industry contributes to both air and water pollution. Industries such as electricity production, coal and natural gas, and industries that burn fossil fuel for energy. The transportation industry is a large contributor of toxicant exposure as well. Many of the communities located next to these industries are low-income, communities of color, and other systemically oppressed groups.3 The proximity to these industries exposes these groups to more toxicants from air and water pollution, thus creating more health hazards including higher rates of chronic disease. 4 For example, minority neighborhoods have higher rates of overall mortality, morbidity, and health risk factors compared with white neighborhoods, even after accounting for economic and other factors affecting minority neighborhoods. 1,2,3,4
One study precisely looked at whether income and geography were linked to more toxicant exposure. The study found higher exposure to industrial pollution in neighborhoods with medium income under $25,000. There happened to be more polluting industries near these lower income neighborhoods. The study also looked at specific regions of the U.S. to see if race was a factor in toxicant exposure. It found that in the Midwest and south-central parts of the United States, African Americans and Hispanics had higher toxicant exposure compared to whites in the same geographical area. However, in the mid-Atlantic part of the US there were no racial differences in exposure. 5 This lack of difference was attributed to more interracial inner city living environment in these regions, meaning there were all around less polluting industry near the interracial urban, inner-city areas.
Over time the toxicants produced by these industries have both short term and long-term health effects. In is a known fact that toxicants in our air, water, food and cause illness and disease. Racial and economic disparities already exist in healthcare especially in regard to conditions such as asthma, cancer, and heart disease. 6 These conditions just happen to be linked to air pollution, pesticide, and lead exposure. Exposure to these chemicals is higher in minority and lower income communities for several reasons including proximity of pollution sources (such as, waste incinerators), illegal dumping, poor enforcement of environmental regulations, and inadequate response to community complaints. 6 Not only do these communities face more toxicant exposure they are also faced with overall disparities in healthcare. Racial and ethnic minorities tend to receive a lower quality of healthcare than whites, even when access-related factors, such as insurance status and income are controlled. 6 These are factors health care providers need to consider when evaluating patient’s illness and disease.
Some argue that the employment opportunities created by these polluting industries outweighs the risk of toxicant exposure from the industry. Often industries move into areas of lower economic status and areas with higher percent of racial minorities under the guise of job creation. A 2018 article published in the Proceedings of the National Academy of Sciences of the United States of America investigated if the risks associated with pollution are worth the employment opportunities. They examined data from 712 facilities that happen to create more than two-thirds of the health risks from industrial air pollutants releases in the US. They compared the pollution exposure risk to total jobs created and better paying jobs created. (two selling points the industries use when trying to establish in lower income and minority areas). The study found that the share of toxicant exposure risk borne by blacks and Hispanics exceeds their share of employment at the polluting facilities. 8 The break down showed blacks receive 17.4% of the toxicant exposure risk but hold only 10.8% of the jobs and 6.9% of higher paying better jobs. Hispanics receive 15.0% the exposure risk but hold only 9.8% of the jobs and 6.8% of better jobs. 7
Example- The Navajo reservation in Page AZ
As stated, many environmental toxicants released by industry in minority and lower income areas do so under the guise of job creation. The Navajo Generating coal plant near Page AZ is an example. It was built in the 1970’s to supply power to Southern California, Nevada and Arizona on land leased from the Navajo nation providing a source of income for the tribe. Prior to its closing in Nov 2019, the plant employed over 750 people, mostly Native Americans from the area. Between the land lease and wages to the Navajo workers, the plant was a significant source of income. But at what cost? For 45 years the plant emitted toxicants from its smokestacks, including mercury, arsenic, sulfur dioxide and nitrous oxides. These contributed to air pollution and adverse health effects. The plant was built before the creation of the National Environmental Policy Act and the Clean Air Act. Basically, the plant was built with minimal environmental and pollution controls. The plant promised the people of the Navajo area job and well-paying jobs. But what did they get in return?
A 2006 Indian Health Services report that found asthma rates and hospitalizations increased dramatically in the Native American population who lived near or worked at the plant during the height of the coal plats operation. Between 1972 and 1974 and between 1996 and 1998, Navajo death rates for cancer increased from 43.7 per 100,000 population to 87.5 per 100,000. Data from the Clean Air Task Force, an independent environmental advocacy group, found that the Navajo Generating Station contributed to 26 deaths, 15 heart attacks, 184 asthma attacks, seven hospital admissions, nine asthma ER visits and 1,345 work-loss days each year. The report estimated that 8,542 people, 2,852 of them children, living within 12 miles of the plant were at risk. The amount of carbon dioxide the plant emitted in a year equaled the greenhouse gases emitted by 296,557 passenger cars driven for one year, or about 3.4 billion miles driven. In addition to the emissions from the plants’ smokestacks, the plant also had landfills, lined and unlined industrial ponds and wastewater treatment and storage basins. The irony of the Navajo Generating Plant is that after four decades of providing energy and power to the Southwest, literally fueling the growth of Phoenix AZ and Las Vegas NV, it is estimated that 15,000 Navajo tribal members have no electricity at all. 8 The plant closed in 2019 leaving those who worked there having to seek other employment and possibly leaving them with health effects from the toxicants emitted from the plant.
The EPA
In 2018, the Environmental Protection Agency acknowledged that environmental racism exists. EPA’s National Center for Environmental Assessment released a study indicating that people of color are much more likely to live near industrial polluters and breathe polluted air, especially fine particulate matter. Fine particulate matter is a known carcinogen, contributes to lung conditions, heart attacks, and premature deaths. It is linked to asthma, low birth weights, and high blood pressure. The study found that black people are exposed to about 1.5 times more particulate matter than white people, and Hispanics had 1.2 times the exposure of non-Hispanic whites. The study found that people in poverty had about 1.3 times more exposure than people above the poverty line. Again, it highlights the fact that industrial polluters are often disproportionately located in communities of color. One example is hydraulic-fracturing oil wells are more likely to be in minority neighborhoods. Another example is that benzene and other aromatic chemicals are linked to race, as well as lead exposure in the drinking water.
Example- Lead in the drinking water of Flint MI
Many are aware of the environmental crisis that took place in Flint MI when over 140,000 residents were exposed to lead in the drinking water. This happened in 2014 when the city’s drinking water source was changed from Great Lakes' Lake Huron to the Flint River without corrosion control treatment to prevent lead release from pipes and plumbing. Lead is particularly detrimental to children’s development. It is week know that lead exposure in children can lead to alterations in intelligence, development, behavior, attention, and other neurological functions. Many see this crisis as another example of environmental racism. This theory is backed by research published in 2016 by a pediatrician in Flint MI. She found that children’s blood lead levels throughout the city had doubled since the 2014 water contamination and that levels nearly tripled in minority and socioeconomically disadvantaged neighborhoods. 10
Even prior to the 2014 changing of the source of water in Flint that created lead exposure from the drinking water, Flint MI was an example to environmental health disparities. Prior to 2014, higher blood lead levels were found in residents living in neighborhoods where poverty and vacancy rates have been high for many decades. But the lead exposure from the 2014 water source change highlighted these disparities even more. Higher income areas took faster prevention control efforts such as increased water sampling for lead, filter distribution to remove lead from the water, and corrosion control. 10 In 2014 when the source of water serving the Flint Mi area was changed, lower income and minority communities’ complaints of changes in water taste and color were ignored by officials. 11
The Flint Water Task Force, created by then Governor Rick Snyder, analyzed the date from the water contamination and cover-up and determined “The facts of the Flint water crisis led us to the inescapable conclusion that this is a case of environmental injustice. Flint residents, who are majority Black or African American and among the most impoverished of any metropolitan area in the United States, did not enjoy the same degree of protection from environmental and health hazards as that provided to other communities.” 11.
Summary
An entire book could be written citing examples of racial and economic disparities and environmental health. The reality is that it exists in the U.S. Health care providers are in the unique position of making the connection to health conditions, environmental toxicants, and increased exposure based on race and economic factors. It is important for providers to screen for metals such as lead, and other toxicants and employ an environmental medicine approach to illness and disease conditions. A good environmental intake can help determine if a patient lives in proximity to polluting industries and looking at local municipality water test results and air pollution reports are another way to be aware of often overlooked factors affecting health. Providers can encourage avoidance and protective measures such as home water testing, water filtration, and room HEPA air filters as a preventative approach to healthcare. Not all providers are trained in, nor interested in, environmental health and medicine but can always find a physician in their community with whom to coordinate care and improve the health of all patients.
References
1. Environmental Protection Agency. Learn About Environmental Justice. https://www.epa.gov/environmentaljustice/learn-about-environmental-justice. Accessed March 20th 2021.
2. Bullard R.D., Johnson G.S. Environmental Justice: Grassroots in Activism and its Impact on Public Policy Decision Making. Journal of Social Issues. 2000;56(3):555-578.
3. Franklin, M. Fumes across the fence-line. Public Health Newswire, March 1, 2018. http://www.publichealthnewswire.org/?p=19858. Accessed March 21 2021.
4. Deaton A, Lubotsky D. 2003. Mortality, inequality and race in American cities and states. Soc Sci Med. 2003; 56:1139-1153.
5. Zwickl K, et al. Regional variation in environmental inequality: Industrial air toxics exposure in U.S. cities. Ecological Economics. 2014; 107:494–509
6. Gee G, Payne-Sturges D. Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts. Environ Health Perspectives. 2004;112(17):1645-1653.
7. Ash M, et al. Racial disparities in pollution exposure and employment at US industrial facilities. PNAS. 2018;115(42): 10636-10641.
8. Nicola, Andrew. Will power plant's closure help clear the air, restore the view of Grand Canyon? The Arizona Republic. 2019; October. https://www.azcentral.com/story/news/local/arizona-environment/2019/10/16/closure-navajo-generating-station-clear-air-over-grand-canyon/1710330001/. Accessed online 03/4/2021.
9. Ihab Mikati, et al. 2018:Disparities in Distribution of Particulate Matter Emission Sources by Race and Poverty Status. American Journal of Public Health. 2018;108:480-485.
10. Hanna-Attisha M, et al. Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. Am J Public Health. 2016;106(2):283-290.
11. Flint Water Advisory Task Force . Flint Water Task Force Final Report. Office of Governor Rick Snyder; Lansing, MI, USA: 2016