October 13, 2025
Health inequality in the United States is shaped not only by individual behaviour or biology, but also by social, economic, and environmental structures. Within this framework, the unequal incidence of lung cancer among populations exposed to pollutants through work or hazardous living conditions reveals a profound moral and structural injustice. The very people most likely to develop environmentally induced cancers are often those least able to access or afford treatment - a disparity that reflects both economic exclusion and what anthropologist Paul Farmer (2004) termed ‘structural violence.‘
Environmental exposure remains a major determinant of lung cancer risk beyond tobacco use. Communities located near industrial sites, highways, and waste facilities face elevated levels of carcinogenic pollutants such as fine particulate matter (PM2.5), asbestos, and diesel exhaust (United States Environmental Protection Agency, 2023). These exposure patterns are not always accidental; they are often the outcome of historical processes of segregation, zoning, and industrial siting that have long burdened low-income and minority communities disproportionately (Bullard, 2000; Hicken, Hedwig and Sampson, 2021).
Workers in construction, manufacturing, and mining are similarly exposed to hazardous substances. Yet, as Farmer (2005) argues, structural inequalities render certain bodies more “disposable” than others: economic necessity compels many to accept dangerous labour conditions, while systemic neglect ensures that protective enforcement remains weak (Centers for Disease Control and Prevention, 2022). Thus, occupational illness is not an isolated misfortune but often a predictable outcome of social hierarchies.
Anthropological and public health research alike highlight the compounding effects of poverty on health outcomes. In the U.S. healthcare system, where access depends heavily on financial capacity, treatment for lung cancer can often exceed $200,000 per patient, placing it out of reach for many (National Cancer Institute, 2023). For those without comprehensive insurance, seeking care can mean catastrophic debt or foregoing treatment entirely.
The unequal distribution of environmental hazards corresponds with what Merrill Singer and colleagues (2017) identify as the social ecology of disease, wherein environmental, social, and political forces shape patterns of illness. The phenomenon of environmental racism - the systematic exposure of minority and low-income communities to pollutants - exemplifies this (Bullard, 2000; Gee and Payne-Sturges, 2004).
For residents of such communities, the impact is not only biological but experiential.
Anthropologists like Nancy Scheper-Hughes and Margaret Lock (1987) have described how suffering becomes “embodied”, literally inscribed on the physical body. This can manifest in mental and physical illness, body conduct or observed traits. Unevenly distributed lung cancer rates as a result of environmental racism and social inequity is an example of this. Following this, Adriana Petryna’s (2002) work on biological citizenship illustrates how illness caused by state or industrial neglect forces individuals to navigate complex bureaucracies in pursuit of recognition and care. Within the U.S. context, low-income lung cancer patients exposed to environmental pollutants often lack both political and biomedical avenues for redress, exemplifying Petryna’s concept of the unequal “right to health.”
Paul Farmer (2004) conceptualises structural violence as the patterned ways in which social arrangements harm or disadvantage individuals. The intersection of environmental exposure and healthcare inaccessibility embodies this form of violence. It is not a matter of personal failure or random misfortune but of political and economic systems that privilege profit over protection. The fact that communities most at risk for environmentally induced lung cancer are also those most excluded from high-quality healthcare represents a failure of both public health and moral responsibility.
Another layer added to this comes from Didien Fassin (2012), who argues that this form of injustice also involves an unequal distribution of compassion — what he calls the moral economy of life. Certain populations are deemed more “deserving” of care and protection than others, a hierarchy reflected in policy priorities and media attention. The invisibility of environmentally induced illness in public discourse perpetuates the marginalisation of those who suffer from it. The perpetuation of this by a chunk of society may well be unconscious, but even this aids in replicating inequality.
Confronting this injustice requires integrating environmental regulation with health equity and social justice frameworks. Strengthened environmental protections, strict enforcement of workplace safety standards, and expanded healthcare access are essential starting points (National Academies of Sciences, Engineering, and Medicine, 2022). Yet, as anthropologists emphasise, meaningful reform also demands attention to lived experience, community knowledge, and the political economy of health.
The unequal burden of lung cancer in the United States reflects more than environmental neglect or healthcare inequity; it reveals deep-seated social hierarchies and moral exclusions. Through the lens of anthropology, these disparities can be understood as forms of structural violence that render certain lives more vulnerable to both illness and abandonment.
Achieving justice requires more than technical reform. It demands recognising that the right to breathe clean air and the right to receive medical care are inseparable - and that denying either is a violation not just of policy, but of humanity itself.
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