The best Rx for environmental health disparities

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Illustration by Glenn Harvey No one should be surprised to learn that higher rates of coronavirus infection and death have plagued racially marginalized African American, Latin American and Native American communities. Other infectious diseases such as HIV and hepatitis C have shown a similar pattern.

Still, astonishment erupted last April when data revealed that although African Americans made up 13% of the population, they made up about 40% of reported COVID-19 cases. Twitter users have come up with some familiar theories to explain it. On April 4, Robert Fiore, whose hashtagged MAGA profile identified him as vice president of the Manhattan GOP, asked, “Is it race or obesity? It seems obese people are fair. [sic] worse. Also men as well as people who smoke and drink alcohol. flouting social distancing mandates. Some respondents were quick to cite criminal propensities to explain the disproportionate infection rates: “Compare areas with high crime rates to areas with high COVID-19 cases. I imagine the domains would match because of the lack of compliance with the law and how it relates to following CDC guidelines. “

Within minutes, Twitter’s social microcosm presented a persistent pattern that has also dominated news accounts, medical reports, and broader public discourse. The responses ignored or denied disparate racial treatment as a factor and instead blamed people of color for their own illness. African Americans, Latinos and Native Americans allegedly courted their own illness by being obese; smoking, drinking and using drugs; choosing ruined housing and vermin infested public housing rather than suburban dormitory areas; and ignoring social distancing and, by extension, the law as they ventured out and gathered on a daily basis.

The history of the United States has often featured this criminalization of infection. I thought of the American School of Ethnology, those 19th century scientists and their ilk who first described African Americans as inferior types, unintelligent, prone to disease, hungry for drugs and alcohol. and inherently criminals who failed to take precautions against diseases and in so doing spread them widely. For these Victorian scientists, the unbelievably high infant mortality rate for slaves was a direct result not of starvation, physical labor, untreated illnesses and draconian punishments of the particular institution, but rather of mistreatment and abuse. neglect of black parents.

Doctors of the day called pellagra a black infectious disease that only struck African Americans because of their penchant for living in dirty and overcrowded conditions. It wasn’t until 1920 that Joseph Goldberger’s research revealed it to be a deficiency disease, linking it to the malnutrition that had been so common during slavery.

Today’s singled out speech echoes the ideology of these long-dead scientists. The only way to build a healthy future for everyone is to understand and fight against the injustices of the past and the present.

Obesity, with its implications of laziness and lack of self-control, is commonly cited as the reason for racial vulnerability to COVID-19. The same claim, that obesity increases the risk of death, was raised after the H1N1 (swine flu) epidemic, but was later proven to be incorrect when analysis of the data showed that the obese did not present no increased risk of death and were actually less likely to die. than others (yet they were less likely to receive some care, such as access to ventilators). Even though the data shows that obesity – and not the poorer treatment offered to the obese – is indeed a risk factor for COVID-19, we must remember that living in food swamps, where nutritional food is scarce and expensive, increases people’s dependence on fats, sugary fast foods and increases their body mass index. Food swamps also foment vitamin C and D deficiencies which are known risk factors for COVID-19.

The harms of exposure to environmental toxins go far beyond COVID-19. Air pollution promotes kidney and heart disease; lead exposure increases vulnerability to other viral infections. Although some suggest that these environmental risk factors are driven by the economy, racism is responsible: A 2008 study determined that African Americans with an average annual income between $ 50,000 and $ 60,000 are exposed to more pollution than white households with an average income of less than $ 10,000.

Environmental racism is wreaking mental and psychological havoc on communities of color – an ongoing public health disaster that the mainstream medical system has largely ignored. Exposure to heavy metals, iodine and other nutritional deficiencies, as well as the consumption of fish contaminated with mercury cause neurological syndromes and developmental delays. American children lose up to 23 million IQ points per year from lead poisoning alone, leading to academic and life failures and increased incarceration rates. High crime rates in the United States have been linked to areas with high lead exposure rates from interior paint and gasoline.

We know that pollution is behind this shipment of neurological, mental and behavioral diseases; we can prevent them and treat them. And we have known for a long time how to do it. For example, we can develop prenatal counseling protocols for pregnant women to educate them about mercury exposure at minimal cost.

The key to preventing these diseases in the future is to aggressively tackle environmental health risks today. Instead of blaming people of color for illusory and stigmatizing drug use, smoking and alcohol, we should design holistic treatment models that take into account the environmental pollution that may be at the root of poor health.

We also need a strong federal watchdog dedicated to protecting communities from environmental risks. It starts with the revitalization of the Environmental Protection Agency, which is in shambles thanks to the Trump administration. Trump and his allies have rolled back dozens of protections that kept big polluters from exposing people to carbon dioxide, methane, mercury and other emissions long known to be responsible for major public health effects , such as cardiovascular disease, neurological disorders and stroke. Prior to the Trump administration, the EPA had a long history of successfully targeting suppliers of environmental poisons by enforcing industry standards, backed by government surveillance and sanctions. It is time to rebuild them.

Eliminating the shameful inequity of environmental racism also requires confronting and correcting the health care flaws that shape it. We must foster a society in which we address and treat all patients with the same respect and care. The problem is racism, not race. We know that people of color are less likely to have a personal doctor or health insurance and are more likely to live where “safety net” hospitals have closed. When they access health care, they are less likely to have their symptoms recognized and treated appropriately, or to have their pain treated.

To remedy this, health insurance should be extended to everyone and the government should invest in keeping local hospitals open. We can start by expanding health care to all essential workers who are forced to forgo social distancing.

Fortunately, as one of the richest countries in the world, we have the solution to medical inequalities and we can afford it. We just need the political will.

This article appeared in the January / February issue with the title “Rx for Environmental Health Disparities”.


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