Environmental Justice, Public Health, and Health Disparities

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Environmental Justice, Public Health, and Health
Disparities

• Sacoby M. Wilson, MS, PhD
• Institute for Families in Society and Department
  of Epidemiology and Biostatistics
• University of South Carolina
• June 27, 2008

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History of the EJ Movement

• Martin Luther King, Jr. and Garbage Workers
  Strike in Memphis (1968)
• Landfill issues in Houston, TX (1970s)
• PCB Landfill in Warren County, NC (1982)

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Classic EJ Studies

• US GAO Siting of Hazardous Waste Landfills and
  Their Correlation with Racial and Economic Status
  of Surrounding Communities (1982)
• UCC Toxic Wastes and Race in the US (1987)
• Bryant and Mohais Race and the Incidence of
  Environmental Hazards A Time for Discourse
  (1992)
• Bullards Dumping in Dixie (1990)
• There is a disproportionate burden of locally
  unwanted land uses and environmental hazards
  including landfills, hazardous waste sites,
  incinerators, Superfund sites, TRI facilities on
  populations of color and low-income populations
• KEY POINTS Disproportionate burden and
  differential exposure

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Institute of Medicine (IOM) Report

• Toward Environmental Justice Research,
  Education, and Health Policy Needs (1999)
• Concluded that government, public health
  officials, and the medical and scientific
  communities need to place a higher value on the
  problems and concerns of EJ communities
• Confirmed that minority and low-income
  communities are
• Exposed to higher levels of pollution than the
  rest of the nation
• Experience certain diseases in greater number
  than more affluent, White communities

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Major Points

• Vulnerable EJ populations are disproportionately
  burdened by environmental hazards, pollution, and
  unhealthy land uses
• This leads to differential exposure and increased
  health risks
• Greater susceptibility of these populations leads
  to greater chance of adverse health outcomes
  and/or exacerbation of current health conditions
• EJ movement is a public health justice movement!

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Emerging Research

• Emerging research has examined the spatial burden
  of unhealthy land uses, hazards, and pollution on
  disadvantaged communities and populations and
  related adverse health outcomes as part of EJ
  science
• Literature includes
• UCC Christs Toxic Wastes Race (2007)
• Bullard (2005, 2007)
• Morello-Frosch et al (2000, 2001, 2002, 2006)
• Payne-Sturges and Gee (2006)

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Expansion of the EJ framework to other
health-related issues

• Grocery store access and fast food distribution
  in EJ communities and obesity (Moreland et al.
  2002)
• Liquor store distribution (Romley et al, LaVeist)
• Built environment, transportation, urban sprawl
  impacts on health (Frumkin, Bullard)
• Access to parks, green space, pedestrian
  environments (LaDuke 1999, Wolch et al 2001,
  Pulido 2000 Floyd and Johnson 2004)
• Lack of basic amenities including sewer and water
  services (West End Revitalization Association in
  Mebane, NC)
• Transportation planning and traffic-related
  health outcomes (Forkenbrock and Schweitzer 1999,
  Houston et al 2004 Song et al )
• Climate change and heat stress (Harlan et al,
  ONeill, Larsen)
• Air pollution and respiratory outcomes and
  spatial relationships (asthma, bronchitis, lung
  disease) (Phil Brown and Marie ONeill Maantay
  2007)

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Evidence for Health Disparities

• A large body of research has explored the
  contribution of social factors, health behaviors,
  and health care access to US health disparities
• Research has emerged to examine the contribution
  of environmental determinants to racial/ethnic
  and SES health disparities
• Place and environmental context matter!

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Environmental Oppression

• Vulnerable communities (e.g., people of color,
  the poor, marginalized, indigenous, rural,
  elderly, etc) are used (directly or indirectly)
  to host social and environmental disamenities and
  externalities through planning, zoning,
  industrial siting, infrastructure and development
  inequities, while communities consisting of
  dominant racial and class populations benefit
  from the inequities, access to more amenities,
  and ecological goods and services

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• There is an underdevelopment and/or
  destabilization in the growth, health, and
• quality of life of host communities overburdened
  by environmental and social externalities and
  spatially and socially bounded by limited access
  to amenities and positive health-promoting
  infrastructure.
• Wilson SM. Environmental Justice Movement
  Reflection
• on History, Research, and Public Health Issues.
  Journal of Public Management and Social Policy.
  Under Review.

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Structural Factors (Macro and Meso-level) Institut
ional Racism/ Discrimination Investment
Flows Infrastructure Development Economic
System/Policies Housing Policy Wealth
Distribution Legal Codes and System Sociohistori
cal Conditions Political System and Power
Distribution Opportunity Structures
Segregation (Residential, Economic,
Occupational)
Community Planning, Zoning and Development
Community Ecosystems
Healthy
Unhealthy
Environmental Salutogenesis
Salutogenic Features
Pathogenic Features
Environmental Pathogenesis
Health Disparities, Well Being, and Quality of
Life Community Level Population Level Individual
Level Biological (Embodiment)
Ecological Framework to Address Health and Health
Disparities
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• This EJ literature and ecological framework
  focuses on aspects of the built environment and
  spatial processes which create riskscapes
  (Morello-Frosch and Lopez 2006) or geographic
  sacrifice zones
• Populations who live in or are exposed to
  riskscapes experience environmental health
  disparities (Gee and Payne-Sturges 2004)

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Alternative to Exposure-Disease Paradigm

• Legal Epidemiology the process of assessing the
  intersection of environmental laws, public health
  statutes, civil rights, and building codes to
  study and explain infrastructure and exposure
  disparities in overburdened, marginalized,
  disadvantaged, and underserved communities
• Focuses on non-compliance with legal statutes by
  municipalities, industry and other entities,
  which leads to disparities in infrastructure and
  the production of sources of unhealthy exposures
  for disadvantaged communities
• Other epidemiological approaches focus on the
  exposure, dose, and disease in the
  exposure-disease continuum and causality instead
  of the source of exposure and infrastructure
  disparities
• Using legal epidemiology and the ecologic
  framework may lead to improvements in living
  conditions and health outcomes by gaining
  compliance with environmental laws, public health
  statutes, Title VI of the Civil Rights Act and
  Clintons EJ Executive Order

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Examples

• West End Revitalization Association
• Wilson et al Study

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• Built Environment and Environmental Health Issues
  in Low-Income African-American Communities in
  Mebane, North Carolina

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EJ Issues in Mebane, NC

• Physical Barriers 119-bypass/interstate,
  dead-end and unpaved streets, and landfills.
• Artificial Boundaries industrial park zoning,
  land use planning exclusion, red-lining under
  Extraterritorial Jurisdiction (ETJ) statutes.
• Institutional Limitations Economic disparities,
  racial discrimination (old south values in the
  New South).
• Non-compliance to civil rights and EJ
  regulations.

(Wilson OR, Wilson SM, Heaney CD, Cooper J, 2007
Social Justice in Context Accepted for
Publication.)
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WERA Community Owned and Managed Research (COMR)
Model

• Flexible, community-tailored, context-driven
• Funding CBO directly as PI and/or project manager
• CBO leads development of research questions and
  study design
• CBO and community contextual experts partner with
  informed university experts
• Focus on equity in power distribution and
  resources
• Data is used for action, empowerment, and change
• Seek compliance with laws and mitigation of
  health conditions

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WERA Collaborative Problem-Solving Model

• Collaborative-Problem Solving Model Project was
  established through EPA funding and built on
  WERAs Community-Owned and Managed Research
  (COMR) framework and EPA CPSM principles
• Established a team of multiple stakeholders to
  use research, resource leveraging/mobilization,
  and conflict resolution to obtain environmental
  compliance, infrastructure improvements, and
  better planning and development
• Heaney CD, Wilson OR, Wilson SM, Cooper J,
  2007a,b Progress in Community Health
  Partnerships
• Wilson OR, Wilson O, Bumpass N, Snipes M, 2008.
  Progress in Community Health Partnerships.
  Accepted for Publication.
• Wilson SM, Wilson OR, Heaney CD, Cooper J, 2007
  Progress in Community Health Partnerships

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Community-Driven Water Research
Septic system failure High prevalence of failure
in West End (24), White Level (18), and
Buckhorn/Perry Hill (11) Exposure pathways
Septic system failures represent pathways of
exposure to fecal contamination Household
drinking water Evidence of E. coli, fecal
coliforms, Enterococcus and F-specific coliphage
Turbidity levels exceeded national drinking water
standards for turbidity (1.0 NTU) Surface water
Fecal indicators were detected at WERA control
and study sites exceeding EPA standards
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EPA Collaborative Problem-Solving Model Grant
Capacity Building for WERA Staff and
Collaborative Problem-Solving Partners
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Paved Streets and Install Up-to-code Surface
Water Drainage
Installation of Safe Up-to-code Water and Sewer
Services
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Impacts of WERAs COMR Project

• City of Mebane forced to report withheld
  information on contamination problems in
  municipal water supply
• State legislature developed water infrastructure
  grant program for disadvantaged communities
• Moratorium on 119 Bypass has been extended and
  proposed route of roadway has changed to impact
  fewer homes in West End and White Level
  neighborhoods
• Omega Wilson is contributing to new EJ and public
  health policy as one of the community
  representatives on the National Environmental
  Justice Advisory Council (NEJAC)

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Wilson et al Study

• Examine the distribution of ecologic pathogens
  and salutogens across different racial/ethnic and
  SES groupings at the county-level in the US.
• Assess the relationship between ecologic
  characteristics and population health at the
  county-level in the US.
• Determine the contribution of ecologic pathogens
  to population racial/ethnic and SES environmental
  health disparities.

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Methods

• Collection of demographic, pathogen, salutogen
  and health data for the entire US at the county
  level from 2000 to 2005
• Regression
• Employ Geographic Information Systems (GIS) to
• Spatial distribution of salutogens, pathogens,
  and population health indicators
• Develop risk index and burden maps

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Sample of Variables in Database
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Results
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Percent Black in the US (2000)
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Average Levels of Salutogens, Pathogens,
Demographics, and Health Indicators across
Tertiles of Percent Black in the US
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REGRESSION
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Regression All-Cause Mortality
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Regression US Average Life Expectancy
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GIS INDEX MAPS
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Reclassified LBW Raster Map (2000)
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Riskscapes
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Strategies and Solutions

• Policy Interventions
• Senate Bill 2047 Healthy Communities Act of 2005
  introduced by Senator Barak Obama
• Senate Bill 2506 Healthy Places Act of 2006
  introduced by Senator Barak Obama
• Environmental Justice Bill of 2007
• Community Reinvestment Act
• State of Michigan Land Bank Act
• Brownfields Redevelopment Act
• Zoning and Planning Interventions
• Green and Healthy Zoning and Planning Initiatives
• Conditional Use Permits
• Environmental Preservation Districts
• Community-Based Planning Boards

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Strategies and Solutions Contd

• Infrastructure Improvements
• Focus on improving salutogenic infrastructure of
  the built environment
• Robert Wood Johnson Active Living by Design
  Program
• Urban Gardening and Farmers Markets
• Philadelphia
• Detroit
• Oakland
• Kansas City
• New Urbanism and Smart Growth use core principles
  of equity and justice
• EJ Sustainability Movement
• Grassroots Research and Leadership (GRAL)
• Utilize community-driven research approaches
• Community-Owned and Managed Research (COMR)
  approach
• Establish Collaborative Problem-Solving
  Partnerships
• Community-based planning initiatives

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THANK YOU!!!
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Acknowledgements

• Institute for Families in Society (USC)
• Robert Wood Johnson Health Society Scholars
  Program
• Malo Hutson, Mahasin Mujahid, and other RWJ HSSP
  colleagues
• WERA and EJ colleagues