Amid all of our tumultuous debates about health care, there has been a growing bipartisan consensus on the need to focus on population-level outcomes. A 2016 report commissioned by the Ohio Office of Health Transformation found, for example, that over the past few decades “Ohio’s performance on population health outcomes has steadily declined relative to other states,” and that the state “also has significant disparities for many health outcomes by race, income and geography” -- findings that led Ohio to undertake sweeping changes aimed at reversing these trends.
It’s hard to overstate the importance of geography in health outcomes. A Health Affairs article from two years ago, “Defeating the ZIP Code Health Paradigm,” found that in “today’s America, people live in two distinctly different worlds. The life expectancy for a child born in New Orleans can vary as much as 25 years between neighborhoods just a few miles apart.”
This research has focused almost entirely on individual behavior and access to care, not on the impact of the physical environment or especially on the role of air, water and ground pollution in these places. But there are signs that the focus is shifting. A recent report on the oil and gas industry by the NAACP and the Clean Air Task Force found that “African-Americans are exposed to 38 percent more polluted air than Caucasian Americans” and that blacks are 75 percent more likely to live in neighborhoods adjacent to industrial facilities. I don’t think it’s a coincidence that asthma rates for African-Americans are 32 percent higher than those for whites.
In this month’s article on the work of an activist who was the recipient of the Goldman Environmental Prize for his work in East Los Angeles, reporter Natalie Delgadillo writes that in the largely Latino area “the air is toxic to breathe.” That toxicity, as she reports, stems at least in part from industrial pollution that state regulators had failed to stop even though they had been aware of it for decades.
In my experience, the sorts of breakdowns in regulation Delgadillo describes are common. Back when I was a government auditor, I did more than a hundred examinations of government inspection programs. Most of those audits uncovered problems with the programs, nearly all of which favored the regulated industries. It’s imperative that we turn that situation around. Environmental justice needs to be a key component of any plan to improve population health outcomes.