Environmental justice and interpretation of human biomonitoring results European Conference on Human Biomonitoring November 4 and 5, 2008, Paris, France Prof. Dr. Claudia Hornberg University of Bielefeld School of Public Health Bielefeld, Germany Environmental Justice Principles and discussion from a public health point of view 1
Key events in the history of environmental justice 1980s Local grassroots organizations joined to form what they called the environmental justice movement to address the disproportionate number of hazardous pollution sources (e.g., landfills) in minority neighborhoods (e.g., African-American) and low-income communities. 1992 The US EPA Office of Environmental Equity is formed (renamed Office of Environmental Justice in 1994) 1994 Executive Order on Federal Actions to Address Environmental Justice in Minority Populations and Low-income Populations 1994 Federal Interagency Working Group on Environmental Justice 2002 Second People of Color National Environmental Leadership Summit Core definition of environmental justice Environmental justice seeks the equitable treatment and involvement of every person regardless of race, color, national origin, educational level or income in the development, implementation and enforcement of environmental programs, laws, rules and policies on a distributive, procedural and precautionary level. Environmental Protection Agency (EPA) 2
Basic principle of environmental justice: Environmental health issues cannot be addressed without considering social issues physical chemical biological social Health disparities are inextricably linked with inequalities in environmental resources hazards across economic strata across different regions and communities of lower socioeconomic status amongst population (sub)groups (e.g., minorities) Conceptual framework of social disparities in environmental health Race, ethnicity, gender Variation in exposure Different exposure settings => workplace => neighbourhood (e.g., outdoors pollutants) => housing (e.g., crowding, allergens, noise) Socioeconomic status Different vulnerabilities health behavior individual-level vulnerability community-level vulnerability psychosocial stress genetic susceptibility access to health care Effect modification Environmental exposure Bolte/Kohlhuber 2005 (modified and expanded) Health outcomes respiratory diseases allergies developmental disturbances cancer 3
(1) Variation in exposure Exposures to environmental hazards differ according to socioeconomic status because people of lower socioeconomic status are likelier to live and work in places with more environmental pollutants O'Neill et al. 2003 (2) Effect modification People of lower socioeconomic status may be more susceptible to adverse effects of environmental hazards than those in higher socioeconomic groups because of limited access to adequate health care, lack of material resources, worse nutrition, higher prevalence of smoking, etc. 4
Evidence is mounting that the gap in hazardous environmental exposure, social conditions and health outcomes is widening both inside and outside the USA. The concept of environmental justice focused on poverty and socioeconomic status was taken up in many countries Environmental justice Empirical findings from a EUfunded research project 5
Policy Interpretation Network for Children s Health and Environment (1) Analysis and interpretation of existing research regarding methods to define socioeconomic factors in research projects, and the impact of socioeconomic factors on exposure to environmental hazards (air pollution, noise, carcinogens, neurotoxins), susceptibility characteristics, children's environmental health across Europe. (2) Survey of socioeconomic factors within the EU-funded framework programs 4 and 5 (FP4, FP5) Key results reported in 2005 lack of data to evaluate and quantify the effect of socioeconomic factors on environmental exposure and children s health in Europe lack of comparability between studies and research projects in Europe diversity in defining social differences diversity of terms and concepts to describe and measure variables of social difference and social gradients different methods of collecting data on SES factors in environmental exposure and environmental health no project has studied SES as such SES has rarely been considered as an influencing/independent variable or effect modifier In most cases there is evidence of an inverse social gradient with increased burden of exposures and health effects in children of lower social status. 6
Environmental justice An emerging public health issue in Germany? (1) Empirical evidence from Germany There is some evidence indicating current environmental injustice across Germany. Attention to the relationship of socioeconomic factors and exposure in data analysis has been growing with the German Environmental Survey for Children (GerES IV) The first step to a comprehensive database related to inequalities in environmental health http://www.umweltbundesamt.d e/survey/grafik/kus1.jpg 7
Environmental pollution only a problem of lower social status groups? Results of the latest GerESs Social gradients could be found for the use of several household products with potential health risks. Detergents such as disinfectants and sanitary cleaners are used more frequently by families with low socioeconomic status. Pesticides are used mainly by families with high socioeconomic status. (2) Human biomonitoring studies in North Rhine-Westphalia (NRW), Germany Human biomonitoring studies have been conducted in the Ruhr area (an important area for coal mining, steel production and other heavy industries in central Europe) for more than 30 years, mainly to evaluate the internal exposure to air pollutants, but the distribution of the environmental burden between social groups and its health impact, especially around industrial sites, was neglected. 8
Results of the hot spot study Associations between exposure conditions and health parameters Clear and consistent correlations were found: - Increased concentrations of total suspended particulates (TSP) in children s homes/rooms are more prevalent amongst socially disadvantaged groups. - Children in socially disadvantaged groups show a disproportionately greater incidence/prevalence of passive smoking and living in unsuitable homes. Results of the hot spot study Social disparities in health outcomes There were clear and consistent correlations between social status and the health endpoints infections and allergy : - The prevalence of infections and allergies (answers given to a survey questionnaire) was considerably higher for groups with higher social status than for socially disadvantaged groups. - Weaker but similar correlations were found for social status and immunological endpoints as well as allergological tests. - On the other hand, more children from socially disadvantages groups had worse lung function test results. 10
Results (1) Social disparities in environmental exposure Socially disadvantaged mothers and children are affected more and more often objective criteria (suspended particles) subjective criteria (survey answers) The findings were largely in agreement with those of other international studies. (2) Effect modification and health outcomes Social status was an effect modifier in various subgroups: suspended particles allergies, allergological findings suspended particles lung function characteristics of the home allergological findings passive smoking allergies passive smoking infections Human biomonitoring: Methods and tools to support public health research on the correlation between social differences in exposures to multiple environmental stressors and health outcomes with biological monitoring of exposure and biological monitoring of effects for risk analysis as well as preventive measures, public health promotion and recommendation for policy intended to address social and environmental factors. Human biomonitoring studies are essential for risk assessment in the public health action cycle. 11
Human biomonitoring and the public health action cycle (PHAC) Evaluation Assessment Assurance Policy Development http://www.henet.ch/ebph/bilder/publichealtactioncycle_grafik.gif Assessing variation in exposure by socioeconomic status and effect modification by socioeconomic factors as the key mechanisms: shifting the research focus from etiological epidemiology and individualized risk estimates towards social conditions and social forces affecting exposure to physical and chemical hazards or toxins. participatory assessment at the micro level can combine quantitative (e.g., human biomonitoring) and qualitative research while using specific information about the affected community. Human biomonitoring a useful strategy for extended analysis of the association between socioeconomic factors and the somatic burden of pollutants? 12
Human biomonitoring AND environmental justice research maybe useful for developing an integrated conceptual research framework on the correlations between biological markers and pathways of exposure as well as their social dimensions; improving exposure assessment in diverse populations and specific study groups; improving demographic and/or geographic comparisons and trends in environmental exposure and health disparities over time and regional differences; setting priorities for surveillance and exposure reduction; improving the understanding of environmental health disparities both at the individual and at the population level; evaluating environmental policy measures. Using synergisms between social epidemology and environmental epidemiology for getting more information about the purpose of socioeconomic factors and social conditions as effect modifiers; generating more representative data on the distribution, association and contamination routes of environmental exposure and health outcomes in different subpopulations; better understanding social differences in vulnerability and susceptibility characteristics; answering methodological challenges posed by the simultaneous occurence of different types of exposure to multiple environmental hazards modified by socially adverse conditions, at different spatial scales (e.g., individual and community level). 13
Considering issues of justice and fairness in developing research concepts and projects Selecting a particular geographic location, population subgroup or potential environmental hazard for studying has direct implications for the fair distribution of potential research benefits and burdens across economic strata, and the development of trust and long-term relationships between the researchers and the study population/communities. Concentration of widespread exposure with potential influence on environmental health at both the individual and the population level. Thank you for your attention. claudia.hornberg@uni-bielefeld.de 14