Leading for Health Equity
remediation efforts will have to be intentional and directed through laws, regulations and changes in societal attitudes. In other words,“ Reducing macro-level inequalities in health will require macro-level interventions” and foresight.
Societal changes are not likely to come about in the absence of empathy and an understanding of the challenges faced by those most affected by pollution. There are members of our community who don’ t fully grasp the impact of pollution on their neighbors, and I suspect that this may also be true for some physicians. The Earth and Spirit Center through the Environmental Justice Tour and Workshop provides an opportunity to get first-hand exposure and a better understanding of the connection between environmental challenges, the health of our bodies and our communities and issues of race, income and justice. This program is conducted by Tim Darst and includes a workshop and a bus tour through West Louisville and the Lee’ s Lane Landfill Superfund site. For information, email info @ earthandspiritcenter. org or call The Earth and Spirit Center at 502-452-2748.
As medical professionals, we can lend our expertise and knowledge to grassroot environmental organizations at both the local and national level. These groups engage with quasi government agencies, regulators, businesses and policy makers. communities. Air pollutants can disperse freely throughout a region. However, the impact of air pollution is amplified in these communities because of proximity to the source and therefore greater exposure to the pollutants, coupled with the limitations posed by socio-political determinants of health.
Levels of 18 airborne Volatile Organic Compounds( VOC) obtained using the Health Impact Evaluation Tool( HIET) from two different zip codes in Jefferson County highlight the significance of proximity. Figure 1 shows VOC levels for ZIP code 40059, a predominately white area in the East End of Jefferson County, and Figure 2 shows VOC levels for ZIP code 40203, a predominantly African American neighborhood in the Rubbertown area. There was only one VOC outside of the acceptable range in 40059, compared to 16 in 40203.
It’ s not only how you live – but where you live.
Those factors contributing to the disparity in health caused by pollution are not immutable. Rather, they can be remediated and are“ responsive to political, social and economic changes.” This may require weighing the economic benefits and convenience for one segment of the population against the expense of the health of another. Therefore,
Nationally, groups such as“ Greenaction for Health and Environmental Justice”( greenaction. org) and“ Center for Health, Environment, and Justice”( chej. org) have proven records of working with disparate groups and have achieved measures of success. Locally, organizations such as the Louisville Climate Action Network( www. louisvillecan. org) and the West Jefferson County Community Task Force have been successful in working with all stakeholders in identifying environmental concerns, educating the residents and working towards equitable solutions.
If information is knowledge, then The Health Impact Evaluation Tool( HEIT) is an eye-opening experience. This is a relatively straightforward web-based tool that lists the levels of 18 different airborne Volatile Organic Compounds( VOCs) within a specified zip code and provides information on the health effects of each one of the compounds.
The generated report is presented in an easy-to-understand color coded table with recommendations regarding the next steps to be taken. If a particular VOC line is shaded green, then that VOC is within the acceptable risk range. However, if a VOC line is shaded either yellow or red, then the measured level is outside of the acceptable range, and the patient should seek a health screening.
Armed with the VOC information, users can then plan their activities to both minimize exposure and potential exacerbation of underlying medical conditions. This tool can also be used by providers as an aid in determining the patients’ exposure and their risk assessment.
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