A Renewed Commitment to Environmental Justice in Health Disparities Research

Today, environmental justice and health equity have come to represent powerful principles of fairness. They demonstrate the potential to promote issues of equality in our public policies as they affect diverse population groups and establish the predicate for positive change in those communities.

In many ways, challenges faced by the environmental justice community and efforts in the health disparity communities have paralleled those of the civil rights movement. Both endeavors focused on addressing the issues of racism and poverty, the threats of toxic pollution and unsafe environments, democracy, and the compelling need to achieve equity in providing basic social goods and services. Although much of the early activities of environmental justice research have examined the disproportionate distribution of hazardous facilities located in marginalized communities, the principles in both movements have broadened to include interventions on the social and economic processes involved in perpetuating environmental health injustices.¹ Environmental justice and health disparities reduction activities extend beyond traditional notions of environmental pollution or health care issues to addressing population health, employment, working conditions, food security, transportation, zoning laws and land use, and, ultimately, the organization of our nation's programs and policies. The foundation of both movements determines the extent to which they ensure equal opportunities to all citizens to obtain access to goods and services—conditions that are critical to functioning in a just and productive society. This includes the extent to which communities are exposed to healthy environments, provided with resources to achieve social capital, satisfy member needs, and cope with societal challenges.

THE IMPACT OF POVERTY

Across regions of the United States, there is evidence of geographic variation associated with disparities in health status. Regions with concentrated poverty have a higher probability of their populations exhibiting fair or general poor health, exhibiting poor mental health, and having high prevalence of diabetes, hypertension and stroke.² Impoverished communities, especially those with segregated racial and ethnic minority populations, are also at greater risks living in settings of environmental degradation, hazardous waste, and toxins that negatively impact health.³ These communities are characterized by an overall lack of community resources and the economic power to improve these conditions on their own. The impacts of poverty and the burden of environmental degradation are most evident in the three regions that rank the lowest across the nation in terms of life expectancy and poor outcomes. Marlboro County, South Carolina, an impoverished rural community with approximately 29 000 residents has an average life expectancy of 69.6 years, one of the lowest in the country. Approximately 31% of the residents are living below the national poverty level. There are high unemployment rates, and more adolescents aged 15 to 17 year are referred to the criminal justice system compared with the rest of the state. The county is predominantly African American (51%), and the mean household income is $27 000.⁴ Health statistics in the county reveal higher rates of low birth weight babies, more hospitalizations for diabetes, and more deaths from heart disease compared with the rest of the state.⁵ The Delta region, made up of 252 counties and parishes in 8 states, is one of the most historic, culturally rich parts of the country, yet daily life remains a struggle for many residents. The area has had high, even extreme, rates of poverty for decades and poor health status.⁶ For example, Phillips County, Arkansas, on the edge of the Mississippi river, also ranks among the worst in the nation in life expectancy for men and women at 69.8 years. In the Arkansas Delta alone, where 61% of the state's population lives, estimated poverty rates across the region have increased since 2005, and seven counties in the region have a poverty rate of 25% or greater.⁷ In Mississippi County, another subregion in the Delta, 35% of children live in poverty, and 40% of residents lack a high school diploma.⁸ Shannon, Bennett, and Jackson Counties in South Dakota, which comprise Pine Ridge (Lakota tribe) Indian reservation, have the lowest life expectancy at birth in the western hemisphere at 66 years; next is Haiti at 62.2 years. About 80% of residents on Pine Ridge reservation are unemployed (versus 10% of the rest of the country), and 49% of the residents live below the federal poverty level (61% of whom are under the age of 18 years). Health status and outcomes are poor and statistics show that obesity, diabetes, and heart disease rates are high. The infant mortality rate is 5 times higher than the national average, and amputation rates due to diabetes are 3 to 4 times higher than the national average.^9,10

Despite the hardships faced by impoverished regions, they are communities with pride, with culture, and with aspirations. The real life issues that communities and tribal nations are facing need the strong foundations of sound science and environmental justice. Place matters in education, access to clean air, clean water, quality food, and healthy environments. Place also matters in crime, violence, and access to quality health care. These are issues that influence health and lifetime opportunities; the opportunities that can be transferred to our children and across generations.

BEYOND RESEARCH AND POLICY

We share a vision of a nation where economic development, social capital, and environmental protection are intertwined. To make that a reality for the citizens in communities within Marlboro County, South Carolina; Philips County, Arkansas; and Bennett County, South Dakota, for example, we need to enhance and accelerate the pace of our efforts. These are communities whose confidence, understanding, collaboration, participation, and trust must be gained in each step and throughout our efforts to address and eliminate environmental health disparities and injustices.

We owe it to these communities to renew and revitalize partnerships across the federal government in environmental justice and be unyielding in our defense of their children. To start the process, the National Institute on Minority Health and Health Disparities (NIMHD) recently undertook a new initiative with the Environmental Protection Agency (EPA) to develop Centers of Excellence in research with a focus on environmental justice and health disparities. This research partnership is a significant effort toward advancing science to better understand diseases that are linked to environment, the development of innovative tools and methods to assess exposure, cumulative health effects and disproportionate health risks and impacts, and an increased understanding of population vulnerability. Such expansion and advancement of scientific inquiry is necessary for the NIMHD and the EPA to adequately address environmental justice stakeholder's concerns about environment, sustainability, and health disparities. The science of environmental justice must be a priority for NIMHD health disparities research and interventions. When we develop interventions or implement public health policies that will affect the health and welfare of a community, we must have an unwavering commitment to the very best scientific analysis.

Today, in health disparity communities and throughout the nation, there is tremendous support for creation of jobs, clean energy, and the long list of ideas and innovations that will grow and improve our nation's economy. We have important obligations that must be met in mitigating the potential effects of environmental and social degradation on our children's health and welfare. It will take all of us working together—private, public, and foundations. It must also involve our communities. These are critical times for our environment and our economy. We have much to do to ensure that communities directly impacted by environmental deprivation have not only a voice but also a seat at the decision-making table. Our shared response to these issues in the next few years is going to define the work of a generation. Early life exposures and chronic stress can have tragic, life-long effects and we must be diligent in preventing any possible dangers. The challenges of environmental justice and health equity are large in scale and urgency, but we must intensify our actions to overcome the challenges. ▪