Social Justice and Environmental Health

Each week the CDC publishes health statistics under the title “Morbidity and Mortality Weekly Report.” As you can imagine, it’s always a cheery read. Last week was especially interesting because it was the first annual “Health Disparities and Inequalities Report.”

I hope you’re not surprised to learn that poor people are more likely to have poor health than middle class people who in turn are more likely to have poor health than people who are well-off. One of the most striking features of the report is a chart that shows the relationship between what is called “healthy days” and an index of health risks in each state.

“Healthy days” is how many days out of the last 30 people report feeling in good health or better as opposed to feeling poorly or worse. So for each state, there is an average number of healthy days for the entire population that is a number between 0 and 1: the closer to 0, the worse people feel; the closer to 1, the better people feel.

The measure of health risk is based on the Gini index, used in economics to indicate how income is distributed in a population. Like healthy days, the Gini index ranges from 0 to 1. The closer to 0, the more equal income is distributed. The closer to 1, the more unequally income is distributed. The CDC adapted the Gini index to indicate not only income distribution but other measures of the social determinants of health.

The CDC put the measure of healthy days and its version of the Gini index together in a graph that shows how things stack up in each state. The picture is alarmingly clear: fewer healthy days are closely associated with inequality of health risks. And in case you’re wondering, the five best states (that is, high in healthy days, low in health risk inequality) are, in order, Utah, Connecticut, North Dakota, Hawaii, and Washington DC. The worst five states, in reverse order from worst to slightly less so, are West Virginia, Kentucky, Tennessee, Alabama, and Louisiana.

A huge gap in these statistics is being addressed over at the Environmental Protection Agency. Last week the EPA released a report about a symposium it held titled “Strengthening Environmental Justice Research and Decision Making: A Symposium on the Science of Disproportionate Environmental Health Impacts.” The news here was no better than that from the CDC. In fact, it was worse because it added the dimension of environmental exposure. That is, not only does social inequality increase the risk of illness and injury, environmental exposures also increase the risk of illness and injury independently of the effects of social inequality. Let me say that again: social inequality and environmental exposures affect health independently.

I hasten to add that social inequality and environmental exposures are closely related. But they aren’t the same.

Shouldn’t we be doing something about this?

The CDC is just reporting what’s going on. The EPA, according to its report, wants to “lay the groundwork for developing a systematic and scientifically defensible approach for incorporating environmental justice concerns into EPA’s decision-making process.” In other words, they aren’t doing anything either.

Meanwhile last week, researchers at UC San Francisco reported on a study of 167 industrial toxins found in the bodies of pregnant women. All of the women had detectable levels of most of these toxins—for example, the endocrine disruptor bisphenol A, widely used in plastics and food packaging, was present in all of the women.

Although this is alarming, that pregnant women are awash in toxins was only part of what’s in this particular study. The researchers used a comparison group of women who were not pregnant. For me, a striking result is that for many chemicals, women who were pregnant differed from women who were not pregnant in the amount of chemical in their bodies. In some cases, pregnant women had higher concentrations (for example, the amount of the gasoline additive MTBE was on average twice that of women who were not pregnant). In other cases, pregnant women had lower concentrations (for example, the amount of bisphenol A was on average half that of women who were not pregnant).

In other words, this seems to imply that for some toxins the pregnant women’s bodies were accumulating more than if they weren’t pregnant. Conversely, for some toxins their bodies were better at getting rid of it.

In the case where the body is accumulating a toxin, I have to wonder about the effect on the fetus. And in the case of accumulating less, I have to hope that the way a woman’s body is getting rid of it is through better detoxification rather than passing it to the body of the fetus.

The news item in the San Francisco Chronicle that reported on this research ends with some advice on what to do about all this bad news: eat a balanced diet, don’t microwave food in plastic (use glass or ceramic), keep your house clean, and shop for safe, non-toxic products.

Good grief! That’s appalling! How about getting out of town? How about forcing the captains of industry to stop poisoning us, pregnant or not? How about demanding a safe, effective, non-pharmaceutical way to get industrial chemicals out of our bodies?