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The Physical Environment & Population Health. HSERV 534 May 18, 2006. C. Linn Gould, MS, MPH Erda Environmental Services, Inc. ErdaEnv@aol.com. Agree or Disagree.

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C linn gould ms mph erda environmental services inc erdaenv@aol com l.jpg

The Physical Environment

& Population Health

HSERV 534

May 18, 2006

C. Linn Gould, MS, MPH

Erda Environmental Services, Inc.

ErdaEnv@aol.com


Agree or disagree l.jpg
Agree or Disagree

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


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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?


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Argument for today

Environmental (in)equality is an important determinant of health


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Objectives

  • Explore environment definition

  • Environmental racism/(in)justice and health

  • Where is the evidence?

  • Income inequality, the environment, and population health

  • Discussion



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Different Definitions of Environment

Everything

Minus genetic

Minus behavior

Minus social

Minus natural

Physical, chemical,

biological agents

Adapted from Smith et al, 1999


Actual causes of death l.jpg

5% Environment

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


Environment definitions l.jpg
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)


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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


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What is environmental (in)justice (EJ)?Can you give some examples?


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“Toxic Terrorism”

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


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Nigeria

Niger River Delta

Oil discovered 1958


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Contamination from Explosion

Flares - 28 million cubic meters per day

Oil contaminated water


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Polluted Swamps

On Niger Delta


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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


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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




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What Duwamish would

look like if not filled in



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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


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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


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EJ environment defined differently: susceptibility to disease

  • Includes home, workplace, community in addition to toxic assaults

  • “A community’s perception is its reality”(Bullard, 1994)

  • Health impacts can be psychosocial – If water/air perceived to be contaminated, lifestyle is affected (Edelstein, 2002)


Pyschosocial impacts on health l.jpg
Pyschosocial Impacts on Health susceptibility to disease

  • 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


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EJ movement redefines environmentalism susceptibility to disease

“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 can’t separate the physical environment from the culturalenvironment.”

Robert Bullard, 1999


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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)


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Where is the evidence??????? to EJ

?

Environmental

hazards

Pollution

exposure

(air, water, soil)

Adverse

health

effect

(low cumulative

doses)

Gould, 2005


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Environmental to EJ

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 country’s 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


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Where is the evidence? to EJ

?

Pollution Exposure

(industrial facilities,

transportation corridors)

Adverse health

effect

(premature death,

chronic disease)

Burden of proof placed on the exposed.

Why hasn’t the research been done?

Institutional discrimination?

Classist?


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Lack of evidence – racist? to EJ

“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)


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The evidence: to EJ plethora of conceptual models being introduced

Poverty/

SES

Physical

Environment

Health

Quality

Evans & Kantrowitz, 2002


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Analytic Framework: to EJ

Geographies of Susceptibility, Exposure, and Risk

Geography

of

Exposure

Geography

of

Risk

Geography

of

Susceptibility

Jerrett & Finkelstein, 2005


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“Double Jeopardy” to EJ

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


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Potential Pathways for Socioeconomic Position to EJ

to Increase Susceptibility and Exposure

Socioeconomic position

Race/ethnicity/sex

Differential exposures

Work: low-wage job,

occupational exposures

Neighborhoods: outdoor pollutants

Housing: crowding, allergens,

indoor pollutants

Differential vulnerability

-Existing medical conditions

-Genetic susceptibility

-Access to health care

-Access to fresh foods

-Violence/stress

Unequal health outcomes

O’Neill et al, 2003


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Air Pollution to EJ

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


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Air Pollution to EJ

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


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The Evidence: to EJ Social 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.


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The Evidence: to EJ Pre-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


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Brownfields in Baltimore, Maryland to EJ

(Litt et al, 2002)

Brownfields

Excess mortality

A Former Metal Stamping Plant

The rail industry


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Population Characteristics to EJ

Percent Minority

*by Census Block Group

Percent Below

Poverty

Home-Owner Occupancy

0 - 19 percent

0 - 19 percent

0 - 22 percent

20 -50 percent

20 -39 percent

23 - 44 percent

51 - 82 percent

40 - 59 percent

45 - 64 percent

83 - 100 percent

60 percent and higher

65 - 88 percent

Source: Litt et al,, Environ Health Perspect 110(suppl2):183-193 (2002)


Slide42 l.jpg

Population Characteristics to EJ

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)


Slide43 l.jpg

Mortality Patterns for Leading Causes of Death: to EJ 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)


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Mortality Patterns for Leading Causes of Death: to EJ Age-Adjusted Mortality Rates (Litt et al, 2002)

COPD

Lung

Lowest Rates

Lowest Rates

Highest Rates

Highest Rates


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Methods: Statistical Analysis to EJ

Response Variables:

Mortality:

- 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)


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United States to EJ

Maryland

Rest of City

Southeast Baltimore

Comparing Baltimore’s 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)


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Causal Pathway from Income Inequality to Population Health through Environment

Income

Inequality

Environmental

Quality

Indicator:

Morbidity?

Mortality?

Power?

Well being?

Gould, 2003


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Environmental Paglin-Gini (EPG) through Environment

  • 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


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Environmental Kuznets Curve through Environment

Environmental degradation

Environmental quality initially worsens but ultimately improves

with income

Per capita income


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Redrawn Environmental Kuznets Curve through Environment

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


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Power Distribution Hypothesis through Environment(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.”


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Why has an environmentalist won a Nobel Peace Prize? through Environment

  • 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


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Environmental Inequality Framework through Environment

  • 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


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Discussion: through EnvironmentEnvironmental Inequality

What can be done?


Thank you l.jpg
Thank You through Environment


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How measure power? through Environment

  • Voter participation

  • Tax fairness

  • Medicaid accessibility

  • Educational attainment

  • Power distribution as a function of income inequality

Boyce et al, 1999


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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


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Argument for social well being index environment

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


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Subjective Social Status environment

"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


Environment and disease association or causation l.jpg

Strength environment – 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

Environment and disease: association or causation?

Sir Austin Bradford Hill, 1965


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Cause Effect Framework: Taking Action environment

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


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Cultural Competence Continuum: environment

A developmental process

Cultural destructiveness

Cultural incapacity

Culturalblindness

Cultural pre-competence

Cultural competence

Culturalproficiency

(Cross et al, 1989)


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Argument for today environment

Environmental (in)equality is an important determinant of health

Our responsibility to incorporate EJ as part of the inequality equation


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Acknowledgements environment

  • Dr Sharyne Shiu Thornton – Cultural Competency professor, University of Washington

  • Dr Owens Wiwa – Nigerian EJ Activist, University of Toronto

  • Stephen Bezruchka - UW


Slide65 l.jpg

Income inequality environment

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

GreenSpace

Recreation

Aesthetics

Controlled nature

Physical activity

Figure 3:

Effects of income inequality on health through environmental factors

Gould, 2003


Slide66 l.jpg

Findings: Brownfields and Community Health environment

  • 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)


Slide67 l.jpg

Political inequality environment

(i.e., policy decisions)

Economic inequality

(i.e., income, wealth)

Inequality

Population

Health

Social inequality

(i.e., social capital)

Gould, 2003


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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


Ej environment defined differently69 l.jpg
EJ environment defined differently: susceptibility to disease

  • Includes home, workplace, community in addition to toxic assaults

  • “A community’s perception is its reality”(Bullard, 1994)

  • Health impacts can be psychosocial – If water/air perceived to be contaminated, lifestyle is affected (Edelstein, 2002)


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Pyschosocial Impacts on Health susceptibility to disease

  • 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


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susceptibility to diseasePoverty is both a cause and a symptom of environmental degradation…When you’re in poverty, you’re trapped because the poorer you become, the more you degrade the environment, the poorer you become.”

Dr.Wangari Maathai

www.progressive.org,


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Honduras – outside of La Ceiba visiting Adelante Foundation. Women receiving microcredit make charcoal. Yet, deforestation scars on mountain.

Gould, 2005


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Direct effects Foundation. Women receiving microcredit make charcoal. Yet, deforestation scars on mountain.

-Resources bombed

(oil refineries, factories)

-Land mines

-Depleted uranium

-Deforestation to finance war

Indirect effects

-Refugees

-Sanctions

-infrastructure collapse (dumps, water)

-Corruption

-Habitat loss (wetlands)

War and EnvironmentPekka Haavisto UNEP


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War and Environment – Foundation. Women receiving microcredit make charcoal. Yet, deforestation scars on mountain.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


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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


Slide76 l.jpg

Nigerian women disparities

threaten nudity

  • Corporate responsibility

  • Demand for jobs, schools

  • scholarships, hospitals, water,

  • electricity, and env protection


Environmental racism injustice l.jpg

Environmental Racism/injustice disparities

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


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Birth of Modern Environmentalism disparities

  • 1960’s

    -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

  • 1970’s

    -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


Mainstream environmentalism 1970 s continued l.jpg
Mainstream Environmentalism disparities(1970’s 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


Ej movement birth early 80 s l.jpg

EJ Movement Birth (early 80’s) disparities

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)


Slide81 l.jpg

disparitiesWe 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


Slide82 l.jpg

Pekka Haavisto, UNEP disparities

‘Effects of war on environment are psychological…people are afraid to use their resources because they don’t know if they are contaminated or not.’

‘People say that people living in developing countries don’t care about the environment. To the contrary, they do care – their lives depend on it.’


Dominant current environmental protection paradigm l.jpg
Dominant Current Environmental Protection Paradigm: disparities

  • 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


Environmental justice paradigm ejp l.jpg
Environmental Justice Paradigm (EJP) disparities

  • 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


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Complex relationship between poverty, pollution, and health disparities

  • 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)


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Why no exposure disparities 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)


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Why no exposure disparities 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)


Common myths attitudes racist classist l.jpg
Common Myths/Attitudes disparitiesRacist? Classist?

  • Risk assessment culture (perpetuates injustice)

  • Which came first? Facility siting or move-in? (blame the victim)

  • Where’s the evidence? (burden of proof)


Slide89 l.jpg

Where is the evidence? disparities

?

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)


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Alleviation of economic disparities and air pollution disparities

  • Reliable estimates of health effects including potential confounding and effect modification


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Link between Environment and Health Disparities disparities

High dose issues – no contest

  • Vermiculite mining in Libby Montana and mesothelioma, asbestosis, lung cancer

  • Chemical facilities in Louisiana


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Cause and effect: Temporality disparities

  • 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 don’t count

Smith et al, 1999


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SEP, pollution, and health disparities

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.

O’Neill 2003


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Eco-epidemiology disparities

  • “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


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EPA EJ Definition disparities

“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.”


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The Evidence: Exposure to outdoor air toxics disparities(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