We Need Environmental Health Justice Research and Action for LGBTQ+ People

Goldsmith and Bell (p. 79) coalesce findings from the few studies that have examined and documented patterns of environmental injustice for lesbian, gay, bisexual, transgender, queer or questioning, and other (LGBTQ+) populations into a novel, preliminary framework that should guide future research. We know very little about environmental health injustices experienced by LGBTQ+ people despite evidence that many of the conditions disproportionately affecting this community have definitive environmental etiology (e.g., cancers, respiratory diseases) or are influenced by or interact with environmental exposures (e.g., obesity, stress, depression, suicidality, HIV).

We know that oppressive social institutions and structures constrain residential choices, employment opportunities, and health care access; generate social stress; and influence risky health behaviors (e.g., smoking) among LGBTQ+ people; therefore, we should expect this community to experience environmental injustices and compounding health effects. We base that expectation on the analogous marginalization of people of color in the United States and their well-documented experiences of environmental injustice.¹ With that understanding, we conducted initial LGBTQ+ environmental justice research several years ago. We found that neighborhoods with high compositions of same-sex partner households experienced disparate residential exposures to air pollution in Greater Houston, Texas,² and nationwide.³ Unfortunately, few scholars have sought to expand knowledge of LGBTQ+ environmental health justice in the intervening years. Thus, Goldsmith and Bell's article comes as a welcome, albeit overdue, contribution.

OVERLOOKING ENVIRONMENTAL HEALTH JUSTICE

Fields of research on environmental justice and LGBTQ+ health disparities have emerged over roughly the same period—from 1980 to the present—yet they have evolved as separate domains (with the exception of the few studies that Goldsmith and Bell review). Competing claims about the existence of racially unequal exposures drove the development of the environmental justice field, and many environmental justice analysts tested the question of whether race (especially Black vs White) or class more powerfully explained variation in environmental exposures.⁴ Because of the political contestation underpinning environmental justice research, the unjust environmental exposures experienced by some people of color, such as Asian Americans, went largely overlooked until recently.^5,6 Over the past two decades, environmental justice research has expanded to evaluate disparate environmental exposures based on other axes of social oppression (e.g., gender, age, religion, and immigration status), yet the environmental justice field has neglected to examine environmental injustices experienced by LGBTQ+ people.

Scholars of LGBTQ+ health disparities have ignored the role of the physical environment, largely because of their field’s disciplinary–theoretic orientation. In a 2016 AJPH editorial, Stall et al. traced the development of research on LGBTQ+ health disparities.⁷ Studies have expanded from small-scale analyses of psychosocial health problems and AIDS based on convenience samples to large-scale epidemiological studies of representative cohorts in which rigorous comparisons with the cisgender, heterosexual population have documented disparities for LGBTQ+ populations. Still, theoretical frameworks orienting the field prioritize psychosocial pathways translating stressful life experiences of antigay stigmatization and victimization into disproportionate health risks. Extending from such frameworks, recent research has documented syndemics of traumatic experiences, psychosocial health problems, and behaviorally mediated physical health conditions in LGBTQ+ populations. And although the contextual roles of policy structures, social environments, and intersectional oppression in LGBTQ+ health problems have received recent analytical attention, environmental injustice has not, in part because we have failed to recognize the LGBTQ+ population as an environmental justice community in research and practice.

Recent advances in knowledge are partly attributable to US science institutions taking seriously the need to expand the LGBTQ+ health research enterprise. In 2011, the National Academy of Medicine released a report outlining research status, challenges, and needs.⁸ This was followed in 2013 with an official statement elevating the importance of research on LGBTQ+ populations⁹ and the 2015 establishment of the Sexual & Gender Minority Research Office by the National Institutes of Health (NIH). Subsequent NIH funding reflects prioritization of research on LGBTQ+ health disparities. Our NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database search revealed the expansion of annual funding for research on LGBTQ+ populations from hundreds of thousands of dollars in the early 2000s to hundreds of millions by 2019. Our search also revealed no NIH-funded projects focused on environmental exposures in LGBTQ+ populations. We cannot ascertain whether scholars have not proposed such research or whether the disciplinary– theoretic organization of this field has rendered such proposals uncompetitive.

Whatever the case may be, the two most relevant research fields and federal funding initiatives have overlooked a topic of import. That needs to change if we are to develop a genuinely integrated understanding of LGBTQ+ health disparities.

ADVANCING KNOWLEDGE

We need more research on LGBTQ+ environmental health justice, which demands coordinated efforts. Federal funding agencies and private foundations should recognize that environmental exposures play a role in LGBTQ+ health and support research on this topic. LGBTQ+ environmental health justice research has the potential to characterize causal processes that underlie specific health disparities in subpopulations as well as health disparities that remain undetected. Scholars must span the boundary separating the environmental justice and LGBTQ+ health disparities fields through collaborative projects, because expertise from both is foundational.

Advancing knowledge also depends on improving data on LGBTQ+ populations, which Goldsmith and Bell detail. For example, our own studies used aggregated Decennial Census data on same-sex partner households, which comprise a fraction of the LGBTQ+ population, and we could only differentiate households based on binary biological sex categories.^2,3 Developing an intersectional understanding of LGBTQ+ environmental health injustice requires analyses of large, representative, individual- and household-level data sets with information on sexual orientation, gender identity, race/ethnicity, socioeconomic status, age, immigration status, health care, health status and behaviors, lifetime trauma, social support, and geographic identifiers of homes and workplaces. Better data will enable the examination of direct, indirect, and interactive effects of environmental exposures, intersecting identities, and structural factors on health disparities experienced by subgroups in the LGBTQ+ population.

PROMOTING ENVIRONMENTAL HEALTH JUSTICE

We must build more knowledge of LGBTQ+ environmental health injustice before we can target appropriate and effective public health interventions. What can we do in the meantime? A key implication of Goldsmith and Bell’s article, along with the handful of previous studies that orient it, is that LGBTQ+ populations experience environmental injustices that have gone unrecognized by scholars of environmental justice and LGBTQ+ health, policymakers, activists, public health workers, and the public. Promoting LGBTQ+ environmental health justice involves identifying and ameliorating distributional and procedural injustices, but more fundamentally it depends on recognizing these people’s manifold experiences of social and environmental oppression.¹⁰

We should take the recent federal shift as an opportunity to include LGBTQ+ voices in important discussions about environmental justice. The federal government should promote LGBTQ+ recognition justice by revising Executive Order 12898—Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations (1994)—which mandates that agencies make achieving environmental justice part of their missions by identifying and addressing disproportionate effects of their activities. Revising Executive Order 12898 to mandate the consideration of disparate environmental impacts on LGBTQ+ populations is critical. The renewed federal emphasis on environmental justice, including the establishment of the White House Environmental Justice Advisory Council, indicates that we are in a moment of possibility. However, the council’s recently released final recommendations for revisions to Executive Order 12898 fail to recognize the LGBTQ+ population as an environmental justice community.¹¹ Before we can take meaningful action, we must recognize LGBTQ+ people’s experiences of environmental injustice. We hope that Goldsmith and Bell’s article and our own work^2,3 help enhance broader societal recognition.