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Environmental Justice in Air Quality Policy Development

Environmental Justice in Air Quality Policy Development. Marie S. O’Neill Assistant Professor Epidemiology and Environmental Health University of Michigan School of Public Health NERAM Colloquium V Vancouver, BC, Canada October 17 , 200 6.

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Environmental Justice in Air Quality Policy Development

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  1. Environmental Justice in Air Quality Policy Development Marie S. O’Neill Assistant Professor Epidemiology and Environmental Health University of Michigan School of Public Health NERAM Colloquium V Vancouver, BC, Canada October 17, 2006

  2. WHO AQG Global Update 2006 Environmental Equity ChapterPatrick L. Kinney and Marie S. O’Neill • First time theme addressed separately • Other AQG chapters address • international inequalities in exposure • socio-economic factors as correlate or indicator of individual susceptibility

  3. Environmental justice/equity • Like value of life, term has an ethical component • More than ‘inequality’ in exposure/outcome • Addresses procedural justice Ikeme, J. (2003). Equity, environmental justice and sustainability: incomplete approaches in climate change politics. Global Environmental Change, 13, 195-206. • Implicit moral judgment that environmental inequalities are unfair and we need to rectify them • Intranational, international, and intergenerational justice • Fairness as a goal of environmental management (South African constitution, State of California law)

  4. Health is socially patterned • Socio-economic gradients not confined to just ‘the poor’-seen across whole range • Individual & area level social determinants • Influences occur throughout life course • Environmental (physical) exposures may contribute to observed gradients O'Neill MS, Jerrett M, Kawachi I, Levy JI, Cohen AJ, Gouveia N, Wilkinson P, Fletcher T, Cifuentes L, Schwartz J. (2003) Health, wealth, and air pollution: advancing theory and methods. Environmental Health Perspectives. 111:1861-70 Kawachi, I., & O'Neill, M. (2005). Social disparities. Environmental Health Perspectives special issue http://ehp.niehs.nih.gov/docs/2005/essays/toc.html

  5. Commonly used indicators of socio-economic position (SEP) • Individual • education, occupation, income • Neighborhood/area • Composition (% people with high school degree, % literacy, % poverty) • Contextual (features of the community or society, parks, food stores, crime rate, social networks)

  6. Air pollution, health and SEP • Different effects of air pollution on health by SEP may be observed because of different patterns of • Exposure • Susceptibility • Both

  7. Air pollution exposure can differ by socio-economic level • proximity to roadways: particle/NO2 exposure, O3 exposure (scavenging) • settlement patterns (center city vs. suburbs), topography/meteorology • indoor and occupational exposures • location-dependent • Mexico City: richer neighborhoods, high O3 • Santiago, Chile: poorer neighborhoods, high PM

  8. Individual susceptibility patterned by socio-economic factors • Medical conditions (diabetes, CVD, asthma) • Age structure of population • Life “choices”: smoking, diet, exercise • Access to anti-oxidant rich foods • Infections (crowding, sanitation) • Life course experiences • hygiene hypothesis in asthma

  9. Examples: Does educational attainment modify air pollution effect on mortality? • Two cohort studies • Traffic pollution in the Netherlands • PM2.5 in the United States • Preliminary results from time series study • PM10 in 3 Latin American mega-cities

  10. Potential pathways for low education to increase susceptibility & exposure Low educational attainment Lower health status (diabetes, hypertension) Low wage job, low income neighborhood • Higher levels of indoor pollutants (e.g., NO2 from gas stove) • Proximity to outdoor pollutant sources (e.g. diesel exhaust) • Few nearby supermarkets with fresh fruits/vegetables • Crowded living conditions (higher infection level) • Low quality health care (access limited, prevention lacking) • Violence/insecurity (in home or neighborhood) leading to stress

  11. Netherlands • 5,000 elderly people 1986-1994 • Long term black smoke (BS) exposure • Mortality rate ratios and 95% confidence intervals Hoek G, Brunekreef B, Goldbohm S, Fischer P, van denBrandt PA. Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. The Lancet2002;360:1203-09

  12. United States • American Cancer Society: 500,000 adults, 1982-1998 • Education level: Less than high school (HS), HS, > HS • All-cause, lung cancer, and cardiopulmonary mortality • Relative risks expressed per 24.5 ug/m3 PM2.5 HEI. Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air Pollution and Mortality (A special report of the Institute's Particle Epidemiology Reanalysis Project). Cambridge, MA: Health Effects Institute, 2000. Pope, C. A., 3rd, Burnett, R. T., Thun, M. J., Calle, E. E., Krewski, D., Ito, K., et al. (2002). Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA, 287(9), 1132-1141.

  13. Air pollution, temperature & mortality in 3 Latin American mega-cities Marie S. O’Neill1*, Michelle L. Bell2*, Nalini Ranjit1, Victor H. Borja-Aburto3, Luis A. Cifuentes4, Nelson Gouveia5, Dana Loomis6 *Co-Principal Investigators 1 University of Michigan, Ann Arbor, MI, USA 2 Yale University, New Haven, CT, USA 3 Instituto Mexicano del Seguro Social, Mexico City, Mexico 4 Universidad Pontificia Catolica de Chile, Santiago, Chile 5 Universidad de Sao Paulo, Sao Paulo, Brazil 6 University of North Carolina, Chapel Hill, NC USA Project initiated at ISEE 2004, support from Robert Wood Johnson Foundation Health & Society Scholars Program

  14. Educational attainment among deaths 1998-2002

  15. none some primary some secondary 12 + years

  16. Other work underway • Examine lags out to 40 days (to approach cohort study effects, evaluate harvesting) Zanobetti, A., Schwartz, J., Samoli, E., Gryparis, A., Touloumi, G., Atkinson, R., et al. (2002). The temporal pattern of mortality responses to air pollution: a multicity assessment of mortality displacement. Epidemiology., 13(1), 87-93. • Further stratify by gender, cause of death • Evaluate main effects of temperature • Seek evidence for heterogeneity among cities in population patterns of susceptibility and exposure by educational attainment……

  17. Research limitations/applications • Studies reveal patterns by education, but difficult to disentangle whether exposure, susceptibility or other factors contribute Finkelstein, M. M. (2002). Pollution-related mortality and educational level.[comment]. JAMA, 288(7), 830. Pope, C. A., 3rd, Burnett, R. T., & Thurston, G. D. (2002). Pollution-related mortality and educational level [author reply]. JAMA, 288(7), 830. • Can/should air quality policy be tailored to address socio economic differences? • At what level? (National, international, local?)

  18. Is there a place for environmental justice in air quality management? • National standards, international guidelines typically pick one level • Equity concerns not often taken into account in risk assessments • But: intra-urban spatial variability • ‘hot spots’, esp. relevant to motor vehicle emission • Concentration caps, exposure reduction targets

  19. Black carbon in 2 New York City communities differing by traffic density and socio-economic level (unpublished data of P.L. Kinney)

  20. Research and action at local level • Community-based participatory research • Questions designed jointly to address local problems • Detroit Urban Research Coalition Michigan professors present air pollution/asthma results at public hearings on truck transfer depot sitings • Environmental justice activists using molecular evidence to document environmental exposures Shostak, S. (2004). Environmental justice and genomics: Acting on the futures of environmental health. Science as Culture, 13(4). • Clean Air, Clean Lungs, Clean Buses Campaign in Los Angeles www.busridersunion.org

  21. Challenges to action on environmental justice • Inherent lack of political/economic power, access to information in lower status groups • Air pollution may rank low on priority concerns of socio-economically deprived • Pollution exposures/pollution-health associations not always higher in lower socio-economic group • research contradicts expectation and may not support actions desired by activists • Different sectors responsible for relevant policies (transport, zoning, social welfare)

  22. Conclusion of WHO AQG Environmental equity chapter ‘At present…insufficient data exist to incorporate these emerging findings (on SEP and air pollution) quantitatively into the setting of air guidelines of general applicability.’

  23. Conclusions on research needs • Better conceptualize and interpret individual- vs. area- level socio-economic variables in environmental research • Document whether exposures to and/or health effects associated with air pollution exhibit gradients by SEP in a variety of settings; • Characterize patterns of population exposures resulting from local sources in a variety of settings • Frame research questions relevant to and responsive to identified needs of policymakers and affected communities • Select indicators of SEP amenable to policy intervention • Involve representatives of local communities affected by pollution, in problem identification, research design and practice, translation of findings into action to reduce air pollution levels and exposure

  24. New directions: Integrating social, physical environments in policy U.S. researchers and policymakers Payne-Sturges, D. et al (2006). Workshop summary: Connecting social and environmental factors to measure and track environmental health disparities. Environmental Research, 102, 146-153. EPA Cumulative Risk Assessment Guidelines European Union sustainable development report includes social equity and cohesion among objectives Commission Communication "Draft Declaration on Guiding Principles for Sustainable Development" (Commission of the European Communities 2005). http://europa.eu.int/comm/sustainable/docs/COM_2005_0218_F_EN_ACTE.pdf

  25. Other new directions • Bring together dialogue on inequities related to air pollution and climate change U.S. Congressional Black Caucus Foundation 2004 Report http://www.ejcc.org/index.html • Justify air quality management in cleaner areas by discussing global connections/fairness Will Finland’s emission reductions keep the Maldives above water longer? • Join efforts with scientists and policymakers interested in social determinants of health Kelly, M. P., Bonnefoy, J., Morgan, A., & Florenzano, F. (2006). The development of the evidence base about the social determinants of health. World Health Organization Commission on Social Determinants of Health: Measurement and evidence knowledge network.

  26. Thank you! marieo@umich.edu

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