CENTER FOR POLICY ANALYSIS AND RESEARCH Health Equity
February 2024
Oluwatosin Oyadiran, B.Pharm, MD, MPH, John R. Lewis Social Justice Fellow
Breathing Injustice: Environmental Inequality and its Impact on Black Health
CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
Environmental Hazards and Black Health Achieving health equity is crucial to promoting fairness and justice in our society. It requires ensuring everyone has equal access to the best possible healthcare, regardless of social or demographic background. Strengthening environmental justice is a significant factor in the race towards health equity, as it profoundly impacts health and well-being. The United States’ long-standing practices of racism have resulted in health inequities that disproportionately affect the Black community. Environmental racism is a form of systemic racism that encompasses policies, practices, and regulations that discriminate against and attempt to dehumanize minority communities. This practice has its roots in slavery and segregation, as Black communities have historically been denied opportunities to own homes and achieve financial empowerment. These same communities have been relegated to neighborhoods with substandard and poorly maintained infrastructure, government facilities, and limited green spaces, making them more susceptible to environmental hazards that can cause health problems. Various forms of environmental racism perpetuate systemic racism and contribute to poor health outcomes for Black Americans, including air, water, and noise pollution, as well as toxic waste sites. This policy brief sheds light on the critical intersection between environmental justice and Black health, examining environmental hazards, health disparities, and potential solutions.
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
AIR POLLUTION The 1970 Clean Air Act Amendments provided the Environmental Protection Agency (EPA) the authority to establish primary National Ambient Air Quality Standards (NAAQS) to safeguard public health against air pollution. Yet, the United States has one of the highest pollution rates among developed nations. The current (12µg/m3) and proposed (9-10µg/
m3) air quality indices exceed the current World Health Organization (WHO) standard (5µg/m3) for particulate matter (PM) 2.5μm by at least two times (US EPA, 2023). These lenient environmental standards disproportionately impact communities that have been historically marginalized and individuals with cumulative exposure to multiple pollutants. Studies have revealed that neighborhoods redlined in the 1930s still suffer from elevated levels of air pollution, indicating the lingering effects of historical segregation on presentday disparities (Lui et al., 2021). These areas showed higher levels of nitrogen dioxide in 80% of grade D communities and lower levels in 84% of grade A communities between 1990 and 2010 (Lui et al., 2021). Air pollution levels are comparatively lower among white Americans than people of color residing in the same community, possibly due to a higher proportion of minority residents, particularly in Black and Asian neighborhoods, frequenting regions with elevated levels of air pollution (Brazil, 2022; Lui et al., 2021). Residents in minority neighborhoods tend to venture beyond their residential areas more frequently than those in white and non-poor regions (Brazil, 2022). This trend may stem from insufficient access to healthcare facilities, grocery stores, restaurants, and other essential community infrastructure and amenities (Brazil, 2022). Environmental pollution from various sources, including industries, agriculture, vehicles, construction work, residences, and restaurants, disproportionately affect Black Americans compared to other people of color and white Americans (Tabuchi & Popovich, 2021).
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
Recent studies have identified over one thousand hotspots of toxic industrial air pollution across the United States. These hotspots disproportionately impact predominantly Black neighborhoods, with levels of toxic industrial pollution experienced in these communities more than double that of majority-white neighborhoods (Shaw, 2022). One such area is the Kanawha Valley in West Virginia, also known as “Chemical Valley.” This area stands out as one of only two majority-Black census tracts in the state and serves as a significant pollution source for its residents, emitting substantial quantities of air pollution, particularly ethylene oxide (Elbeshbishi, 2023). Living in these areas exposes residents to carcinogens and increases the risk of rare cancers. For example, vinyl chloride exposure from a Westlake Chemical plant led to the residents of Calvert City, Kentucky, and Lake Charles, Louisiana, developing angiosarcoma of the liver, which is a cancer of the blood vessel linings (Office of Public Affairs, 2022). A second example is Louisiana’s “Cancer Valley.” Despite the significantly higher rate of cancer in this Black-concentrated community, the Environmental Protection Agency (EPA) recently closed its investigation into Louisiana’s “Cancer Valley” without making any formal findings or changes to the status quo (Juhasz, 2023). Studies show that individuals living in majority-Black communities suffer a greater risk of premature death linked to particle pollution compared to individuals living in predominantly white communities (American Lung Association, 2023). Coal, being a fossil fuel, is known to contribute to air pollution, especially among Black Americans, owing to the emission of carbon dioxide (CO2), PM, sulfur dioxide, mercury, and nitrogen oxide. Despite making up 13% of the United States population, about 68% of Black Americans live near coal-fired power plants compared to 56% of white Americans (Wilf & Madrid, 2012). Mercury, a potent neurotoxin used as a primary fuse in World War munitions and commonly present in coal plants, impairs brain development in children and causes a range of diseases by depositing in human organs, while PM is associated with poor birth outcomes, respiratory diseases, and heart complications (Wilf & Madrid, 2012). A neighborhood’s economic status and racial composition notably influence the disparities in environmental conditions. For example, areas predominantly inhabited by Hispanic, nonHispanic Black, and Asian populations exhibit elevated levels of PM pollution, specifically with PM2.5 levels ranging from 8.72 to 8.85. In contrast, neighborhoods with predominantly white residents experience comparatively lower PM2.5 levels at 7.81 (Brazil, 2022). These environmental disparities manifest differently across various U.S. states, with non-Hispanic Black, Hispanic, and Asian populations experiencing at least a 5% higher exposure to PM2.5 in 63%, 33%, and 26% of states in 2010, respectively (Lui et al., 2021). Additionally, nonHispanic Black Americans face an increased risk of exposure to heightened levels of ozone (O3), sulfate (SO2), and zinc compared to white and Hispanic communities (Lui et al., 2021).
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
WATER POLLUTION AND LEAD POISONING In communities of color, rising water costs and racial discrimination compound to exacerbate the issue of water quality. According to a 2016-2022 study of water systems in 7,783 communities, Black and Hispanic communities were at a higher risk of harmful levels of per- and poly-fluoroalkyl substances (PFAS) in their water supplies (Liddie et al., 2023). PFAS, also known as “forever chemicals,” decompose slowly in the body after exposure and are more prone to accumulate than other toxic wastes (McMahon et al., 2022). Jackson, Mississippi, a majority Black community (82.8%), faced water scarcity issues during a winter storm in February 2021, a boil-water advisory in July 2022, and another water crisis in September 2022 when the main water treatment plant failed.
Similarly, in 2014, Flint, Michigan, another majority Black community (56.7%), experienced the devastating effects of water pollution when their municipal water supply source was changed to save costs, contaminating the water with lead and causing long-lasting health implications for the residents. Despite the residents’ complaints about the water’s poor taste and odor, skin rashes, hair loss, and itchy skin, government officials ignored their concerns for 18 months. Residents were then advised to drink filtered water only, but the damage was already done (NRDC, 2018).
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
SPOTLIGHT: In Flint, Michigan, the decision to increase the amount of chlorine in the water to address a fecal coliform bacterium in the city’s water supply resulted in exposure to total trihalomethanes (TTHM), which are known to be cancercausing byproducts of water chlorination (NRDC, 2018). This exposure led to a deadly Legionnaires’ disease outbreak. The Michigan Department of Health and Human Services conducted an incidence analysis spanning 19 years (20002018) and found a significant surge in colon, stomach, lung, larynx, and prostate cancer cases among Flint residents (Michigan Department of Health and Human Services, 2021). The analysis also revealed higher rates of stomach and prostate cancers among Black Flint residents compared to their white counterparts (Michigan Department of Health and Human Services, 2021).
Lead exposure is a serious health concern that can have severe adverse effects on both children and adults. Children who are exposed to lead may suffer from anemia, delayed growth, brain developmental issues, low IQ, cognitive disorders, lifelong psychological problems, damage to vital organs, seizures, and even death (Santa Maria et al., 2019). In adults, lead exposure is associated with anemia, hypertension, cardiovascular diseases, and decreased immune function, damage to vital organs, seizures, and even death (Santa Maria et al., 2019). Lead exposure may originate from sources other than water, including lead-based paint in houses built before 1978, fossil fuels, battery manufacturing, industrial factories, and contaminated sites (Debnath et al., 2019). Lead and its derivatives have been used in ceramics, plumbing materials, gasoline, ammunition, food and drink cans, dietary supplements, imported products, food, and spices (Lewis, 2022; Triantafyllidou & Edwards, 2012; US EPA, 2013). Lead may also be present in cosmetics like lipsticks due to impurities in color additives and other raw materials used in makeup production (Al-Saleh et al., 2009). Hair treatments commonly used by Africans, Asians (particularly South Asians), and Black Americans may also contain impurities like lead, mercury, and arsenic (Lewis, 2022). For example, henna samples are more likely to have lead and other heavy metals (like mercury and arsenic) and an allergenic colorant, p-phenylenediamine, at levels deemed acceptable by the FDA (Lewis, 2022). Despite products falling within the FDA-approved lead limits, there are no safe thresholds for lead exposure; prolonged and additional environmental exposure to lead may cause it to accumulate in the body, resulting in severe health problems (NRDC, 2018). Factors like age, diet, genetics, and secondary exposure may also contribute to varying rates of lead
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
retention in the body (Riantafyllidou & Edwards, 2012). Diets low in calories, calcium, and iron, along with infrequent meals, are associated with higher lead absorption (Riantafyllidou & Edwards, 2012). Children absorb up to half of the lead they are exposed to, a significantly higher percentage than the 10% absorbed by adults. Children may also get exposed to lead through adults with occupational exposure, reaching levels that can induce blood cancers such as acute myeloid leukemia and acute lymphoid leukemia (Whitehead et al., 2015). Pregnant women exposed to lead and other heavy metals are at risk of miscarriage, intrauterine fetal death, hypertension, and poor health outcomes (Lewis, 2022). TOXIC WASTE SITES A decentralized system for landfill, hazardous waste, and industrial site permitting, entrusted solely to local officials before 1976, fostered discriminatory practices that concentrated polluting facilities and toxic waste dumps near subsidized housing within low-income and minority communities (Taylor, 2022). A 1983 Government Accountability Office (GAO) study revealed that three out of four landfills in the Southeast were in predominantly Black neighborhoods and the repercussions persist in those identified neighborhoods (NRDC, 2023). The Nuclear Regulatory Commission recently reported that more than 15 million Blacks and 8 million Hispanics live in communities with uncontrolled toxic waste sites (Taylor, 2022). Exposure to toxic waste can have severe health consequences for humans and aquatic life. Toxic wastes can spread to water systems, more commonly during rainfall, and feed into the ocean (Al-Taai, 2021). They can also leach into the soil and contaminate groundwater, accidentally leak into the air, or contaminate agriculture consumed by humans (Al-Taai, 2021). One of the most significant sources of toxic waste pollution is located in Anniston, Alabama. The chemicals stored at the Anniston Army Depot (ANAD), a munitions storage facility, in the 1960s began to leak (Ap, 1981; Browder, 1996). These chemicals, including nerve agent VX, GB, and mustard gas, were eventually dumped onto the ground and spread into neighborhoods, contaminating water, air, and soil. Despite being labeled as a Superfund site (one of the most contaminated waste sites), the EPA’s efforts to clean this Black neighborhood have been slow, with the destruction of mustard-filled munitions officially beginning in July 2009 (EPA, n.d.; Hess, 2011). A research study was conducted to investigate the levels of air pollutants in Anniston, Alabama; however, the study did not yield any conclusive results due to the limited amount of data collected. The researchers only tested two 24-hour samples at three sampling locations, which is not enough to draw statistical conclusions about the concentrations of harmful chemicals and the associated cancer risks. (ATSDR, 2013).
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
NOISE POLLUTION Excessive noise pollution poses a significant threat to both physical and psychological health, causing various ailments such as hearing loss, tinnitus, high blood pressure, sleep disorders, stress, anxiety, and depression (Casey et al., 2017). Redlining has resulted in minorities facing difficulties in purchasing property and investing in their communities, resulting in their residences being situated in more affordable yet less desirable areas near highways, industrial zones, trains, and airports. With urbanization and development, noise pollution levels have surged, raising baseline noise levels from 43 decibels in rural areas to 61 decibels in urban areas (Ayush et al., 2022). Research indicates that neighborhoods with a higher proportion of Black residents, about 75%, are subjected to substantially higher noise levels than those without Black residents, resulting in disproportionate exposure to noise pollution for Black and Hispanic residents relative to their white counterparts (Casey et al., 2017). In New York City, New York, Black residents experience 58 decibels of noise pollution compared to 48 decibels for white residents, while in Chicago, Illinois, Black residents are exposed to 55 decibels compared to 45 decibels for white residents (Huang et al., 2021). Neighborhoods with high poverty and low education rates also exhibit high levels of noise pollution, even for white residents in segregated cities. In the most segregated cities, white residents were exposed to 42.5 decibels of nighttime noise on average, compared to 38 decibels in the least segregated cities (Casey et al., 2017).
Environmental Injustice and Health Disparities Humans are closely connected to their environment, and the relationship between health disparities and environmental health is complex and multifaceted. Exposure to hazards poses a significant health risk, particularly for marginalized communities, leading to early symptoms of diseases and long-term effects that can be passed down through generations (Ekeli, 2004; Wells, 2016). Air pollutants can cause immediate skin and eye irritation, autoimmunity, allergic rhinitis, atopic dermatitis, asthma, and other respiratory conditions (Schraufnagel et al., 2019). These conditions may persist, leading to more severe health problems, such as weakened immune systems, osteoporosis, bone fractures, conjunctivitis, dry eye disease, blepharitis, inflammatory bowel disease, increased intravascular coagulation, infertility, and reduced glomerular filtration rate (Schraufnagel et al., 2019).
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Burdened by environmental toxins and barriers to health care, Black Americans face adverse health outcomes. Black children have a higher incidence and 500% higher death rate from asthma and present with twice the rate of mortality at infancy than their white counterparts (Willer et al., 2023). Black adults present with higher rates of respiratory infections, kidney diseases (up to four times more likely to have end-stage renal disease than white Americans), heart disease, diabetes, stroke, cancers (highest mortality rate for all cancers compared to other racial/ethnic groups), and are also 30% more likely to die from heart disease, and twice as likely to die from stroke than whites (NIDDK, 2023; OMH, 2021). The 2021 life expectancy at birth between Blacks and whites differed by at least five years (74.8 years for Black women, 79.2 years for white women, 66.7 years for Black men, and 73.7 years for white men (OMH, 2021). Access to green spaces is often limited in marginalized communities, which can result in residents spending more time indoors due to poor environmental conditions. This may promote sedentary lifestyles, boredom, stress, depression, and anxiety, along with chronic diseases such as hypertension, cardiovascular disease, and diabetes (Yang et al., 2021). The health disparities encountered by Black communities may be partly attributed to the poor environmental health they are exposed to, one of the many ways in which systemic racism worsens health outcomes for Black Americans (Patnaik et al., 2020). Adverse environmental conditions may also exacerbate infectious disease patterns and increase infection frequency, duration, morbidity, and mortality (Baker et al., 2022).
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
Communities already exposed to environmental hazards are prone to experiencing more severe consequences of climate change, including higher temperatures, extreme weather events, and shifts in disease patterns (Thomas et al., 2019). This often exacerbates health issues, leading to increased incidences of heat-related, respiratory, and infectious diseases within these communities (Thomas et al., 2019; Wilf & Madrid, 2012). Additionally, they are more vulnerable to natural disasters or environmental emergencies related to climate change, such as flooding and wildfires, which can cause poor health conditions, mass displacement and migration, food and water insecurity, economic challenges, and limited social resources (Thomas et al., 2019). The consequences of inadequate infrastructure that is not resilient to climate change and cannot handle changing weather conditions can be worsened by environmental injustice, resulting in obstacles to water supply, sanitation, and transportation (Thomas et al., 2019).
The Inflation Reduction Act and other Government Initiatives The environmental justice movement emerged in the 1970s, and since then, the government has implemented policies and programs to address environmental challenges caused by systemic racism. The Biden administration has taken decisive steps toward environmental justice for Black Americans by passing legislation and rejoining the international Paris Agreement, which seeks to reduce greenhouse gas emissions and limit global warming to below 2 degrees Celsius (US Department of State, 2021). The 2021 Bipartisan Infrastructure deal incorporated provisions for clean water in all households, the elimination of lead service lines, the modernization of America’s power infrastructure, the promotion of energy technology to ensure carbon neutrality, the remediation of historical pollution by cleaning up superfund and brownfield sites, the reclamation of abandoned mines, and the capping orphaned oil and gas wells (WH, 2021). The Inflation Reduction Act (IRA) earmarked $3 billion towards reducing air pollution in lower-income Black communities near ports (DOE, 2023; Neal, 2022). The law also allocated an additional $3 billion for community-led projects aimed at addressing environmental disparities and a $3 billion more in grants to promote neighborhood access and equity, targeted towards alleviating the adverse impacts of transportation and construction projects in disadvantaged communities (Cox, 2023; Neal, 2022). The IRA established the Environmental and Climate Justice Program under the EPA to carry out activities that benefit underserved and overburdened communities (US EPA, 2023). The IRA also includes tax incentives for clean energy, investments in clean energy infrastructure, methane emissions reduction, and climate resilience and adaptation programs to support communities in disaster preparedness and ensure climate-resilient agriculture (DOE, 2023).
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CPAR | Breathing Injustice: Environmental Inequality and its Impact on Black Health
Moving Forward While efforts have been made to inch towards a healthier environment for Black Americans, the journey towards achieving health equity and environmental justice is ongoing. To foster community-led initiatives, grassroots organizers must work towards engaging residents and government officials to raise awareness on environmental justice problems. Black communities must continue to recognize the importance of their environment and advocate for health and environmental rights. Addressing environmental injustices and racism requires a focus on upstream solutions. Government officials must invest in renewable energy and sustainable infrastructure, integrate environmental resilience in public health strategies, and promote equitable environmental justice initiatives. The EPA must prioritize the needs of minority communities, especially as climate change brings a unique perspective to the environment. The agency must align guidelines and regulations with the effects of climate change, and provide stricter, enforceable air and water quality guidelines. Legislators must address environmental issues through policy and investigation. They must empower Black communities to fight against environmental discrimination, as exemplified by the Environmental Justice for All Children Act of 2023. The legislation empowers discriminated persons to sue for intentional discrimination and mandates the EPA to consider environmental justice issues when developing regulations (Sen. Duckworth, 2023). It also allocates $60 billion for environmental justice initiatives (Sen. Duckworth, 2023).
Conclusion The issue of environmental racism has had a profound impact on American communities, particularly on Black American health. The intersection between environmental hazards and health disparities highlights the urgent and pressing need for comprehensive and equitable solutions. Disparities in exposure to environmental hazards, from air and water pollution to the heightened vulnerability to climate change, underscore a systemic injustice that disproportionately affects communities of color. Concerted efforts are required to dismantle systemic racism, address economic inequalities, and ensure that community-led solutions, awareness campaigns, and inclusive and sustainable policies are prioritized. It is imperative to address environmental injustice as it is not only an environmental issue but also a social justice and health equity concern.
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CENTER FOR POLICY ANALYSIS AND RESEARCH Health Equity
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