OHSU third-year medical students Olivia Glatt and Mehtab Sal document the disproportionate impact of pollution on communities of color as a call to action for change.

This was a year of overwhelming extremes: global pandemic, a national reckoning on racism, devastating wildfires and political disarray. To some it was perhaps just a difficult year. But to those who can identify the common thread of injustice, it is clear that 2020 was the product of decades of systemic and societal inequities. It is also clear that if these inequities are not addressed, what we experienced in 2020 is just a preview of what is to come.

Among issues at the intersection of all these tragedies is environmental racism.

According to Benjamin Chavis, a prominent environmental activist, environmental racism is “racial discrimination in environmental policy making, the enforcement of regulations and laws, the deliberate targeting of communities of color for toxic waste facilities, the official sanctioning of the life-threatening presence of poisons and pollutants in our communities, and the history of excluding people of color from leadership of the ecology movements.”¹

These environmental toxins continue to be located in close proximity to communities of color without their input because they are not at the decision-making tables. It is our hope that incremental inclusion of minority communities such as President-Elect Joe Biden’s appointment (pending Senate confirmation) of U.S. Rep. Deb Haaland, D-New Mexico, as secretary of the Department of the Interior will begin to change this.

A member of the Laguna Pueblo Tribe who would be the first American Indian cabinet member, Rep. Haaland is vice chair of the House Committee on Natural Resources.² Her understanding of environmental racism is first hand; her ability to forge a better path – in partnership with President Biden and other federal and state agencies – is immense.

It is important, then, to understand the damage that has been done in order to frame the action that must follow.

Sacrifice zones

An integral concept in environmental racism is “sacrifice zones.”³ Historically, as industrial factories move into a neighborhood, white residents escape to the suburbs, leaving behind people of color without the political and financial power to flee the resulting contamination. More and more industrial plants move in as property values drop. Those left to endure toxic chemicals in the air, water and soil describe feeling “sacrificed” for the sake of industry and capitalism.

There are myriad examples of environmental racism.

• In Newark, New Jersey, glue, plastic and leather factories as well as sewage processing and fat rendering facilities surround areas such as the South Ward and Ironbound.³ Community members describe the persistent stench as “carcass-y” and experience an increasingly dangerous air quality rating and high rates of asthma and lung cancer. South Ward is 3 percent white while the state of New Jersey is 59 percent white.³
• In Louisiana, an industrial area that includes chemical plants near predominantly Black neighborhoods is now called “Cancer Alley” for its increased rates of disease.⁴
• Famously, officials in Flint, Michigan ignored lead-laced drinking water for months in 2014 while it sickened the town’s primarily Black residents.⁵
• Water pollution was also the concern for the Standing Rock Sioux Reservation when the Dakota Access Pipeline was proposed, in view of the recent Kalamazoo River oil spill nearby; the pipeline would cross the Missouri River, the reservation’s only water supply.⁶

Closer to home, in an industrial neighborhood of west Eugene, Oregon, the predominantly Latino and low-income residents are exposed to 99% of all of Eugene’s air toxins, with local groups reporting double the rate of childhood asthma.^7,8

Recently, the federal Environmental Protection Agency found that Eugene’s Lane Regional Air Protection Agency discriminated against these residents, primarily through inadequate air monitoring and lack of engagement with the community, such as not providing a way to make complaints in languages other than English.⁷

The ever-worsening climate crisis only exacerbates these harms.

"You can’t have climate change without sacrifice zones, and you can’t have sacrifice zones without disposable people, and you can't have disposable people without racism,”⁹ says Hop Hopkins, vice president of strategic partnerships for the Sierra Club.

Climate change-associated air pollution and heat exposure increase poor pregnancy outcomes like preterm birth and stillbirth, affecting Black mothers, who already face high morbidity and mortality in the U.S., the most.¹⁰ Such vulnerable populations as incarcerated or houseless people are often without air conditioning or heating. They are more affected by air pollution, as evident during the Oregon wildfires this year.^11,12 Natural disasters that are increasing with climate change also tend to affect "disposable people” the most.

Role of health care

Health care providers are intertwined with both environmental racism and climate change. We care for the “disposable people.” Unfortunately, healthcare also contributes to both crises.

Medicine has a deeply racist history, including involvement with eugenics, abuse of vulnerable populations through acts of injustice and indecency like the Tuskegee syphilis trials, and as a contributor to structural racism.¹³ A local example is  the Legacy Emanuel campus that occupies what was the heart of North Portland’s African American community before nearly 300 homes and businesses were razed, causing dislocation and associated harms.¹⁴ The plan was approved without informing residents, who subsequently received only one hearing to no avail.

Environmental racism also makes people sick. The most current of myriad examples: a Harvard study linked a single microgram/cubic meter increase in pollution to an 8% increase in mortality from COVID-19.¹⁶ Researchers say this undoubtedly helps explain the disproportionate affect COVID-19 is having on Black and Hispanic Americans.

As for climate change, health care is responsible for a staggering 10% of carbon emissions in the U.S.¹⁷ This is unsurprising when you consider hospitals produce 29 pounds of waste per bed a day and that the anesthetic gases we use daily are themselves greenhouse gases.¹⁸ Environmental racism and climate change demand a response on par with our organization against COVID-19.

How can we be part of the solution?

• Call for more sustainability within health care. Examples include the recent push to switch anesthesia from desflurane to the more environmentally friendly but otherwise similar sevoflurane, using regional instead of general anesthesia altogether, and the emerging trend of safely reusing N95s and even gowns.^{19, 20, 21}
• Pursue research and education. Academic programs at OHSU are increasingly incorporating climate change lectures into curricula, and in winter term are offering a new climate change and human health elective.
• Advocate. Oregon Physicians for Social Responsibility recently joined many local groups and the Columbia River Tribes in fighting a proposed water bottling plant. They succeeded in preserving water resources and avoiding additional pollution.²²

At OHSU, follow the work of the Environmental Sustainability Steering Committee, or the newly formed OHSU Students for a Sustainable Future (SSF). Get involved in the local and national groups listed below. And on a personal level, listen to your patients. Learn how their environment affects them. Advocate for their home equipment needs. Amplify their stories. Testify to lawmakers. No action is too small.

To learn and do more:

• EPA Mapping Tool: https://www.epa.gov/ejscreen
• Practice Green Health: https://www.practicegreenhealth.org
• Medical Society Consortium on Climate & Health: https://medsocietiesforclimatehealth.org/
• Alliance of Nurses for Healthy Environments: https://envirn.org/
• Nurses Climate Challenge: https://nursesclimatechallenge.org/
• American College of Physicians: https://www.acponline.org/advocacy/advocacy-in-action/climate-change-toolkit
• Oregon Physicians for Social Responsibility: https://www.oregonpsr.org/
• Oregon Health Authority: https://www.oregon.gov/oha/ph/HealthyEnvironments/climatechange/Pages/index.aspx
• Oregon Public Health Association: https://www.oregonpublichealth.org/

Citations:

1. Environmental Justice. Paul Mohai, David Pellow, J. Timmons Roberts. Annual Review of Environment and Resources 2009 34:1, 405-430. https://www.annualreviews.org/doi/10.1146/annurev-environ-082508-094348
2. Biden Nominates Deb Haaland for Secretary of the Interior, Jeff Turrentine. The Natural Resources Defense Council. Dec 22 2020. Biden Nominates Deb Haaland for Secretary of the Interior | NRDC
3. What Racism Smells Like. Sharon Lerner. The Intercept. Aug 8 2020. https://theintercept.com/2020/08/08/coronavirus-pollution-environmental-justice-racism/
4. Welcome to “Cancer Alley,” Where Toxic Air Is About to Get Worse. Tristan Baurick. ProPublica. Oct 30 2019. https://www.propublica.org/article/welcome-to-cancer-alley-where-toxic-air-is-about-to-get-worse
5. Lead-Laced Water In Flint: A Step-By-Step Look At The Makings Of A Crisis. Merrit Kennedy. NPR. Apr 20 2016. https://www.npr.org/sections/thetwo-way/2016/04/20/465545378/lead-laced-water-in-flint-a-step-by-step-look-at-the-makings-of-a-crisis
6. Oil Pipeline. Rachel Linneman. Native American Water Justice. http://native-american-water-justice.leadr.msu.edu/native-americans-and-environmental-justice/   (can find additional resources for this too)
7. EPA Supports Neighborhood Facing Toxic Air. Jessica Douglas. Eugene Weekly. Oct 10 2019. https://eugeneweekly.com/2019/10/10/epa-supports-neighborhood-facing-toxic-air/
8. EJ Project History. Beyond Toxics. https://www.beyondtoxics.org/work/environmental-justice-2/ej-project-history/
9. Racism is Killing the Planet. Hop Hopkins. Sierra. Jun 8 2020. https://www.sierraclub.org/sierra/racism-killing-planet
10. Bekkar B, Pacheco S, Basu R, DeNicola N. Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review. JAMA Netw Open. 2020;3(6):e208243.  doi:10.1001/jamanetworkopen.2020.8243. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260
11. We Don’t Have To Halt Climate Action To Fight Racism. Mary Annaïse Heglar. Huffington Post. Jun 16 2020. https://www.huffpost.com/?icid=hjx004
12. Portland homeless struggle with wildfire smoke, fear coronavirus. Brian Wood. Katu News. Sept 15 2020. https://katu.com/news/homeless-crisis-the-best-we-can-do/portland-homeless-struggle-with-wildfire-smoke-fear-coronavirus
13. A brief history of racism in healthcare. Harry Kretchmer. World Economic Forum. Jul 23 2020. https://www.weforum.org/agenda/2020/07/medical-racism-history-covid-19/
14. Fifty years later, Legacy Emanuel Medical Center attempts to make amends for razing neighborhood. Casey Parks. The Oregonian. Sept 22 2012. https://www.oregonlive.com/portland/2012/09/post_273.html
15. The link between climate change, health and poverty. Cheryl Holder. TEDMED. https://www.tedmed.com/talks/show?id=772448
16. Wu, X., Nethery, R. C., Sabath, M. B., Braun, D. and Dominici, F., 2020. Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. Science advances, 6(45), p.eabd4049.
17. Eckelman, M. J., & Sherman, J. (2016). Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PloS one, 11(6), e0157014. https://doi.org/10.1371/journal.pone.0157014
18. Yasny JS, White J. Environmental implications of anesthetic gases. Anesth Prog. 2012;59(4):154-158. doi:10.2344/0003-3006-59.4.154. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900601/
19. Effects Of Surgery On A Warming Planet: Can Anesthesia Go Green? Kristian Foden-Vincil. NPR. May 6 2019. https://www.npr.org/sections/health-shots/2019/05/06/716415598/effects-of-surgery-on-a-warming-planet-can-anesthesia-go-green
20. Doctors' Choice of Anesthesia Could Help Curb Climate Change. Health Day. June 17 2020. https://consumer.healthday.com/health-technology-information-18/anesthesia-news-721/doctors-choice-of-anesthesia-could-help-curb-climate-change-758623.html
21. Coronavirus Prompts Hospitals to Find Ways to Reuse Masks Amid Shortages. Saabira Chaudhuri. Wall Street Journal. March 31 2020. https://www.wsj.com/articles/coronavirus-prompts-hospitals-to-find-ways-to-reuse-masks-amid-shortages-11585647000
22. The People Said No: How we stopped Nestlé’s Water Grab in Oregon. Maura Fahey. Crag Law Center. Dec 13 2017. https://crag.org/people-said-no-campaign-nestles-water-grab-oregon/