Environmentally Mediated Health Disparities.

We describe important settings where environmental exposure leads to disease disparities. Lead exposure in urban settings disproportionately impacts the urban Black poor. Native Americans have been forcibly relocated to areas of the West that have arsenic-contaminated groundwater or exposure to radionuclides near mines and nuclear development. Latino farm workers are disproportionately exposed to pesticides and herbicides. These chemicals are associated with cancer, neuropsychiatric disorders, renal failure, and respiratory disorders. The rural poor, both white and of color, are disproportionately impacted by hydraulic fracturing, exposing residents to volatile organic compounds such as toluene and benzene and heavy metals such as lead and arsenic. The urban and rural poor are both exposed to air pollution that significantly impact health. Short- and long-term ambient air pollution exposure has been associated with all-cause cardiovascular disease, stroke, blood pressure, and ischemic heart disease. Cancer due to air pollution has disproportionately impacted poor communities like "Cancer Alley" where numerous industrial sources are geographically clustered. Understanding local environmental hazards and available resources to address them can enhance the quality of medical care.

Lead Pollution, Demographics, and Environmental Health Risks: The Case of Philadelphia, USA.

Lead (Pb) soil contamination in urban environments represents a considerable health risk for exposed populations, which often include environmental justice communities. In Philadelphia, Pennsylvania (PA), Pb pollution is a major concern primarily due to extensive historical Pb-smelting/processing activity and legacy use of Pb-based paints and leaded gasoline. The U.S. Environmental Protection Agency (USEPA) organized and/or compiled community-driven soil sampling campaigns to investigate Pb content in surface soils across Philadelphia. Using these data (n = 1277), combined with our own dataset (n = 1388), we explored the spatial distribution of Pb content in soils across the city using ArcGIS. While assessing Zone Improvement Plan (ZIP)-code level data, we found strong correlations between factors, such as the percentage of children with elevated blood lead levels (% EBLL) and % minority population as well as between % EBLL and % children in poverty. We developed a "Lead Index" that took demographics, median measured Pb-in-soil content, and % EBLLs into account to identify ZIP codes in need of further assessment. Our results will be used to help lower the Pb-exposure risk for vulnerable children living in disproportionately burdened communities.

Environmentally Overburdened Gulf State Residents Lack Access to Environmental Specialty Care.

Residents in Louisiana, Mississippi, and Alabama have experienced repeated natural and man-made environmental exposures. As frequency and intensity of exposures increase, the need for environmental specialty care rises in environmentally overburdened communities. We evaluated access to environmental health expertise in these states. We determined if providers accepted private health insurance and/or self-pay mapping their location using ArcGIS. Of sixty-four physicians meeting inclusion criteria, only eleven (17%) accepted private health insurance and thirty-four (53%) accepted self-pay. The ratio of physicians with environmental expertise who accept private health insurance and/or self-pay, to the population is < 1:1,000,000. Occupational clinics employ specialty physicians to provide care to industry employees but generally not patients with non-work-related exposure. We discuss the implications of limited access to environmental specialty care. To improve the availability of specialty expertise in this region, we recommend increased funding for training physicians in environmental exposure assessment in underserved communities, especially environmental justice communities.