Correlation between the disproportionate occurrence of asthma

A STUDY OF ASTHMA AS A SOCIO-ECONOMIC
HEALTH DISPARITY AMONG MINORITY
COMMUNITIES
Gray, Lolita D; Johnson, Glenn S . Race, Gender & Class ; New Orleans Vol. 22, Iss. 1/2, (2015): 337-357.
ProQuest document link
ABSTRACT (ENGLISH)
This study examines the correlation between the disproportionate occurrence of asthma and (1) Minorities and
persons residing in Low-Income Communities, (2) The Socio-Economic effect on the United States, and (3) The
need for the creation of a National Asthma Law. The overriding theory asserts that in communities where lowincome and minority individuals reside, there is a disproportionate exposure to environmental health hazards,
which has lead to an epidemic increase in the occurrence of asthma among minorities and persons living these
communities. Asthma costs the United States $56 billion each year. Therefore, through policy research,
conducting quantitative and qualitative studies, as well as, the inclusion of significant seminal data, this study
seeks to raise the awareness of this health disparity and amplify the need for the creation of a national asthma law
that specifically address this disparate impact.
FULL TEXT
Headnote
Abstract: This study examines the correlation between the disproportionate occurrence of asthma and (1)
Minorities and persons residing in Low-Income Communities, (2) The Socio-Economic effect on the United States,
and (3) The need for the creation of a National Asthma Law. The overriding theory asserts that in communities
where low-income and minority individuals reside, there is a disproportionate exposure to environmental health
hazards, which has lead to an epidemic increase in the occurrence of asthma among minorities and persons living
these communities. Asthma costs the United States $56 billion each year. Therefore, through policy research,
conducting quantitative and qualitative studies, as well as, the inclusion of significant seminal data, this study
seeks to raise the awareness of this health disparity and amplify the need for the creation of a national asthma law
that specifically address this disparate impact.
Keywords: asthma disparities; asthma laws; environmental health; environmental justice
As harmful elements detected in everyday household items increase, rates of chronic diseases have also risen
sharply. These conditions are the leading causes of childhood illnesses and death. As such, this study seeks to
examine the sociological impact of asthma as a health disparity. Air pollution and cigarette smoke contribute to
asthma, the most common chronic disease of childhood; and asthma has increased 160 percent within the last 15
years for children under 5. Moreover, children with asthma, in particular, are at risk for more respiratory diseases,
increased medication use, chronic phlegm, and bronchitis; following exposure to high levels of particulate
pollution. In urban areas, a decrease in air quality can result in increased hospitalizations for asthmatics
(Chatham-Stephens, Mann et al., 2012). Currently, an estimated 25.9 million people, including almost 7.1 million
children, have asthma. Of these percentages, asthma prevalence is higher among persons with family incomes
below the poverty level (CDC, 2012). Figure 1 depicts the most current poverty level as determined by the
Department of Health and Human Services:
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According to the Environmental Protection Agency (EPA), African Americans continue to have higher rates of
asthma emergency department visits, hospitalizations, and deaths than do Caucasians. Based upon EPA
statistical reporting,
. The rate of emergency department visits is 330% higher.
. The hospitalization rate is 220% higher.
. The asthma death rate is 180% higher. (EPA, 2013)
Too, the Center for Disease Control and Prevention (CDC) reports,
* Asthma is one of the most common serious chronic diseases of childhood.
* Asthma is the third-ranking cause of hospitalization among children under 15.
* An average of one out of every 10 school-aged children has asthma. (CDC, 2012).
Moreover, the CDC reports that over 10 million U.S. children under age 18 (14%) have ever been diagnosed with
asthma; 7.0 million children still have asthma (10%). Non-Hispanic black children were more likely to have ever
been diagnosed with asthma (21%) and to still have asthma (16%) than Hispanic (15% and 10%) or non-Hispanic
white (12% and 8%) children. And, children in poor families were more likely to have ever been diagnosed with
asthma (18%) or to still have asthma (13%) than children in families that were not poor (12% and 8%) (CDC, 2012).
Data on age-related susceptibility to environmental insults are more robust now than in the past. Differential
exposures and developing organ system of infants and children put them at higher risk that adjusts for several
environmental toxicants; one of these risks is the contracting of asthma. (2010). Specific to this research, this risk
is more prevalent among minorities. As such, this study advocates for the determination of a causal relationship
between living in close proximity to toxic pollutants and the disproportionate occurrence of asthma among
minority children, thereby, magnifying the need for environmental health asthma laws that directly and effectively
address this issue.
Linkage of Asthma and Environmental Health Hazards
Numerable studies providing factual evidence of the correlation between environmental health hazards and the
occurrence of asthma have been conducted. However, this research advances that more efforts need to be taken
to determine that there is a causal relationship between environmental health hazards and the occurrence of
asthma. Moreover, this enigma appears disproportionately among minority youth. Following this particular strand,
this research advocates for the creation and implementation of environmental health asthma laws that are
enacted to effectively address this issue. In an article entitled, “Environmental Factors Influencing Public Health
and Medicine: Policy Implications,” the authors put forth, “To effectively respond to the growing concerns about
the role of the environment and human health, clinicians, researchers, educators, public policy officials, and the
general public must join together to reduce the risk of environmental health threats and improve quality of life
(Warren, Walker, &Nathan, 2002).
Exposure to environmental agents has emerged as key among the determinants of environmental related disease
and dysfunctions. There is also concern about the adverse health effects of multiple chemical exposures to
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populations already overburdened with chronic diseases. These populations have limited geographic and financial
access to health services. Approximately 40,000 hazardous waste sites have been identified by federal regulatory
authorities; some 1,200 have been classified as posing significant risk to human health (Warren, Walker, &Nathan,
2002). These neighborhoods are often disproportionately communities of color or communities where low-income
people live. The Institute of Medicine calls these neighborhoods “communities of concern.” This study also
suggests the use of biomarkers, which are measurable presences of an exogenous substance, its metabolite, or
the product of its interaction with a target molecule or cell to support research agenda. The study also posits that
there is a potential for injury due to inhaled environmental particles among different areas of the respiratory tract.
(Warren, Walker, &Nathan, 2002). While this study is not a scientific one, its purpose is to emphasize the biological
effects caused by environmental health hazards that result in asthma disparities.
As reported by the U.S. Department of Health and Human Services (HHS), studies are underway to document and
evaluate health effects in contaminantrelated exposures. As asserted by the HHS, no matter how toxic, no
chemical can harm a person (child, adult, or both) unless exposure occurs. After a sufficient level of exposure
(dose) to the chemical, biologic uptake, target organ contact, and biologic change can occur, all of which can lead
to disease or other effects (U.S. Dept. of Health and Human Services, 2013). To this end, this study will focus on
the linkage between toxic pollutants and the occurrence of asthma.
Various studies have been focused on toxic exposure and environmental health hazards. For example, Manuel
Pastor Jr., Rachel Morello-Frosch, and James L. Sadd, found that there exists a link between toxic pollutants and
asthma, which they presented in their article, “Breathless: Schools, Air Toxics, and Environmental Justice in
California” (Pastor Jr., Morello-Frosch, &Sadd, 2006). Comparable to these findings, Paul Mohai, Byoung-Suk
Kweon, Sangyun Lee and Kerry Ard, in their examination of the extent of air pollution from industrial sources
around public schools in Michigan to find out if this air pollution jeopardized children’s health and academic
performance, asserted that exposing children to environmental pollutants during times of physiological
development can lead to long-lasting health problems, dysfunction, and disease (Mohai et al., 2011).
Consistent with the findings of the previous studies discussed in this article, Phil Brown, Brian Mayer, Stephen
Zavestoski, et al., claim that “asthma rates have risen so much in the United States that medical and public health
officials invariably speak of asthma as a new epidemic.” In their document entitled, “The Health Politics of Asthma:
Environmental Justice and Collective Illness Experience,” these authors state:
The number of individuals with asthma in the United States grew 73.9 percent between 1980 and 1996, with an
estimated 14.6 million people reported suffering from asthma in 1996. This is widely believed to be a real increase,
not an artifact of diagnosis. In the same period hospitalizations for asthma rose 20 percent, and by 1995 there
were 1.8 million emergency room visits a year. The estimated cost to society from asthma is greater than $11
billion a year. As the number of cases has increased, medical and public health professionals and institutions have
expanded their treatment and prevention efforts, environmental and community activists have made asthma a
major part of their agenda, and media coverage has grown (Brown, Mayer, et al., 2005).
Now that we have submitted evidentiary studies that suggest there is a linkage between asthma and toxic
pollutants, we will identify and examine several public policies that can be used to address this asthma issue.
Examination of Specific Public Policies that Can Be Applicable to Addressing Asthma Disparities
This article will provide an examination of specific enacted polices that can be adopted to address the asthma
issue discussed in this work. Further, this examination incorporates an eventual history of these policies, the
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purpose for their enactment, and the scope and ability of the policies to effectively obviate the asthma issue.
Asthma statistical data, based on studies conducted within the United States, will be employed to present a
comparative analysis of the disproportionate occurrence of asthma among minority populations. These variables
will be juxtaposed within the policy analysis.
Title VI of the Civil Rights Act
Declaring that the struggle for civil rights is not over, some of the nation’s most foremost experts on environmental
justice declared, “We are demanding immediate action and enforcement of Title VI of the Civil Rights Act of 1964
and other equal protection laws,” during a press conference held in Washington, D.C. (EJRC, 2009). This legislation
Declares it to be the policy of the United States that discrimination on the ground of race, color, or national origin
shall not occur in connection with programs and activities receiving federal financial assistance, and authorizes
and directs the involved federal departments and agencies to take action to carry out this policy. Title VI prohibits
discrimination whether intentional or where the unintended effect is unduly burdensome (U.S. Dept. of
Transportation, 2010).
Examination of Title VI of Civil Rights Act of 1964
In July 1964, Congress passed the Civil Rights Act of 1964. Title VI of the Civil Rights Act states that “No person in
the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied
the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial
assistance.”
The goal of Title VI of the Civil Rights Act of 1964 is to prohibit discrimination on the basis of race, color, or
national origin in programs and activities receiving Federal financial assistance. Specifically, Title VI provides that
“no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation
in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal
financial assistance” (U.S. Dept. of Transportation, 2010). In a ground-breaking action, Attorney Linda McKeever
Bullard, on behalf of the residents of Houston’s Northwood Manor, brought the nation’s first lawsuit that
challenged the siting of a waste facility based on violations of the civil rights laws. In moving for a preliminary
injunction, Ms. Bullard argued that locating a garbage dump in the plaintiffs’ mostly African- American community
was an act of racial discrimination in violation of Section 1983 of the Civil Rights Act of 1871. This lawsuit served
as a catalyst for the legal arm of the environmental justice movement (Rainey-Brown &Johnson., 2011).
Notably, this law does not directly address asthma. When used as a basis for legal action in environmental justice
cases, application was based upon equity issues and to address perceived discriminatory matters. As stated by
Julia B. Latham Worsham in her article, “Disparate Impact Lawsuits Under Title VI, Section 602: Can A Legal Tool
Build Environmental Justice?” “The same parallels between traditional civil rights challenges and environmental
justice challenges that make equal protection claims appealing for plaintiffs also make other civil rights causes of
action compelling.” Most intriguingly, Worsham puts forth that plaintiffs proceeding under the statutory provisions
of various civil rights Acts may be relieved of the heavy burden of proving intent to discriminate. To that end, Title
VI began to emerge as a possible tool for environmental justice challenges in the early to mid-1990s. At that time,
leading environmental justice commentators observed that Title VI had “promise” and a “potentially great” reach.
However, it was only within the past few years that several judicial and administrative decisions interpreted Title
VI, specifically, as it applies to discriminatory siting decisions. These developments may threaten the efficacy of
Title VI in environmental justice suits because they could be interpreted to limit significantly the meaning of
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“disparate impact” and the very legitimacy of a private cause of action for such claims (Worsham, 2009).
The question of who has standing to sue under Title VI is actually an issue of discerning the “breadth of the
statute’s prohibition on discrimination.” How courts determine this parameter, however, is not settled. Courts have
applied four different standards in deciding whether a plaintiffmay bring a private action under Title VI: (1) whether
the plaintiffis the “intended beneficiary” of the federal funds in question; (2) whether the discrimination inflicted on
the plaintiffwill harm the intended beneficiaries of the statute; (3) “whether the plaintiffcan show actual harm
attributed to an allegedly illegal act committed by the administrators of a federallyfunded program which could be
remedied by a federal court;” and (4) whether the plaintiff’s interests fall within the zone of interests that Title VI is
designed to protect, i.e., a person being discriminated in the administration of a federally funded program.
Additionally, to have standing to request injunctive relief (but not monetary damages), community organizations
representing impacted residents must show that they meet three requirements: (1) the members would have
standing to bring suit individually; (2) the interests that the group acts to protect are germane to the purpose of the
group; and (3) the claim asserted or the relief requested necessitates the involvement of individual group members
in the suit (Worsham, 2009). The case, Bean v. Southwestern Waste Management Corporation, (1982) launched the
use of the courts as a tool for the new movement and highlighted the need for data collection and access to
information by communities challenging environmental decisions (Johnson &Rainey-Brown, 2011).
Such criticisms became more important in light of the Supreme Court’s decision in Alexander v. Sandoval (2001),
finding that individual plaintiffs had no private right of action to enforce EPA’s disparate impact regulations
directly in court. With doctrinal developments that make it more difficult for private citizens to directly enforce
EPA’s Title VI disparate impact regulations, those wronged will have to place more reliance on administrative
remedies to vindicate their interests. Attention to this weakness was emphasized by environmental justice
advocates in their letter to members of Congress in which they asked Congress to “Provide a Legislative Fix for
Title VI of the Civil Rights Act of 1964 that was gutted by the 2001 Alexander v. Sandoval U.S. Supreme Court
decision that requires intent, rather than disparate impact, to prove discrimination.” Nonetheless, EPA’s Title VI
Guidance is one of the few attempts to articulate substantive decision-making criteria for government officials
(and industry) interested in acting responsibly with regard to the concerns of the environmental justice movement
(Bullard et al., 2007).
Executive Order 12898
In 1994, former U.S. President William J. Clinton (Bill) issued Executive Order 12898- Federal Actions To Address
Environmental Justice in Minority Populations and Low-Income Populations. Section 1-1 Implementation
establishes the Agency Responsibilities to be:
To the greatest extent practicable and permitted by law, and consistent with the principles set forth in the report
on the National Performance Review, each Federal Agency shall make achieving environmental justice part of its
mission by identifying and addressing, as appropriate, disproportionately high and adverse human health or
environmental effects of its programs, policies, and activities on minority populations, and low-income populations
in the United States and its territories and possessions, the District of Columbia, the Commonwealth of Puerto
Rico, and Commonwealth of the Mariana Islands (Executive Order 12898, 1994).
Examination of Executive Order 12898
Essentially, Executive Order 12898 was created to address disproportionate impacts in minority and low-income
communities. This legislation was embraced by the Environmental Justice Movement (EJM) as a celebrated
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milestone in their mission to achieve environmental justice and equal environmental policy protection in lowincome and minority communities.
In examining this policy, we found neither the term “asthma,” nor the terms “toxic dumps/pollutants” mentioned in
this Order. One would wonder why this particular legislation was received so favorably by members of the EJM as
crucial and progressive to their movement; which it very well may be. As written; however, the Order generally
refers to addressing inequities in minority communities in Section 1-102(b) stating, “The Working Group shall: (1)
provide guidance to Federal agencies on criteria for identifying disproportionately high and adverse human health
or environmental effects on minority populations and lowincome populations” (Executive Order 12898, 1994).
In Sandra George O’Neil’s “Superfund: Evaluating the Impact of Executive Order 12898,” she postulates that the
U.S. Environmental Protection Agency (EPA) addresses uncontrolled and abandoned hazardous waste sites
throughout the country. Sites that are perceived to be a significant threat to both surrounding populations and the
environment can be placed on the U.S. EPA Superfund list and qualify for federal cleanup funds. The equitability of
the Superfund program has been questioned; the representation of minority and low-income populations in this
cleanup program is lower than would be expected. Thus, minorities and lowincome populations may not be
benefiting proportionately from this environmental cleanup program. In 1994 President Clinton signed Executive
Order 12898 requiring that the U.S. EPA and other federal agencies implement environmental justice policies.
These policies were to specifically address the disproportionate environmental effects of federal programs and
policies on minority and low-income populations.
Relative to environmental health issues, O’Neil further states, “Although the specific ways in which toxins in the
ground, water, or air produce adverse health effects in humans are still disputed, the toxicity of such sites and
potential risks posed to human populations and the environment certainly warrant attention.” According to O’Neil,
The Order specifically demands that agencies, including the U.S. EPA, ensure that their policies and programs do
not disproportionately affect minorities and the poor. However, whether the agency has complied with this Order
and to what degree has been questioned (O’Neil, 2007).
The Clean Air Act of 1970
The Clean Air Act of 1970 (CAA) is the law that defines EPA’s responsibilities for protecting and improving the
nation’s air quality and the stratospheric ozone layer. As of this writing, the EPA has celebrated the 40th
anniversary of the Clean Air Act. The last major change in the law, The Clean Air Act Amendments of 1990, was
enacted by Congress in 1990. During the study, this law was referred to several times in interviews as well as in
responses to the survey instrument.
The Clean Air Act, like other laws enacted by Congress, was incorporated into the United States Code as Title 42,
Chapter 85. The House of Representatives maintains a current version of the U.S. Code, which includes Clean Air
Act changes enacted since 1990. The purposes of this law is to 1) to protect public health and welfare from any
actual or potential adverse effect which in the Administrator’s judgment may reasonably be anticipated to occur
from air pollution or from exposures to pollutants in other media, which pollutants originate as emissions to the
ambient air), notwithstanding attainment and maintenance of all national ambient air quality standards, 2) to
preserve, protect, and enhance the air quality in national parks, national wilderness areas, national monuments,
national seashores, and other areas of special national or regional natural, recreational, scenic, or historic value, 3)
to insure that economic growth will occur in a manner consistent with the preservation of existing clean air
resources, 4) to assure that emissions from any source in any State will not interfere with any portion of the
applicable implementation plan to prevent significant deterioration of air quality for any other State, and 5) to
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assure that any decision to permit increased air pollution in any area to which this section applies is made only
after careful evaluation of all the consequences of such a decision and after adequate procedural opportunities for
informed public participation in the decision-making process (EPA, 2012).
Examination of the Clean Air Act
Although cited from various participants of this study, the Clean Air Act does not specifically address toxic dumps
and the occurrence of asthma; its focus is air pollution prevention and control. Asthma is not mentioned in this
Act; however, insofar as air pollutants and ambient air quality, asthma occurrences can be inferred. According to
the EPA, The Clean Air Act (CAA) is the comprehensive federal law that regulates air emissions from stationary and
mobile sources. Among other things, the law authorizes EPA to establish National Ambient Air Quality Standards
(NAAQS) to protect public health and public welfare and to regulate emissions of hazardous air pollutants.
In spite of the fact that “asthma” is not mentioned in the text of the Act, a big part of controlling asthma means
cleaning up the air. (Lyon &Madrid, 2011) Therefore, it is conceivable why participants would include this policy
when asked about public policies enacted to address the asthma issue. To this end, the Clean Air Act addresses
the increase in asthma; however, the lens through which it addresses this increase focuses on air toxics.
Therefore, we assert that there is a need for the enactment of a national law that specifically addresses the
disproportionate increase in asthma among minorities and those residing in lowincome communities. This appeal
was made by Bullard et al. (2007) in their report, “Toxic Waste and Race at Twenty: 1987-2007 Grassroots
Struggles to Dismantle Environmental Racism in the United States.” In this report, advocates sought to establish
an unequivocal legal mandate and impose federal responsibility by asking Congress to codify Executive Order
12898 (Bullard et al., 2007). As of the writing of this article, Executive Order (EO) 12898 has not been codified.
Therefore, it remains that no legal cause of action can be brought in a court of law using this Order as law.
The National Environmental Policy Act of 1969
The National Environmental Policy Act (NEPA) [42 U.S.C. 4321 et seq.] was signed into law on January 1, 1970. The
Act establishes national environmental policy and goals for the protection, maintenance, and enhancement of the
environment and provides a process for implementing these goals within the federal agencies. The Act also
establishes the Council on Environmental Quality (CEQ). The National Environmental Policy Act (NEPA) requires
federal agencies to integrate environmental values into their decision making processes by considering the
environmental impacts of their proposed actions and reasonable alternatives to those actions.
Examination of the National Environmental Policy Act of 1969
The purposes of the National Environmental Policy Act of 1969 are 1) to declare a national policy which will
encourage productive and enjoyable harmony between man and his environment, 2) to promote efforts which will
prevent or eliminate damage to the environment and biosphere and stimulate the health and welfare of man, 3) to
enrich the understanding of the ecological systems and natural resources important to the Nation, and 4) to
establish a Council on Environmental Quality (NEPA, 2008). Comparable to the Civil Rights Act, the Clean Air Act
and the Executive Order 12898, this Act also does not specifically mention asthma or toxic dumps. Consistent with
these Acts, the asthma issue can be inferred under broad, general terms.
Relative to this case study, the Act states,
The Congress, recognizing the profound impact of man’s activity on the interrelations of all components of the
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natural environment, particularly the profound influences of population growth, high-density urbanization,
industrial expansion, resource exploitation, and new and expanding technological advances and recognizing
further the critical importance of restoring and maintaining environmental quality to the overall welfare and
development of man, declares that it is the continuing policy of the Federal Government, in cooperation with State
and local governments, and other concerned public and private organizations, to use all practicable means and
measures, including financial and technical assistance, in a manner calculated to foster and promote the general
welfare, to create and maintain conditions under which man and nature can exist in productive harmony, and fulfill
the social, economic, and other requirements of present and future generations of Americans (NEPA, 2008).
As stated in the Act, “In order to carry out the policy set forth in this Act,” one of its objectives as it relates to this
study, is to, “Attain the widest range of beneficial uses of the environment without degradation, risk to health or
safety, or other undesirable and unintended consequences” (NEPA, 2008)
Limitations of the Study
Many states, especially those with high levels of toxic releases, fail to adequately track cases of cancer, birth
defects, asthma and other chronic diseases. Only three states, California, Iowa and Massachusetts possess
cancer and birth defects registries that meet the highest standards for quality as well as any system at all for the
tracking of asthma cases. As a result, researchers, health officials, and the public cannot adequately determine
whether disease rates show patterns reflecting the release of high quantities of chemicals linked to those diseases
(U.S. PIRG, 2010). Likewise, a recent report by the CDC recognizes many of these same issues claiming that the
measurement of an environmental chemical in a person’s blood or urine does not by itself mean that the chemical
causes diseases. For any particular community, understanding the potential health threats that could result from
toxic releases is a nearly impossible task. Public health officials often lack sufficient understanding of how
citizens have been exposed to toxic substances, how those substances work within the body, and how many
people have contracted chronic disease (Krieg &Faber, 2004).
Notwithstanding, the authors acknowledge that environmental inequity is not only experienced by minorities. To
this point, Mary M. Timney argued the fact that in Ohio, a high percentage of poor is white Appalachians or bluecollar ethnics who live in the most polluted areas along with Blacks and minorities (Timney, 1998). Although,
research supports that non-minorities have been significantly less impacted by environmental inequities; this
demographic have been impacted. Therefore, we put forth that environmental health asthma laws would not only
benefit minorities, but also some non-minorities.
Plaintiffgroups have successfully asserted their common law tort rights, such as public or private nuisance or
personal injury, against industrial or hazardous waste facilities in addition to challenging siting permits under
traditional environmental laws. Such suits, however, may present significant barriers to minority communities as
plaintiffs. First, because the plaintiffmust prove intentional or unreasonable conduct by the defendant when
bringing a public nuisance claim, liability may be hard to establish where the facility is operating in compliance
with validly issued environmental permits. Second, because the plaintiffmust have a property interest to bring a
private nuisance action, many environmental justice plaintiffs may not have standing for this cause of action.
Third, causation in personal injury claims may present a difficult hurdle for plaintiffs due to a lack of information
concerning the health effects of toxins. Lastly, because common law tort claims are typically geared towards the
complaints of individual plaintiffs, with the exception of public nuisance, minority communities may find such suits
frustrating and divisive (2009).
In addition to applying environmental and tort law, environmental justice lawyers also have attempted to establish
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environmental inequity in the siting of facilities as a violation of the United States Constitution. Quoting Attorney,
Luke Cole, in PRI’s Environmental Justice News Magazine’s interview on a segment entitled, “Toxic Waste and Civil
Rights II,”
Well, in civil rights law, there are two different standards, two different burdens of proof. One is proving
discriminatory intent, and the other is proving discriminatory impact. All of the cases that have been reported so
far have alleged violations of the Fourteenth Amendment of the Constitution, that is, violations of the equal
protection clause. Now that requires a proof of discriminatory intent by government decision makers. It’s very
difficult to find the kind of smoking gun, to find a legislator who’s said, on the record, ‘I’m doing this because it’s
the black people who live there’, or ‘the Latino people who live there’. The strength of Title Six-actually, regulations
under Title Six that are promulgated by government agencies such as the EPA, Department of the Interior,
Department of Agriculture, Department of Defense-all have discriminatory impact clauses. So that if a community
can show that a government decision is going to have a discriminatory impact-that is, say, the black community is
going to get more of the burden from a toxic waste site than the white community-then that is actionable under
these regulations (Cole, 1994).
Evidence strongly supports that human exposure to toxic pollutants constitutes a significant threat to health and
leads to increased risk of many different diseases. In a study conducted by Kudyakov, Baibergenova, Sdeb, and
Carpenter, the hypothesis tested there was that living in a zip code containing or abutting a Persistent Organic
Pollutant (POP)-contaminant zip code poses a risk of exposure, and that such exposure increase the risk of
hospitalization for both acute and chronic respiratory diseases of an infectious origin. The most serious limitations
to their study was said to be exposure assessment. Nonetheless, this reports states that their hypothesis is not
without support from other studies (Kudyakov, Baibergenova, Zdeb, et al., 2004). Their hypothesis and postulation
is aligned with the research questions posed within this case study. Many environmental factors are associated
with the exacerbation and/or development of asthma.
As observed by pioneers of the environmental justice movement, polluters tend to take the path of least resistance
when making decisions regarding the siting of toxic dumps. This researcher posits that stronger penalties should
be imposed on the polluters and equally enforced for all communities. Whereas, causation is more difficult to
prove than correlation, this researcher posits that more studies conducted on this asthma issue may increasingly
magnify the existence of a definitive linkage of exposure to toxic dumps and the occurrence of asthma and
determine the existence of a causal relationship and the disproportionate socioeconomic impact of asthma on
minority communities. Grassroots organizations should form coalitions whose purpose is to serve as watchdogs
and monitor actions of polluters as well as policy makers. Community involvement can play a key role in
advocating for stronger policies as this involvement can bring about increased civic participation. Community
members can coalesce and serve as watchdogs of their communities and monitor the siting of toxic dumps within
their communities. Increased civic participation can narrow the path of least resistance. Notably, the
Environmental Justice Movement has been successful in facing numerous and problematic challenges and
overcoming difficult milestones.
Former U.S. President, Franklin D. Roosevelt’s Great Society Programs notably sought to eliminate poverty just as
Title VI of the Civil Rights Act of 1964, The Clean Air Act, Executive Order 12898, and the National Environmental
Policy Act all sought to eliminate discrimination and environmental degradation. Just as it became clear that the
Great Society Programs did not eliminate poverty, actually fell very short of this goal, these Acts have also been
ineffective in addressing the asthma disparities associated with environmental hazards. Accountability of the
Great Society Programs were sought, just as accountability of these Acts should be sought in how effective they
have been the decreasing the disproportionate socioeconomic impact of asthma among minority youth.
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Discussion
As this article purports, there exists a disproportionate increase in asthma among minority youth residing in
minority communities. Too, this research study reveals that numerous studies underscore that minority youth have
been disproportionately affected by the occurrence of asthma. The results of the findings using qualitative,
quantitative and statistical data, this observable fact has remained constant throughout this study. This research
process employed within this study follows Neil J. Salkind’s guide:
ØAsking the Question
ØIdentifying the Important Factors
ØFormulating a Hypothesis
ØCollecting Relevant Information
ØTesting the Hypothesis
ØWorking the Hypothesis
ØReconsidering the Theory
ØAsking New Questions (Salkind, 2003).
In order to more effectively reduce disparate environmental exposure, the EPA has committed and engaged
relevant constituencies in participation processes early, provide these constituencies with the resources and
information that can contribute to effective participation, and ensure that the outcomes reflect participation.
Specifically, helping communities develop the capacities to create, access, use, and interpret scientific information
and changing Agency practices to better incorporate community voices in scientific activities and decisions will be
a key and proper task for EPA. Therefore, the EPA proposes to establish programs and provide federal government
support to increase technical and scientific capacity in communities (EPA, 2013).
As put forth by the EPA, communities must be the driver for local solutions. However, the EPA asserts that far too
many communities lack the capacity to truly change environmental conditions for the better. As a result, many
low-income, minority, tribal, and indigenous communities in the United States live near areas affected by some of
the nation’s worst pollution (EPA, 2013). To this end, the EPA seeks to implement programs to support community
empowerment and provide benefits ranging from basic educational and leadership development to comprehensive
approaches, which includes Community-based programs; such as, Childhood Asthma, Superfund, and Brownfields
(EPA, 2013).
Of the strategies the EPA has developed to accomplish these goals, those most pertinent to this case study are 1)
Advance environmental justice principles by building strong state and tribal partnerships through the National
Environmental Performance Partnership System (NEPPS) and National Program Manager (NPM) guidance, 2)
Promote an integrated EPA presence to engage communities in the Agency’s work to protect human health and
the environment, and 3) Explore how EPA funding, policies and programs can inform or help local decision-makers
to maximize benefits and minimize adverse impacts from land use decision-making, planning and siting (EPA,
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2013).
Findings of this study suggest that many environmental factors are associated with the exacerbation and/or
development of asthma. The distinction between primary causation and subsequent morbidity is critical. Most
prevention measures, with the notable exception of discouraging smoking during pregnancy and around young
non-asthmatic children, are aimed exclusively at preventing exacerbations in asthmatic patients. However, there is
strong epidemiological evidence indicating that there is a direct role of environmental factors in the etiology and
exacerbation of asthma. Conversely, the evidence supporting the effectiveness of interventions directed at
environmental factors is modest. Therefore, clinicians, policy-makers, and public health officials should convene
and set an agenda for the development of an aggressive public health approach to reduce some key environmental
factors. At the national and federal levels, there needs to be support for research to address critical unanswered
questions (Brugge, Hyde, et al., 2004).
Comparatively, the U.S. Department of Health and Human Services (HHS) is responsible for creating Healthy
People. This program comprises a set of goals and objectives with 10-year targets designed to guide national
health promotion and disease prevention efforts to improve the health of all people in the United States. Released
by the U.S. Department of Health and Human Services each decade, Healthy People reflects the idea that setting
objectives and providing science-based benchmarks to track and monitor progress can motivate and focus action.
Healthy People is used as a tool for strategic management by the federal government, states, communities, and
many other public- and private-sector partners. Its comprehensive set of objectives and targets is used to measure
progress for health issues in specific populations, and serves as (1) a foundation for prevention and wellness
activities across various sectors and within the federal government, and (2) a model for measurement at the state
and local levels (HHS, 2013).
The HHS has also created Healthy People 2020. This approach is intended to draw attention to “upstream”
determinants that affect the public’s health and contribute to health disparities from infancy through old age,
thereby highlighting strategic opportunities to improve health and quality of life for all Americans. Collectively,
Healthy People 2020’s overarching goals include:
1. Recognizing that factors related to social and physical environments, multisector policies, individual behaviors,
health services, and biology and genetics influence the ability of individuals and communities to make progress.
2. Examine leading health indicators by using a life stage perspective that recognizes that specific disease
outcomes, risk factors, and health determinants need to be addressed at various stages across the lifespan and
highlights the importance of tailoring strategies to fit a particular age group.
These goals are intended to motivate action at the national, State, and local levels, as well as among individuals,
families, and communities. They can also help us best focus our energies to live better and longer. The missions of
Healthy People include the engaging of multiple sectors to take actions to strengthen policies and improve
practices that are driven by the best available evidence and knowledge and identifying critical research, evaluation,
and data collection needs (2013). Organized units such as the one presented here can be crucial in the role of
advocating policies that address the asthma issue presented in this study.
Recommendations
This research incorporates the Environmental Justice Framework (EJF) as part of the theoretical framework for
this case study.
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Program evaluations are also critical. The call for reform and accountability in government and the need to cut the
costs of wasteful programs has made the evaluation process a central concern for managers, elected officials, and
the public. Evaluation can be considered as a systematic process that gathers information about and measures
the results of programs, policies, and organizations. The evaluation process can be considered to involve five basic
steps: 1) Identifying problems pertaining to the program or organization, 2) setting goals and making the goals of
the program or organization the basis for the evaluation and decision making about their result, 3) determining
beforehand what is being evaluated and the measurement criteria, 4) conducting the actual evaluation, and 5)
using the findings to inform any action about the program or organization (Watson, 2002).
As the studies examined in this research has supported the relationship between individuals living in close
proximity to toxic pollutants, there exist a growing need for more rigorous research to be conducted on the
linkages between environmental toxic pollutants and the occurrence of asthma. The 2000 Asthma in Georgia
Report confirmed that asthma is a major public health problem in Georgia, as it is in the rest of the nation. At that
time; however, because asthma was not contagious and not often fatal, few numbers were available about the
prevalence of asthma in Georgia. In my communication with the Deputy Director of Communication with the
Georgia Department of Public Health, I was advised The Georgia Department of Health collects data on asthma
from four (4) primary sources:
A. The Behavioral Risk Factor Surveillance System (BRFSS), which provides prevalence data and not incidence.
B. Hospital discharges
C. Emergency room visits
D. Death records
When asked whether or not health departments were mandated to report asthma occurrences, we were advised
that asthma is not a reportable disease (2010). However, given the findings of this research, it is the researchers’
assertion that mandates should be placed on health departments in their reporting of asthma cases; especially,
when it is found that a high number of cases are in minority neighborhoods. This information can be determined by
use of the patient’s zip code. Therefore, we would recommend more studies geared towards the linkage of asthma
and toxic dumps. The researchers are cognizant of research limitations; such as, the utilization of exposure and
proximity to toxic pollutants as determining factors. However, much research supports the existence of significant
linkages between toxic pollutants and asthma.
There is now extensive evidence that conditions before birth and in early childhood influence health in adult life.
Children are unable to choose the environment in which they live, their diet, living situation, and exposure to
pollutants. They also have a very limited ability to understand the long-term consequences of their behavior. Yet, it
is precisely during this crucial phase that many health behaviors are shaped. Speaking to this truism, asthma is
mostly underdiagnosed and under-treated (in particular in children), causing high morbidity and significant
mortality. Children of low socioeconomic status are more likely to require resources because of their asthma.
Many children with undiagnosed asthma miss school and require emergency department visits, albeit that those
with a current diagnosis of asthma report more resource use (World Health Organization, 2007).
As posited by Robert J. Brulle and David N. Pellow, scholars have amassed a considerable volume of studies
regarding (a) the nature of health disparities in the United States and (b) the nature of environmental inequality
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and the movements that seek environmental justice. However, these literatures are limited in their scope for a
number of reasons. First, the literature on the role of race and health has identified community characteristics as a
significant factor in the creation and maintenance of health disparities. However, the role of exposures to toxic
pollution on community health is nearly absent from this literature, except for an occasional acknowledgment that
research on the topic is sorely lacking. This lack is significant because it is well established that residential
segregation is a major mechanism contributing to environmental inequality, poverty, and health disparities in the
United States. Thus, it is highly likely that the stark spatial distribution of environmental disamenities in society
would also produce health disparities. Thus there is a critical need to integrate research on the impacts of
environmental inequality and exposure to environmental pollution into existing studies of community health and
health disparities (Brulle &Pellow, 2006). To this end, much of the body of research on asthma pertains to asthma
management and prevention of asthma attack. Specifically, we found that much of the research focuses on
prevalence, risk factors, and prevention and management (Blackwell, Wu, et al., 2003).
The EPA is aware of communities’ concerns about land use planning. To respond to these concerns, EPA has
committed to explore how programs affect land use planning, siting, permitting, and decision making in
overburdened communities. While land use planning is usually a local government responsibility, the EPA can
provide interested jurisdictions with information on best practices regarding policies and approaches that can
benefit all community stakeholders and minimize adverse impacts. In efforts to accomplish these objectives, the
EPA developed plan entitled, Environmental Justice, Plan EJ 2014. This plan is constructed as a roadmap for
integrating environmental justice into its programs and policies as indicated by the phrase, “Advancing
Environmental Justice through Compliance and Enforcement.” The stated goal of this plan is to “strengthen
community-based programs to engage overburdened communities and build partnerships that promote healthy,
sustainable, and green communities, (2013).”
Conclusion
Like many diseases, asthma and its burden are tied closely to the environments in which people live, work, worship,
learn, and play. In turn, asthma control activities must continue to expand outside the doctor’s office and to
incorporate a public health-based approach (CDC, 2013). Currently, there is a growing body of scientific evidence
that shows that the widespread use of chemicals in our society harms our health and the health of our children.
The incidence of many serious health problems-including premature birth, learning disabilities, behavioral
disorders, asthma and allergies, early puberty, obesity, diabetes, reduced fertility, and some types of cancer-shows
links with exposure to chemicals that can interfere with the process of growth and development (Adeola, 2011).
CDC’s National Asthma Control Program helps Americans with asthma achieve better health and improved quality
of life. The program funds states, school programs, and non-government organizations to help them improve
surveillance of asthma, train health professionals, educate individuals with asthma and their families, and explain
asthma to the public (CDC, 2014). Moreover, this program goals include reducing the number of deaths,
hospitalizations, emergency department visits, school or work days missed, and limitations on activities due to
asthma. The program supports the goals and objectives of Healthy People 2010 and Healthy People 2020 for
asthma. The program does this by developing and implementing evidence-based best practices that reduce
asthma-related morbidity and mortality, and continually enhancing our surveillance systems to monitor our
progress (CDC, 2013). Lastly, the authors’ study seeks to continue to attempt to identify a causal link between
living in close proximity to environmental health hazards and the occurrence of asthma to support the study of
asthma as a socioeconomic health disparity among minority communities.
Abbreviations
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BRFSS Behavioral Risk Factor Surveillance System
CAA Clean Air Act
CDC Centers for Disease Control and Prevention
CEQ Council on Environmental Quality
EJF Environmental Justice Framework
EJM Environmental Justice Movement
EO Executive Order
EPA Environmental Protection Agency
HHS U.S. Department of Health and Human Services
NAAQS National Ambient Air Quality Standards
NEPA National Environmental Policy Act
NEPPS National Environmental Performance Partnership System
NPM National Program Manager
POP Persistent Organic Pollutant
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AuthorAffiliation
Lolita D. Gray
Department of Political Science
Jackson State University
Glenn S. Johnson
Department of Political Science
Department of Urban Planning and Environmental Policy
Texas Southern University
Lolita D. Gray, Ph.D. is a member of the Graduate and Undergraduate faculty of Jackson State University (JSU),
where she serves as an Assistant Professor of Political Science in the College of Liberal Arts. Dr. Gray has also
served as a Visiting Professor in the Executive Masters of Public Administration program in the Barbara Jordan
Mickey Leland School of Public Affairs, at Texas Southern University and an adjunct professor in the Political
Science Department at Clark Atlanta University. As a professor at JSU, Dr. Gray is a member of the The Academy of
Academic Research and Scholarly Engagement, as well as, a member of the research advisory board of the
Mississippi Urban Research Center (MURC), in the College of Public Service at JSU. As a Fulbright-Hays
scholarship recipient, Dr. Gray has conducted research in environmental health hazards and health disparities in
several countries, which include Ghana, Togo, and Burkina Faso and South Africa. Her most recent publication,
“Asthma and Public Policies: An Environmental Justice Case Study on Minority Youth in Georgia,” appears in the
Race, Gender, Class Journal, Volume 20, 2013. Her research areas include: public policy, urban communities and
politics, environmental justice, minority health disparities, and American government.
Address: Jackson State University, College of Liberal Arts, Department of Political Science, Jackson, MS 39217.
Ph.: (601) 979-2725, Fax: (601) 979-2904, Email: [email protected] or [email protected] Website:
http://www.jsums.edu/polisci/dr-lolita-d-gray/
Glenn S. Johnson, Ph.D. is the Associate Dean for Research and Graduate Studies at the Barbara Jordan-Mickey
Leland School of Public Affairs at Texas Southern University. Prior to this position he was a research associate in
PDF GENERATED BY PROQUEST.COM Page 16 of 18
the Environmental Justice Resource Center and associate professor in the Department of Sociology and Criminal
Justice at Clark Atlanta University. He coordinated several major research activities including transportation
racism, urban sprawl, smart growth, public involvement, facility siting, toxics, Emergency Response and
Community Preparedness, and regional equity. His research can be found in Humanity and Society, Georgia State
University Law Review, The Western Journal of Black Studies, Forum for Applied Research and Public Policy,
Human Rights Magazine ABA Section on Individual Rights, The Journal of Social Issues, Journal of Planning
Association, Journal of Public Management and Social Policy, and Race, Gender, and Class. He is co-editor of the
following books: Just Transportation: Dismantling Race and Class Barriers to Mobility (New Society Publishers
1997), Sprawl City: Race, Politics, and Planning in Atlanta (Island Press 2000), Highway Robbery: Transportation
Racism and: New Routes to Equity (South End Press 2004), Environmental Justice Reader: Addressing the History,
Issues, Policy and Change (Linus Publications, 2011) and Environmental Health and Racial Equity in the United
States: Building Environmentally Just, Sustainable, and Livable Communities (American Public Health Association
2011).
Address: Texas Southern University, Barbara Jordan-Mickey Leland School of Public Affairs, Department of
Political Science, 3100 Cleburne, Houston, Texas 77004. Ph.: (713) 313-4845, Fax: (713) 313-7153, Email:
[email protected] or [email protected] Website:
http://www.tsu.edu/academics/colleges__schools/publicaffairs/default.php
DETAILS
Subject: Environmental justice; Consciousness; Law; Income; Hazards; Health; Low income
areas; Low income groups; Policy research; Outdoor air quality; Studies; Chronic
illnesses; Disease control; Minority &ethnic groups; Asthma; Health disparities;
Socioeconomic factors; Qualitative research
Location: United States–US
People: Jordan, Barbara Leland, Mickey
Company / organization: Name: Environmental Protection Agency–EPA; NAICS: 924110
Classification: 0410: group interactions; social group identity &intergroup relations (groups based
on race &ethnicity, age, &sexual orientation)
Ethnicity: Multi-Ethnic
Publication title: Race, Gender &Class; New Orleans
Volume: 22
Issue: 1/2
Pages: 337-357
Number of pages: 21
Publication year: 2015
PDF GENERATED BY PROQUEST.COM Page 17 of 18
LINKS
UC e-Links
Database copyright ï›™ 2021 ProQuest LLC. All rights reserved.
Terms and Conditions Contact ProQuest
Publication date: 2015
Publisher: Race, Gender and Class
Place of publication: New Orleans
Country of publication: United States, New Orleans
Publication subject: Multi-Ethnic, Women’s Studies, Men’s Studies, Ethnic Interests
ISSN: 10828354
Source type: Scholarly Journals
Language of publication: English
Document type: Journal Article
Document feature: Tables References
ProQuest document ID: 1757046897
Document URL: https://www.proquest.com/scholarly-journals/study-asthma-as-socio-economichealth-disparity/docview/1757046897/se-2?accountid=14509
Copyright: Copyright Race, Gender and Class 2015
Last updated: 2020-05-11
Database: Alt-PressWatch,Black Studies Periodicals Database,Ethnic
NewsWatch,GenderWatch,Black Studies Center,Sociological Abstracts,ProQuest One
Literature
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