The Inequitable Impact of the Environment on Health

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0:03 Donele Wilkins: I simply believe that every child deserves to breathe clean air, to drink safe and healthy water, to live in neighborhoods where playgrounds are free from lead, to be able to attend schools where their asthma is not triggered in the school buildings, and that shouldn't be based on race and income and ZIP code. We do know many people have been in denial about racism, particularly among African-Americans and other people of color, but racism is a route for a number of these poor outcomes.

0:35 Narrator: According to a 2019 study published by the National Academy of Sciences, African-Americans are exposed to 56% more pollution than they produce. Meanwhile, white Americans are exposed to 17% less pollution than they produce. African-Americans are also 75% more likely to live near industrial facilities than white Americans, compounding the risk for harmful environmental exposures tied to negative health outcomes like asthma, birth defects, cancer and cardiovascular disorders.

Hello and welcome to Population Healthy, a podcast produced by the University of Michigan School of Public Health. In this season of Population Healthy, we'll examine health inequities through the lens of race in America by talking to public health researchers, experts, and others to learn more about what can be done to work toward health equity in our communities and across our country.

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01:35 Narrator: In this episode, we'll learn more about the disproportionate environmental risk that communities of color face in the age of climate change, and we'll examine what is and what could be done at a policy level to balance out inequitable burdens of poor environments and environmental health outcomes. We'll start with Amy Schulz, a professor of Health Behavior and Health Education at the University of Michigan School of Public Health. She's an expert in how social and environmental factors impact health and health equity.

02:02 Amy Schulz: My work is focused on understanding the social and physical environmental contributors to health inequities. A majority of that work is conducted in the City of Detroit, really trying to understand the drivers of health inequities that are experienced by residents of the Detroit community.

02:19 Narrator: Shortly, Dr. Schulz will introduce us to the term, environmental racism; the ways communities of color, and specifically black communities are being disproportionately harmed by environmental factors.

02:30 Schulz: One of the ways that environmental racism and that racism more broadly also works is in discounting the voices of communities of color. I think a really good example of this is with the Flint water crisis, their water, the water that was coming in to their bathrooms and their kitchens that was discolored and contaminated, they were raising their voices and raising the concerns about the water and for a long time those concerns were discounted and were not heard until ultimately members of the scientific community came in and were able to document that. I think that the importance of the scientific documentation is real and it helps to support and amplify the concerns, but I also think we do need to pay attention as a public health community to the voices of people who are first-hand experiencing those environmental exposures and are raising concerns about them and to not discount them and not always wait until the scientific evidence is there to back them up.

03:32 Schulz: There's a principle in environmental health, it's called the precautionary principle. In the United States, the burden of proof is often on the communities who are being impacted by environmental exposures to demonstrate that their health is being adversely affected by those exposures. That kind of proof is very hard to come by, it can take years for the evidence space to build, and while that scientific evidence is being built, many, many people are continuing to be exposed and are continuing to experience adverse health impacts until we get to a point where we say, "Okay, the body of evidence is strong enough that we can make a policy change." The precautionary principle essentially flips the order of things, and what it does is suggest that the burden of proof should be on the companies or the sources of emissions or of the environmental exposures to prove that they are safe before they put them out into the air, before they put them out into the water and affect populations who are exposed to those things. And there's some strong movement in other countries, in Europe and other places where there's much more reliance on this precautionary principle.

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04:50 Narrator: For over two decades, Dr. Schulz has worked with community partners like Donele Wilkins, a community organizer and director of a non-profit called the Green Door Initiative. Wilkins has been a leader and advocate for environmental justice issues on behalf of her community for over 20 years. In 1998, she began partnering with Dr. Schulz to conduct research aimed at understanding the environmental drivers of health inequities experienced by Detroit residents.

05:16 Donele Wilkins: The Green Door Initiative is primarily focused on achieving environmental justice, which really means working to ensure that everyone has access to clean air, clean water, and all the benefits that human beings deserve. We're very closely with folks like Dr. Amy Schulz and others around this idea of community-based participatory research, I can certainly say that being on the ground level on communities, facing families and individuals and residents who are often blamed for their own health outcome and rarely are considered to be exposed to poor environmental conditions, oftentimes people lack the ability to find remedies for their health outcomes, consideration for bigger issues outside of the individual's own household or ability to control their lives is what we aim to do. We really have to bring attention to those kinds of conditions in order to find remedy for people so they can live and thrive like everyone else in this country.

06:28 Wilkins: Environmental racism is racial discrimination in environmental policymaking and is racial discrimination in the enforcement of regulations in law. It is racial discrimination in the deliberate targeting of communities of color for toxic waste disposal and deciding of polluting industries. It is racial discrimination in the official sanctioning of the life-threatening presence of poisons and pollutants in communities of color, and it is racial discrimination in the history of excluding people of color from the mainstream environmental groups, decision-making boards, commissions and regulatory bodies. Those combinations of structural racism increases the devastating outcomes that we often see in our communities. There's a lot to be done around policy and trying to figure out ways to right the wrongs of legacy, racial practices underlined by public policy.

07:26 Schulz: In Detroit, in cities that are comparable to Detroit that have an industrial legacy and manufacturing legacy and that also have strong histories of housing discrimination that have shaped where African-American and Latino communities are able to purchase homes and also the value of their homes, there is a strong correlation with multiple environmental exposures that are linked to poor health outcomes. Those include access to clean water, access to clean air, and the extent to which people are exposed to toxins, legacy pollutants and contemporary pollutants in the soil and in the homes that they live in. The combination of those multiple exposures is sometimes talked about as cumulative risk, and we see that disproportionately associated, significantly associated with the proportion of residents in communities who are African-American or Latino, or other black and brown communities, and that contributes then because many of those exposures have links to disproportionate health risks, it contributes to health inequities because of those high levels of exposure.

08:33 Schulz: The other thing that's important to understand is that some communities, because of either their age distribution or their ability to access resources that can protect them from the adverse health effects of those environmental exposures. Some communities are disproportionately impacted. In some of the research that we have done with Donele and others in Detroit, we've looked at the location of environmental exposures, we look at the quality of the air in areas of the city, and then look at that against population characteristics. One of the things that we are very concerned about related to environmental racism and environmental injustice is that not only do we have high levels of pollution that disproportionally affect black and brown communities, low-income communities, but that also within those communities, there are high proportions of residents who are more susceptible to the adverse health effects of those exposures, so both children under the age of 5 and also adults over the age of 60 tend to have more severe health outcomes when they're exposed to environmental pollutants.

09:43 Wilkins: I often share the story about what keeps me going. When I think about a little boy by the name of Xavier Joe, who in 2012 at 10 years old lost his life because he could not breathe. He couldn't breathe because he had asthma. He ran into the home and told his mom he couldn't breathe. His mom did not own an automobile, she called 911 and did not get a response in time, and when they showed up, her son was dead in her arms in her driveway. What made news that particular day was the fact that 911 didn't show up, emergency technicians didn't show up in a timely fashion. But for me, it was the fact that this little boy could not breathe, and we have too many of those kind of stories and too many of those kind of outcomes. It's really time to fight for black lives and others, so that we matter as much as anybody else. Environmental factors are key to these issues, it must be elevated in a way that we really impact public policy, and if we can't impact public policy that changes the way that decisions are made about environmental quality, then all this work is done in vain. We have to change policy.

10:52 Schulz: Some of the most important work that I think Donele and I have been involved with over the last few years is the ability to actually map the combined risk factors across the Detroit Metropolitan area, and be able to see visually how those risks are clustered in communities of color and in low-income communities contributing to the inequitable health risks that are experienced within those communities, and from a public health perspective, that allows us to look at health inequities, at the factors that contribute to health inequities, and to think very explicitly about where we might want to focus our public health efforts so that we have the most benefit by working in the communities that are currently experiencing the greatest combined risks to their health.

11:40 Schulz: We've been able to document that there are 690 deaths annually that we can directly attribute to higher levels of air pollution within the city. In addition to those deaths, there are 1800 hospitalizations and emergency room visits that are asthma-related that we can attribute to levels of air pollution that are experienced by residents of the City of Detroit. The monetized cost associated with those health impacts is $6.9 billion annually. And so, there are tremendous societal as well as personal costs that are associated with the levels of air pollution that are experienced in the City of Detroit. There are real opportunities for members of the public health community to come together with residents of communities that are disproportionately impacted to have an impact on those processes and to push back against them in order to promote health and to promote health equity.

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12:43 Wilkins: When I think about environmental racism, I also think about the hope that achieving environmental justice provides. One of the things that came out of the birth of the environmental justice movement was this idea that communities, we speak for ourselves, we are the experts in our communities, we have the stories and experiences, and if we're not at the table helping to guide this process, communities will continue to be the, almost like guinea pigs, and serve the purpose of folks who are really aiming to achieve their research goals and that kind of thing, and lead the community with nothing that changes for the community. It is vital that we're at the table, it's vital that we add to that process and help to define that, and that we're not just being subjects for research, but that we are engaged in a process that will ultimately bring about some intervention and outcomes that improve the quality of life and change things for our communities.

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13:46 Narrator: Community-focused efforts, like the ones Donele Wilkins and Dr. Amy Schulz contribute to, do so much to bring support and awareness at a local level, but they both agree, systemic inequities need to be dismantled at broader levels, including national policy. Dr. Jalonne White-Newsome has had a long career in environmental health injustice, including her role as a Senior Program Manager at the Kresge Foundation, a philanthropic foundation in Metro Detroit. White-Newsome earned her PhD in Environmental Health Sciences at the University of Michigan School of Public Health, and has most recently founded her own consulting firm called Empowering a Green Environment and Economy. She talked to us about what she sees as the most pressing national and global environmental concerns that also disproportionately impact minority populations, and she shares the current and future efforts that can be made to find solutions that help everyone.

14:37 Jalonne White-Newsome: Our environment is the places that we as humans live, work, play and pray, and if those environments are hazardous to our health, meaning you can't find a grocery store with fresh fruits and vegetables in walking distance, but only liquor stores and fast food. That is hazardous to our health. If you can't step outside your door and really take in a breath of fresh air, but instead smell and taste sulfur as one example, that is hazardous to our health. If you, for instance, have to drive 50 miles to the nearest park or plot of green space in your community, that's environmental racism. And if for some reason, the members of your community don't have the infrastructure to receive clean and healthy water, or even the infrastructure to manage water after a storm or flood, that is hazardous to our health.

15:32 White-Newsome: I would say the top specific issues that are exacerbated by structural and institutional racism, in my opinion, are COVID and the next pandemic, climate change, and really the health of our children. When you think about COVID or any other pandemic we're gonna face, that is a huge environmental health issue for our society, just because in the way it spread, how it's another yet complicating factor for low-income communities and communities of color and others that are already compromised and have pre-existing medical conditions that make them more susceptible or at higher risk when these pandemics happen, that's one piece.

16:12 White-Newsome: Climate change is something that I've worked on for the past 15 years, and it is not going away. The extreme heat we're seeing right now on the West Coast, the increased flooding that we continue to see even more in communities across this country, both extreme heat and flooding are the leading causes of death related to extreme weather, and it is only gonna get worse and it's gonna continue to hit our urban centers as well as our rural communities really, really hard. We can no longer plan and practice like we are in a normal situation because climate has made it even more un-normal. I would say the last piece is our children. Environmental health is such a big umbrella, and as I think about the impact of our environment on our children, on my children, the physical health and the mental health, that is gonna be a tremendous environmental health issue that we're gonna have to address now and later.

17:03 White-Newsome: Just think about the impact of COVID on our children, and that will undoubtedly have ramifications that we can't imagine. You think about families that are food insecure, the fact that some of our children are not gonna get the proper exercise, and just the mental health and stress toll of this pandemic and all of the stuff that's going on, these are huge issues that we are gonna have to keep in mind.

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17:29 White-Newsome: I've had the opportunity to work in different sectors, all with the thread of environment health injustice. So whether I was working as an engineer in a manufacturing facility, a researcher and advocate, an environmental justice, lobbyist, working in state government and now in philanthropy, unfortunately, there are some lessons that cut across all those sectors that I think the public, they really need to be aware of. Number one, environment and health is connected to everything we do. I don't care if you make computers or you cut lawns, or the most simple job that you never think would be connected to environment and health, it is connected. And I think until people realize that everything we do and how we function in this world is connected to environment and health, or can have a negative impact or a positive impact on the environment and health of your self individually or your community, then we're gonna continue to be running in circles. So really that general understanding that everything I do is connected to the environment and health of myself individually or my community.

18:41 White-Newsome: The second thing that I think is critical is that equity, real equity needs to be essential part of the processes and outcome in whatever we do. That is so critical because similar to what was termed as green washing back in the day, where all these companies said, "Okay, I'm being environmentally friendly, and I'm doing this, and that," it was like a lot of talk, my hope is that the recent talk and uprisings around equity that many institutions and corporations and organizations are talking about goes beyond the talk, thinking hard about what equity means to the work that they do, and how you actually operationalize that. Equity can no longer be an add-on, it can no longer be an afterthought, it needs to be central to whatever the process is and what the outcome should be.

19:30 White-Newsome: The third piece, I think, is that the folks that are being the most impacted by anything need to be a part of the solution, so they have to be a part of the conversation, it is just essential. We can no longer try and determine someone else's destiny without having them in the room and being in leadership positions to make that change happen. We have to ensure that everybody has a voice that needs to have a voice in these big conversations to solve these really wicked problems. The last one, the importance of accountability. Whether you're working in a polluting facility, whether you're working as a funder, whether your job is to make sure that you are responding to the latest public health threat in your community, if you have no accountability, then who's to say that you were one actually providing that service in a way that's helpful, or you're not actually harming the community anymore? Accountability is missing in so many aspects of the environmental and health sector, and we need to figure out what is the systems that we are gonna begin to put in place to hold people accountable.

20:42 White-Newsome: Because if we don't, we will continue to see the cancer alleys of our world, we will continue to see the COVID hotspots of our world, and it will be the same people that continue to get run over, mistreated, misused, invisible to these unconscionable threats to our society. We still have a lot of work to do, but I think if we at least try and keep in mind those things that we can begin to continue to make some progress, I do feel like this is a moment where the conversation around racism and inequity is hot and we need to take advantage of it. We need to take it beyond conversation to action. We have a lot of work to do because in this last administration, there have been many roll-backs, there have been many attacks on the protections of our environment, whether it be air, waste, water, in terms of ways that communities should be able to interact with the process and inform the process.

21:43 White-Newsome: The work right now is hopefully getting to a point where we can bring back some of those protections. That is the work right now, and as it relates to our environment protection, but then even with the right laws and the right leaders in place, there has to be enforcement and accountability, because even when we had an administration that pushed out laws and created climate plans, they're still community suffering and people dying every day because the laws and the policies aren't enough for protection, particularly for low-income communities and communities of color. In addition, we need to make sure that there is a stronger set of accountability practices in place to actually protect people or push the laws that aren't working for people and make them stronger as we think about the broader work that needs to be done is really helping create this next generation of leaders that are ready and willing to come into these spaces and to these institutions and organizations with a clear understanding of why we cannot just do what we've done before, that we have to do that equity analysis before we make change in policy or create this program or this funding opportunity.

22:56 White-Newsome: That next generation I think is gonna be so critical to helping transform this country in a way where we can hopefully one day get to the point where everybody, regardless of your skin color or your income, where you live, what your background is, folks are able to live, breathe, work, play, and pray in a space that is not hazardous to their health. 

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0:23:22 Narrator: On the next edition of Population Healthy.

23:23.6 Speaker: At a very fundamental level, when you're talking about food access, you're talking about a student's ability to grow and learn because if you're hungry, you aren't able to focus on what the teacher is saying at the front of the room because your basic physiological needs are not being met, so there's definitely an impact on learning outcomes.

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23:48 Narrator: Thanks for listening to this episode of Population Healthy: Race, Inequity, and Closing the Health Gap from the University of Michigan School of Public Health. We hope you learned something that will help you make the world a healthier place. Please subscribe or follow our podcast on Apple Podcast, Google Play, Stitcher, Spotify, or wherever you listen to podcasts. Interested in studying public health with us? Join our interest list by going to our homepage, publichealth.umich.edu, and check out our programs and degrees and other helpful resources across our website. Be sure to follow us @umichsph on Twitter, Instagram, and Facebook. To join the conversation, learn more from Michigan public health experts and share episodes of the podcast with your friends and followers. You can also check out the show notes on our website, publichealth.umich.edu/podcast for more resources about the topics discussed in this episode. If you wanna stay up-to-date with the latest research and expertise from Michigan Public Health, subscribe to our weekly newsletter, Population Healthy. Head to publichealth.umich.edu/news/newsletter to sign up. And be sure to join us next time. Thanks for listening and doing your part to make the world a healthier place for all.