Environmental Justice From Pennsylvania to Paris: A Public Health of Consequence, January 2023

Mitigating the impact of environmental disasters and climate change on vulnerable groups of people calls for an environmental justice‒based approach that makes “the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income” a top priority.¹ In 2011, Gracia and Koh presciently wrote that promoting environmental justice “requires reaffirming, revitalizing, and reinvigorating past national commitments” to how we plan and sustain laws, policies, and practices.^2(pS14) An environmental justice‒based approach to ensuring “greater access to health care, clean air and water, healthy and affordable food, community capacity building through grants and technical assistance, and training to educate the health workforce about environmentally associated health conditions”^2(pS15) for all is the path to bridging environmental justice and health equity.³ In this editorial, I highlight the historical and current calls for an environmental justice approach to preparing for and responding to man-made as well as natural environmental disasters.

DONORA, PENNSYLVANIA

Ask now, and it is unlikely that many people know where Donora, Pennsylvania, is or what it signifies. In late October 1948, a heavy smog rising from steel and zinc factories enveloped Donora and caused at least 20 deaths and close to 6000 mild and moderate cases of respiratory distress immediately after the smog settled.⁴ The preliminary US Public Health Service (USPHS) report on the immediate impacts of the Donora smog pointed to increased mortality and morbidity among the elderly and those with preexisting cardiopulmonary conditions.⁵ Adding to these findings, a follow-up study provided evidence of the unequal distribution of mortality and morbidity—those who were poor, not White, of limited English proficiency, and living in substandard housing were overrepresented among the dead and the ill immediately after the smog and during follow-up investigations.⁶

Today we recognize what happened in Donora as an example of environmental injustice in which the commercial concerns of the steel and zinc industries superseded concerns about the health and well-being of factory workers. Moreover, without any federal oversight, these industries were able to operate factories with little to no regulatory oversight.

While Donora was most certainly not the only man-made environmental disaster in the United States during this time, it stands out for being a driving force behind the enactment of the federal Clean Air Act in 1963. The Clean Air Act was the first federal legislation concerned with “controlling” air pollution and authorized the USPHS to support research into techniques for monitoring and controlling air pollution. As Vernon MacKenzie,⁷ chief of the Division of Air Pollution in the USPHS, wrote,

Air pollution can no longer be dismissed with excuses and half-way measures. Through the congressional action in enacting the Clean Air Act, we have made a commitment to bring an end to the steady increase in the national air pollution problem. We must keep that commitment.^7(p904)

PLANNING, PREVENTING, AND RESPONDING

Fast forward and, according to the National Oceanic and Atmospheric Administration, Hurricane Ian was the 15th environmental disaster to cause at least $1 billion in damage as of October 11, 2022 (https://bit.ly/3yKUAzY). To date, more than 100 people have died in Florida as a result of the hurricane, making it the deadliest hurricane to hit Florida in more than 85 years (https://bit.ly/3eCRAiw). One of the questions that will likely be raised in the months to come is whether local preparedness as well as response were appropriate and implemented in a timely manner.

Such questions are of greater relevance now, and as Schmeltz et al. (p. 15) write about in this issue of AJPH, there are indeed gaps in preparing for and responding to climate change hazards. While their article focuses on extreme heat events, the findings are applicable to a range of extreme weather events and environmental disasters. Their review of Heat Action Plans in California suggests that the current planning focuses on emergency response and warrants redirection to focus on preventing negative health outcomes. A review of the organization and governance of extant Heat Action Plans in California also indicates a greater need to focus on preparedness for extreme heat events as well as coordinating with local and state departments of health to devise a public health preparedness plan and response.

Health departments and local stakeholders are needed to foster environmental justice and protect vulnerable people.⁸ The need for such coordination is supported by Schwarz et al., who found that people experiencing homelessness and were either younger or elderly or had an underlying mental health burden were especially vulnerable to heat waves and more likely to seek care in an emergency department for health care during extreme heat events.⁹ Planning and practice that seeks to ensure resources are equitably allocated to those most likely to experience greatest exposure to environmental harms is necessary to ensure health equity and environmental justice.¹⁰

HOW MUCH DOES 1.5°C REALLY MATTER?

As confirmed by the International Panel on Climate Change’s Special Report on Global Warming, a 1.5°C (2.7°F for those in the United States) increase in the average global temperature will cause an escalation of natural environmental disasters across the world.¹¹ This increase will yield more extreme weather in the forms of heat waves and polar vortexes, more and longer periods of droughts, worsening floods and heavy rains, decreased availability of fresh water, rising sea levels, and shrinking polar ice caps. The list is long, and the consequence of each one of these environmental disasters threatens the security of our global community, particularly for those with the fewest resources and in the most vulnerable situations. This past year alone, we witnessed large wildfires and severe heat waves across the United States and Europe; flooding in Bangladesh, India, Pakistan, Brazil, and in the Appalachian (Kentucky) region in the United States; and another above-average hurricane and tropical storm season in the Atlantic region.

UPHOLDING OUR OBLIGATION TO THE PARIS ACCORDS

With the Clean Air Act of 1963, the creation of the Environmental Protection Agency (EPA) in 1970, and the Paris Accords of 2015, there were slow but steady efforts to motivate state, federal, and global actions to reduce greenhouse gas emissions and slow increases in global temperatures to achieve a climate-neutral world by 2050. In affirming the 1963 commitment to bringing an end to the “national air pollution problem,” in 2015, the Obama administration issued a broad and comprehensive Clean Power Plan under the Clean Air Act to rein in power plant emissions and provide states opportunities to identify and implement plans to switch to cleaner energy options. Under the Trump administration, the vast majority of rules enumerated in the Clean Power Plan were rolled back (https://nyti.ms/3gaIYA0). And while the Biden administration has sought to undo these reversals, in some instances, it may take years to fully undo these rollbacks.

Most recently, the US Supreme Court ruled in West Virginia v. Environmental Protection Agency (EPA) that the EPA could not put state-level caps on carbon emissions as clearly laid out in the 1970 Clean Air Act, but that this authority rested with the US Congress. In so ruling, the Court opined that the EPA lacked the authority to pursue its primary mission of limiting pollution attributable to toxic and harmful substances and lacked authority to pursue goals set under the Clean Power Plan.

POLICIES, NOT POLITICS

The West Virginia v. EPA ruling poses significant threats to our ability to meet our obligations to the Paris Accords and the global community to reduce our greenhouse gas emissions and slow the climate crisis. For the public health community, this ruling threatens progress in achieving health equity as well as in promoting environmental justice and ignores the substantial evidence base on the physical and mental health harms associated with environmental disasters. So, this editorial serves as a call to all in the public health community to advocate and agitate for climate justice, for environmental justice and health equality for all of humanity. In the words of Jake Edwards of the Onondaga Nation Council of Chiefs: “We all need the same things: clean air and clean water. We have a lot of work to do, but if we can combine our strengths, we can fight for what’s right” (https://bit.ly/3VLwejM).