Environmental Determinants of Health

When I was studying environmental economics in graduate school, a prominent scholar in the field made the argument that environmentalism was a middle class issue. The implication was that all the fuss about saving the whales and whatnot was nothing more than a consumer preference that people with enough money could afford to have and as a consequence should not be taken seriously in the same way as poverty. I was quite offended. He was obviously wrong. But what struck me was the obvious conclusion, based on this conventional economic analysis, that everyone should have an income that enables them to afford and consume environmental protection.

That memory came up as I read an article in Forbes, the magazine that celebrates wealth and the people who have it. The title of the article was “Two New Reasons to Worry about Air Pollution: Obesity and Diabetes.” Because my dissertation and subsequent book was about the political economy of air pollution, I’m always drawn to the issue—especially since the science and the regulation churn out a continuous stream of bad news.

When I was studying it 30 years ago, the major health effects were respiratory. As time passed, cardiovascular and metabolic diseases were added. That’s the point of the Forbes article: while the political elite falls over itself to clear the way for business to make money and allegedly create jobs, they seem to forget that using the air as a dump has costs of its own—although what it actually does is help maintain the medical system as a growth industry by creating an ever-growing number of patients suffering from chronic illness.

One of the resources for the Forbes article is a report out of Canada titled “Early Exposures to Hazardous Chemicals/Pollution and Associations with Chronic Disease.” As the title suggests, we’ve got serious health assaults from an ever-widening range of substances. And, also as the title suggests, the assaults begin in the womb.

What doesn’t show up in the title is the perspective taken to this problem The report acknowledges the limits to approaching health promotion as managing individual risk factors: stop smoking, get some exercise, eat healthy food. The report instead turns to the social determinants of health: those social conditions such as socioeconomic inequity that cause illness. Beyond that, the report examines the environmental determinants of health: the health assault that is the result of the complex brew of pollutants to which each of us is exposed.

The significance is that the science has advanced to the view that effective health promotion comes about through social and environmental change, not through changing bad habits. For example, a recent article is titled “Place, Not Race: Disparities Dissipate in Southwest Baltimore When Blacks and Whites Live Under Similar Conditions.” What these researchers examined was a low-income, integrated community “exposed to the same set of socioeconomic, social and environmental conditions.” What these researchers conclude is that “[a] more effective policy approach would be to address the differing resources of neighborhoods and improve the underlying conditions of health.”

As I mentioned, the Forbes article opens by describing the attacks on environmental regulation in the name of economic necessity, as though environmental health is a luxury item (as the scholar who so irked me in graduate school believed), nice to have but not so nice as to sacrifice the business of business. Environmentalists have long seen that dichotomy as absurd. Nevertheless, it persists—for fairly obvious reasons.

Last week, the Republican controlled legislature of North Carolina went about the business of dismantling the state’s Air Toxics Program. And to show bipartisanship, don’t forget that Barack Change-You-Can-Believe-In Obama reversed a decision by his EPA Administrator to tighten air pollution standards. How many heart patients, diabetics, and asthmatics can we expect from that?

Another early environmental lesson I learned in graduate school is that the so-called environmental movement began as the politics of place. People living their lives in a place they liked saw distant forces despoil that place and resisted. The logic might be to grow the economy and create jobs, a logic enforced in Washington, DC or some state capitol, but somebody’s kid living in a specific neighborhood is going to get sick. Even if his or her parents object, how do they stop it?

The answer is obvious: they have to work to stop it. Often, it’s to no avail. Then what?

This is an issue of control: how much control do you need over your social and physical environment, over the place you live?

In the middle of smog-drenched Los Angeles, there’s a place where people get around on bicycles, where they take traffic-calming tea in the middle of intersections to remind car-drivers who’s in charge, where they work together in the common permaculture green space. It’s an intentional community called Los Angeles Eco-Village located in Central LA. Compared to the rest of Los Angeles, it’s disproportionately low-income and African-American.

Although what Los Angeles Eco-Village is doing is a way to reduce exposure to air pollution, it’s mostly a way to take control of the place you live.