Introduction
Environmental Justice is based on the principle that all people have the right to be protected from environmental pollution, and to live in and enjoy a clean, healthy environment. The Massachusetts Executive Office of Energy and Environmental Affairs (EOEEA) established a statewide Environmental Justice Policy in 2002 to help address the disproportionate environmental burdens experienced by lower-income people and individuals of color.
Various forms of discrimination and racism have created long-standing health inequities for people of color and lower-income individuals. These populations have historically been excluded from meaningful participation in decisions that impact their communities’ environmental health. People of color and people with limited incomes are more likely to live near toxic waste sites, in areas with high air pollution, and in low-quality housing because of the inequitable distribution of high pollution sites. Structural inequities result in fewer healthcare providers in the community, limited access to transportation options, and limited access to health information due to the production of inaccessible health communications or access for non-English speakers.
EJ criteria
In Massachusetts, EJ Populations are defined as neighborhoods (U.S. Census block groups) that meet one or more of the following criteria:
- Income (I): annual median household income is at or below 65% of the statewide median income; or
Community of color (C)*: 40% or more of the residents reported to the U.S. Census Bureau their race as Black, American Indian/Alaska Native, Asian, or Native Hawaiian/Other Pacific Islander, some other race, and/or were two or more races, and/or that their ethnicity was Hispanic or Latino; or
25% or more of the residents reported their race as described above, and their municipality’s annual median household income does not exceed 150% of the statewide median household income; or
- English isolation (E): 25% or more of the residents are not fluent in the English language.
EJ neighborhoods where more than one criteria are met may be the most at risk of exposure to environmental and health hazards.
* While statutes and other policy documents refer to populations in Environmental Justice neighborhoods that meet this criterion as “Minority,” this term marginalizes people of color and is often inaccurate. A neighborhood where this criterion is met is instead referred to as a “Community of Color” throughout this tool.
Vulnerable health EJ criteria
The Vulnerable Health EJ Criteria are four environmentally related health indicators to identify populations with evidence of higher-than-average rates of environmentally related health outcomes. The DPH’s Bureau of Environmental Health worked with EOEEA to identify these vulnerable health indicators in the EOEEA EJ Policy. There were four primary considerations in the selection of these health outcomes:
- availability of reliable and adequate data for selected health outcomes,
- well-documented scientific evidence of associations between the health outcomes and environmental exposures,
- evidence that selected health outcomes are associated with broad, long-term impacts on one’s health and well-being, and
- that the selected health outcomes, taken together, can represent health across all ages within a community.
These indicators represent sentinel health outcomes that provide an efficient means for understanding a community’s general health vulnerability to environmental exposures. However, as noted in the EOEEA EJ Policy, they are by no means the only relevant indicators of a population’s vulnerability to environmental exposures.
Heart attack
5-year average age-adjusted rates of hospitalizations for myocardial infarction (heart attack) that is equal to or greater than 110% of the state rate.
Heart attack hospitalization is a criterion used to identify vulnerable health EJ populations because exposure to air pollution can increase the risk for heart attack and other forms of heart disease, and it is indicative of a serious chronic illness that can lead to disability, decreased quality of life, and premature death. People living in EJ areas have higher than average heart attack hospitalization rates when compared to other communities.
Structural drivers, such as long-term historical injustices, have placed low-income communities and communities of color near toxic waste sites, areas with high air pollution, and other adverse environmental exposures. Short and long-term exposure to air pollution, such as ozone or particulate matter, can increase the risk of heart attack and other forms of heart disease. As a result, people living in EJ areas with higher than average heart attack hospitalization rates may be more vulnerable to adverse environmental exposures. These same communities often experience limited access to quality preventive health care due to the same structural drivers, compounding risk, and further increasing inequities.
Community-based health interventions can help reduce high rates of heart attack hospitalizations in communities that experience exposure to multiple environmental and social stressors. This may include outreach programs that improve awareness of heart disease and risk factors associated with heart disease (e.g., high blood pressure, high cholesterol), preventative care screenings, and increased access to affordable care that meets social, cultural, and linguistic needs. Additionally, addressing the existing air pollution burden in these communities can help reduce disproportionate rates of heart disease.
Childhood blood lead
5-year average prevalence of elevated (≥5ug/dL estimated confirmed ) childhood blood lead levels (ages 9-47 months) that is equal to or greater than 110% of the state prevalence.
Childhood lead exposure is a criterion used to identify vulnerable health EJ populations because lead exposure disproportionately impacts lower income communities and communities of color, and childhood exposure to relatively low levels can cause severe and irreversible health effects, including damage to a child’s mental and physical development. Lead paint is the primary cause of childhood lead exposure. Historical housing policies that have perpetuated segregation and limited opportunity for home ownership, such as redlining, have led to the increase in risk factors for lead poisoning in black communities, including older housing stock, dilapidated housing, and fewer owner-occupied housing units. Children living in low-income communities are more than 3.4 times more likely to have elevated blood lead levels than children living in high-income communities. Multi-race children are 3 times more likely to have lead poisoning than white children. Black children are 1.7 times more likely to have elevated blood lead levels than White children.
Preventing childhood lead exposure starts by building awareness and empowering communities at highest risk with the tools and resources for identifying and remediating sources of lead exposure. The most common sources of exposure are lead-contaminated house dust or soil and loose or deteriorating lead paint, frequently found on windows and home exteriors. Unsafe renovation work is an example of a common exposure pathway that can be easily prevented. Interventions should be tailored to better reach individuals in EJ communities.
Low birth weight
5-year average low birth weight rate among full-term births that is equal to or greater than 110% of the state rate.
Low Birth Weight (LBW) is a criterion used to identify vulnerable health EJ populations because exposure to environmental contaminants can increase the risk of delivering a LBW baby and LBW is a significant predictor of maternal and infant health. Women of color and women of low income have a higher risk of delivering a LBW baby. LBW can increase the risk of infant mortality and morbidity, health problems throughout childhood, developing cognitive disorders, developmental delay, and chronic diseases as an adult such as cardiovascular diseases and type 2 diabetes.
Though smoking during pregnancy is the most significant contributor to LBW, smoking rates in Massachusetts are actually lower among Black, Asian, and Hispanic mothers compared to non-Hispanic White mothers. Therefore, smoking is not likely to be the driver of this disparity. Exposure to indoor and outdoor environmental contaminants, on the other hand, which tend to be higher in low-income communities and communities of color, may be an important factor contributing to the increased risk of delivering a LBW baby among these populations. Additionally, maternal experience of racial discrimination is associated with LBW, as it influences important drivers of reproductive health such as stress levels, access to prenatal care, employment opportunities, and other neighborhood characteristics.
Preventing LBW can improve health throughout a lifetime and strengthen overall community well-being. Prevention starts by tailoring interventions to better reach women in EJ communities. The elimination of health inequities in adverse reproductive outcomes will involve improving access to prenatal care and dismantling structural and institutional racism and other forms of classism which has perpetuated social and environmental injustices.
Childhood asthma
5-year average rate of emergency department visits for childhood (5-14 years) asthma that is equal to or greater than 110% of the state rate.
Childhood asthma is a criterion used to identify vulnerable health EJ populations because people of color and low-income individuals are at greater risk for asthma exacerbations due to increased exposure to asthma triggers, and uncontrolled asthma can impact an individual’s overall health and wellbeing. For example, uncontrolled asthma can reduce activity levels, negatively impact cardiovascular fitness, and increase school absenteeism.
Structural racism puts people of color and communities of color at risk of developing asthma and makes controlling asthma harder. Asthma has been directly linked to air pollution, exposure to other environmental contaminants, and poor housing conditions. Due to structural drivers of housing inequities, communities of color and low-income families are more likely to live in areas where there is greater exposure to asthma triggers, leading to increased asthma exacerbations. These environmental and health-access injustices are likely factors that contribute to EJ communities being disproportionately impacted by childhood asthma. Rates of emergency department (ED) visits and hospitalizations for asthma are higher among Black, non-Hispanic children when compared to White, non-Hispanic children. Further, hospitalization rates are highest among children of color in low-income communities.
Access to high-quality care and scheduled checkups are important to control and avoid asthma triggers, manage symptoms, and ensure effective use of medicine. Preventing and controlling asthma would improve the overall health of a child, reduce rates of absenteeism, and increase a child’s activity level, while concurrently reducing the cost of care and health spending.