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The Physical Environment & Population Health HSERV 534 May

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Title: The Physical Environment & Population Health HSERV 534 May


1

The Physical Environment Population Health
HSERV 534 May 18, 2006
  • C. Linn Gould, MS, MPH
  • Erda Environmental Services, Inc.
  • ErdaEnv_at_aol.com

2
Agree or Disagree
  • The physical environment does not have much to do
    with population health compared to other factors
    like income inequality or poverty.

3
What Stephen asked me to do
  • Is there an independent effect of the physical
    environment that can be demonstrated over and
    above the ideas of relative poverty?
  • What is there in the science or facts that the
    physical environment is a critical factor?

4
Argument for today
  • Environmental (in)equality is an important
    determinant of health

5
Objectives
  • Explore environment definition
  • Environmental racism/(in)justice and health
  • Where is the evidence?
  • Income inequality, the environment, and
    population health
  • Discussion

6
How define environment?
7
Different Definitions of Environment
Everything
Minus genetic
Minus behavior
Minus social
Minus natural
Physical, chemical, biological agents
Adapted from Smith et al, 1999
8
Actual Causes of Death
our health is determined by factors acting not
in isolation but by our experience where
domains interconnect.
30 Genetics
40 Behavior
10 Medical
15 Social circum- stances
Adapted from McGinnis et al. 2002
9
Environment definitions
  • The interplay between ecological (biological),
    physical (natural and built), social, political,
    aesthetic, and economic environments.
  • (IOM, 2001)
  • The environment includes the chemical, physical,
    and biological agents to which we are exposed in
    our regular everyday surroundings, but also
    lifestyle choices, socioeconomic status, poverty,
    diet and nutrition, and behavior
  • (NIH from EPA, Building Healthy Environments to
    Eliminate Health Disparities Symposium, 2003)


10
Causal Pathway Between Socioeconomic Status and
Health Through Environmental Risk Exposure
Poverty/ SES
Environment
Health Quality
  • Environment defined as
  • Ambient and indoor air
  • Water quality
  • Noise
  • Residential crowding
  • Housing
  • Education
  • Work
  • Neighborhood conditions

Evans Kantrowitz, 2002
11
What is environmental (in)justice (EJ)?Can you
give some examples?
12

Toxic Terrorism
  • Toxic residues exported from developed countries
    to developing countries OR to our own people
    (garbage, mercury, pesticides, etc)

13
Nigeria
Niger River Delta Oil discovered 1958
14
Contamination from Explosion
Flares - 28 million cubic meters per day
Oil contaminated water
15
Polluted Swamps On Niger Delta
16
Ken Saro-Wiwa
  • Ogoni people deprived of economic prosperity of
    own lands
  • Poverty one of highest in Nigeria. No
    electricity, piped water, health care, schools
    limited
  • Sick people from oil contamination. Life
    expectancy drops to 6 years less than national
    average.
  • Structural adjustment oil produces 20 billion
    annually

Hung for protesting against Shell
17
Global Climate Change and Population Health
  • Increased heat related morbidity and mortality
  • More frequent and intensified weather disasters
    (Hurricane Katrina)
  • Increases in geographic range and incidence of
    vector borne diseases
  • Climactically related production of photochemical
    air pollutants, pollens, and spores
  • Environmental refugees?

Tong el al, 2002
18
EJ issues in Washington State


19
Duwamish industrial corridor today
20
What Duwamish would look like if not filled in
21
Contaminated fish consumption
22
EJ vs. Mainstream Environmental Movement - social
agenda
  • Social determinants of health orientation
    exposure to pollution is rooted in disparities
    caused by societal structure
  • Social justice demands clean jobs, sustainable
    economy, safe and affordable housing, racial
    justice (Cole Foster, 2001)

Cherry Cayabyab, LELO
23
EJ Movement Recognition Social factors
increases susceptibility to disease
  • Poor nutrition
  • Socioeconomic stress
  • Insufficient access to health care
  • Lack of affordable and/or safe housing
  • Lack of community cohesion
  • Limited control at work
  • Co-exposure to other pollutants

24
EJ environment defined differently
  • Includes home, workplace, community in addition
    to toxic assaults
  • A communitys perception is its reality
    (Bullard, 1994)
  • Health impacts can be psychosocial If water/air
    perceived to be contaminated, lifestyle is
    affected (Edelstein, 2002)

25
Pyschosocial Impacts on Health
  • Noise, odors, traffic, etc
  • Loss of control of physical and social
    environment
  • Distrust and stress if no participation in
    decision making
  • If environment perceived to be contaminated, life
    style behavior changes (bathing, gardening,
    cooking, diet, cleaning)

Edelstein, 2002
26
EJ movement redefines environmentalism
  • It basically says that the environment is
    everything where we live, work, play, go to
    school, as well as the physical and natural
    world. And so we cant separate the physical
    environment from the cultural environment.

Robert Bullard, 1999
27
Political, Economic, Social, and
Cultural/Spiritual Context to EJ
Stress
Crime
Activities (work, play, church,
cultural practices, etc.)
Housing (affordable, safe, etc)
Transportation
Health care access
Sustainable economy
Individual factors (diet, smoking, alcohol,
genetics)
Natural world (green space)
Contamination (air, water, food, soils, etc)
28
Where is the evidence???????
?
Environmental hazards
Pollution exposure (air, water, soil)
Adverse health effect (low cumulative doses)
Gould, 2005
29
Environmental hazards

Pollution Exposure (air, water, soil)
The Evidence US GAO, 1983 African Americans
make up majority of population where landfills
are located. United Church of Christ, 1987
Minority and low income communities are afflicted
with disproportionate amount of countrys
pollution. EPA, 1992 same as above National Law
Journal, 1992 Unequal enforcement in minority
communities across nation - Proof that least
power receives inadequate protection. Lopez,
2002 Increased segregation associated with
increased disparity in potential exposure to air
pollution Morello-Frosch et al, 2002 Communities
of color bear a disproportionate burden in
location of treatment, storage, and disposal
facilities and Toxic Release Inventory
Facilities AND MANY MANY MORE
Gould, 2005
30
Where is the evidence?
?
Pollution Exposure (industrial
facilities, transportation corridors)
Adverse health effect (premature death, chronic
disease)
Burden of proof placed on the exposed. Why
hasnt the research been done? Institutional
discrimination? Classist?

31
Lack of evidence racist?
  • Those scholars who attempt to isolate economics
    from racism as causal factors in explaining
    environmental inequity are missing the point. In
    fact, such efforts to tease out, for analytical
    purposes, the effects of these discrete variables
    on pollution impacts can itself be seen as a form
    of racism (Clarke and Gerlak, 1998)

32
The evidence plethora of conceptual models
being introduced
Poverty/ SES
Physical Environment
Health Quality
Evans Kantrowitz, 2002
33
Analytic Framework Geographies of
Susceptibility, Exposure, and Risk
Geography
of
Exposure
Geography of Risk
Geography of Susceptibility
Jerrett Finkelstein, 2005
34
Double Jeopardy
High frequency and magnitude of multiple
contaminant exposure
Psycho-social Stressors Poverty, Material
deprivation, Lack of services
Health Disparities (Birth outcomes)


Morello-Frosch Shenassa, 2006
35
Potential Pathways for Socioeconomic Position
to Increase Susceptibility and Exposure
Socioeconomic position
Race/ethnicity/sex
Differential vulnerability -Existing medical
conditions -Genetic susceptibility -Access to
health care -Access to fresh foods -Violence/stres
s
Differential exposures Work low-wage job,
occupational exposures Neighborhoods
outdoor pollutants Housing crowding, allergens,
indoor pollutants
Unequal health outcomes
ONeill et al, 2003
36

Air Pollution
Asthma
  • Natural disasters such as London Fog
    thousands of deaths in 1952
  • Particulates in smoke associated with and
    pulmonary morbidity and CHD
  • 1996 Atlanta Olympic games no cars allowed in
    city 42 reduction in asthma claims reported to
    Medicaid

Brown et al, 2003
37

Air Pollution
Asthma
  • Increases of 74 between 1980 and 1996 in US.
  • 14.6 million suffering from asthma in 1996 with
    cost at 11 billion/yr
  • Blacks and poor 15-20 more likely to have
    asthma
  • Causes Indoor and outdoor air pollution

Brown et al, 2003
38
The EvidenceSocial ecology and child
vulnerability to environmental pollutants (Weiss
Bellinger, 2006)
  • Exposure to neurotoxic chemicals in early life,
    even prenatal environment creates permanent
    changes in brain structure and chemistry and
    behavior
  • Early social environment variables (neighborhood
    and community characteristics) need to be
    accounted for SES is not enough
  • Traditional approaches need to be revised.

39
The EvidencePre-term births social environment
and physical environment interactions(Ponce et
al 2006)
  • Adverse social environment (concentrated poverty,
    unemployment, dependence on public assistance)
  • Adverse physical environment (winter thermal
    inversions trapping traffic related air
    pollutants)
  • Pre-term births higher in low SES neighborhoods

40
Brownfields in Baltimore, Maryland (Litt et al,
2002)

Brownfields
Excess mortality
A Former Metal Stamping Plant
The rail industry

41
Population Characteristics
Percent Minority by Census Block Group
Home-Owner Occupancy
Percent Below Poverty
0 - 19 percent
0 - 22 percent
0 - 19 percent
20 -50 percent
23 - 44 percent
20 -39 percent
51 - 82 percent
45 - 64 percent
40 - 59 percent
83 - 100 percent
65 - 88 percent
60 percent and higher
Source Litt et al,, Environ Health Perspect
110(suppl2)183-193 (2002)
42
Population Characteristics
Less than High School Degree
Working Class
2 - 17 percent
21 - 46 percent
18 - 24 percent
47 - 66 percent
25 - 44 percent
66 - 75 percent
45 - 73 percent
75 percent or higher
Source Litt et al,, Environ Health Perspect
110(suppl2)183-193 (2002)
43
Mortality Patterns for Leading Causes of Death
Age-Adjusted Mortality Rates
Heart Disease
Cancer
Stroke
Lowest Rates
Lowest Rates
Lowest Rates

Highest Rates
Highest Rates
Highest Rates
Source Litt et al,, Environ Health Perspect
110(suppl2)183-193 (2002)
44
Mortality Patterns for Leading Causes of Death
Age-Adjusted Mortality Rates (Litt et al, 2002)
COPD
Lung
Lowest Rates
Lowest Rates
Highest Rates
Highest Rates
45
Methods Statistical Analysis
Response Variables Mortalit
y - Leading Cause of Death Index - Heart
Disease - Cancer - Stroke - Influenza
-Pneumonia - Diabetes - COPD - Liver Disease
Independent Variables - Brownfields Score - Age
(categorical) - Area of census tract - Principal
Component 1 Poverty status, Percent
Minority and Home- Owner Occupancy - Principal
Component 2 Working Class, Educational
Attainment
Cancer Incidence - Respiratory System -
Digestive System - Brain and Other Nervous
System - Multiple Myelomas - Leukemias - Lymphomas
Log (Expected Deaths) ?0
?1(Brownfields Score) ?2 (Age) ?3 (Area of
Census Tract) ?4 (PC1) ?5 (PC2)
Source Litt et al,, Environ Health Perspect
110(suppl2)183-193 (2002)
46
Comparing Baltimores Mortality to Maryland and
U.S. Rates
Findings Excess mortality in Zone 3 compared to
Zone 1 was observed when adjusted for
socioeconomic position, age, and area of census
tract.
Age-Adjusted Rates per 100,000
Source Litt et al,, Environ Health Perspect
110(suppl2)183-193 (2002)
47
Causal Pathway from Income Inequality to
Population Health through Environment

Income Inequality
Environmental Quality

Indicator Morbidity? Mortality? Power? Well
being?
Gould, 2003
48
Environmental Paglin-Gini (EPG)
  • If air and water emissions unequally distributed
    across locations, no equity unless
    individuals/states appropriately compensated.
  • EPG is calculated 1988-1996 for states and then
    grouped by amount of per capita manufacturing.
  • EPG higher in high manufacturing areas but has
    improved with time
  • Overall inequality is rising

Millimet Slottje, 2002
49
Environmental Kuznets Curve
Environmental degradation
Environmental quality initially worsens but
ultimately improves with income
Per capita income

50
Redrawn Environmental Kuznets Curve
Environmental degradation
Environmental quality initially worsens, then
improves, but then worsens due to increasing
income inequality increasing power
inequality?? (Torras Boyce, 1998)
Per capita income
Gould, 2005
51
Power Distribution Hypothesis (Boyce et al, 1999)
  • Wider inequalities of power tend to result in
    greater environmental degradation
  • Power inequalities will affect size of pollution
    pie, as well as how it is sliced.

52
Why has an environmentalist won a Nobel Peace
Prize?
  • Wars are fought over resources and they are
    becoming increasingly scarce (ie water, oil)
  • People with power undermine those without.

AP
Dr Wangari Maathai receives Peace Prize
53
Environmental Inequality Framework
  • Inequality
  • Economic, social, political
  • Segregation (race/ethnicity, income)
  • Lack of social capital
  • Community Policy Decisions
  • Institutional (siting, pollution
  • prevention, control strategies)
  • Structural (development, transportation,
  • job creation)
  • Environmental Health Stress
  • Siting (facilities, transport corridors)
  • Pollution exposures (air, water, soil)
  • Increased health risk (cancer, noncancer)
  • Population Health
  • Premature death rate
  • Chronic diseases (asthma)

Adapted from Morello-Frosch et al, 2002
54
DiscussionEnvironmental Inequality
  • What can be done?

55
Thank You
56
How measure power?
  • Voter participation
  • Tax fairness
  • Medicaid accessibility
  • Educational attainment
  • Power distribution as a function of income
    inequality

Boyce et al, 1999
57
Measuring relationship between population health
and environment
  • Do we have the right indicators?
  • Are mortality rates sensitive enough?
  • What about aggregate indicators?
  • (Genuine Progress Indicator? - combines
    economics, social and environmental indicators)
  • What about measurements of social well being?

Soskolne and Broemling, 2002
58
Argument for social well being index
  • SES and degraded environmental conditions are
    often likely to aggregate together, as higher
    income households have better means (including
    access to knowledge and a stronger political
    voice) with which to insulate themselves. The
    widening gap between the rich and poor may
    provide a sensitive measure of declining social
    well being.

Soskolne and Broemling, 2002
59
Subjective Social Status "Think of this ladder
as representing where people stand in our
society. At the top of the ladder are the people
who are the best off, those who have the most
money, most education and best jobs. At the
bottom are the people who are the worst off,
those who have the least money, least education,
and worst jobs or no job."
Place an X on the rung that best represents where
you stand on the ladder.
Singh-Manoux et al, 2003
60
Environment and disease association or causation?
  • Strength chimney sweeps and scrotal cancer,
    smoking and lung cancer, sewage water and cholera
    (John Snow, 1854)
  • Consistency disease in several places
  • Specificity TB ? lung
  • Temporality length of time for disease
    development
  • Biological gradient or dose response the higher
    the dose, the more likely the disease.
  • Plausibility biological plausibility may
    depend on knowledge of the day
  • Coherence generally known facts of natural hx
    and biology of disease
  • Experiment does prevention stop disease?
  • Analogy similar disease with similar evidence

Sir Austin Bradford Hill, 1965
61
Cause Effect Framework Taking Action
Driving force
A C T I O N
Inequality/race based policies
Pressure
Choice of residence
Outdoor/indoor pollutants housing quality, job
control
State
Exposure
Multiple contaminants from industry (historic and
current)
Effect
Increased morbidity (asthma), decreased well being
Adapted from Corvalan et al, 1999
62
Cultural Competence Continuum A developmental
process

Cultural destructiveness
Cultural incapacity
Cultural blindness
Cultural pre-competence
Cultural competence
Cultural proficiency
(Cross et al, 1989)
63
Argument for today
  • Environmental (in)equality is an important
    determinant of health
  • Our responsibility to incorporate EJ as part of
    the inequality equation

64
Acknowledgements
  • Dr Sharyne Shiu Thornton Cultural Competency
    professor, University of Washington
  • Dr Owens Wiwa Nigerian EJ Activist, University
    of Toronto
  • Stephen Bezruchka - UW

65
Income inequality


Reduced social cohesion

Roads Sidewalks Public transport Safety Walk/bike
vs. bus/car

Disease/ Well being
Injuries/accidents Obesity Mental Health
Environmental Quality Loss of forest/farm
land Global climate change Air pollution Hazardous
waste sites Water supply/purity
Asthma Cancer Chronic
Stress Heart disease Obesity
degraded ENVIRONMENT
Green Space Recreation Aesthetics Controlled
nature Physical activity
Figure 3 Effects of income inequality on health
through environmental factors
Gould, 2003
66
Findings Brownfields and Community Health
  • Log (Expected Deaths)
  • ?0 ?1(Brownfields Zone) ?2 (Age) ?3 (Area
    of Census Tract) ?4 (PC1) ?5 (PC2)
  • Excess mortality in Zone 3 compared to Zone 1
    was observed when adjusted for socioeconomic
    position, age, and area of census tract.
  • Leading cause of death index
  • Total cancer deaths
  • Lung cancer mortality
  • New respiratory cancers
  • Respiratory-related mortality (lung cancer, COPD,
    and influenza)

Source Litt et al,, Environ Health Perspect
110(suppl2)183-193 (2002)
67
Political inequality (i.e., policy decisions)
Economic inequality (i.e., income, wealth)
Inequality
Population Health
Social inequality (i.e., social capital)
Gould, 2003
68
EJ Movement Recognition Social factors
increases susceptibility to disease
  • Poor nutrition
  • Socioeconomic stress
  • Insufficient access to health care
  • Lack of affordable and/or safe housing
  • Lack of community cohesion
  • Limited control at work
  • Co-exposure to other pollutants

69
EJ environment defined differently
  • Includes home, workplace, community in addition
    to toxic assaults
  • A communitys perception is its reality
    (Bullard, 1994)
  • Health impacts can be psychosocial If water/air
    perceived to be contaminated, lifestyle is
    affected (Edelstein, 2002)

70
Pyschosocial Impacts on Health
  • If environment perceived to be contaminated, life
    style behavior changes (bathing, gardening,
    cooking, diet, cleaning)
  • Noise, odors, traffic, etc
  • Loss of control of physical and social
    environment
  • Distrust and stress if no participation in
    decision making

Edelstein, 2002
71
  • Poverty is both a cause and a symptom of
    environmental degradationWhen youre in poverty,
    youre trapped because the poorer you become, the
    more you degrade the environment, the poorer you
    become.

Dr.Wangari Maathai
www.progressive.org,
72
Honduras outside of La Ceiba visiting Adelante
Foundation. Women receiving microcredit make
charcoal. Yet, deforestation scars on mountain.
Gould, 2005
73
War and EnvironmentPekka Haavisto UNEP
  • Indirect effects
  • -Refugees
  • -Sanctions
  • -infrastructure collapse (dumps, water)
  • -Corruption
  • -Habitat loss (wetlands)
  • Direct effects
  • -Resources bombed
  • (oil refineries, factories)
  • -Land mines
  • -Depleted uranium
  • -Deforestation to finance war

74
War and Environment long term health effects
unknown
  • What if we had addressed environmental effects of
    Hiroshima?
  • What if we had cleaned up after Agent Orange
    spraying in Vietnam?
  • Depleted uranium now in ground water in Kuwait
    because ammunition corroded and migrated to it.
  • Take Precautionary Principle?

Depleted uranium shells
75
Environment and social inequality Maternal and
child health disparities(Morello-Frosch
Shenassa, 2006)
  • Disparity for pre-term births and low birth
    babies between blacks and whites still high

76
Nigerian women threaten nudity
  • Corporate responsibility
  • Demand for jobs, schools
  • scholarships, hospitals, water,
  • electricity, and env protection



77
Environmental Racism/injustice
  • Environmental racism is considered a human rights
    violation. It deprives communities of color of
    their economic, social, and cultural rights
  • Any policy, practice, or directive that
    differentially affects or disadvantages (whether
    intended or unintended) individuals, groups, or
    communities based on race or color.
  • Environmental racism combines public policies
    and industry practices to provide benefits for
    whites while shifting industry costs to people of
    color.
  • It is reinforced by governmental, legal,
    economic, political, and military institutions.

Bullard, 2000
78
Birth of Modern Environmentalism
  • 1960s
  • -preservation of wilderness and wildlife,
    resource conservation, pollution abatement,
    population control
  • -Social justice orientation with roots in civil
    rights and anti-Vietnam war movements -
    participatory
  • 1970s
  • -Legal (RCRA, Superfund, etc) and scientific
    approaches (RA, CULs) to solving environmental
    issues - pollution business industry evolves.
  • -Movement becomes insider focused and elitist,
    white dominant paradigm

79
Mainstream Environmentalism (1970s continued)
  • Social justice dropped from environmental agenda
  • Communities of color and low income groups
    excluded
  • Disadvantaged groups lack expertise to
    participate or assist in environmental decision
    making

80
EJ Movement Birth (early 80s)
  • People of color have come to understand that
    environmentalists are no more enlightened than
    non-environmentalists when it comes to issues of
    justice and social equity
  • (Robert Bullard, 2000)

81
We survived slavery, colonization, and
neocolonialism but we may not survive economic
globalization.The corporations came as
vectors, as carriers of diseases, that killed or
made people very ill. Good public health practice
addresses bad practices, such as the double
standard of environmental racism. (Dr Owens
Wiwa, May 2005) Environmental racism is
considered a human rights violation. It deprives
communities of color of their economic, social,
and cultural rights(Bullard, 2000)Wiwa sues
Shell in U.S. Supreme Court
82
Effects of war on environment are
psychologicalpeople are afraid to use their
resources because they dont know if they are
contaminated or not.
Pekka Haavisto, UNEP
  • People say that people living in developing
    countries dont care about the environment. To
    the contrary, they do care their lives depend
    on it.

83
Dominant Current Environmental Protection
Paradigm
  • Discriminatory zoning and land-use practices
  • Institutionalizes unequal enforcement of laws
  • Trades human and ecological health for profit
  • Differential exposure to harmful chemicals in
    home, school, neighborhood, workplace
  • Places burden of proof on victims as opposed to
    polluting industry itself
  • Risk assessment perpetuates injustice
  • Exclusionary policies and practices in
    participating in decision making
  • Cleanup actions delayed

Bullard, 1994
84
Environmental Justice Paradigm (EJP)
  • Framework comes from civil rights movement
    communitarian discourse
  • Ideological framework which explicitly links
    ecological concerns with class, race, gender,
    labor and social justice
  • Community, grassroots, bottom up
  • Diverse - Leaders are 50 male/female, high
    minorities.
  • Cooperative endeavors
  • BUT.. caught in reactive vs proactive mode
    stopping environmental bads

Agyeman, 2005
85
Complex relationship between poverty, pollution,
and health
  • Health disparities exist in low income
    communities
  • What is the environment in these communities
  • Genetics loads the gun, but the environment
    pulls the trigger (Judith Stern)

86
Why no exposure ? health evidence?
  • Lack of scientific consensus on health based
    standards for toxic substances
  • No clear data regarding effects of exposures to
    many toxic substances
  • Difficulties in assessing impact from substances
    not yet tested (1500 new chemicals introduced
    each year)
  • Distance on toxicity not well documented (poor
    monitoring methods and models for predicting
    exposures)

Maantay (2001)
87
Why no exposure ? health evidence? (cont)
  • Difficulty in assessing cumulative and
    synergistic impacts
  • Uncertainties in assessing impacts emitted
    through different media (air, soil, water) and
    exposure pathway (ingestion, dermal, inhalation)
  • Even if standard thresholds, set for average
    individual as opposed to vulnerable population
  • Lack or reliable actual emission measurements
    (polluters are responsible) and no account for
    other polluters (regulated and/or unregulated)

Maantay (2001)
88
Common Myths/AttitudesRacist? Classist?
  • Risk assessment culture (perpetuates injustice)
  • Which came first? Facility siting or move-in?
    (blame the victim)
  • Wheres the evidence? (burden of proof)

89
Where is the evidence?
?
Pollution Exposure (industrial
facilities, transportation corridors)
Adverse health effect (premature death, chronic
disease)


Many institutions and researchers stating the
need for research NEJAC (2000), Maantay (2001),
Morello-Frosch (2002), Northridge et al (2003),
National Environmental Policy Commission (2003),
EPA (2003), Jerret Finkelstein (2005)

90
Alleviation of economic disparities and air
pollution
  • Reliable estimates of health effects including
    potential confounding and effect modification

91
Link between Environment and Health Disparities
  • High dose issues no contest
  • Vermiculite mining in Libby Montana and
    mesothelioma, asbestosis, lung cancer
  • Chemical facilities in Louisiana

92
Cause and effect Temporality
  • What to do about time?
  • If sufficiently long time horizon is taken, all
    disease is environmental (chronic vs infectious
    diseases even genetics)
  • If causation is confined to limited time period,
    long term environmental health threats such as
    global change dont count

Smith et al, 1999
93
SEP, pollution, and health
  • SEP both a potential confounder and effect
    modifier
  • Groups with lower SEP have higher exposure to air
    pollution
  • Lower SEP groups have compromised health status
    due to material deprivation and psychosocial
    stress more susceptible to health effects of
    air pollution
  • Combination of exposure susceptibility
    greater health effects.

ONeill 2003
94
Eco-epidemiology
  • Non-threshold and threshold health effects,
    induced by exposure to degraded environmental
    states, must be understood within populations
    rather than at the individual level

Soskolne and Broemling, 2002
95
EPA EJ Definition
  • The fair treatment and meaningful involvement of
    all people regardless of color, national origin,
    or income with respect to development,
    implementation, and enforcement of environmental
    laws, regulations and policies. Fair treatment
    means that no group of people should bear a
    disproportionate share of negative environmental
    consequences from industrial, municipal, and
    commercial operations or the execution of
    federal, state, local, and tribal programs and
    policies.

96
The Evidence Exposure to outdoor air toxics
(Morello-Frosch et al, 2002)
  • Exposure to outdoor toxics from mobile and
    stationary sources in Southern California
  • Controlled for socioeconomic and demographic
    indicators
  • Disproportionate exposure for communities of
    color
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