Why are people in some places in the U.S. consistently less healthy than those in others? If you look to health and fitness magazines, it may seem as if poor diet, lack of exercise and other bad behaviors are to blame. Genetics and access to health care are also commonly cited reasons for why some people are healthier than others.
But where a person lives, works and plays also matters. As a public health researcher interested in how society affects our health, my research shows where you live plays a powerful role on your health.
Public health experts often talk about the “ social determinants of health”: community traits such as housing quality, access to nutritious and fresh food, water and air quality, education quality and employment opportunities. These factors are thought to be among the most powerful influences on a person’s health.
Alabama, Arkansas, Louisiana, Mississippi and West Virginia also share a similar economic environment. Data from the Economic Innovation Group (EIG), a bipartisan public policy organization in D.C., shows that these states are the top five most economically distressed states in the U.S.
In fact, Alabama and Mississippi have the highest shares of people living in distressed ZIP codes.
The U.S. has experienced economic prosperity since the end of the Great Recession. But not all states have shared equally in this economic growth. In North Dakota, for example, employment rates increased almost 20 percent between 2010 and 2013. During the same time period, residents in Alabama have seen only about 4 percent growth in employment.
Local communities in every state across the U.S. face similar poor economic realities: 52.3 million Americans live in economically distressed ZIP codes. This means that about 17 percent of the U.S. population lives in places with limited opportunities for education, good housing and employment. These factors are essential for good health.
Place and health
Analysts at the Economic Innovation Group found that people in prosperous counties live, on average, five years longer than those living in distressed counties. In distressed counties, deaths from mental and substance abuse are 64 percent higher compared to prosperous counties.
My own analysis of EIG data and the 2017 County Health Rankings follow this pattern. The more economically distressed a county is, the worse their health outcomes are. This is true across measures of clinical care, quality of life, mortality, chronic conditions, health behaviors and health environments.
I am currently researching a range of health outcomes across the U.S. My unpublished results show that infants are about 20 percent more likely to die before their first birthday in distressed counties. Adults in distressed counties are 18 percent more likely to report poor or fair health than those in prosperous counties.
Those in distressed counties are also more likely to live in places with fewer resources for good health. For example, distressed counties are 26 percent more likely to have limited access to healthy foods and have about 24 percent fewer opportunities for exercise. They also have about 20 percent fewer primary care providers than prosperous counties.
Investing in solutions
Shared economic prosperity is good for our health and good for the economy.
Improving population health requires more than changing health behaviors or increasing health care access. Similarly, if we want to increase shared economic prosperity among those who need it most, we need to focus on more than employment rates and average incomes.
As public health researcher David Williams and Robert Wood Johnson Foundation Executive Vice President James Marks wrote, “reaching America’s full health potential will require that targeted initiatives have a dual focus” on health and community economic development. This means that the health and economic sectors must collaborate, which is often made difficult by separate funding streams and political battles.
Despite challenges, there are successful examples of communities working together to improve health and foster economic opportunity. In Sacramento, California, the Building Healthy Communities program worked with community members to develop bike paths and expand community gardens. This effort was a part of an initiative to transform formerly contaminated land into healthy, livable and usable property.
More investments in the social determinants of health will help close the health gaps we see across the U.S.
This article was originally published by The Conversation. It has been edited for YES! Magazine.
Air pollution: black, Hispanic and poor students most at risk from toxins – study
By Oliver Milman in New Jersey
Schoolchildren across the US are plagued by air pollution that’s linked to multiple brain-related problems, with black, Hispanic and low-income students most likely to be exposed to a fug of harmful toxins at school, scientists and educators have warned.
The warnings come after widespread exposure to toxins was found in new research using EPA and census data to map out the air pollution exposure for nearly 90,000 public schools across the US.
“This could well be impacting an entire generation of our society,” said Dr Sara Grineski, an academic who has authored the first national study, published in the journal Environmental Research, on air pollution and schools.
Grineski and her University of Utah colleague Timothy Collins grouped schools according to their level of exposure to more than a dozen neurotoxins, including lead, mercury and cyanide compounds.
The research found that:
- Only 728 schools achieved the safest possible score.
- Five of the 10 worst polluted school counties have non-white populations of over 20%
- The five worst polluted areas include New York, Chicago and Pittsburgh, as well as Jersey City and Camden in New Jersey. One teacher in Camden told the Guardian that heavy industry was “destroying our children”.
Cash-strapped authorities have routinely placed schools on the cheapest available land, which is often beside busy roads, factories or on previously contaminated sites. Teacher unions worry that the Trump administration’s enthusiasm for charter schools, championed by education secretary Betsy DeVos, will diminish federal intervention to reverse this.
The study found that pre-kindergarten children are attending higher risk schools than older students – a stark finding given the vulnerability of developing brains.
Pollution exposure is also drawn along racial lines. While black children make up 16% of all US public school students, more than a quarter of them attend the schools worst affected by air pollution. By contrast, white children comprise 52% of the public school system but only 28% of those attend the highest risk schools. This disparity remains even when the urban-rural divide is accounted for.
Schools with large numbers of students of colour are routinely located near major roads and other sources of pollution, with many also grappling with other hazards such as lead-laced drinking water and toxins buried beneath school buildings
Grineski said there were a range of consequences. “We’re only now realizing how toxins don’t just affect the lungs but influence things like emotional development, autism, ADHD and mental health,” she said. “Socially marginalized populations are getting the worst exposure. When you look at the pattern, it’s so pervasive that you have to call it an injustice and racism.”
The research is “important and is consistent with other localized information we’ve seen over the years,” according to Stephen Lester, science director of the Center for Health, Environment and Justice, who wasn’t involved in the study.
“Children are facing risks that will affect their ability to learn,” he said. “It’s a serious problem that needs a serious government response.”
When you look at the pattern, it’s so pervasive that you have to call it an injustice and racism
As scientists have pieced together evidence showing the link between air toxins and neurological harm, American cities are still largely wedded to a legacy that has juxtaposed certain neighborhoods with heavy traffic and hulking industry.
Only a handful of states require that schools are not placed next to environmental hazards. In 2010, the EPA issued national guidelines on picking school locations but backed away from imposing mandatory buffer zones.
The guidelines were deemed voluntary “after a whole lot of pushback from various financial and political interests,” according to Lester, who was part of a group advising the EPA.
High risk: New Jersey and New York
Grineski’s study suggests the problem is particularly acute in New York and New Jersey, where a third of schools across the two states are in the highest risk category for air pollutants.
Camden, which hugs a curve of the Delaware River in New Jersey, was once home to one of the world’s largest shipyards and a vast Campbell’s Soup factory. Camden’s industrial base has diminished, but persistent air pollution continues to gnaw away at a city that has been blighted by poverty and struggling schools.
Of the 140 worst schools identified for air pollution in Grineski’s study, 11 are in a wedge of south Camden, near the industrialized waterfront. Neighbors include a cement plant, a metal scrapyard and a sewage treatment plant. It is estimated around 330,000 trucks pass through south Camden each year.
Camden is heavily African American, Hispanic and young – around a third of the 75,000 population is under 18. A further third of the population lives in poverty. The schools, around half built before the Great Depression, endure creaking buildings, lagging test scores and absenteeism.
“The city and state are bringing industry to Camden and it is destroying our children,” said Doris Carpenter, a music teacher who helped start a charter school just 300 yards from the I-676 highway.
Carpenter recalls visiting the nurse’s room at DUE Charter School and seeing lines of children in respirator masks. She said the majority of the 600 students, some as young as six years old, had asthma. DUE was closed, ostensibly because of poor test results, in 2014 as part of a dizzying reorganization that has introduced 11 new and rebadged “Renaissance” schools.
“Lots of days were lost because of asthma,” Carpenter said. “We also had a lot of ADHD and learning disabilities which I think was exacerbated by the air. The children weren’t able to concentrate like other kids can.
“It’s all over the city. In summer, you walk outside and it can smell like a cesspool. How can you learn in that environment?”
Scientific endeavour is uncovering a jumble of neurological reactions to air pollution, from early onset Alzheimers to schizophrenia. Much of this work is in its infancy, but scientists say there is well established evidence that children are far more susceptible to pollutants than adults, with potentially severe consequences for their development.
Camden has the second highest asthma rate in the state and is heavily affected by certain cancers, such as of the lungsand kidneys. Teachers in Camden are also starting to ponder whether student performance could, at least in part, be pinned on the local environment.
Five schools in Camden are located on plots of land considered actively contaminated by the New Jersey department of environmental protection.
A sixth, the Early Childhood Education Center, was built on a former chemical dumping site that had dangerously high levels of arsenic in the soil. In 2006, the school was demolished and then rebuilt, after a layer of soil was excised, in the same spot.
Camden’s school district also spends around $75,000 a year on bottled water because the drinking supply has been tainted with lead. Fountains in schools have been shut off and only hand washing is permitted at sinks, although cooking with the tap water is allowed. The problem is, incredibly, entering its 16th year, with no long-term remedy in sight.
Across the school district, only 12% of high schoolers in Camden meet expectations in English language tests, with even fewer making the grade in mathematics. At Camden High School, a gothic landmark known as “the castle on the hill” that is being demolished and will be replaced by a public school, 43% of 12th graders were “chronically absent” in 2016-17. Just 6% of their counterparts at Cherry Hill High, in a wealthier, whiter area just 10 miles to the east, werefrequently missing from lessons.
“Before, we might have labelled a kid with bad behaviour as just being a bad kid,” said Keith Benson, who taught history in the Camden school system before becoming the head of the local teacher’s union.
“Now we are thinking about it another way. There’s no telling how much potential has been lost because of environmental issues, how many hopes were stunted because these kids were not close to clear air and water.”
Camden’s school district admitted that it had been “beleaguered with steep challenges decades in the making”, including a grade-fixing scandal, prior to a state intervention in 2013. Since then, the district said, the graduation rate has jumped, school suspensions have dropped and millions of dollars have been spent on improving aging buildings, some of which in the county have been affected by mold.
But there’s only so much the district can do about air pollution beyond the school gates. “As an urban district, we recognize the realities of our environment and do what is within our capacity to ensure the health and wellbeing of our students and our community,” said a district spokeswoman.
According to the New Jersey DEP, Camden’s air quality now meets national standards in four out of five key pollutants, with only ozone, which can create smog, exceeding the EPA threshold. Fumes that waft across the river from Philadelphia are a major culprit, the DEP said.
“Overall, the state’s biggest challenge is with ozone, due in large part to all of the traffic in the region, but also a result of less stringent emissions controls on power plants and industrial sources in Pennsylvania and other upwind states,” said a DEP spokesman.
For many Camden residents, hardened by negative portrayals of their city, air pollution is simply another challenge. “The mold, the air quality, all of that is a concern to me,” said Rosa Trent, a longterm Camden resident who has three school age children – two have asthma and one has slight autism. “The pollution here will always stay with them. I grew up here and it’s a fraction of who I am as a person. It’s because we are people of color. I own my own business, I have a bachelors. But to people I’m Hispanic and I’m from Camden. That’s the bracket I’m in and it’s hard to break out from that.”
- This article was amended on 1 February 2018 to clarify that the site of Camden High School will become a public school, the schools closed due to mold were located in the county of Camden, not the city, and that Renaissance schools are not run by corporations.