Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts

University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, Michigan, USA.
Environmental Health Perspectives (Impact Factor: 7.98). 01/2005; 112(17):1645-53. DOI: 10.1289/ehp.7074
Source: PubMed


Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure-disease paradigm has long suggested that differential "vulnerability" may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards.

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    • "Mitchell & Dorling (2003) completed a comprehensive review of UK air quality social equity studies and concluded that most studies investigating the relationship between air quality and deprivation, tended to show that air pollution is greater in more deprived communities (Mitchell and Dorling 2003). These inequalities are complex (Briggs, David et al. 2008; Deguen and Zmirou-Navier 2010), but can be framed within the theory of environmental justice, in that some groups are disproportionately subject to environmental hazards and disadvantage predisposing them to poor health (Gee and Payne-Sturges 2004). "
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    ABSTRACT: Many of the positive and negative health consequences associated with transport are well acknowledged: Motorised vehicles are known as a source of localised air pollution and greenhouse gas emissions. Air pollution and greenhouse gas emissions in turn impact directly on respiratory and cardiac health in exposed populations (COME 2006; Hoek et al. 2002; Le Tertre et al. 2002), and contribute to indirect health effects of climate change (World Health Organization 2009). Motorised transport also contributes to our increasingly sedentary lifestyle (Hill and Peters 1998), which in turn play a part in growing proportions of the population being overweight and obese. Numerous secondary health risks are associated with these conditions, including cardiovascular disease, type 2 diabetes, cancer, osteoarthritis and work disability. Furthermore, road transport is directly responsible for a significant burden of morbidity and mortality; in Great Britain, in 2009, there were 163,554 road accidents reported to the police involving personal injury, and 2,222 traffic related deaths (National Statistics 2009). In contrast, ‘active transport’ (walking and cycling) is seen to be associated with a wide range of health benefits (Haskell et al. 2009; Johan de Hartog et al. 2010), and reduced greenhouse gas/air pollution emissions (Dennekamp and Carey 2010; Lindsay et al. 2011; Rissel 2009). However, despite the acknowledged benefits of active transport, there has been a 24 percent decline in the number of trips made on foot (292 to 221 trips per person per year 1995/97 to 2008; (Department for Transport 2009), and a decline in the number of primary and secondary school children walking to school (53 and 42% in 1995/97 versus 48% and 40% in 2008) for primary and secondary school children respectively) (Department for Transport 2009). In the UK, up to 40% of the road traffic in the morning peak hour now estimated to be involved in some way in the school run (Mudu et al. 2006). Our transport systems affect our ability to access work, education and services, as well as social activities, all of which are important for maintaining health and wellbeing. However, transport and transport availability is not equitably spread across the population. People on low incomes, in chronic ill-health, or with limited mobility may be less able to access or pay for the transport systems they need to acquire work, education and services (Jarvis and Alvanides 2008). Those on low incomes are also more likely to suffer the adverse effects of road traffic, for instance exposure to air pollution and noise (Marshall et al. 2009; Namdeo and Stringer 2008; O'Neill et al. 2003). Mitchell & Dorling (2003) completed a comprehensive review of UK air quality social equity studies and concluded that most studies investigating the relationship between air quality and deprivation, tended to show that air pollution is greater in more deprived communities (Mitchell and Dorling 2003). These inequalities are complex (Briggs, David et al. 2008; Deguen and Zmirou-Navier 2010), but can be framed within the theory of environmental justice, in that some groups are disproportionately subject to environmental hazards and disadvantage predisposing them to poor health (Gee and Payne-Sturges 2004). It is becoming increasingly recognised that patterns of behaviour established in infancy and childhood influence later behaviour, meaning that disadvantage in childhood may exert a lifelong health and social affect. Physical activity, smoking, and diet are socially patterned, with behaviours established in adolescence being shown to ‘track’ into adulthood (Due et al. 2011). In the context of travel and health, travel behaviours established in childhood may set the pattern for healthful or less healthful behaviours throughout the life course. However, a more 6 detailed understanding of the development of such pathways is still very much needed to design effective, sustainable and acceptable policies that will encourage more healthful travel behaviour. To briefly outline the state of the art thinking on transport and health we are including the abstracts from the two papers submitted to the Journal of Transport Geography that resulted from this workshop. The first paper is entitled ‘Public health consequences of transport policy’ by Dr Eugene Milne, reflecting a public health practitioner’s approach to transport issues within strategic improvement of health and wellbeing. The second, entitled ‘Towards an interdisciplinary science of transport and health: A case study on school travel’ by Dr Susan Hodgson, Dr Anil Namdeo, Dr Vera Araujo-Soares and Prof Tanja Pless-Mulloli, outlining key concepts using knowledge, skills and evidence from transport and exposure science, civil engineering, health psychology and behaviour change as well as sustainability. More available at:
    Full-text · Article · Sep 2015
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    • "The need to integrate socioeconomic context and environmental pollution exposures into health research has long been recognized (IOM, 1999; Gee and Payne-Sturges, 2004; Morello- Frosch and Shenassa, 2006), and there is growing attention to the role of multiple exposures and heightened physiologic susceptibility [i.e., allostatic load (McEwen and Seeman, 1999)] in driving health disparities (Nweke et al., 2011; Sexton and Linder, 2011). There is substantial evidence for adverse impacts of area-level deprivation on pregnancy outcomes, even after accounting for individual socioeconomic position (SEP) (Picket and Pearl, 2001; O'Campo et al., 2008; Blumenshine et al.,2010). "
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    ABSTRACT: Numerous studies have linked air pollution with adverse birth outcomes, but relatively few have examined differential associations across the socioeconomic gradient. To evaluate interaction effects of gestational nitrogen dioxide (NO2) and area-level socioeconomic deprivation on fetal growth, we used: (1) highly spatially-resolved air pollution data from the New York City Community Air Survey (NYCCAS); and (2) spatially-stratified principle component analysis of census variables previously associated with birth outcomes to define area-level deprivation. New York City (NYC) hospital birth records for years 2008-2010 were restricted to full-term, singleton births to non-smoking mothers (n=243,853). We used generalized additive mixed models to examine the potentially non-linear interaction of nitrogen dioxide (NO2) and deprivation categories on birth weight (and estimated linear associations, for comparison), adjusting for individual-level socio-demographic characteristics and sensitivity testing adjustment for co-pollutant exposures. Estimated NO2 exposures were highest, and most varying, among mothers residing in the most-affluent census tracts, and lowest among mothers in residing in mid-range deprivation tracts. In non-linear models, we found an inverse association between NO2 and birth weight in the least-deprived and most-deprived areas (p-values<0.001 and 0.05, respectively) but no association in the mid-range of deprivation (p=0.8). Likewise, in linear models, a 10ppb increase in NO2 was associated with a decrease in birth weight among mothers in the least-deprived and most-deprived areas of -16.2g (95% CI: -21.9 to -10.5) and -11.0g (95% CI: -22.8 to 0.9), respectively, and a non-significant change in the mid-range areas [β=0.5g (95% CI: -7.7 to 8.7)]. Linear slopes in the most- and least-deprived quartiles differed from the mid-range (reference group) (p-values<0.001 and 0.09, respectively). The complex patterning in air pollution exposure and deprivation in NYC, however, precludes simple interpretation of interactive effects on birth weight, and highlights the importance of considering differential distributions of air pollution concentrations, and potential differences in susceptibility, across deprivation levels. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Aug 2015 · Environmental Research
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    • "Firstly race, as a social, but certainly not biological construct, existed in a very concrete way during the apartheid era in South Africa, and the individuals included in this study were separated and segregated in every aspect of life according to their government-designated racial category of either black or white. In addition race, as a sociocultural construct (and distinct from biological or genetic ancestry) has been shown to have a profound impact on health and health outcomes worldwide and is an important factor in the social determinants of health and environmental epidemiology (Dressler et al., 2005; Gee and Devon, 2004; Gravlee, 2009; Gravlee and Dressler, 2005; Gravlee et al., 2005; Hicken et al., 2012; Williams and Collins, 2001). As such, race is often used as a categorical variable in epidemiological studies as it is here, and the terms " black " and " white " are common categorical designations. "
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    ABSTRACT: Manganese is a potent environmental toxin, with significant effects on human health. Manganese exposure is of particular concern in South Africa where in the last decade, lead in gasoline has been replaced by methylcyclopentadienyl manganese tricarbonyl (MMT). We investigated recent historical levels of manganese exposure in urban Gauteng, South Africa prior to the introduction of MMT in order to generate heretofore non-existent longitudinal public health data on manganese exposure in urban South Africans. Cortical bone manganese concentration was measured by inductively coupled plasma mass spectrometer in 211 deceased adults with skeletal material from a fully identified archived tissue collection at the University of Pretoria, South Africa. All tissues came from individuals who lived and died in urban Gauteng (Transvaal), between 1958 and 1998. Median Mn concentration within the sampled tissues was 0.3 μg g−1, which is within reported range for bone manganese concentration in non-occupationally exposed populations and significantly below that reported in individuals environmentally exposed to MMT. No significant differences were seen in bone Mn between men and women or in individuals of different ethnicity, which further suggests environmental, as opposed to occupational exposure. There were no significant temporal or geographic differences in bone Mn. The results suggest that Mn exposure was low and uniformly distributed across the whole population prior to the introduction of MMT as a gasoline additive. In addition, should manganese exposure follow the same patterns as vehicle-emitted lead, a clear pattern of exposure will emerge with individuals in the urban core facing the greatest manganese exposure.
    Full-text · Article · Mar 2015 · International Journal of Paleopathology
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