City Planning and Public Health
Lynn Zhang
Service Opportunities in Leadership
8 December 2004
Social Issue Portfolio
Contents:
Research Question
Focusing Statement
Annotated Bibliography
Extended Annotated Bibliography
Book Review
Practitioner Interview
Policy Memo
Summary Analysis
Research Question
My primary research question is that of
how city planning and especially zoning laws disproportionately
affect public health in areas with higher percentages of low-income
populations. The tension between human living environments and public
health first became a prominent social issue during the Industrial
Revolution. During that time, unplanned, heavily polluted and unsanitary
cities lead to widespread incidences of infectious diseases. This
triggered large-scale city planning efforts to increase sanitation
and curb the rampant spread of disease.
At the beginning of the 20th century,
efforts at city planning gave rise to the first zoning laws, culminating
in the case of Village of Euclid, Ohio vs. Ambler Realty Co,
which concluded that zoning laws were constitutional because they
were in the interest of the public good. Of course, who defined
‘public good’ was still a matter to be answered and
zoning efforts gradually diverged from its public health roots.
Modern zoning and city planning efforts are primarily influenced
by real estate concerns and city aesthetics.
This shift away from city-wide health
concerns, however, has led to the abuse of zoning laws and other
city ordinances for often blatantly discriminatory objectives such
as keeping minorities out of wealthy white districts. Such zoning
regulations have included everything from specifying house sizes
and building materials to stipulating minimum dollar values. In
the case of Southern Burlington County NAACP vs. Township of
Mount Laurel, NJ, however, zoning regulations designed to make
it virtually impossible for low or moderate income families to move
into certain areas of town were deemed unconstitutional. Even so,
there still exists a significant degree of de facto discrimination
as both a legacy of the past and a reflection of the political weakness
of certain groups to influence or enforce zoning decisions, making
them convenient dumping grounds for a city’s undesirable industries.
As much as city planning has moved
away from public health, health officials, too, have moved away
from any city planning concerns. Whereas environmental factors clearly
dominated the violent and concentrated outbreaks of disease in cities
during the Industrial Revolution, genetics and individual lifestyles
have replaced the living environment in the eyes of health officials
as the primary determinants of health. This has led to a fundamental
separation between public health and civic planning.
The enduring connection between the
environment and public health cannot be denied, however, as numerous
case studies point out. There is Triana, AL, the “unhealthiest
town in America” due to cancers and other disorders caused
by DDT from a chemical plant nearby and there is “cancer alley,”
a series of towns affected by petrochemical plants, just to name
a few examples. Factors that contribute to making an environment
unhealthy are profuse. These factors can be divided into two major
divisions: those of proximity, such as landfills, waste incinerators,
chemical treatment plants, and heavily congested traffic, and those
of activity, such as the levels of allowable emissions and the levels
of allowable asbestos, lead and mercury to be used in production.
These factors are further compounded by the lack of concrete data
on what constitutes a ‘safe’ level, what the synergistic
effects of several of these factors are and what their relation
to other social factors in human development are. There is a significant
lack of comprehensive research in this area (most information available
is in the form of case studies) partly due to the difficulty of
conducting such studies and partly due simply to the lack of public
interest.
The discrepancy between city planning
concerns and public health efforts has led to the disproportionate
creation of harmful environments in areas of underprivileged populations.
The inequity in zoning and the application of environmental regulations
don’t necessarily stem from conscious racism, although that
is certainly still a concern; more commonly, it is simply more politically
expedient to zone certain industries in voiceless areas. The Bathgate
Industrial Park, for example, was zoned in the South Bronx where
the residents, though against the project, couldn’t gather
the political force necessary to counter it. Recent renovation and
public works projects in NYC, on the other hand, have occurred in
areas where influential land-owning constituents stood to benefit
heavily. Numerous studies have corroborated a systemic problem as
exemplified by the situation in NYC, with low-populations bearing
the brunt of the harmful industries a city produces.
In recent years, concerns with these
issues have coalesced into the environmental justice (EJ) movement.
This movement seeks to link the issues of public health, municipal
planning and environmentalism. Two major shifts in approaches to
the problem of inequitable zoning laws have accompanied this movement.
The question of which came first: harmful industries or the low-come
populations has fallen beside the point. Whatever the reason, the
fact remains that low-income populations suffer many detrimental
health effects from the harmful environments they live in. That
point the EJ activists are concerned about, then, is what do we
do about it? The second major shift is the move away from the “not
in my backyard” idea towards a “not in anyone’s
backyard” idea. The focus in this respect is on reducing industrial
emissions and polluting industries overall.
In this research project, I seek to
probe the possibilities of the two questions of how we should deal
with what we have now and what policies should be implemented in
the future in the area of environmental justice. The question of
how zoning has disproportionately affected the health of low-income
populations is intimately related to this and ultimately the necessary
solutions to this problem stem from an understanding of the social
structures that enable injustices.
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Focusing Statement
Noxubee County, Mississippi, population
12,600, is a poverty stricken area with little industrial development
that relies primarily on agriculture and is struggling with unemployment.
It has a literacy rate of 45% and 41.1% of the population lives
below the poverty line. The per capita income of the white population
is more than three times that of the African-American population,
which comprises 68.6% of the total population. Only fifteen miles
away is the nation’s largest hazardous waste facility. The
area has come to be known as “the pay toilet of the country.”
It was in Noxubee County that Federated Technologies, Inc. (FTI)
proposed in 1990 to build their new hazardous waste disposal facility,
striking a deal with both the county and Indiana University (IU),
which owned the land FTI wanted to purchase. A three-year, charged
battle ensued with FTI and many county officials on one side and
community and IU student activists on another. The crux of the controversy
was whether or not the inherent health risks of the proposed plant
could be justified by the benefits it would provide the community.
The arguments on both sides are both
familiar and fundamental to community development. FTI made the
argument that their plant would provide many jobs to the struggling
community and, indeed, they received the tacit support of a majority
of the County’s residents. The activists argued that such
a large waste disposal plant would seriously aggravate the already
risky health environment of Noxubee County. Moreover, they asserted
that only a small portion of the plant jobs, and the most menial
ones at that, would go the County’s population. The plant
would have to bring in outside educated technicians to fill all
of the meaningful plant positions.
The tensions brought up by in this
case study have been in the public consciousness, sometimes more
prominently than others, for over two hundred years. Now, instead
of regulating the placement of tanneries and slaughterhouses, we
deal in terms of chemical plants and waste-treatment facilities
like FTI. Are there certain aspects of civilization that are detrimental
to health? To what degree are those aspects necessary evils? How
does a compromise between industry and health transfer to public
policy?
Indeed, truly comprehensive city planning
rose to prominence with the explosion of health problems caused
by the Industrial Revolution. The health effects of unregulated
development could clearly be seen. Diseases could easily reach epidemic
proportions and, with no designated method of sanitation, sewage
and garbage littered the streets and the stench of cities could
often be recognized far before one actually entered them. As such
examples of the indiscriminately harmful effects of unplanned cities
faded, however, city and public health officials split. City planners
began to focus on real estate values and public health officials
put the spotlight on genetics and lifestyle as causes of disease.
However, the connection between municipal planning and health disparities,
if more tenuous than before, cannot be ignored.
Communities with polluting chemical
plants tend to have significantly higher rates of cancer and other
disorders. Places with a high concentration of incinerators and
polluting industries tend to have abnormally high rates of asthma
and respiratory problems. Moreover, the influence of city planning
on public health, especially in inner city urban environments, extends
much further than the placements of harmful industries. The lack
of safe urban play areas and supermarkets and the preponderance
of fast-food places tend to encourage obesity in children. Dilapidated
urban sprawl and vacant lots filled with trash can have a depressing
effect on mental health. Clearly, the urban environments that city
planners design can have a tremendous influence on public health.
While the general detrimental health
effects of harmful living environments may seem obvious, there remains
a significant degree of scientific uncertainty as to the true extent
of these effects, largely due to a lack of studies in this area.
For example, the synergistic effects of many different chemical
wastes in one area is not well studied, and even though regulated
levels of mercury and lead are low, these materials do not dissipate
over time and are able to accumulate over the years in the body,
making their full impact difficult to assess. It remains, however,
that the lack of answers to these questions should be an impetus
towards further study in this area and certainly should not be used
as an excuse for inaction.
The case for environmental justice,
though, is further complicated by interrelated social factors. In
the Noxubee County case, for example, race and class tensions rose
to the forefront. Those opposing FTI openly charged the company
with environmental racism, saying that their community was selected
for the plant because it had little power to resist and that FTI
would not have done the same to a predominantly white community.
FTI, in turn, responded by charging the activists with environmental
paternalism, saying that the activists were deciding what was best
for the community without actually consulting the community.
The relationship between race, income
and the distribution of environmental hazards has been the subject
of numerous studies over the past decade. In 1983, the US GAO report
said that 75% of hazardous waste facilities were zoned next to predominantly
African-American communities. A 1992 study in Detroit suggested
that the closer one moved to commercial hazardous waste facilities,
the greater the population of minorities and poor people. A 1996
study in Texas concluded that the presence of hazardous waste facilities
was positively associated with poor white populations. A 1997 study
of hazardous waste facilities in LA proposed that those facilities
were associated with greater minority populations, although not
necessarily of a lower income level. There have also been studies
indicating that there is little or no direct relationship between
race or income and zoning, although case studies such as Noxubee
County and others would suggest that this type of discrimination
does exist, even if not as a readily visible problem.
In attempting to take into account
the health, social and environmental issues involved in inequitable
city planning, the concept of environmental justice has developed.
More and more people are beginning to realize that when considering
issues of public health, a broader perspective than the traditional
epidemiological one must be taken into account since health is not
determined in a vacuum, but is inextricably linked with our living
environments and these environments have numerous adjustable social
and political determinants. Inequitable policies in city planning
efforts result in health inequities along a similar line. Public
health officials and city planners, though, have generally overlooked
that line and, in doing so, have forfeited a primary avenue through
which public health can be improved. The primary issue, then, is
that there exists a systemic dichotomy between public health officials
and city planners. This dichotomy has resulted in significant damage
to public health and a fusion of public health and city planning
is needed to effectively address community health concerns.
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Annotated Bibliography
Themes: These articles focus on the relationship
between public health and the “built environment,” especially
in urban areas. The built environment consists of all human constructs
such as buildings, roads, cars, parks and landfills and the ways
in which these constructs alter the environment through such factors
as water and air pollution. Humans live in these built environments
and their health can be drastically affected by them. Moreover,
since built environments are human constructs, they are subject
to regulation through policy measures such as zoning and industrial
guidelines. The necessity for such measures and the critical need
to examine public health from an environmental perspective are affirmed
by these articles.
Atlas, Mark. “There Goes the Neighborhood: Environmental
Equity and the Locations of New Hazardous Waste Management Facilities.”
Policy Studies Journal. Vol. 30, No. 2, (2002): 171-192.
While numerous studies have been
conducted concerning the environmental inequity associated with
the placement of waste treatment, storage, and disposal facilities
(TSDFs), there has been little consistency in these studies, both
in terms of variables analyzed and results obtained. In Texas, a
1996 study of TSDFs indicated that low-income, white areas bore
the brunt of those facilities, while a study in North Carolina the
same year indicated that TSDFs were more likely to be in areas of
high-income, white populations, which seems to flout assertions
of discrimination. The only federal study conducted on this subject,
a GAO report in 1983, concluded that nationally, African-Americans
carried a disproportionate load of the nation’s TSDFs, although
a report in LA in 1997 indicated that placements of TSDFs were little
related to concentrations of African-American populations. In contrast,
Hispanic populations were cited in that study as the most discriminated
against population, casting doubt on the ability of any single study
to make generalizations on this subject and reinforcing the often
variable decision making processes occurring across the country.
Atlas credits the discrepancies in
previous studies on this subject to differences in the variables
measured. Theses include how one defines the area around a TSDF
(concentric rings, counties, zip codes, or census blocks), what
races one counts as minorities, what one uses to measure wealth
(poverty levels, household income, or use of public assistance),
and which TSDFs are examined (treatment plants, landfills, or financially
thriving TSDFs). These variables are further complicated by their
independent assortment in each study, creating many different combinations
and results. Atlas, moreover, proposes another variable often overlooked:
political power. He asserts that political power, which is often,
but is not necessarily related to race or income is often the true
determinant of TSDFs placement. Areas with long-time residents who
have greater property investments and areas with high populations
of children have populations that would be more resistant to TSDFs
in their community, and studies have shown that TSDFs tend not to
be placed in such communities.
Furthermore, Atlas examines the trend
of new TSDFs to determine if the outcry against possible past discrimination
in TSDF placement has changed more recent placements in the nineties.
His study concludes that, in general, income level is not significantly
related to TSDF placement, but, overall, minorities still have greater
percentages near new TSDFs. The data for minorities in his study
was skewed, however, by a few locations that had extremely high
minority populations. This, again, emphasizes the difficulty of
making national generalizations on this subject.
Perdue, Wendy Collins, et al. “The Built Environment
and its Relationship to the Public’s Health: The Legal Framework.”
American Journal of Public Health. Vol. 93, No. 9, (2003): 1390-1394.
During the 1800s, the connection
between public health and city planning was undeniable. The movement
of residential areas out from under the shadow of heavily polluting
industries, the designing of buildings with adequate ventilation
and lighting, and the creation of sanitation systems did wonders
to increase public health. The idea of “sanitation engineer”
and “urban planner” was essentially synonymous. However,
through the 1900s, the focus on public health as derivative of the
public environment began to wane. Health officials focused on the
epidemiology of disease as related to the risk-factors of individual
lifestyle and genetics. City planners focused on preserving property
values and city aesthetics.
This lack of a public health voice
in city planning has been detrimental to recent zoning efforts.
The lack of public parks and the distance of stores encourage a
sedentary lifestyle, the preponderance of fast-food restaurants
and lack of urban grocers contributes to a deficiency in access
to health foods, gridlock traffic contribute significantly to respiratory
problems, and toxic industries lead to high rates of certain diseases.
To counter these trends, Perdue et al encourage public health officials
to get involved in urban planning decisions early on in the process,
bring substantial data to the table, and represent a distinct community
voice.
Sclar, Elliot, and Mary E. Northridge. “Property,
Politics, and Public Health.” American Journal of Public
Health. Vol. 91, No. 7, (2001): 1013-1015.
The potential for city planners
to improve public health is undeniable, but the great barrier that
remains to achieving such an activist approach is politics. Zoning
emerged in the early part of the 20th century and was shaped by
the progressive era as a tool to serve the “public interest.”
The public interest, though, essentially meant using zoning to keep
minorities and low-income people out of affluent areas and to preserve
and improve the real estate investments of the wealthy. It was only
when disease and debilitating conditions would not confine themselves
to the most powerless segments of society that public officials
took up a semblance of social justice.
Today, Elliot and Northridge argue,
even that pretence of social justice is on the decline as city officials
become less proactive in urban renewal efforts, but wait instead
for proposals given to them by corporate, and especially real estate
interests. City planning has moved away from being a conscious community
effort towards an independent goal and has become simply a gateway
to corporate interests. It is still to be seen whether city and
public health officials can revive the place of zoning as a tool
of public health, rather than private ambition.
Dannenberg, Andrew L., et al. “The Impact of Community
Design and Land-Use Choices on Public Health: A Scientific Research
Agenda.” American Journal of Public Health. Vol. 93,
No. 9, (2003): 1500-1508.
Community design has been shown
to have a significant effect on public health, but it is difficult
to use this to shape public policy since there are not enough specifics
on what it is about community design that adversely affects public
health. To address this, the CDC gathered numerous health and civic
officials together at a conference. They came up with a detailed
proposed research design to address the particulars of how public
health is affected by community planning.
Obesity rates, they concluded, were
influenced by the availability of public recreation areas and choices
of transportation. Further investigation would include determining
what encourages physical activity like walking and use of public
parks. Another necessary area of study is the rate of unintentional
injuries such as traffic and workplace accidents. Methods of improving
traffic flow would need to be studied. The health effects of air
and water pollutants should also be studied by comparing their impact
on different community designs. Broader environmental justice concerns
need to be examined as well to determine whether or not community
design particularly favors one segment of the population over another.
Dannenberg, et al, hope that data collected on these subjects will
be more specifically applicable to city panning than the current
generalized data.
McCally, Michael. “Medical Activism and Environmental
Health.” The Annals of the American Academy of Political
and Social Science. Vol. 584, No. 145, (2002): 1-17. web.lexis-nexis.com/universe/printdoc
Physicians have been a relatively
politically conservative segment of the population, generally valuing
the status quo and small government. They have also tended to shy
away form social activism, deeming it overly political or unprofessional.
The political clout that physicians have exerted, moreover, has
been mainly self-interested. The American Medical Association, for
example, accepts money from tobacco companies and lobbies against
nationalized health care to keep physician paychecks high. Part
of the general political apathy of physicians, though, is derived
from the deeply rooted concern over the individual patient as opposed
to the health of the population.
Ideally, neither of these aspects
of the health profession should be sacrificed. Physicians are more
and more to realizing their strength as social activists. One of
the areas that physician activism is just beginning to move into
is the impact of the environment on public health. Physicians have
a unique position to play in the environmental justice movement,
including offering a detailed physiological analysis of the health
effects of pollutants and connecting individual health to public
health. Rachel Carson, for example, as an “activist professional”
essentially single-handedly changed our views of pesticide usage
and its effects on public health. Moreover, the Health Care Without
Harm organization and Physicians for Social Responsibility have
tackled medical waste incineration and have had important successes
in reducing mercury and dioxin output. Increased physician activism
like this is needed to restore the moral imperative of medicine
in an increasingly consumerized system.
Corburn, Jason. “Confronting the Challenges in
Reconnecting Urban Planning and Public Health.” American
Journal of Public Health. Vol. 94, No. 4, (2004): 541-546.
The reconnection of urban planning
and public health work is important since the two are essentially
related. Without collaboration, each will suffer a handicap in its
capacity to accomplish its goals. Public health would feel this
handicap more and a re-evaluation of our priorities is necessary
to put health first. Despite having the same roots in efforts of
the 1800s to combat terrible urban epidemics, public health has
come to focus on individual risk factors such as diet and exercise,
while urban planning, alienated from what had given it a public
face, turned instead to economic development projects. In recent
years, though, these two estranged fields have begun to merge again.
In 2001, for example, a report by the Institute of Medicine cited
the environment as having a significant role to play in population
health dynamics. Also, the Center for Disease Control and Prevention
now has a National Center for Environmental Health, which has explicitly
linked city planning to public health.
Even with these and other advances,
there is still a way to go in re-integrating public health and city
planning. While Environmental Impact Statements, for example, take
into account human health, they are mostly focused on the effects
of carcinogens. Health officials remain largely separated from urban
planning decisions. To combat this, Corburn argues that the social
justice perspective needs to be asserted in the city planning tradition.
The city planner must have the gall not to simply respond to market
forces, but be willing to use governmental clout to empower certain
groups and facilitate multidisciplinary decisions that includes
not only professionals, but local community representatives as well.
Williams, Robert W. “Environmental Injustice in
America and its Politics of Scale.” Political Geography.
Vol. 18, (1999): 49-73.
With the emergence of the environmental
justice movement in the 1980s, one the biggest questions raised,
though it was not directly addressed, was that of scale. Just how
widespread was the purported environmental racism and what groups
did it involve? This question is of great importance since it would
determine what type of change is needed—a national systemic
effort, more stringent laws in certain locales, or something in
between? The question of scale, moreover, extends not just to the
geographical sense of how widespread this problem is, but also to
the social sense of what is really at stake and what groups are
affected. Ultimately, scale is difficult to determine because environmental
justice can be examined from so many different aspects, including
market forces, racism, and political favoritism.
Beall, Pat. “Toxic Sites Found More Among Poor.”
The Wall Street Journal. 3 July 1996: F1.
A report on environmental issues
in Florida concluded that minorities in the state lived disproportionately
around heavily polluted areas. Moreover, not only did minority and
low-income populations exist disproportionately near hazardous sites,
but they also repeatedly filed complaints about the situation. Officials,
though, were slow to provide help or information. While only 27%
of Florida’s population consisted of minorities, 54% of those
living near landfills were minorities. Besides the inequity in the
placement of environmentally detrimental sites, the Florida report
also stressed that there was a critical lack of information concerning
the exact health impacts of those sites simply because few such
studies have ever been conducted. The report concludes with several
recommendations for action. These include tracking birth defects
in the state, creating a new state governmental position to be an
environmental justice watchdog, and ensuring that communities are
not put at the intersection of multiple toxic sites at once.
Evans, Gary W. and Lyscha A. Marcynyszyn. “Environmental
Justice, Culmulative Environmental Rick, and Health Among Low- and
Middle-Income Children in Upstate New York.” American Journal
of Public Health. Vol. 94, No. 11, (2004): 1942-1944.
This is a study conducted on the
cumulative effects of different environmental factors on the health
of children in New York City. The premise of the study is that environmental
risk factors such as housing quality, noise levels and environmental
toxins play a more prevalent role in the lives of the children of
low-income families, which could potentially contribute to long-term
health problems in those children.
A study population of low-come children
(determined by an “income-to-needs” model) was compared
to a middle-income control population. Each child’s living
environment was individually analyzed for noise levels, over-crowding
and building quality with a seventy-two item evaluation that included
everything from structural integrity, to ventilation, to the proximity
of outdoor play areas. Urine tests were then performed on the children
to test for certain neuroendocrines indicative of chronic stress,
higher risks for cardiovascular disease and weakened immune systems.
The results indicated that children
in low-income households were significantly more affected by environmental
risks than middle-income children. The results, moreover, stressed
the cumulative effects that several negative environmental situations
can have when brought together.
Beatley, Timothy. Ethical Land Use. Baltimore:
The Johns Hopkins University Press, 1994.
Beatley asserts that land use decisions
are essentially ethical decisions in the same way that allocating
a limited budget to military or social services is an ethical decision.
In America, a market driven perspective is generally applied to
land use with utilitarianism as the justifying principle. However,
considering land as a pure market commodity has difficulties since
land use has such great potential for externalities, such the creation
of pollution, which can have far-reaching effects on the population.
Land use, then, must be considered from an ethical perspective that
takes into account the community that is affected.
Among the considerations that must
be taken into account are maximal public benefit, which acknowledges
distributive justice and environmental concerns; the right for all
people to be free from excessive risks created by the built environment,
obligations of sustainable development to future generations, the
interjusrisdictional nature of land use, which acknowledges that
the consequences of land use don’t simply stop at county lines;
and the treatment of land development as a privilege and not a right.
Most importantly, the ethical use of land involves moving beyond
seeing land use decisions as isolated economic transactions and
beginning to see them as acts in community development.
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Extended Annotated Bibliography
Rhodes, Edwardo Lao. Environmental
Justice in America: A New Paradigm. Bloomington: Indiana University
Press, 2003.
The environmental justice (EJ) movement
is a relatively recent movement that has arisen in the United States
over the past decade. This movement is based on the assertion that
built environments have a significant impact on public health and
that the placement of hazardous sites disproportionately affects
minorities and low-income populations. As an emerging issue, it
has encountered opposition form both established private interests
and traditional environmental activists who feel the social aspect
of the movement detracts from their cause. This double opposition
is a reflection on the shear complexity of tackling this issue.
Rhodes, however, is confident that this issue will soon rise in
prominence in the social agenda.
The traditional environmental movement
as embodied by organizations like Green Peace and the Sierra Club
has been averse to adopting a social perspective to their issue.
While it has essentially been taken for granted in other areas,
such as education and health care, that it is necessary to examine
the differential effects of policies on different segments of the
population, environmentalists have resisted this shift and have
instead focused on looking at the human population as a whole. This
is reflected in the relative lack of minorities in the environmental
movement. In the Environmental Protection Agency, for example, a
smaller percentage of African Americans are employed than in other
similarly sized bureaucracies. Among the minorities employed by
the EPA, moreover, a majority cited job stability and benefits as
the reason for taking the job, while among the Caucasian employees,
the major reason was a desire to help the environment. This may
be due to a general disconnect between minorities and an environmental
movement that doesn’t address their more immediate concerns
and which carries a certain “anti-urban ethos.” This
is not to say, however, that minorities are unconcerned about the
environment—just that the current environmentalist structure
is not as accessible to them as to the Caucasian population.
The EJ movement concerns a broad and
complicated spectrum of issues that it itself has yet to resolve.
Within the EPA, the EJ movement is only grudgingly accepted and
in regards to actual policy, little more than lip-service is played
to it. One of the difficulties faced in trying to extract key policy
issues in the EJ movement is that land usage cannot be isolated
from greater market forces. Moreover, while toxic wastes may be
reduced, they cannot be eliminated, making the BANANA idea (build
absolutely nothing anywhere near anything) unworkable. Another practical
concern in working towards environmental justice is the high transaction
costs of shifts in land use. These costs include negative externalities
in public health, the high costs of obtaining information, the lack
of information flow between communities and industries, a high degree
of uncertainty in the information obtained and the free rider problem
in regulating industry.
In identifying and evaluating a problem
of environmental justice, there are just so many factors that the
current environmental framework can’t take them all into account,
with social issues often being sacrificed in favor of traditional
environmental issues. The factors further complicating a comprehensive
study of environmental justice include selecting from a lengthy
list of demographic characteristics like race, income, home ownership
and education and designating a certain environmental hazard, including
specifying a type, length and medium of exposure, and determining
its geographic limitations. All of these characteristics will affect
the outcome of a study on human health and the environmental and
the possible avenues for addressing the problems will differ.
A case study in the struggle for environmental
justice was that in Noxubee County, Mississippi. This city, in the
early nineties, had a population of 12,600, 68.6% of which was African-American.
Agriculture was the primary industry and unemployment and poverty
were chronic problems. Only fifteen miles away was the nation’s
largest hazardous waste facility, leading the area to be known as
“the pay toilet of the country.” It was in Noxubee County
that Federated Technologies, Inc. (FTI) proposed in 1990 to build
a new hazardous waste disposal facility.
When the community got word of this,
a coalition of citizens formed called Protect the Environment of
Noxubee County (PEON). They worked aggressively with city officials
to stop the plant from being built, arguing that, among other charges,
such a facility was a blatant example of environmental racism, would
adversely affect the health of the population, would contaminate
the local dairy industry and would provide few local jobs to justify
such a great risk since FTI would have to bring in educated technicians
from outside the community to fill many of important jobs. When
students at Indiana University, from whom FTI was buying the land,
got word of the issue, they, too, tenaciously fought the administration
to stop the sale, uniting with PEON to put up a two-front battle.
FTI for its part charged its opponents with environmental paternalism.
Indeed, the majority of the African-American population in Noxubee
County supported the development of the plant for the jobs it could
provide. In the end, PEON and the student activists were successful.
This case illustrates some of the
complexity of what is at stake in environmental justice. More and
more we are becoming unable to ignore the inequities in living environments
that current city planning, if not caused, has allowed. With traditional
environmental movement having won numerous victories since its inception
in the seventies, the time is ripe to examine the disproportionate
application of environmental laws and the balance of risk between
health and economics in creating built environments. Rhodes believes
that this is the new paradigm of the environmental justice movement
and that the time of environmental justice has come.
El-Ahraf, Amer, et al. The Impact of Public Policy
on Environmental Quality and Health: The Case of Land Use Management
and Planning. London: Quorum Books, 1999.
Since the Industrialization Revolution,
concern about land-use and its effect on the health and the environment
has grown to become a prominent issue. Moreover, this is far from
an isolated problem of any area or country but is instead a worldwide
problem that transcends not only political borders, but generations
as well.
Concern over the negative impact of
unrestricted development on both human health and the environment
has led to the passage of many acts. The Clean Air Act, first passed
in 1963, but amended several times in the years thereafter, regulates
the ambient atmosphere by limiting both emissions, such as carbon
monoxide and ozone, and the discharge into the air from products
made with such compounds as asbestos and benzene. The Clean Water
Act, first passed in 1956 and amended in the years after, regulates
all kinds of industrial water use, from discharges to sanitary systems
to outputs directly into natural bodies of water. Several other
significant environmental regulations have also been passed, including
the Federal Insecticide, Fungicide, and Rodenticide Act, the Toxic
Substances Control Act, and the Energy Policy Act, all aimed at
creating a more healthy and sustainable living environment.
There are numerous public health reasons
that these actions have come about. Communicable diseases can be
carried by poorly planned, unsanitary environments, and the rates
of incommunicable diseases such as cancer can be significantly increased
by chemicals and pollution. There are numerous aspects of the environment
which can be impacted by human land use. They are air, water, soil,
noise, and “visual pollution,” which includes the use
of garish, mentally grating, or monotonous buildings.
While many policies to regulate industrial
output have been enacted in part to improve public health, land
use planning measures such as zoning have not been used to their
full potential to aid public health. Effective use of city planning
must take into account a great deal of factors which are all influenced
by land use decisions. Considerations of economic development and
aesthetic value must be balanced with conditions of public health,
social isolation, and ecological protection. Zoning is the most
common method of governmental land use planning. The constitutionality
of zoning was affirmed in 1926 when the Supreme Court overturned
its previous decision in Village of Euclid vs. Amber Realty Company
which had banned zoning. Today, zoning authority lies with the states,
which have, in turn, with few exceptions, delegated authority to
cities and counties. Zoning has become exceedingly more complicated
since its birth in the early 1900’s, now touting more than
twenty different zones, as well as numerous discretionary zoning
policies for such structures as schools, houses of worship and hospitals.
The utility of zoning, though, is complicated by not only the need
to consider numerous factors, but also by the fact that there is
really no guarantee that the private sector will develop in an area
just because it is zoned for development.
The environmental impact of land use
management and zoning efforts are regulated by numerous acts, the
most important of which is perhaps the National Environmental Policy
Act, which regulates everything from highway construction to oil
and gas pipeline placement. The Environmental Impact Statement is
another significant factor in land use decisions. Despite these
efforts, there remains a lack of coordination among state and local
officials responsible for zoning. Environmental and city planning
officials are numerous and fragmented, and coordinated efforts between
these scattered groups are sparse. In general, new zoning ordinances
are begun when a local municipality establishes a planning commission
to look into possibilities for new ordinances. This agency conducts
studies, gathers data and tries to synthesis different community
voices in their proposal, which is then placed before city legislatures.
In efforts to bring about a fusion
of the different aspects that must be considered in city planning,
one the biggest changes that must take place is that we must begin
to view the environment as a social issue. This brings to light
the interrelatedness of public health, the environment, economic
and social development, and how all of these can be affected by
land use decisions.
Back to Top
Book Review
Hofrichter, Richard, ed. Health and Social Justice:
Politics, Ideology, and Inequity in the Distribution of Disease.
San Francisco: Jossey-Bass, 2003.
The central theme of this book is
that inequities in health have been caused by the systemic inequities
in numerous other related social issues. Basic access to healthcare
as a policy goal, while important to public health, can obscure
the deeply rooted social causes of health disparities. A population
living near or below the poverty line, for example, will likely
suffer many more health problems than a wealthy district nearby.
Providing additional free clinics, while important, neglects to
probe the causes of those health discrepancies. Does the environment
expose that population to more toxins? Does the stress of poverty
and dilapidated environments cause them to feel isolated and forgotten?
Has economic displacement removed some of the social supports upon
which the community had relied? These factors compromise an individual’s
health not only by making it difficult to access healthcare or maintain
a healthy lifestyle, but also by interjecting many more pressing
concerns above physical health. Indeed, some of the greatest advances
in health have not been made by going head to head with diseases,
but by addressing social reforms such as regulations in child labor,
consumer protection laws, and reductions in poverty. Modern health
professionals, though, as Rajiv Bhatia, the Director of Occupational
and Environmental Health in the San Franscico Department of Public
Health puts it, are “so busy pulling drowning people out of
the water that they don’t see them falling in farther upstream”
(Bhatia 575).
This idea of public health as a social
construct, rather than an approach for combating diseases and disorders
quickly caught my attention. This was a new way of examining public
health, which I was primarily interested in, from social aspects
that I had not previously considered. However, I was not prepared
for the extraordinarily expansive scope of issues that Hofrichter
would cover in his book. Everything from race to globalization to
political structure is examined in relation to public health. While
this offers an excellent idea of just how interrelated and complex
any single issue can be if we are willing to step back and look
at it in the context of society as a whole, it is somewhat daunting
in the perspective of identifying a practical solution since I was
asked to consider so many factors at once.
The social determinants of public
health that Hofrichter outlines are numerous. The first is class,
defined not only in terms of disparities in wealth, but also in
terms of capitol and labor conflicts. Race and Gender come next,
involving the stubborn institutional racism and sexism that still
lingers, and its effects, conscious or unconscious, on public decisions.
Low-income populations and minorities may be particularly vulnerable
to the deterioration of public services, the spread of urban decline
and sprawl, and may be saddled with a disproportionate burden of
environmental hazards. Moreover, they may face greater workplace
hazards and stress, and face a greater chance of confronting violence
and other concerns exacerbated by deteriorating social and economic
conditions. Such groups are also the most politically powerless
and often don’t have a voice in decisions affecting these
issues. Political power, in turn, also influences what subjects
are funded for research, especially medical research.
The book goes on to describe how economic
disparity is among the most important issues that need to be addressed
if inequities in health are to be tackled. Poverty levels have been
shown to directly impact health, not just from a health care access
perspective, but from the perspective of compounding everyday health
risk factors. Indeed, economic condition is so formative that “material
circumstances early in life are more potent predictors of later
health than social position during adulthood” (Raphael 73).
In describing the various social determinants
of health, though, a strong general theme in this book is the tremendous
complexity and interrelatedness of those issues. Parental socioeconomic
position affects education, which affects occupation, which affects
income, which affects health, which is further affected by combinations
of age, gender, and race. Moreover, the environmental factors of
discriminatory zoning, loose enforcement of hazardous waste regulations,
and the social stresses of poverty have an additionally synergistic
effect on health.
The importance of these complex issues
is reinforced by demonstrating that political traditions aimed at
social equity have achieved the greatest advance in public health.
An examination of Europe’s social democratic nations shows
that reductions in socioeconomic disparities have contributed to
significant increases in levels of public health. A study in Norway,
for example, indicated specifically that social and environmental
improvements, including such enhancements as a new school, new parks,
and landscaping produced significant improvements in mental health
and social cohesiveness. A similar trend can be seen in the US where
increases in social security match roughly with improvements in
public health.
The emphasis on the great complexity
of the social determinants of health in this book, while true and
worth considering, are, however, counterproductive to Hofrichter’s
presumably reformative motivations in editing this book. At times,
I couldn’t help feeling being inundated by the sheer bulk
of issues I was asked to consider. Hofrichter seemed to imply that
to be a truly effective public health advocate, one had to have
a knowledge of every facet of society from poverty to environmentalism.
Moreover, some of the articles themselves seemed not to take into
account the complexity that was emphasized. The positive correlation
between health and social security brought up by one of the contributors,
for example, could easily have been influence by many other factors
such as the production of newer drugs and increased awareness of
how to be healthy. The book also delves into global health disparities,
although it stops short of proposing international measures for
tackling those disparities.
While health disparities are particularly
striking in the US due to the contrasts in wealth and to the relatively
small return we get from the comparatively large amounts of money
we invest in health care as compared to other industrialized nations,
health disparity is clearly a worldwide problem. Numerous statistics
are listed in this book to demonstrate global health inequities.
Ninety-five percent of those infected with HIV/AIDS reside in developing
countries. If a girl is born today in Japan, she has a 50% chance
of seeing her 100th birthday, while a girl born in Afghanistan has
only a 75% chance of living to age five. These figures point to
one thing: “poverty kills” (Gershman 160). In developing
countries, poverty is a critical social determinant of health. While
America cannot directly change the policies of foreign states, it
can play a big role in addressing this issue by regulating the trend
towards globalization and thereby increasing economic conditions
in developing countries. However, with America as an example, it
would be a mistake to associate GDP directly with universal improvements
in health care since resource distribution also greatly impacts
poverty levels and health disparities.
The book goes on to discuss the possible
mechanisms by which health disparities arise from socioeconomic
discrepancies. A psychosocial interpretation would suggest that
having such blatant reminders of social inequity causes emotional
stress and social frustrations that may influence behavior and attitudes.
A neo-material view suggests that environmental factors such as
pollution and the lack of healthy foods precipitate health inequalities.
Again, the authors emphasize the complexity of these issues and
both the psychosocial and neo-material perspectives are held to
be partly correct.
No such analysis of social issues
would be complete, however, without at least a cursory examination
of possible solutions. Many individual articles do indeed offer
practical solutions to the specific problems they address. The section
on zoning and public health, for example, suggests certain environmental
regulations to reduce industrial toxins overall, rather than just
shifting pollutants from one district to another. However, the articles
that attempted a comprehensive solution to the social determinants
of health tended to be bogged down by the shear expansiveness of
the issue. The authors’ attempt at a synthesis of these topics
was ineffective because they could not move past ideology. While
such a synthesis is important, from a policy perspective, it would
involve great difficulties since no single account of policy can
possibly take into account all aspects of society. Practical policy
making, then, is much more effective if a narrow, case by case approach
is taken.
This book suggests that we need a
fundamental shift in the focus of public health to address the social
determinants of health. Current ideas in epidemiology, the book
further asserts, are stringently quantitative, which eschews social
issues that do not easily fit into particular molds. Even the World
Health Report 2000 removed “considerations of social justice
from the measurement of health disparities, reducing it to an exercise
devoid of practical meaning” (Braveman 317). However, it has
become imperative that health officials address the root causes
of disease. A comprehensive synthesis of environmental justice,
social determinants, and epidemiology is called for. Central to
beginning such a move is the acknowledgement that health is a right.
America is described as having many
difficulties to overcome in striving towards equitable health care
since its health care system is built on a “foundation of
inequality…[which] has created a sick society, even as we
invest more and more to repair the damage” (Levins 373). A
framework of social justice is needed. Community task forces and
a strong public health lobby need to be created to give voice to
these issues. Possible direction for policy includes emphasis on
preventive care, filling in the gaps in social services, urban renewal
efforts, state-funded daycare and an increased minimum wage. Ultimately,
Nancy Krieger, a Harvard Professor of Society, Human Development,
and Health, asserts that “social justice is the foundation
of public health….It is an assertion that reminds as that
public health is indeed a public matter, that societal patterns
of disease and death, of health and well-being, of bodily integrity
and disintegration intimately reflect the workings of the body politic
for good or ill” (Hofrichter 14).
Hofrichter has assembled a comprehensive
collection of articles that examine the social determinants of health.
He provides an assessment of public health from a unique social
perspective and establishes connections that are often overlooked
or written off as having nothing to do with public health. However,
I got the sense that every single aspect of society somehow affected
public health, which may very well be true, but the authors seemed
to imply that to have good public health, we must first solve all
of society’s problems. Hofrichter would probably counter that
his emphasis is not on addressing all problems, but on integrating
public health with concerns of social justice to create a new, cohesive
social movement that would then design new policies within this
framework.
A balance must be struck between abstract
generalizations and specific reform in striving towards practical
solutions in public health. Efforts that target zoning law perhaps
best illustrate that balance by acknowledging that human health
is environmentally influenced and that there is systemic inequity
in the distribution of this influence, but focusing policy on local
land use policies to improve what is in place. Indeed, I choose
to examine the effects of zoning laws on public health since this
is one of the more focused issues presented in this book.
While the plethora of social determinants
should be taken into account in the long term, collective progress
is made as a sum of the parts. In other words, just because all
of society isn’t moving forward it doesn’t mean that
individual parts can’t do so. Policies and regulations such
as bans on having several hazardous polluting industries in the
same area or improved Environmental Impact Statements can be enacted
that takes into account public health and social justice, though
they don’t directly address those issues. This is something
of a bottom-up approach. Should such environmental practices be
successful, it would chip away a little at systemic discrimination
and economic inequity. Hofrichter’s approach is something
more of a top-down approach. Zoning laws would become more equitable
as racism and poverty are dealt with.
This book has given me an excellent
overview of how public, public health is. Its uniquely social perspective
on public health conveys a real sense of a faulty social network
through which many people fall through the cracks. Moreover, the
book’s emphasis on synthesizing different viewpoints and bringing
together a myriad of social determinants has reinforced the connection
of broader social issues with public health in my mind.
References
Bhatia, Rajiv. “Swimming Upstream in a Swift Current: Public
Health Institutions and Inequality.” Health and Social
Justice: Politics, Ideology, and Inequity in the Distribution of
Disease. Hofrichter, Richard, ed. San Francisco: Jossey-Bass,
2003. p. 575.
Raphael, Dennis. “A Society in Decline: The Political, Economic,
and Social Determinants of Health Inequalities in the United States.”
Health and Social Justice p. 73.
Gershman, John, et al. “Getting a Grip on the Global Economy:
Health Outcomes and the Decoding of Development Discourse.”
Health and Social Justice. p.160.
Braveman, Paula A. “Measuring Health Inequalities: The Politics
of the World Health Report 2000.” Health and Social Justice.
p.317.
Levins, Richard. “Is Capitalism a Disease?: The Crisis in
US Public Health.” Health and Social Justice. p. 373.
Hofrichter, Richard. “The Politics of Health Inequalities:
Contested Terrain.” Health and Social Justice. p. 14.
Back to Top
Practitioner Interview
Dr. Marie Lynn Miranda is an associate
professor of environmental policy at Duke University and the Director
of the Undergraduate Program in Environmental Sciences. She is also
the director of the Children’s Environmental Health Initiative
(CEHI), a program in the Nicolas School of the Environment. The
CEHI studies the effect that environmental factors have on the health
of children. Moreover, the CEHI employs the relatively new concept
of geographic information systems (GIS), which correlates statistics
to geographical data, offering the additional dimension of spatial
analysis to traditional statistical analysis. Dr Miranda also serves
on several other committees at the intersection of the environment
and public health, including the North Carolina Lead Elimination
Action Plan Strategic Planning Group, the North Carolina State Asthma
Coalition, and the Board of Directors for the Alliance for Healthy
Homes. Her general research interests lie in environmental justice
and environmental economics.
[The Interview was conducted in person and the answers written
down. The answers reproduced here are reconstructions of Dr. Miranda’s
answers and are not verbatim.]
1. One of the challenges in environmental justice, it seems, is
that, while numerically there is great deal of information on this
topic, much of it is dispersed and unintegrated. What do you see
as the unifying trends in the past studies on environmental inequities?
Do generalizations derived from past studies sufficiently
take into account the differences in variables and definitions between
studies, such as what defines poverty, what kind of environmental
elements are measured, and what geographical scale is used?
Even if no single, comprehensive
and conclusive study has been done on the inequitable environmental
factors of health, the current literature has provided a strong
indication that a problem exists. Moreover, just because something
isn’t actively going wrong with environmental equity doesn’t
mean that we can ignore environmental justice issues. The research
in this area has certainly demonstrated the prevalent potential
for such problems to occur.
Another difficulty often faced in
drawing generalizations about environmental justice is that it can
present itself as such a divergent group of challenges across the
nation. For example, a place like Iowa may not have any problems
with strip mining, but pesticides may be an issue. West Virginia,
on the other hand, would be much more concerned with strip mining
than with pesticides. Both of these have different health consequences
and different possible avenues of redress, but both fall under the
spectrum of environmental justice in that they are environmental
circumstances that adversely affect public health.
2. Market forces are often cited as the primary cause of inequities
in land distribution, rather than systemic discrimination. Polluting
industries are attracted to cheap land for the same reason that
poor people are. Do economics play a leading role in the
inequities of human ecology, or are there more specific issues that
need to be dealt with? If market forces truly are the crux
of the issue, is there anything we can do to address environmental
justice that does not include a fundamental, and probably impractical,
change in thinking about economics?
At the heart of this is something
of a “Which came first: the chicken or the egg?” type
question. Did polluting industries move into underprivileged districts,
or did underprivileged communities grow up around polluting industries?
This is a fundamental question and while the answer would be useful,
albeit difficult, to know, it is a moot point. We are confronted
with the reality of the inequitable distribution of harmful environmental
factors and whether these resulted from conscious intent or not,
it does not detract from the harm this situation causes. We have
to be able to fight this inequity as it is, even if we do not yet
have definitive answers as to why such situations are created.
Such economic situations related to
geographic locations, moreover, have an added political factor.
The power of the people in these situations is reflected not only
in the ability to vote with the ballot, but also with one’s
feet. Underprivileged populations tend to have a significantly lower
ability to vote with their feet, which can easily exacerbate the
harmful environmental factors the population is facing.
3. Do you see a split between current public health advocates
and environmentalists? What do you see as the primary cause
of this split and is environmental justice the natural synthesis
of the two movements?
Currently, the trend has been towards
significantly increased cross-over in the two fields, and the dichotomy
seems to be much reduced. Both parties understand that at the root
of it all, the same problem is being tackled: pollution causes health
problems.
The major distinction that may exist
is between what are known as ‘green issues’ such as
species diversity and deforesting, and ‘brown issues’
such as air and water pollution and solid waste disposal. Public
health officials have leaned more towards brown issues, but they
are so interrelated that overlap seems to be natural for the two
groups. The EPA, moreover, is not as adverse to public health issues
as it may be made out to be.
4. The environmental justice movement is in some ways part of a
larger move towards viewing social problems as derivative of numerous,
interrelated causes. While this may have a great deal of validity,
it also greatly complicates immediate issues of policy since it
seems to require tackling poverty, racism, globalization, and environmental
regulations all at the same time. How does environmental
justice avoid over-stretching itself in the issues it draws under
its umbrella?
You seem to have this very broad,
ambiguous conception of environmental justice. You run into problems
of generalization when you just throw around that term and have
nothing substantial to apply it to. Personally, I would describe
myself as working on environmental issues that have a public health
aspect to them. Lead poisoning in residential areas, for example,
is something that I have done a lot a work with, both researching
the toxicology of it and addressing the social aspects of fixing
the problem. On a broader scale, the problem of lead poisoning in
children can only be systemically fixed if substandard housing is
dealt with. But while this is our ideal goal, we must also be able
to take immediate steps to relieve and treat the situation. Progress
is not an all or nothing bid.
There are long-term, middle-term,
and short-term goals for every set of complex problems like this.
The broad, systemic changes always reside in the long-term category,
but these categories are not mutually exclusive—each one may
certainly be pursued without compromising the other areas. The short-term
goals, moreover, are often the stepping stones to the higher goals.
5. With the Clean Air Act, the Clean Water Act, and similar legislation,
many environmental toxins have come under federal regulation. The
studies that have lead to these acts, though, have tended to be
somewhat discursive in their overall breadth and unlinked to each
other. Have established “safe levels” of environmental
toxins failed to take into account their synergistic effects? What
do you see as the necessary future direction for research in this
area?
In regards to a general direction
for research, the synergistic effects that need to be studied occur
at a much more fundamental level. Imagine a triangle with a child
in the center. One side represents social factors, one side represents
environmental factors, and the last side represents genetics. All
three sides exert pressure on the child through moments of supreme
vulnerability in his or her development and all three determine
the outcome of that child’s life and health. This development
process and the factors affecting it are the most important areas
of further research. Our ability to advance in this area, though,
hinges a lot on our ability to make connections and synthesize the
three sides of the triangle to form a cohesive picture.
While genetics and psychology have
been given a fair amount of attention, environmental factors and
geospatial trends is a relatively new area and one in which we need
a deeper understanding. Geospatial analysis is of particular interest
to me since it allows us to see how these different factors come
together in the area where a child lives.
Moreover, many of the past studies
have focused on the effects of environmental conditions on the health
of socially vulnerable populations, but more attention needs to
be paid to physically vulnerably populations such as children and
the elderly. These populations suffer additional health problems
when faced with a highly toxic environment and should not simply
be lumped together with the general average.
6. From a policy perspective, how do you think that environmental
justice can be framed as a truly public issue rather than the isolated
concern of certain communities or populations? In pursuing
such policies, how can we avoid simply switching from environmental
racism to environmental paternalism, especially when a polluting
industry may provide a significant amount of jobs to a community?
You should look up what Bob Kuehn
did in Louisiana’s cancer alley with the Shintech case. It
should be an interesting case study and explains well what you are
asking. [That was the extent of her answer. I looked up the Shintech
case later and found that it involved a chemical company called
Shintech that wanted to build a large chemical plant that would
be replete with environmental toxins near the small town of Convent,
Louisiana. Convent has a 60% unemployment rate, is mostly African-America,
and has an average per capita income of $7,200. Moreover, it was
already located in ‘cancer alley,’ so named for the
plethora of refineries and chemical plants in the area. Convent
and the surrounding area have one of the highest cancer rates in
the country. When Shintech proposed to build yet another major chemical
plant in the area, parts of the town rebelled. Louisiana’s
governor supported the development as a huge property tax windfall
so the people in the town turned to Robert Kuehn, a law professor
at the Tulane University Environmental Law Clinic. He and others
framed their case as one of racism and for the first time saddled
the EPA with a decision in race relations. This was a defining moment
in environmental justice. The EPA, though, finally caved in to Shintech,
but Kuehn and others continued to fight and, after some key court
victories, won out against the corporation. There was some opposition
against Kuehn from residents in Convent who thought that the plant
might bring jobs, but these were significantly less vocal than those
opposing the plant. This is not the only case in which the pro-job
segment has been unaggressive, suggesting, perhaps that they were
either won over to the opposition, or the promotion of jobs was
not actually what drove their leaders.]
7. What do you see as the primary political leverage that
we have in accomplishing change in this field?
The most important policy we need
to keep in mind is that we need to pursue a net gain solution. It
doesn’t make anything better to move polluting industries
from a poor black neighborhood into a rich white neighborhood since
it would still be discriminatory. We need to focus instead on how
to reduce industrial emissions overall.
Specific political leverage, though,
is only specifically applicable. This is not something we can make
generalizations on. As I described before, no particular solution
or plan is equally applicable across all cases, even if they can
all be lumped together as ‘environmental justice.’
Back to Top
Policy Memo
Attn: Gregory Carmichael, PhD
Deputy Commissioner of Environmental Health
New York City Department of Public Health and Mental Hygiene
Topic: Zoning Laws in NYC and Public Health
Overview:
The New York City Department of Public
Health needs to release a Health Impact Statement every time a new
zoning ordinance is issued. Zoning ordinances are the primary way
in which city planners decide where noxious industries will be placed.
Such industries are known to be a root cause of numerous health
problems, including respiratory diseases, birth defects and cancer.
Simply increasing treatment for those disorders, while necessary,
does not solve the issue. The greatest marginal benefit of any single
action to promoting public health in NYC, then, is the regulation
of noxious industries in residential areas. Low-income areas of
NYC are most affected by the lack of a public health planning in
zoning, but industrial emissions cannot be limited to certain districts.
Currently, city planning officials responsible for zoning have essentially
no public health input in their decision-making process. A Health
Impact Statement should examine the way in which the placement of
new polluting industries would impact the health of both the immediate
community and NYC as a whole. The statement should also be made
publicly available since a goal of this statement is to increase
public awareness of the link between city planning and public health.
This would prepare the way for greater changes in environmental
regulations which would tackle public health at its root.
Problem Statement:
The problem we are facing is this:
city planners in New York City are not paying enough attention to
the public health consequences of their policies. As a result, the
zoning policies in NYC are a major cause of many of the city’s
health problems. The health of the city’s low-income population
is especially impacted since they are the population that is most
negatively affected by the city’s zoning policies. Heavily
polluting and waste treatment facilities are often zoned dangerously
near low-income residential communities. New zoning measures in
NYC are carried out either through the creation of new zones or,
more commonly, the rezoning of areas previously specified as ‘unrestricted’
zones. Unrestricted areas often have both manufacturing (M) and
residential development in close proximity. Whether there zones
are given that final push to become one of the other depends significantly
on the area it is in. The Bronx, for example, had the largest number
of zones recast as M zones and the fewest M zones recast as other
zones; Manhattan, on the other hand, had just the opposite.1
City renewal projects, moreover, favor wealthy areas.2
The people living in low-income areas with heavy industry zoned
near them are often stuck since they do not have the resources to
vote with their feet by moving out and they do not have the political
clout to initiate reform. A further result of this lack of political
power is that in addition to having noxious industries placed near
them, areas with low-income populations also have lower levels of
enforcement for industrial regulations.
These factors force low-income populations
to bear the brunt of the city’s environmental toxins. Although
the specific health effects of such close proximity to numerous
industrial toxins and emissions has received minimal attention from
city officials, numerous case studies have established that serious
negative health impacts of such industries do exist. Hunts Point-Mott
Haven in the Bronx, for example, has a 150% higher rate of asthma
than the rest of NYC, and 1000% higher than NY State. Hunts Point-Mott
Haven is also the home of the largest wastewater sludge pelletization
plant in the Northeast and a disproportionate number of NYC’s
waste handling facilities.3 Health problems in
places such as the Bronx can be effectively reduced not only through
increasing access to health care, which addresses the results of
social inequities, but also by cleaning up the environment, which
addresses the cause of the problem.
A major enabling factor that has allowed
these inequities in zoning to exist is that a systemic dichotomy
exists between NYC municipal planners and city health policy leaders.
Zoning policy is largely decided upon logistic and aesthetic rules,
with little or no input from health officials. Even NYC environmental
health officials fail to examine zoning as a root of public health
problems. Although basic information on the negative health effects
of noxious industries exists, it is simply not given major consideration,
leaving short-run profitability and political expediency to dictate
zoning policy. Public health, for its part, has focused primarily
on the epidemiological origins of disease and healthcare quality
and access. Indeed, in the past, the greatest advancements in public
health have been made by treating the public environment. The health
of the entire city of New York is affected by this lack of a public
health voice in city planning.
Environmental toxins are enduring
compounds and do not respect zoned boundaries. Moreover, great public
expense is expended in hospitals treating the myriad of health conditions
caused by noxious industries and a large degree of community productivity
is lost. The effect of zoning on public health is a vital problem
that needs to be addressed to ensure the future health of New York
City.
Criteria:
Hospital records would be an excellent
criteria by which to measure the effectiveness of different approaches
to this problem. Liver disease, asthma and other respiratory diseases
and, in the long term, birth defects and cancer rates, are good
indexes against which to measure improvements in public health in
relation to changing environmental factors. Air, water and soil
samples should also be taken from areas affected by new environmental
policies to measure the effectiveness of those policies in altering
the environment.
Options/Analysis:
A Health Impact Statement issued by
the NYC Department of Health would be the most effective short term
measure to combat the health disparities resulting from zoning inequities.
What is needed most right now is public awareness that zoning does
indeed impact public health. That awareness is exactly what a Health
Impact Statement would provide. Public awareness can then be harnessed
to exert pressure for further change. The statement, moreover, should
frame the effects of zoning in terms of the public health of the
entire city, including an analysis of the treatment costs and the
potential for industrial emissions to spread.
Further policy in the middle term
needs to focus on enforcing existing zoning laws in order to prevent
industries from expanding illegally, enforcing established emission
maximums by acts like the Clean Air Act and Clean Water Act and
limiting the possibility that several polluting industries would
overlap in a single area. These problems, moreover, are not the
result of a deficient policy, but rather the lack of enforcement
for existing policy. That is why an effort such as the creation
of a Health Impact Statement needs to be implemented to gather the
force necessary to enforce existing measures. Success with these
actions would go a long way in curbing the worst of the environmental
factors affecting health. Low-income areas especially, which tend
to have a lesser political voice to enforce regulations, would be
significantly improved by the stricter enforcement of exiting laws.
In the long-term, we need to promote
research that focuses on industrial processes that produce less
toxins overall. Research into the synergistic effects on public
health of many environmental toxins needs to be conducted and industrial
regulations need to be adjusted to reflect the results of such research.
Ultimately, the goal is not to shift around environmental toxins,
but to eliminate them all together.
Recommendations:
New York City Public health officials
can most effectively combat the detrimental health consequences
of the city’s zoning policies by making a Public Health Impact
Statement. The statement also needs to be made publicly available
and should emphasize how industrial emissions have a ripple-effect
throughout in the entire city, impacting not only disease rates
but also everything from health care costs to future environmental
sustainability since so many chemicals do not dissipate over time.
The New York City Department of Health
and Mental Hygiene needs to issue a Health Impact Statement whenever
alterations to basic zoning laws are made or discretionary building
permits are issued. This statement should encompass an analysis
of the possible concentration of waste products and the probable
industrial emissions that would accompany any changes in or exceptions
made to zoning policy. The statement should extrapolate the possible
health effects that new city planning policies would have on both
the immediate community and New York City at large. The synergistic
effects of several different chemicals and the difficulty of locally
containing any negative impacts on human living environments in
such a dense city should be particularly emphasized. The Public
Health Impact Statement should also be distinct from the Environmental
Impact Statement and focus particularly on human health.
______________________
Footnotes
1 Maantay, Juliana A. “Zoning, Equity, and
Public Health.” Health and Social Justice: Politics, Ideology,
and Inequity in the Distribution of Disease. Hofrichter, Richard,
ed. San Francisco: Jossey-Bass, 2003. 238.
2 Sclar, Elliot, and Mary E. Northridge. “Property,
Politics, and Public Health.” American Journal of Public
Health. Vol. 91, No. 7, (2001): 1013-1014.
3 Maantay, Juliana A. “Zoning,
Equity, and Public Health.” Health and Social Justice:
Politics, Ideology, and Inequity in the Distribution of Disease.
Hofrichter, Richard, ed. San Francisco: Jossey-Bass, 2003. 231.
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Summary Annalysis
Dr. Marie Lynn Miranda provides an
apt summary of the constructs influencing human development. She
describes a triangle with the person at the center. One side of
the triangle represents the social factors such as family, education
and career opportunities. The next side represents genetics. The
final side of the triangle represents the physical living environment,
which includes such factors as housing, air, water and food. In
this complex story of human development, the environmental factors
have tended to be among the least examined. Indeed, a person’s
living environment has a profound effect on his health and on the
health of the entire community at large.
A systemic dichotomy, however, exists
between public health officials and municipal planners concerned
with the public living environment. Public health officials have
a sharp focus on the epidemiological aspects of diseases, wielding
considerable knowledge about microbial mechanisms and how to combat
them. Action on the part of health officials implies treating diseases
and prevention implies a vaccination drive. Disorders where there
are no microbes to fight are assumed to be a product of genetics
and lifestyle, two things that public health officials have relatively
little power over. While all of these factors are undeniably important,
their effectiveness is drastically reduced when an environment highly
conducive to diseases and other health problems is left untreated.
If respiratory problems are significantly higher in one population
than in another, we should examine genetics and we should examine
diet and exercise, but we should also examine easy access to fresh
food, the prevalence of decrepit housing and the concentration of
industrial emissions. If a person in a city doesn’t have a
car, does a grocer of fresh foods exist within walking distance?
Are cheaply built apartments collecting large amounts of mold in
the rafters, filling the rooms with lung-irritating spores? Which
came first: a population’s asthma problem or the heavy pollution
in the area? Taken alone, building a new hospital is not the answer;
it would simply offer a small reprieve at a great cost. The environment
needs to be addressed. If air pollution in the region is reduced
and decrepit housing brought up to par with current standards, respiratory
problems would likely be reduced by a great deal.
City planners, for their part, also
serve to perpetuate the dichotomy that exists between them and public
health officials. City planners are primarily concerned with real
estate values the aesthetics of higher land-value areas. Cities
are designed with the security of real estate investments in mind.
Areas with high concentrations of industrial toxins are often the
default result of intricate planning in high-end districts that
leaves few other areas to place polluting industries. Noxious industries,
then, are not so much placed near the poor, as they are placed away
from the rich. If population health ever enters the equation, it
is only tangentially.
The primary adaptive challenge here
is bringing about a synthesis of the public heath concerns in America
with city planning efforts. A degenerate living environment is one
of the primary causes of disease. The living environment, moreover,
falls well within the domain of public responsibility. An acknowledgement
is needed that public health is indeed a public concern and that
a community’s health is a collective responsibility.
The barriers to such a fusion of public
health and city planning are numerous and multifaceted. On a political
level, there is simply no substantial incentive for such a change
to take place. The root of this lack of will in environmental health
policy stems at least in part from the strong individualistic strain
in American society. An individual’s health, as with her success
and happiness, is her personal responsibility. If a person is unhealthy,
it is because of a combination of her genetics and lifestyle. While
both of these factors boast a large degree of merit in examining
an individual’s health, they are often used in a very simplistic
and condescending manner. A decision can quickly be rendered that
a person either was never meant to be healthy or choose to be unhealthy.
Both avenues work to shift responsibility away from society, meaning
the higher classes, to the individual, meaning the lower classes.
This construction makes it much easier for policy makers since it
supercedes the need for systemic action. An alternation of this
attitude is clearly needed if the human environment is to find a
much needed place in the public health arena.
An example of such a synthesis of
public heath and city planning occurred towards the end of the Industrial
Revolution. It was then that comprehensive sanitation and city planning
measures were taken to curb the rampant spread of diseases like
tuberculosis and cholera. Those wielding political power realized
that diseases knew no class lines, and though those diseases may
begin in the most wretched areas, no amount of money in the bank
would keep them from spreading. The worst of the slums were cleaned
up, sewer systems installed and regulations regarding factory and
residential placements were first enacted. As a result, disease
rates throughout entire cities were lowered. The principle recognized
here was that public health is collective concern. Yes, our modern
day urban slums tend to impact the city at large somewhat less than
before, indeed even astonishingly less, with shimmering corporate
towers a few blocks away from dilapidated tenements, but the same
principle can still be applied. Pollution and industrial wastes
don’t just remain contained within the imaginary borders of
a district. Many industrial emissions, moreover, don’t disappear
over time. They can accumulate for years and even decades. Moreover,
city health costs could potentially be significantly lowered by
the stricter enforcement of environmental regulations and a similar
argument could even be made to extend to crime rates and education
levels. Environment does still, even if less dramatically than a
century ago, have a profound the health of a community.
Indeed, a considerable amount of knowledge
on the environmental impact of health has been accumulated. This
knowledge, however, has created a deceptively binary situation with
a single set goal and one solution. Many environmental health concerns
seem self-evident to the majority of the population and legislation
has responded accordingly. Nonsmoking areas are common in the United
States, and it is probably safe to assume that most Americans, including
smokers, are aware of the health effects of second-hand smoke (they
may, of course, choose to ignore them). Most Americans would probably
also agree that drinking polluted water and breathing noxious fumes
cannot possibly be healthy. Although appearing to be more clear-cut,
than, say delineating what it means to have a ‘good’
family, environmental factors are also much easier to write off.
While the very elusiveness of social structures forces us to constantly
re-examine the issues, it is easy to categorize environmental factors
as resolved. Clean Air Act? Check. Toxic Substances Control Act?
Check. Environmental factors, however, work on a continuum just
like other social issues and are inextricably linked to social and
genetic factors. Complex questions of the living environment arise
quickly. How much mercury in industrial runoff is safe? How is safe
defined? Is safe significantly less safe for people with certain
genetic predispositions? Is safe rendered unsafe by other factors
such as badly built pipes or the compounding effect of numerous
other chemicals? How can education improve the safety of an environment
and how does dilapidated urban sprawl influence a child’s
education? Clearly, environmental concerns are integral to the public
health of a community on many levels.
No matter how many numbers that can
be named suggesting that such a view has merit, however, a shift
towards it will still only occur slowly, partly, perhaps, because
people don’t want to think this way since it would imply responsibility
and an imperative towards action. To enact change in such a system,
public heath officials, who would most likely be concerned with
this area since it deeply involves their current role in society,
need to work closely with community activists to shed light on the
public health impact of city planning. City planners cannot be directly
pressured to make room for health concerns in their work since they
are often appointed, but they can be indirectly pressured by leaning
against the elected officials responsible for municipal appointments.
Even with access only to indirect pressure, the electoral weight
of local communities seems to still be the most immediate avenue
of change. Upon an examination of those communities with the most
pressing self-interest, such as districts with high proportions
of children or those with long-time property holders, a correlation
with political power is established and it is seen that those communities
have fewer harmful industries placed in their vicinities. Many health
professionals and community activists are already tackling this
issue as part of a burgeoning movement known as environmental justice.
The idea behind EJ movement is that
environmental factors have a tremendous and underrated impact on
public health and that there are systemic discrepancies in the distribution
of harmful environmental factors. The EJ movement, moreover, is
not about a “not in my back yard” policy, but one of
“not in anyone’s backyard.” The answer is not
about shifting all polluting industries into wealthy white districts;
it’s about reducing the overall amount of harmful environmental
factors. Indeed, the worst of the factors in harmful living environments
could be drastically ameliorated by simply enforcing existing emissions
regulations and updating old buildings and industrial machines to
meet current standards. Pollution reducing upgrades could be given
to established industries, possibly even through public subsidies,
and research in cleaner manufacturing methods should be encouraged.
To incite the political strength of
community towards environmental justice, there is always the option
of attempting to start a grass-roots organization around a particular
issue or introducing the issue to an already established organization.
The purpose of both would be to spread awareness of the issue and
to instill an imperative for action. The deficit of political power
in certain communities, however, runs much deeper than simply the
lack of information about unjust zoning or unenforced emissions
regulations. If anything, communities are well aware that a toxic
waste dump placed near a large apartment complex can’t possibly
be a good thing. Their inability to exert themselves in elections,
then, is a complex product of poverty, political education and probably
a large degree of social cynicism. There is however, great political
potential that remains untapped. A leader in this area should be
able to tap into that potential. He or she should be able to find
an effective public venue through which to foster a sense of communal
health, but he or she should also understand that step-by-step policy
changes will likely precede any fundamental changes in social thinking.
He or she should be able to focus on those measured victories while
informing public opinion.
Even if it is unlikely that major
change is just over the horizon, every step in the right direction
still brings us that much closer. Simply telling people about these
issues probably won’t get a majority of people to believe
that health is a public concern. Lobbying city officials is no guarantee
that they will set public health alongside real estate prices in
making zoning decisions. Involving other activists and researchers
in related health and environmental fields will not necessarily
achieve the critical mass necessary for visible changes in policy.
But these efforts are not meant to be undertaken in isolation. Together,
they stand a good chance of pushing forward the necessary changes
in thought and policy. If we do not have the power of speed, at
least we can have the power of persistence.
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