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Environmental Justice, Public Health, and Health Disparities


Bryant and Mohai's Race and the Incidence of Environmental Hazards: A Time for Discourse (1992) ... Artificial Boundaries: industrial park zoning, land use ... – PowerPoint PPT presentation

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Title: Environmental Justice, Public Health, and Health Disparities

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

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)

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
  • 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

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

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!

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
  • Literature includes
  • UCC Christs Toxic Wastes Race (2007)
  • Bullard (2005, 2007)
  • Morello-Frosch et al (2000, 2001, 2002, 2006)
  • Payne-Sturges and Gee (2006)

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.
  • 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

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!

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

  • 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
  • Wilson SM. Environmental Justice Movement
  • on History, Research, and Public Health Issues.
    Journal of Public Management and Social Policy.
    Under Review.

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,
Community Planning, Zoning and Development
Community Ecosystems
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
  • 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)

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
  • 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

  • West End Revitalization Association
  • Wilson et al Study

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

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

(Wilson OR, Wilson SM, Heaney CD, Cooper J, 2007
Social Justice in Context Accepted for
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WERA Community Owned and Managed Research (COMR)
  • 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
  • Data is used for action, empowerment, and change
  • Seek compliance with laws and mitigation of
    health conditions

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
  • 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

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
EPA Collaborative Problem-Solving Model Grant
Capacity Building for WERA Staff and
Collaborative Problem-Solving Partners
(No Transcript)
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Paved Streets and Install Up-to-code Surface
Water Drainage
Installation of Safe Up-to-code Water and Sewer
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
  • 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)

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.

  • 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

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

Strategies and Solutions Contd
  • Infrastructure Improvements
  • Focus on improving salutogenic infrastructure of
    the built environment
  • Robert Wood Johnson Active Living by Design
  • 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)
  • Establish Collaborative Problem-Solving
  • Community-based planning initiatives

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