Environmental Justice Through the Lens of Gulf Coast Transdisciplinary Research Maureen Lichtveld,...

Environmental Justice Through the Lens of Gulf Coast Transdisciplinary

Research

Maureen Lichtveld, MD, MPHProfessor and Chair

Director, Center for Gulf Coast Environmental Health Research, Leadership & Strategic Initiatives

PRESENTATION OBJECTIVES

• Describe the transdisciplinary characteristics of Environmental Justice

• Demonstrate the role of public health science and policy in addressing Environmental Justice

• Assess the implications of a holistic approach to environmental Justice for curriculum development and learning delivery

CORE ENVIRONMENTAL HEALTH TENET

The health of the environment is inextricably linked to the health of the

community

ENVIRONMENTAL HEALTH

Those aspects of human health, disease, and injury that are determined by these factors in the environment:• Physical• Chemical• Biological• Social• Psychosocial

www.who.int/phe/en

HEALTH AND THE BUILT ENVIRONMENT

CDC recognizes the following problems:1. Children’s Health2. Elderly Health3. Gentrification4. Home Environment5. Community Design6. Injury7. Physical Activity8. Mental Health9. Respiratory Health10.Water Quality

PRINCIPLE OF ENVIRONMENTAL JUSTICE

“The need for urban and rural ecological policies to clean up and rebuild our cities and rural areas in balance with nature, honoring the cultural integrity of all our communities, and provide fair access for all to the full range of resources.”

ETHICS OF ENVIRONMENTAL HEALTH POLICY

• Where does the burden lie?

• Where should the burden lie?

“WHERE DOES THE BURDEN LIE?”HEALTH DISPARITIES

• “A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” (Healthy People 2020)

• Directed at people who experience greater health obstacles based on their

• Race/ethnic group• Religion• SES• Gender• Age

• Mental Health• Disability• Gender Identity• Geographic Location

“WHERE DOES THE BURDEN LIE?” GEOGRAPHY

Woolf et al 2012; Robert Wood Johnson Foundation

“WHERE DOES THE BURDEN LIE?” SOCIAL DETERMINANTS OF HEALTH

DISPARITIES

• Differential Susceptibility (at-risk groups)• Differential Exposure• Differential Health Behavior• Differential Health Access

All interact to cause differences in health

A NEXUS OF DISPARITIES- CANCER ALLEY, LOUISIANA

• The area known as Cancer Alley is located within a 100 mile stretch between Baton Rouge and New Orleans

• The area is home to up to 300 industries

* Cancer Alley Slides adapted from Randall Garchar Urbs 515: Race, Poverty, and the Environment Professor Raquel Pinderhughes, Urban Studies & Environmental Studies Programs, San Francisco State University Spring2004

CANCER ALLEY LOUISIANA

CANCER ALLEY LOUISIANA

• Have a 55% higher percentage of people of color than the national average

• Have a 48% higher percentage of people of color below the poverty line

• Have a 9% lower household income than the national average

• Have a 24% lower per capita income than the national average

ETHICS OF ENVIRONMENTAL HEALTH POLICY

• Who bears the burden?

• Who SHOULD bear the burden of environmental exposures?

ENVIRONMENTAL JUSTICE

ENVIRONMENTAL JUSTICE

“The fair treatment and meaningful involvement of all people regardless of

race, color, national origin, or income with respect to the development,

implementation, and enforcement of environmental laws, regulations, and

policies.”(EPA, 2013)

ENVIRONMENTAL XXX:WHAT’S IN A NAME?

• E Justice• E racism• E equity• E equality

CASE STUDY:AGRICULTURE STREET LANDFILL

Demographics:• Location: located in New Orleans

• Population: 1990 Census identifies 390 residential units (some 1,000 people) on the site - community is predominantly (97% +) African-American, with middle-to-low income levels

• Setting: the 95 acre former city disposal area that has been partially redeveloped

• 47 acres of the site have private and public housing: the Press Park Community Center; a recreation center; retail businesses, and the Morton Elementary school

• The remainder of the site is undeveloped and covered by dense vegetation

CASE STUDY:AGRICULTURE STREET LANDFILL

• The city dump was opened from 1909 to the late 1960s

• The 190 acre dump received waste from households, construction debris, ash from municipal waste incinerators, and debris from the devastation of Hurricane Betsy in 1965

• No documents were kept as to what materials were dumped into the landfill but anything from household garbage to service station oil waste was dumped, and the landfill was often on fire and commonly referred to as Dante’s Inferno

• Covered by a light layer of sand

CASE STUDY:AGRICULTURE STREET LANDFILL

• In 1969, the city and federal government supported and financed the building of a low-income community on the landfill

• Part of the landfill was developed into three subdivisions, Press Park and Gordon Plaza, a housing complex for the elderly, and a small business complex

• Part of the landfill was left as undeveloped land

CASE STUDY:AGRICULTURE STREET LANDFILL

• 1912-1948: area was used as a dump by the city of New Orleans.

• 1948-1958: dump is converted and used as a sanitary landfill.

• 1958-1959: landfill closed• 1965: landfill is reopened to receive debris

created by Hurricane Betsy• 1976-1986: portion of the site was redeveloped to

support housing

CASE STUDY:AGRICULTURE STREET LANDFILL

• 1986: EPA completed a site investigation Under the old Hazardous Ranking System, which excluded ingestion, the site did not qualify for placement on the National Priorities List (NPL)

• 1993: community leaders requested EPA to re-evaluate the site; EPA collected samples

• 1994: EPA initiated an“accelerated remedial investigation” integrated with removal actions

• May 1994: fieldwork completed and fence built around the undeveloped area and removal of highly contaminated soils at children’s play area

CASE STUDY:AGRICULTURE STREET LANDFILL

• August 23, 1994: site was proposed to the NPL

• December 16,1994: site was formerly added to the NPL

• April 27, 2001: EPA completes cleanup project: 99% of the site has the first two feet of soil replaced

• The remaining 1% of the site belongs to 9 private homeowners in the community who elected not to participate in the removal action

CASE STUDY: CHEF MENTEUR LANDFILL

CASE STUDY: DEEPWATER HORIZON OIL SPILL

ENVIRONMENT AND COMMUNITY HEALTH:WHO MUST PLAY “NICELY” IN THE SANDBOX?

Clean Air, water

Safe seafood

Vulnerable Populations

Communitycapacity building

Industry

Economy

Environmental policies

policymakers

Public Health

Ecosystem

GULF COAST COMMUNITY HEALTH THREATS

Environmental Health

Health Disparities

Disaster Preparedness

Gulf Coast Community Health

TRANSDISCIPLINARY RESEARCH CONSORTIUM FOR GULF RESILIENCE ON WOMEN’S HEALTH

(GROWH)

Addresses three community-driven questions:• “Is the seafood safe?”• “Can I breathe the air?”• “Is my baby safe?”

www.growhgulfsouth.com

GROWH

Goal: to identify individual and community health effects potentially stemming from the Deepwater Horizon oil spill and enhances community resiliency to potential disasters through population-based and laboratory research, and community outreach.

• Research Projects 1, 2 & 3• Community Outreach and Dissemination Core• SAMHSA Supplement (2 projects)

GROWH AIMS

• Determine the effects of the DWH disaster, combined with the other adversities faced by the area, on mental health and reproductive outcomes among pregnant women and women of reproductive age living in affected parishes in Louisiana.

• Characterize exposures of pregnant women and women of reproductive age to selected contaminants through exposure routes of concern to communities - specifically seafood consumption and air.

• Examine the interactions of environmental and social disparities on the health of pregnant women and women of reproductive age.

• Utilize community-based participatory research and outreach strategies to strengthen community resilience in vulnerable Gulf Coast populations.

IS OUR SEAFOOD SAFE TO EAT?

BUILDING COMMUNITY RESILIENCE THROUGH DISASTER MOBILE HEALTH

• Community-based participatory research• Target population of pregnant women and women

of reproductive age living in SE Louisiana• Develop a community-driven disaster mobile health

platform• Train WIC-affiliated CHWs to serve as disaster

interventionists• Examine the effect of disaster mobile health

www.growhgulfsouth.com

STUDY POPULATIONINCLUSION CRITERIA

• 18-45 years old• Resident of six parish

region at the time of DHW spill

• Pregnant and in first trimester with first child

• Recruited at Women, Infant, and Children (WIC) clinics• Had to be eligible

for WIC assistance

Study Demographics (n=112)

  N(%)

Mean Age 25.32 (sd 4.65)

Race/Ethnicity White Black Latina Other

 27 (24.1)64 (57.1)17 (15.2)4 (3.6)

Income Under 10k 10-29k Over 30k

 59 (56.7)29 (27.9)16 (15.4)

Education High school dropout ≥ High school degree

 19 (17.0)93 (83.0)

BUILDING COMMUNITY RESILIENCE THROUGH DISASTER MOBILE HEALTH

PSYCHOSOCIAL HEALTHSAMSHA SUPPLEMENT

Define the biological and psychosocial pathways linking maternal prenatal and postnatal health

Aim: Extend an anthropological model of psychosocial stress and maternal and child wellness that focuses on the modifying effect of cultural context

Influencing Health Needs and Vulnerabilities

He

alth

Dis

pa

ritie

s

Impact on Health

Disparities

Improving the Living Environment: Surveillance of Health Determinants

Poverty

Education

Access to Healthcare

Perceived Discrimination

Environmental Pollution

Housing/Shelter Quality

Workplace Health Hazards

Insurance

Culture

Culturally Competent Providers

INFLUENCERS OF HEALTH DISPARITIES

A COGNITIVE THEORY OF CULTURE

•Culture is the information needed to act appropriately in a given context

•Information is learned and shared by social networks

•Range of factors can influence the information absorbed, and therefore, a person’s culture

(original photo credit Heide Benser/Corbis)

STUDY POPULATIONINCLUSION CRITERIA

• 18-45 years old• Resident of six parish

region at the time of DHW spill

• Pregnant and in first trimester with first child

• Recruited at Women, Infant, and Children (WIC) clinics• Had to be eligible

for WIC assistance

Study Demographics (n=112)  N(%)Mean Age 25.32 (sd

4.65)Race/Ethnicity White Black Latina Other

 27 (24.1)64 (57.1)17 (15.2)4 (3.6)

Income Under 10k 10-29k Over 30k

 59 (56.7)29 (27.9)16 (15.4)

Education High school dropout ≥ High school degree

 19 (17.0)93 (83.0)

Region Orleans WB Orleans EB Suburban WB Suburban EB SW Rural SE Rural

 9 (8.1)23 (20.7)35 (31.5)9 (8.1)16 (14.4)19 (17.1)

STUDY APPROACH

FREELISTING RESPONSES

Stratified sample were asked: • “What are the things in the

environment that threaten mothers and children in your community?”

• “What are ways that mothers prepare or respond to these things?”

• “Who do mothers typically turn to for each of these things?”

Threats in the environment

Frequency (%)

Violence 55

Hurricanes 55

Outdoor air 45

Drugs 40

Indoor air 35

Cigarette smoke 35

Reckless drivers 30

Floods 25

Money problems 25

Risk behavior Interval (1-6)

Collapsed answer

Buy extra food & water 5.77Extremely important

Keep extra power supplies 5.68Extremely important

Watch news during season 5.58Extremely important

Make a plan of what to do 5.53Extremely important

Evacuate before the storm 5.33 Very important

Shelter-in-place 4.99 Very important

Collect important documents during the season

4.95 Very important

Avoid thinking about the threat 4.48Moderately important

Follow what other family members do

4.11Moderately important

What is important to do during hurricane season?CULTURAL MODEL OF HURRICANE RISK BEHAVIOR

Extra

Wat

er

Power

Sup

plie

sPl

an

Wat

ch_N

ews

Evac

uate

Colle

ct_D

ocs

Shel

ter

Don’t_

Focu

s

Follo

w_F

amily

5.97 5.93 5.91 5.84 5.83 5.72

4.97 4.77

4.18

5.074.84

4.29

4.83

3.7

2.73

5.01

3.633.84

Comparison of two subcultures – Risk Behavior6 (Extremely important) – 1 (Not important)

Subculture 1 Subculture 2

Risk behaviorInterval

(1-6)Collapsed

answer

Family 5.53 Extremely likely

TV News 5.51 Extremely likely

Friends 4.77 Likely

Community Leaders 4.75 Likely

Police 4.72 Likely

Internet 4.54 Likely

Government Services 4.51 Likely

People at church 4.16 Somewhat likely

Doctor 2.35 Unlikely

Which are likely sources to turn to during the season/storm?CULTURAL MODEL OF HURRICANE RISK BEHAVIOR

Family TV_News Internet Friends Police Leaders Gov_Services Church Doctors

5.61 5.58

5.15

4.74 4.59 4.584.46

4.28

2.55

5.2 5.39

2.89

4.855.1 5.2

4.63

3.84

1.99

Comparison of two cultures – Sources of support6 (Extremely likely)- 1( Extremely unlikely)

Subculture 1 Subculture 2

GULF REGION HEALTH OUTREACH PROGRAM:When studies are not the right answer

A Healthier Resilient Community

Through Regional Partnerships

Com

mu

nity

Inp

ut

Com

mu

nit

y In

pu

t

Enhanced Frontline Heath

Services

Mental & Behavioral

Health

Primary Care

Environmental Health

EMERGING SCHOLARS PROGRAMS

EJ’S INTERCONNECTEDNESS:IMPLICATIONS FOR CURRICULUM DEVELOPMENT

Environmental

Justice

science

community

policy

ecosystem

EJ’S INTERCONNECTEDNESS:IMPLICATIONS FOR LEARNING DELIVERY

• Transdisciplinary must replace discipline-specific• Problem-based, case-driven• Field-based learning• Flipped lecture• Case study as group assignment• Verbal and written communication performance

assessment• Group learning: peer expert panel debates; peer

evaluations

A HEALTHY NATURAL AND BUILT ENVIRONMENT: NOLA

“We envision a green, healthy New Orleans, a city whose beauty is rooted in the harmony between the natural and the built environment. This means protecting our wetlands and water bodies, enhancing the quality of our air, and preserving the beauty of our community. Healthy, environmentally-conscious New Orleanians will be cooler, use less energy and breathe fresher air. Our City will have fewer drainage problems, less water pollution, and more recreational opportunities. None of this will be possible without active, informed citizens, who share in the responsibility for managing our environment.”