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Minorities and the Poor Clearly Are More Exposed

Tha

he suggestion that social class or

race plays an important role in determining the degree to which people are exposed to environmental hazards, as well as in influencing the effects of those hazards on health and well being, is a disturbing, albeit all too plausible, hypothesis. It does not take much imagination to speculate that poor people, a disproportionate share of which are minorities, routinely encounter elevated levels of pollution in the air they breathe, the water they drink, and the food they eat.

Within the field of environmental health, there are two groups generally considered to be at higher risk: those who experience the highest exposures, and those who are more biologically susceptible to the effects of a given exposure. The subgroup at highest risk is made up of those individuals who are both biologically susceptible and who also come into contact with the highest pollutant concentrations.

Currently, very little data exist on differences between races according to biological susceptibility to environmental pollutants. There is certainly evidence of biological differences, but their relationship to susceptibility is not well understood.

Further, it is difficult to separate the effects of class (socioeconomic status) from the effects of race (ethnicity) on environmental health risk. Poor people, typically, are less well informed about environmental health issues, lack adequate health care, have a substandard diet, and are more likely to have stressful and unhealthful lifestyles. Minority populations may be at higher risk as a result of their genetic makeup, cultural beliefs and practices, and social behaviors. The

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(Dr. Sexton is Director of EPA's Office of Health Research.)

With the notable exception of link class and race directly to

situation is complicated by the fact
that minorities are statistically more
likely to be disadvantaged in terms of
their income, education, and
occupation than their white
counterparts. Consequently, although
there is substantial anecdotal and
circumstantial evidence suggesting that
class and race, taken together, affect
exposure levels, we do not now have
sufficient data to differentiate between
the two.

The calls for public action to mitigate environmental inequities present policy makers with a familiar dilemma. In the face of substantial scientific uncertainties, they must decide whether inequities exist, how serious they are, what are the causes, and what are the most cost-effective mitigation strategies.

As documented elsewhere in this issue of the Journal, there is clear evidence that certain groups—as, for example, subsistence fishermen, migrant farm workers, and residents of inner urban areas experience elevated exposures to hazardous environmental pollutants. It is unclear, however, whether these exposures account, in part, for the higher overall rates of death and disease observed among disadvantaged groups and ethnic minorities.

There are clear and dramatic differences between ethnic groups for both disease and death rates. Age-specific death rates, for example, are higher for African American males and females than for their white counterparts in all age groups from 0 to 84 years of age. Furthermore, overall death rates from cancer are greater in blacks than whites for both males and females. For other ethnic minorities, the overall cancer mortality is lower than for whites. There is, however, substantial variation in the mortality rates associated with different types of

Surprisingly, very little data are evidence is unequivocal: A higher available on disease and death rates

percentage of black children than categorized by important

white children have elevated blood socioeconomic variables. Closer

lead levels. All socioeconomic and examination reveals that the United ethnic groups have children with lead States is the only western country with in their blood high enough to cause a high standard of living whose

concern about adverse health government does not collect mortality consequences; however, a significantly statistics by class indicators, such as higher percentage of black children income, education, and occupation. compared to white children, regardless Recently, there has been an

of socioeconomic strata, have academic debate about whether the unacceptable levels of lead in their

blood.

In general, it is not possible based

on the existing scientific evidence to lead, there is a paucity of

differences in the rates of data relating class and race

environmentally induced disease or to specific environmental

injury. There is evidence, however, as pollutants and associated

mentioned earlier, to suggest that health effects.

exposures to some environmental pollutants vary according to

socioeconomic and ethnic variables. differences in cancer rates between These differences in exposures result blacks and whites can be explained by from the fact that disadvantaged the effects of poverty. Some scientists people, including ethnic minorities, believe that if the differences in

tend to come into contact with higher socioeconomic characteristics could be pollution levels because of where they eliminated, then blacks would actually live, what they eat and drink, and how have a lower overall cancer rate than they earn their living. The available whites. Others suggest that while

scientific basis for evaluating the poverty and lifestyle can explain part equity question, although meager, is of the difference, there is still a

sufficient to raise serious and significant amount of variation that immediate concerns for researchers, can only be explained by race.

risk assessors, and risk managers. The observed differences in the rates Owing to the complexity of of disease and death among ethnic environmentally induced disease, it is groups are undoubtedly caused by a often difficult or impossible to combination of factors, including

establish a direct causal link with economic, social, cultural, biological, pollutant exposures. Nevertheless, the and environmental variables. Although evidence suggesting that poor people some of the differences are dramatic, and ethnic minorities experience as with cancer rates, for example, the higher exposures to many contribution of environmental

environmental contaminants is
pollution is unclear.

compelling. O
With the notable exception of lead,
there is a paucity of data relating class
and race to specific environmental
pollutants and associated health
effects. In the case of lead, the

cancer.

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he Agency for Toxic Substances be tapped include city directories (the Colorado resulted in ATSDR's issuing

and Disease Registry (ATSDR) is a city directory often lists occupation a public health advisory. In addition, U.S. Public Health Service agency and is broken down alphabetically by ATSDR and the state of Colorado headquartered in Atlanta, Georgia. name and also by street address), plat collected samples of blood to detect ATSDR was created to implement the maps in rural areas (plat maps indicate lead levels in potentially exposed health-related measures mandated ownership of land), the county

susceptible populations (i.e., children, under the Comprehensive courthouse (mortgage and other

pregnant women). Environmental Response, housing information might help

ATSDR is currently conducting Compensation, and Liability Act of establish the variable length of

various pilot and epidemiological 1980 (the "Superfund" law). As part of residence), and planning commissions health studies for Native American its response to this charge, ATSDR (building permits).

communities. Mercury contamination established a minority health initiative

in fish is a primary concern in the to address the health impact of Health Perspectives

Everglades (Florida), in Fond-du-lac hazardous waste on minority Health status and access to adequate

(Minnesota), and with the Puyallup communities. The initiative focuses on

tribe (Washington). The prevalence of health care may contribute four areas: demographics, health

PCBs in the breast milk of Native significantly to the impact of perspectives, health communication,

American women of the St. Regis environmental contamination on and health education.

Mohawk tribe (of New York) was minority communities. Significant data

discussed during ATSDR's National gaps exist regarding the relationships Demographics between low-level exposures and

Minority Health Conference held in To determine the proximity of

December 1990. Consequently, a health effects. For example, lead is a hazardous waste sites to minority

study is being sponsored by the pervasive contaminant that has communities, ATSDR will utilize the

Agency. In addition, ATSDR has disproportionately affected minority Geographic Information System (GIS).

signed an interagency agreement with communities; however, additional

the Indian Health Service to address A pilot of five National Priorities List research is needed to determine its (NPL) sites has been tested using both bioavailability in various media (water, of Native Americans as they relate to

the public health needs and concerns manual and computerized soil, slag) and to further define effects

the release of hazardous substances methodologies for determining that may result from low-level

into the environment. population densities and

exposures (blood lead levels of less demographics. In addition, ATSDR is

Lifestyle and culture can play than 10 micrograms per deciliter currently using GIS to evaluate a

important roles. In conjunction with (ug/dl)). randomly selected set of 30 NPL sites. Through an extensive literature

the Connecticut Department of Health As a result of our pilot tests, we have search and the establishment of a

and the Hispanic Health Council, determined the GIS to be the best

ATSDR helped identify the prevalence strong environmental health data base,

of the use of elemental mercury methodology for identifying potentially we have confirmed the paucity of impacted minority populations. information specifically linking

(azogue) for ritualistic purposes In the future, ATSDR will focus on

(Santeria). Specific botanicas that sold pre-existing health factors and determining the relative proximity of increased risk to environmental

azogue were identified in the Hartford

area, and it was found that the most minority communities to all sites on contamination. ATSDR is therefore the NPL. Data for each site can then be sponsoring a substance-specific

prevalent users were within the integrated into a larger database and research program through the

Hispanic community. The Connecticut analyzed using descriptive and Association for Minority Health

Department of Health is determining inferential statistical techniques. An Professions Schools (AMHPS). important data source for that ATSDR's public health studies have

(Dr. Harris is Chief of the Community integration is the 1990 Census of identified specific sites adversely

Health Branch and Williams is Population and Housing, which

impacting minority communities. The includes 100 percent population and impact of lead in soil (as high as

Director of the Division of Health

Assessment and Consultation at the housing counts and characteristics.

20,000 parts per million (ppm)) on a Other possible sources of data that will predominantly Hispanic community in

Agency for Toxic Substances and
Disease Registry in Atlanta, Georgia.)

how best to convey information regarding the potential health hazards associated with the use of the material.

Health Education and Communication

The toxic effects of environmental contamination and environmental health issues must be communicated to minority communities. Such communication can be aided by

training minority health care providers establishing a doctoral program in in how to address environmental

environmental toxicology at Florida health concerns.

A&M University in which ATSDR staff ATSDR is attempting to meet those serve as advisory board members. In training needs and has developed and many rural communities, pharmacists implemented several health education are the first line of health care, so activities. For instance, ATSDR is

ATSDR has identified minority
working closely with AMHPS schools pharmacists as local health
to identify and conduct pertinent

professionals responsible for environmental substance-specific identifying populations at risk and research. ATSDR has also assisted in communicating that risk to their

communities. The National Medical Association (NMA) is one of the oldest minority health care professional organizations. ATSDR has become an active participant in NMA activities by conducting environmental health workshops at regional NMA meetings and presenting at national NMA meetings.

ATSDR also realizes that communities want to be informed and involved and has established Community Assistance Panels (CAPs) in several communities. The purpose is to provide a forum for exchanging information between ATSDR and the affected community during the preparation of a public health assessment or conduct a health study. For example, a CAP has been established to address concerns regarding environmental contamination in the Southeast Chicago area. The CAP members have been active in assisting ATSDR determine community concerns, identify contamination sources, and disseminate information about ATSDR's programs and activities. For that site, CAP meetings will be held quarterly throughout the public health assessment process. O

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Fishing opposite a dump in south Chicago. Inner-city residents may find environmental risks at every turn--including, here, a possible dietary risk from contaminated fish.

Copyright Sam Kittner.

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