Environmental Health Hazards and Social Justice

Geographical Perspectives on Race and Class Disparities

Florence Margai

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136537813
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This book provides geographic perspectives and approaches for use in assessing the distribution of environmental health hazards and disease outcomes among disadvantaged population groups. Estimates suggest that about 40 per cent of the global burden of disease is attributable to exposures to biological and chemical pathogens in the physical environment. And with today's rapid rate of globalization, and these hazardous health effects are likely to increase, with low income and underrepresented communities facing even greater risks. In many places around the world, marginalized communities unwillingly serve as hosts of noxious facilities such as chemical industrial plants, extractive facilities (oil and mining) and other destructive land use activities. Others are being used as illegal dumping grounds for hazardous materials and electronic wastes resulting in air, soil and groundwater contamination.

The book informs readers about the geography and emergent health risks that accompany the location of these hazards, with emphasis on vulnerable population groups. The approach is applications-oriented, illustrating the use of health data and geographic approaches to uncover the root causes, contextual factors and processes that produce contaminated environments. Case studies are drawn from the author's research in the United States and Africa, along with a literature review of related studies completed in Europe, Asia and South America. This comparative approach allows readers to better understand the manifestation of environmental hazards and inequities at different spatial scales with localized disparities evident in both developed and developing countries.

PART I

THEMES AND CONCEPTS

1
Geographic Foundations of Environmental Health Hazards: The Need for a Place-based Perspective

Introduction

As the 21st century unfolds, there are growing concerns that this new era is being marked, and perhaps permanently tainted, by an unusual set of geopolitical events, together with a series of economic, demographic and environmental challenges with profound implications for global health. During the course of this first decade alone, we have witnessed unprecedented levels of human agony and suffering caused by earthquakes, tsunamis, hurricanes, floods and other natural disasters, along with intentional acts of terrorism, civil wars and regional conflicts, all resulting in a significant number of deaths and disabilities. We have also witnessed the rapid integration of national economies into a new and increasingly unstable global economy, the emergence and dominance of multinational corporations, the convergence of global agricultural systems, food processing and distributional networks, changes in the structure and composition of labour markets, the rapid urbanization and large-scale movements of people within and across world regions. Not surprisingly, these events have been accompanied by an even greater transformation of the global and local environments, introducing a whole new set of environmental health hazards while exacerbating others.

Environmental health hazards are spatially differentiated with marked differences from place to place. Throughout the world, in developed economies, transitional and emerging economies one encounters evidence of racial, ethnic and class-based disparities in environmental exposure and health outcomes. The poor and underrepresented groups are too often the ones to bear the brunt of environmental hazards, the most likely to develop health complications from these exposures, and yet the least likely to gain access to beneficial health services that would detect and treat these problems. Knowledge of the environmental exposure risks, distributional patterns and their effects on population health requires a geographic perspective coupled with a social justice mindset to better understand the root causes, the situational contexts in which they occur and the disparities they produce among different population groups. This book offers these perspectives along with a discussion of the geographic tools and methodologies that are used to evaluate the distributional patterns of these hazards. Emphasis is placed on the environmental hazards and locational inequities that produce adverse health outcomes among disadvantaged population groups around the world. Key terminologies such as health disparities, health inequities and the various conceptualizations of race, ethnicity and social class are critically reviewed to draw out the inconsistencies in meaning, and interpretations across time and in varied contexts. The methodological challenges that arise in the use of these theoretical constructs to document population health disparities are discussed.

The text is applications-oriented, illustrating the combined use of demographic, health and environmental data, and geographic approaches to uncover the causes, contextual factors and processes that produce the contaminated environments. To illustrate the international scope of these issues, case studies are drawn from research conducted mostly in the United States and Africa, along with a review of related studies in Europe, Asia and South America. This comparative approach allows readers to gain a better understanding of the global distribution of these environmental hazards, their manifestation at different spatial scales, and the health inequities they produce among people in both developed and developing countries. In this first chapter, we shall examine the general characteristics of environmental hazards, noting the common risk sources, and potential health outcomes. This will be followed by an overview of the four traditions of geographic inquiry, highlighting the need for a place-based (or spatial) perspective in evaluating environmental health issues. The chapter concludes with a synopsis of the remaining chapters of the book.

Overview of environmental health hazards

Environmental health hazards are broadly defined in this text as the complete realm of disease causing agents, pathogens, events and processes in the external environment that threaten the health and well-being of people in their homes, neighbourhoods, communities and other surroundings. This definition calls further for the clarification of the term environment, as used in environmental health research. By environment, we are referring to all of the external circumstances and conditions that influence population health. Though many authors have offered their own interpretations in the literature (see, for example, Last, 1987; Moeller, 1992; Eyles, 1997; Briggs, 2000; Merrill, 2008), a more comprehensive characterization of the environment draws upon at least four frameworks that acknowledge the distinction between (i) the inner and outer environment of the human body; (ii) the personal versus ambient environment of individuals; (iii) solid, liquid and gaseous environments; and (iv) the biological, chemical, physical/mechanical and psychosocial environments. The latter is the most commonly used characterization in the study of environmental health hazards, and will be formally adopted in this book. This framework calls for a complete evaluation of the multiple risk sources of environmental diseases in our external surroundings: the biological, chemical and physical/mechanical factors as well as the psychological and socio-cultural factors. The latter may not always be readily observable but nonetheless have significant impacts on population health. Biological agents include the various forms of bacteria, viruses, parasites, fungi, spores and other pathogens that may be found in the air, food and water, some that are transmissible directly from person to person, or indirectly through animals or insects. Chemical agents consist of air pollutants such as sulphur dioxide or carbon monoxide gas, heavy metals such as lead and mercury, synthetic compounds such as dichlorodiphenyltrichloroethane (DDT), polychlorinated biphenyl (PCB), and the many types of additives, pesticides, household cleaning agents and other hazardous materials. Physical/mechanical agents of disease originate from sick buildings, as well as excessive noise, heat or cold, and various forms of radiation in our surroundings.

Using the above classification of the environment, a summary of the most prevalent global environmental health hazards is provided in Table 1.1. The sources of origin and associated health risks are also provided. Though some of these hazards originate from natural sources, it is evident from the table that human activities now play a dominant role in transforming environments, introducing contaminants and/or triggering the state of events or processes that account for the emerging health hazards. For example, global atmospheric hazards such as ozone depletion, global warming and their attendant health problems observed in recent decades are triggered by anthropogenic activities. Noteworthy also are the residential, occupational and social environments of individuals that contribute further to environmental exposures and poor health outcomes.

As part of the discourse in this book, we shall map out the distribution of these hazards at different geographic scales – globally, regionally and locally – but more importantly examine the social injustices and disparities that are produced among individuals of different racial, ethnic and socio-economic backgrounds. In both developing and developed countries, income inequalities, residential segregation and isolation in contaminated environments, food insecurity, and limited access to life-enhancing resources all serve as key drivers of environmental exposure and ill health. Low-income, minority or working-class populations are often the most likely to bear the brunt of these disparities, which over the course of their lifetimes result in negative health outcomes. The illustration of these problems, globally and locally using geographic tools and perspectives will help draw out the commonalities across spatial scales while at the same time identifying the hotspots where prompt interventions are needed to correct the inequities. For those who are unfamiliar with geography, a brief overview of the discipline, the primary traditions and contributions to environmental health research is provided below.

Table 1.1 Examples of environmental health hazards and associated health risks

Category	Examples of hazards	Health risks
Natural hazards	Volcanic activity	Includes effects of direct injury by volcanic debris, lava, etc.; inhalation of gas, dust and indirect effects of famine, etc.
	Earthquakes	Direct injury from effects of earth tremors (e.g. building collapse), and indirect effects (e.g. flooding, tsunamis, epidemics and famine)
	Flooding/storms	Direct effects of drowning and injury by floods/storms, and indirect effects of water contamination
	Drought	Primary health effects due to lack of potable water and famine
	Hurricanes/wind	Direct effects of injury (e.g. collapsing buildings) but may also include longer term effects of contamination/loss of water supplies
	Soil erosion	Famine and poor diet due to effects of desertification on food supply
Atmospheric hazards	Outdoor air pollution Greenhouse gases / global warming Ozone depletion	Wide range of respiratory, pulmonary and cardiovascular illnesses and cancers Through indirect effects of hurricanes/flooding/drought Increases exposure to UV radiation resulting in risks of skin cancer, cataracts and compromised immune systems
Waterborne hazards	Surface water pollution Drinking water contamination	Primarily diarrhoeal and gastrointestinal illnesses, but may also include chemical poisoning Gastrointestinal and urinary diseases; rarely chemical poisoning
Food-borne hazards	Biological contamination Chemical contamination Food deserts	Bacterial agents cause wide range of diseases of the digestive system Food additives, pesticides such as DDT, hormone supplements and antibiotic residues cause a range of diseases including effects on digestive/urinary systems Limited access to nutritious food
Vector-borne hazards	Water related	Infectious and parasitic diseases
	Animal related	Infectious and parasitic diseases
Domestic/residential hazards	Tobacco smoke / indoor air pollution	Wide range of respiratory and cardiovascular illnesses and cancers
	Lead-based paint	Lead poisoning with effects on nervous, cognitive and developmental systems
	Household chemicals / synthetic compounds	Adverse health effects from cumulative exposures to synthetic compounds such as phthalates, PFCs, and PBDEs. Accidents – physical injury and poisonings, suicide through use of chemicals, drugs and instruments
Occupational hazards	Industrial pollutants	Wide range of respiratory, pulmonary and cardiovascular illnesses and cancers; chemical poisoning
	Occupational accidents	Acute physical injury (e.g. by fire, explosions, accidents with equipment and chronic injuries (e.g. repetitive strain, back pain, etc.)
Infrastructural hazards	Hazardous accidents	Primarily acute physical injury (e.g. by fire, explosions) or chemical poisoning with respiratory effects
	Illegal dumps / abandoned waste sites, contaminated land	Many diseases including cancer clusters, and impacts on the digestive/urinary systems
Social conflicts	War	Almost all forms of health effects
	Terrorism	Acute physical injury (e.g. by fire, explosions) or chemical poisoning with respiratory effects
	Domestic violence	Physical injury; stress-related illnesses

Source: Modified after Briggs, 2000

The importance of geography in environmental health research

Geography is an integrative scientific discipline that examines the interactions and linkages between the natural environments and human societies, and how those interactions produce distinctive landscapes, spatial patterns, processes and outcomes. The discipline is particularly well suited for environmental health research because it offers a blend of natural science and social science paradigms that are crucial to understanding the environments in which we live, our adaptation and activities in those environments and how those interactions impact our health. As Parvis (2002) once wrote, environmental health professionals can benefit from geographic knowledge in several areas including the ability to read and produce maps, learn about atmospheric, hydrological and other geochemical cycles, learn the fundamentals of renewable and non-renewable energy sources, the physical limitations of our environment including the constraints of water and food resources, the use of chemicals in industry and agriculture, and global hazards such as ozone depletion, global warming and health impacts. The discipline also offers the ability to learn about different population groups in our local communities and around the world, the languages they speak, their religious practices, diet, customs and behavioural practices that contribute to ill health, as well as knowledge about the distribution of health-related services.

Geographic research is guided by a strong theoretical foundation that enables the spatial analysis of human – environmental problems. The discipline relies on cutting edge tools and technological methods such as computer cartography, geographic information systems (GIS), geomatics, statistics and remote sensing to compile and analyse spatially and temporally referenced data, and the underlying processes and factors that are responsible for the observable patterns. Contrary to popular myths of geography as a rote-based discipline, geographic research is applied with a focus on problem solving to address the real challenges facing people in their local communities and around the world. Issues of food access, air pollution, water quality and access, housing availability, environmental justice and poor health are matters that affect the lives of many around the world for which we need solutions.

The integrative nature of the discipline of geography is best seen in Figure 1.1 where one notices several subspecialties with a strong overlap with other disciplines in the natural and social sciences. Among these, medical geography is prominently featured with its cognate field in medicine and pub...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyright
• Contents
• List of Figures and Tables
• Acknowledgements
• Preface
• List of Acronyms and Abbreviations
• PART I THEMES AND CONCEPTS
• PART II ENVIRONMENTAL ASPECTSOF HEALTH DISPARITIES
• PART III SOCIALAND ECONOMIC FACTORSIN POPULATION HEALTH DISPARITIES
• Index