Why environmental justice is integral to the future of medicine

This past year has been one of overwhelming extremes: global pandemic, a national reckoning on racism, devastating wildfires and storms, and political disarray. To some it was perhaps just a difficult year. But to those who can identify the common thread of injustice, it is clear that this was the product of decades of systemic inequities. It is also clear that if these inequities are not addressed, what we have experienced is just a preview of what is to come.

Among issues at the intersection of all these tragedies is environmental racism, a crisis that is inevitably relevant to those of us in medicine.

According to Benjamin Chavis, a prominent environmental activist, environmental racism is “racial discrimination in environmental policymaking, the enforcement of regulations and laws, the deliberate targeting of communities of color for toxic waste facilities, the official sanctioning of the life-threatening presence of poisons and pollutants in our communities, and the history of excluding people of color from leadership of the ecology movements.”

Sacrifice zones

An integral concept in environmental racism is “sacrifice zones.” Historically, as marginalized people of color have been pushed to undesirable real estate through practices like redlining, they have been left without the political and financial power to flee contaminating factories and facilities. More and more industrial plants move in as property values drop. Those left to endure toxic chemicals in the air, water and soil describe feeling “sacrificed” for the sake of industry and capitalism.

There are many examples of environmental racism:

In Newark, New Jersey, glue, plastic, and leather factories, as well as sewage processing and fat rendering facilities, surround areas such as South Ward and Ironbound. Residents experience a “carcass-y” stench and increasingly dangerous air quality ratings, with high rates of asthma and lung cancer. South Ward is 3 percent white, while New Jersey is 59 percent white.
In Louisiana, an industrial area that includes chemical plants near predominantly Black neighborhoods is now called “Cancer Alley” for its increased rates of disease.
Water pollution was the concern for the Standing Rock Sioux Reservation when the Dakota Access Pipeline was proposed, in view of the recent Kalamazoo River oil spill nearby; the pipeline would cross the Missouri River, the reservation’s only water supply.
In an industrial neighborhood of Eugene, Oregon, the predominantly Latino and low-income residents are exposed to 99 percent of all of Eugene’s air toxins, with local groups reporting double the rate of childhood asthma. Recently, the Environmental Protection Agency found that the Lane Regional Air Protection Agency discriminated against these residents, through inadequate air monitoring and lack of engagement with the community, such as not providing a way to complain in languages other than English.

The ever-worsening climate crisis only exacerbates these harms.

“You can’t have climate change without sacrifice zones, and you can’t have sacrifice zones without disposable people, and you can’t have disposable people without racism,” says Hop Hopkins, vice president of strategic partnerships for the Sierra Club.

Climate change-associated air pollution and heat exposure increase poor pregnancy outcomes like preterm birth and stillbirth, affecting Black mothers, who already face high morbidity and mortality in the U.S., the most. Such vulnerable populations as low-income or houseless people are often without air conditioning or heating. They are more affected by air pollution, as evident during the wildfires in 2020. Natural disasters like the recent snowstorms that are increasing with climate change also tend to affect “disposable people” the most.

Role of health care

Health care providers are intertwined with both environmental racism and climate change. We care for the “disposable people.” Unfortunately, health care also contributes to both crises.

Medicine has a deeply racist history, including involvement with eugenics, abuse of vulnerable populations through acts of injustice and indecency like the Tuskegee syphilis trials, and as a contributor to structural racism. One example is the Legacy Emanuel hospital campus that occupies what was the heart of Portland’s African American community before nearly 300 homes and businesses were razed in the 1970s, causing dislocation and associated harms. The plan was approved without informing residents, who subsequently received only one hearing to no avail.

Environmental racism also makes people sick. The most current of many examples: a Harvard study linked increases in pollution to increases in mortality from COVID-19. This undoubtedly helps explain the disproportionate affect COVID-19 is having on Black and Hispanic Americans, who are more likely than white Americans to be exposed to higher levels of air pollution.

As for climate change, health care is responsible for a staggering 10 percent of carbon emissions in the U.S. This is unsurprising when you consider hospitals produce 29 pounds of waste per bed a day and that the anesthetic gases we use daily are themselves greenhouse gases. Environmental racism and climate change demand a response on par with our organization against COVID-19.

How can we be part of the solution?

Call for more sustainability within health care, through institutional committees or individual action. Examples include the recent push to switch anesthesia from desflurane to the more environmentally friendly but otherwise similar sevoflurane, using regional instead of general anesthesia altogether, and the emerging trends around conserving or safely reusing PPE.
Pursue research and education. Academic programs are increasingly incorporating climate change lectures into curricula, and this term our institution is offering a new climate change and human health elective.
Advocate. Oregon Physicians for Social Responsibility recently joined many local groups and the Columbia River Tribes in fighting a proposed water bottling plant. They succeeded in preserving water resources and avoiding additional pollution.

Get involved in local and national groups like those listed below. On a personal level, listen to your patients. Learn how their environment affects them. Advocate for their home equipment needs. Amplify their stories. Testify to lawmakers. No action is too small.

To learn more:

Mehtab Sal and Olivia Glatt are medical students.

Image credit: Shutterstock.com