Under-mining health: Environmental justice and mining in India

Despite the potential for economic growth, extractive mineral industries can impose negative health externalities in mining communities. We estimate the size of these externalities by combining household interviews with mine location and estimating statistical functions of respiratory illness and malaria among villagers living along a gradient of proximity to iron-ore mines in rural India. Two-stage regression modeling with cluster corrections suggests that villagers living closer to mines had higher respiratory illness and malaria-related workday loss, but the evidence for mine workers is mixed. These findings contribute to the thin empirical literature on environmental justice and public health in developing countries.     

Environmental justice, cumulative environmental risk, and health among low- and middle-income children in upstate New York

OBJECTIVES: We documented inequitable, cumulative environmental risk exposure and health between predominantly White low-income and middle-income children residing in rural areas in upstate New York. METHODS: Cross-sectional data for 216 third- through fifth-grade children included overnight urinary neuroendocrine levels, noise levels, residential crowding (people/room), and housing quality. RESULTS: After control for income, maternal education, family structure, age, and gender, cumulative environmental risk exposure (0-3) (risk >1 SD above the mean for each singular risk factor [0, 1]) was substantially greater for low-income children. Cumulative environmental risk was positively correlated with elevated overnight epinephrine, norepinephrine, and cortisol in the low-income sample but not in the middle-income sample. CONCLUSIONS: Cumulative environmental risk exposure among low-income families may contribute to bad health, beginning in early childhood.     

Environmental justice: building a unified vision of health and the environment

The assorted and multidimensional concerns that give rise to the issue of environmental justice have proved to be intellectually daunting and highly resistant to positive change. Low-income, people of color, and tribal communities confronting environmental stressors are beset by stressors in both the physical and social environments. For this reason, while the bifurcation of the public health and environmental fields taking place over the past several decades has yielded generally negative impacts in areas of public health, environment, and planning, the consequences for low-income and disadvantaged communities have been especially grievous. This commentary builds on the recent Institute of Medicine workshop titled "Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century." The workshop organizers posited that only by thinking about environmental health on multiple levels will it be possible to merge various strategies to protect both the environment and health. In this commentary we examine how such a new vision of uniting public health and the environment can contribute to attaining environmental justice for all populations.     

Unemployment and health: contextual-level influences on the production of health in populations

While there is a large and growing literature investigating the relationship between an individual's employment status and health, considerably less is known about the effect on this relationship of the context in which unemployment occurs. The aim of this paper is test for the presence and nature of contextual effects in the ways unemployment and health are related, based on a simple underlying model of stress, social support and health using a large population health survey. An individual's health can be influenced directly by own exposure to unemployment and by exposure to unemployment in the individual's context, and indirectly by the effects these exposures have on the relationship between other health determinants and health. Based on this conceptualization an empirical model, using multi-level analysis, is formulated that identifies a five-stage process for exploring these complex pathways through which unemployment affects health. Results showed that the association of individual unemployment with perceived health is statistically significant. Nevertheless, this study did not provide evidence to support the hypothesis that the association of unemployment with health status depends upon whether the experience of unemployment is shared with people living in the same environment. Above all, this study demonstrates both the subtlety and complexity of individual- and contextual-level influences on the health of individuals. Our results caution against simplistic interpretations of the unemployment-health relationship and reinforce the importance of using multi-level statistical methods for investigation of it.     

Knowing the risk: relationships between risk behaviour and health knowledge

Communicating risk is a key public health strategy. The implicit assumptions are that the public interprets risk information in a logical fashion and adopts behavioural changes to reduce risk. We assessed risk behaviour, and knowledge and perception of voluntary and involuntary risks using an anonymous questionnaire completed by 472 students. Risk-taking behaviour was measured as the number of different risk behaviours undertaken in the previous 12 months. Knowledge and perception were measured by the extent to which subjects agreed with statements of risk-related information. These varied in complexity from simple statements linking a behaviour with a health risk to numerical statements describing the strength of such relationships. Risk-taking behaviour was highest amongst younger people, males, people whose parents were in non-manual occupations, and people who believed in God (risk-taking behaviour was not related to voting preference or birth order). Overall, knowledge was not significantly related to risk-taking behaviour (P=0.889). However, risk-taking was positively related to more accurate responses to numerical risk questions (P<0.001) and risk-takers were also more likely to perceive both voluntary and involuntary risks as less risky (P<0.05). At least in this cohort, more information about risk is not related to lower risk behaviour. In fact, those individuals with a better understanding of the precise risk associated with certain behaviours were more likely to be higher risk-takers while those who consistently over-estimated risks were low risk-takers. Overall, knowledge and perception of risk explained relatively little of the variance in behaviour. Although these findings need further examination within the general population, public health measures should not assume that information campaigns will necessarily lead to a reduction in risk behaviour.     

Environmental justice at school: understanding research, policy, and practice to improve our children's health

BACKGROUND: No overarching federal agencies or policies are responsible for ensuring environmental health at schools in the United States, potentially allowing many inequities for low‐income and minority communities to persist. This article examines emergent research, policy, and practice‐based efforts that may be used to identify and address environmental justice at school. METHODS: A brief literature review was conducted to understand (1) major mental, behavioral, and physical outcomes associated with environmental risk for school‐aged children and (2) current research methods for assessing these relationships. Documents prepared by government agencies, school districts, and advocacy groups were also collected and synthesized to improve understanding of the state of planning and policies for maintaining or improving school environments. RESULTS: Environmental risk can manifest in diverse ways such as mold, poor air quality, poor community design, or contaminated playgrounds. Deeply rooted in national and state structures of school funding and planning, such risks can lead to outcomes including respiratory illness, poor performance in school, and reduced levels of physical activity. With growing attention to these concerns, methods for measuring environmental risks and underlying disparities have advanced tremendously in the last few decades, yet development of innovative research approaches may be necessary to further advance and evaluate appropriate interventions. CONCLUSIONS: Environmental injustice is generally unacknowledged during decision‐making in US school districts. Continued dialogue reflective of translatable science is necessary to support school districts with limited funding in ensuring safe, healthy environments for learning.     

Environmental justice and health: a study of multiple environmental deprivation and geographical inequalities in health in New Zealand

There is an increasing interest in the unequal socio-spatial distribution of environmental ‘goods’ and ‘bads’ and the associated implications for geographical inequalities in health. Until recently, research in this area has focused on solitary environmental characteristics and has been hindered by the absence of geographically-specific measures that recognise the multifactorial nature of the physical environment. However, recent work in the United Kingdom has developed an area-level multivariate index of health-related physical environmental deprivation that captures both pathogenic and salutogenic environmental characteristics. Applications of this index have demonstrated that, at the national level, multiple environmental deprivation increased as the degree of income deprivation rose. Further, after adjusting for key confounders, there was a significant association between multiple environmental deprivation and the health outcomes of local residents. In the current study we tested the methods developed in the UK to create the New Zealand Multiple Environmental Deprivation Index (NZ-MEDIx) for small areas across the country (n = 1860). We considered whether socially disadvantaged places in New Zealand had higher levels of multiple environmental deprivation, and if environmental disadvantage exerted an influence on health after adjustment for key confounders such as socioeconomic status. We found that although neighbourhoods with higher levels of multiple environmental deprivation tended to have greater social disadvantage, this association was not linear. Further, multiple environmental deprivation tended to exert a modest effect on health that was independent of the age, sex and socioeconomic structure of the population. These findings demonstrate that it is possible to develop an index of multiple environmental deprivation in an alternative national context which has utility in epidemiological investigations.     

The structure of Canadians' health risk perceptions: Environmental,therapeutic and social health risks

Numerous studies have examined health risk perception through public ratings of health hazards, comparing them across lists, across time or across subpopulations. Yet, few have unveiled people's mental organization and representation of the factors affecting health risk. In order to better understand how the construct of health risk is conceptualized by the public, a principal components analysis was conducted on data from a previous national survey in which Canadians rated a series of hazards with respect to perceived level of health risk. Canadians conveyed their concerns as falling into three broad components: Environmental (e.g., nuclear waste, PCBs or Dioxins, etc.), Therapeutic (e.g., contact lenses, medical X-rays, etc.), and Social health risks (e.g., motor vehicle accidents, street crime, etc.). Generally, hazards perceived as posing the most health risk were those belonging to Social health risks. Perceptions of Environmental, Therapeutic and Social health risks were higher among women, respondents with lower education or income, and among residents of Québec. Results are discussed in relation to the population health approach (Evans et al. 1994 Evans, R. G., Barer, M. L. and Marmor, T. R. 1994. Why are Some People Healthy and Others Not?, New York: Aldine de Gruyter.  [Google Scholar]), in which the physical environment, biology, lifestyle, social environment and health care represent major determinants of the health of populations and population subgroups.     

Habitus, stress, and the body: the everyday production of health and cardiovascular risk

The incidence of coronary heart disease (CHD) and the distribution of contributory risk factors are closely linked with social patterns of advantage and disadvantage. The authors conducted eight focus groups in urban, northern, and rural sites in Ontario, Canada. Participants were all at high absolute risk for or had been diagnosed with CHD. Analysis centered on habitus, which forms the pivotal link between the person and "place." The authors focused on participants' dialogue about stress because it dealt with the impingements of the social world and resultant constraints on health-related activities in everyday places. Participants described four types of places or social positions in their "stress talk": work-places, transitional spaces, gendered situations, and exclusions. Places can support or constrain health related activities in many ways. Habits and practices linked with stress by participants were enduringly associated with these contexts, suggesting that place, body, and health are inseparable and coconstituted.     

Environmental justice, regulation, and the local community.

This article examines the sociological significance of the concept of "environmental justice" for grassroots groups responding to toxic contamination in their local communities. Taking into account nationwide mobilization patterns in such communities, the author documents a precedent-setting episode in the city of Jacksonville, Arkansas, where citizen protests and support from national environmental groups led the Environmental Protection Agency to withdraw three Technical Assistance Grants inappropriately awarded to a group with links to a polluting industry, and subsequently to rewrite the rules for participation in such grants. As the first such challenge nationally, the Jacksonville scenario is an important "test case" and permits a theoretical and practical evaluation of the relationship between social groups, technology, and the governmental regulatory process. More particularly, it gives insight into the Technical Assistance Grants program, which was set up to enable citizens living close to contaminated sites to interpret and evaluate technical information relating to such sites, but which has been undercut by a weak EPA and cooptation efforts by industries. The article concludes with an exploration of the concept of community in relation to the new construction of environmental justice engaged in by grassroots groups fighting contamination locally and nationally.     

Levinas,justice and health care

In this paper I argue that the metaphysical ethics of Emmanuel Levinas captures some essential moral intuitions that are central to health care. However, there is an ongoing discussion about the relevance of ethical metaphysics for normative ethics and in particular on the question of the relationship between justice and individualized care. In this paper I take part in this debate and I argue that Levinas' idea of an ethics of the Other that guides politics and justice can shed important light on issues that are central to priorities in health care. In fact, the ethics of Levinas in seeking the foundation of normativity itself, captures the ethical coreand central values of health care.This revised version was published online in October 2005 with corrections to the Cover Date.     

Autonomy, paternalism, and justice: ethical priorities in public health

With attention to the field of public health ethics growing, significant time has been devoted to identifying a sound ethical justification for paternalistic interventions that override individual autonomy to prevent people from adopting unhealthy behaviors. Efforts focused on specifying the conditions that warrant paternalism, however, are largely misplaced. On empirical and ethical grounds, public health should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Although public health's most highly visible stance is associated with an egalitarian conception of "social justice," it is imperative that public health professionals address gaping divisions in public understandings of justice. I present recommendations for initiating this process.     

Poverty,policy, and pathogenesis: Economic justice and public health in the US

This paper addresses public health and access to care for the urban poor in the context of US urban, economic, and industrial policy. The pathogenic deterioration of 'inner city' neighbourhoods is a direct result of political and economic strategies to facilitate capital accumulation and consolidation, manifested in geographic patterns of uneven development that mirror the relationship between First and Third World countries. The deleterious public health effects of these trends include reduced access to care; medical indigence in the wake of deindustrialization and the restructuring of the blue-collar workforce; and the spread of social epidemics such as AIDS, violence, and substance abuse. Contemporary health policy and 'reform' debates, however, have virtually ignored the pathogenic role played by economic and social inequality in the etiology and dispersion patterns of disease. To confront the health crisis that currently threatens poor and minority communities in the US, economic justice must be explicitly acknowledged as a public health issue, alongside more traditional concerns such as access to care, immunization, vector control, and behaviour modification. It will be necessary to challenge political and economic policies that shore up corporate power at the expense of community development; spur capital accumulation at the expense of social programs and economic opportunity for the poor and politically disenfranchised; and actively facilitate the continued exploitation of, and withdrawal of resources from, the nation's most vulnerable citizens and their communities.