2015 National Environmental Justice Conference

2015 National Environmental Justice ConferenceHEALTH DISPARITIES:POVERTY, The Root of it All!

Congresswoman Donna M. Christensen Inequities in health and avoidable health inequalities arise because of the circumstances in which people grow, live, work and age, and the systems put in place to deal with them. The conditions in which people live and die are, in turn, shaped by political, social and economic forces.

WHO Commission on the Social Determinants of Health (2009) The Roots of Health DisparitiesRacism /discrimination

Lack of Access

POVERTY

Politics

RACISM: Discrimination in healthcare2001 M Report, Unequal Treatment

2012 Study reported in AJPH

2/3 of primary care doctors demonstrated bias towards their African American patients

African Americans still more likely to lack access to early, surgery and emergency room care

Steady rise in people in medium, high-poverty neighborhoods

Poverty and poor health worldwide are inextricably linked. The causes of poor health for millions globally are rooted in political, social and economic injustices. Poverty is both a cause and a consequence of poor health. Poverty increases the chances of poor health. Poor health in turn traps communities in poverty. Infectious and neglected tropical diseases kill and weaken millions of the poorest and most vulnerable people each year.

Health Poverty ActionPOVERTY IS A WEAPON OF MASS DESTRUCTION!Rev. Jesse Jackson, Sr.3/7/2015, NBC News

2000s: Population soars in extreme-poverty neighborhoods

Blacks, Hispanics, Amer. Indians over-concentrated in high-poverty tractsPoor blacks and Hispanics are more likely than poor whites to live in medium- and high-poverty tracts

Racial Residential Segregation Apartheid-era South Africa (1991) and the US (2010)Source: Frey 2011; Massey 2004; Iceland et al 2002

13Negative Effects of Segregation on Health and Human DevelopmentRacial segregation concentrates poverty and excludes and isolates communities of color from the mainstream resources needed for success. African Americans are more likely to reside in poorer neighborhoods regardless of income level.

Segregation also restricts socio-economic opportunity by channeling non-whites into neighborhoods with poorer public schools, fewer employment opportunities, and smaller returns on real estate. 14Negative Effects of Segregation on Health and Human Development (contd)African Americans are five times less likely than whites to live in census tracts with supermarkets, and are more likely to live in communities with a high percentage of fast-food outlets, liquor stores and convenience stores

Black and Latino neighborhoods also have fewer parks and green spaces than white neighborhoods, and fewer safe places to walk, jog, bike or play, including fewer gyms, recreational centers and swimming pools 15Negative Effects of Segregation on Health and Human Development (contd)Low-income communities and communities of color are more likely to be exposed to environmental hazards. For example, in 2004 56% of residents in neighborhoods with commercial hazardous waste facilities were people of color even though they comprised less than 30% of the U.S. population.

The Poverty Tax: Residents of poor communities pay more for the exact same consumer products than those in higher income neighborhoods more for auto loans, furniture, appliances, bank fees, and even groceries. 16Some of the high health costs in minority communities Native American/Alaskan Native and African Americans have lowest life expectanciesAfrican American infant mortality 2X, Native American 1.5X white counterpartsAsian Americans have prevalence of Hepatitis B 1.6 XAfrican Americans and Latinos have highest diabetes rates almost 2X that of WhitesAfrican Americans almost 50% new HIV cases, Hispanics 20%; African Americans 41% of those living with HIV/AIDS, Hispanics 20%African Americans highest death rates from heart disease, cancer and strokeCreate Healthier Communities: Improve food and nutritional options through incentives for Farmers Markers and grocery stores, and regulation of fast food and liquor stores

Structure land use and zoning policy to reduce the concentration of health risks

Institute Health Impact Assessments to determine the public health consequences of any new housing, transportation, labor, education policies

Strengthen education for disadvantaged communitiesDevelop programs to promote/support early childhood development

Expand preschool education access

Address academic barriers to higher education

Improved funding and teacher training in disadvantaged communitiesImprove the Physical Environment of Communities:Improve air quality (e.g., by relocating bus depots further from homes and schools)

Expand the availability of open space (e.g., encourage exercise- and pedestrian-friendly communities)

Address disproportionate environmental impacts (e.g., encourage Brownfields redevelopment)

20Expanding Housing Mobility Options:Moving To Opportunity (MTO)

U.S. Department of Housing and Urban Development (HUD) launched MTO demonstration in 1994 in five cities: Baltimore, Boston, Chicago, Los Angeles, and New York.

MTO targeted families living in some of the nations poorest, highest-crime communities and used housing subsidies to offer them a chance to move to lower-poverty neighborhoods.

Findings from the follow up Three-City Study of MTO, in 2004 and 2005, answer some questions but also highlight the complexity of the MTO experience and the limitations of a relocation-only strategy.

Away from concentrated poverty, it has been shown that families fare better in terms of physical and mental health, risky sexual behavior and delinquency?

Adolescent girls benefited from moving out of high poverty more than boys.

21Implementing the CBC 10/20/30 InitiativeI believe that of all of the resources coming out of these programs, at least 10% of it ought to be directed into these communities where 20% or more of the population has been stuck below the poverty level for the last 30 years.

there are currently 488 persistent poverty counties in America so defined because 20% of the population has lived below the poverty line for the past 30 years or more.

Assistant Democratic Leader James E Clyburn, author of the InitiativePOVERTY IS A WEAPON OF MASS DESTRUCTION!Rev. Jesse Jackson, Sr.3/7/2015, NBC NewsCLOSING THE GAPREPORT (2005)Inequities within the health care system and within larger social, environmental and economic structures persist not because of a dearth of solutions, but because of a failure of political will2424 General Colin Powell 3/8/2015 on This Week It is up to We the People to ensure that there is equal opportunity for all!THANK YOUDonna M. Christensen, M.D.Former Member of Congress, US Virgin Islands

A Study of Environmental Healthof the Industrial Area of St. CroixHOVENSA REFINERY

University of the Virgin IslandsEastern Caribbean Center

EPA Toxic Emissions Reports in the USVIONE OF THE HIGHEST TOXIC EMISSIONS INVENTORIES IN THENATION AND CARIBBEAN REGION UNTIL 2012

2010 760,000 pounds

2011 1.8million pounds All but 25,480 pounds from HOVENSA

2012 0.3milliion poundsAn 83% reduction

*NOTE: HOVENSA closed in January 2012

A Study of Environmental Healthof the Industrial Area of St. CroixThe disparity by race and ethnicity is evident in that proportionately more Blacks (74%) live closer to the industrial area than in the reference area (66%), and similarly, a smaller percentage of Whites (2%) live near to the target area than in the reference area (9%).

41% with less than high school diploma tend to live near the SSIZ, compared to 28% in the reference areaA Study of Environmental Healthof the Industrial Area of St. CroixResidents in the target area expressed the frequent presence of or reported higher frequencies of the occurrence of (1)strong and irritating odors, (2) mold, (3) transportation emissions and exhaust and (4) factory smoke.

The residents of the reference area do not consider themselves to be impacted to the same intensity as residents in the target zoneA Study of Environmental Healthof the Industrial Area of St. CroixAbout 1 in every 5 persons (21.3%) in the target area reported that had experienced asthmatic conditions within the last 5 years and this compares with 1 in 8 (12.5%) in the reference area.

There were more than twice as many residents near the industrial zone who indicate having chronic bronchitis 10.4% - compared to residents who live in the reference area 4.1%Next steps for the Industrial Area and its residentsCareful planning for re-use of the HOVENSA site in consultation and collaboration with the communities

Requests a complete Public Health Assessment from CDC

Target Health Department efforts to address the health findings in the reportSpecial thank you to the Department of Interior, Office of Insular Affairs and Asst. Secretary Anthony Babauta; UVI Eastern Caribbean Center Director Dr. Frank Mills and his collaborators and most of all to the people living in the targeted area for their perseverance, trust and cooperation.

It took 16 years to get here!

Donna M. Christensen, M.D.Former Member of Congress, US Virgin IslandsChart14547.552545254.556.558

100% FPL101%-200% FPL201%-400% 401% FPLLife ExpectancyHigher Income, Longer LifeNumber of Additional Years of Life Expected at Age 25 Years

Sheet1 100% FPL101%-200% FPL201%-400% 401% FPLMen4547.55254Women5254.556.558To resize chart data range, drag lower right corner of range.