Disparities in the Impact of Air Pollution
The burden of air pollution is not evenly shared. Poorer people and some racial and ethnic groups are among those who often face higher exposure to pollutants and who may experience greater responses to such pollution. Many studies have explored the differences in harm from air pollution to racial or ethnic groups and people who are in a low socioeconomic position, have less education, or live nearer to major sources, 1 including a workshop the American Lung Association held in 2001 that focused on urban air pollution and health inequities.2
Many studies have looked at differences in the impact on premature death. Results have varied widely, particularly for effects between racial groups. Some studies have found no differences among races, 3 while others found greater responsiveness for Whites and Hispanics, but not African Americans,4 or for African Americans but not other races or ethnic groups. 5 Other researchers have found greater risk for African Americans from hazardous air pollutants, including those pollutants that also come from traffic sources. 6
Socioeconomic position has been more consistently associated with greater harm from air pollution. Recent studies show evidence of that link. Low socioeconomic status consistently increased the risk of premature death from fine particle pollution among 13.2 million Medicare recipients studied in the largest examination of particle pollution mortality nationwide. 7 In the 2008 study that found greater risk for premature death for African Americans, researchers also found greater risk for people living in areas with higher unemployment or higher use of public transportation.8 A 2008 study of Washington, DC, found that while poor air quality and worsened asthma went hand-in-hand in areas where Medicaid enrollment was high, the areas with the highest Medicaid enrollment did not always have the strongest association of high air pollution and asthma attacks.9 However, two other recent studies in France have found no association with lower income and asthma attacks.10
Scientists have speculated that there are three broad reasons why disparities may exist. First, groups may face greater exposure to pollution because of factors ranging from racism to class bias to housing market dynamics and land costs. For example, pollution sources may be located near disadvantaged communities, increasing exposure to harmful pollutants. Second, low social position may make some groups more susceptible to health threats because of factors related to their disadvantage. Lack of access to health care, grocery stores and good jobs; poorer job opportunities; dirtier workplaces or higher traffic exposure are among the factors that could handicap groups and increase the risk of harm. Finally, existing health conditions, behaviors, or traits may predispose some groups to greater risk. For example, diabetics are among the groups most at risk from air pollutants, and the elderly, African Americans, Mexican Americans and people living near a central city have higher incidence of diabetes.11
Communities of color also may be more likely to live in counties with higher levels of pollution. Non-Hispanic Blacks and Hispanics were more likely to live in counties that had worse problems with particle pollution, researchers found in a 2011 analysis. Non-Hispanic Blacks were also more likely to live in counties with worse ozone pollution. Income groups, by contrast, differed little in these exposures. However, since few rural counties have monitors, the primarily older, non-Hispanic white residents of those counties lack information about the air quality in their communities.12
Unemployed people, those with low income or low education and non-Hispanic Blacks were found to be more likely to live in areas with higher exposures to particle pollution in a 2012 study. However, the different racial/ethnic and income groups were often breathing very different kinds of particles; the different composition and structure of these particles may have different health impacts.13
- Institute of Medicine. Toward Environmental Justice: Research, Education, and Health Policy Needs. Washington, DC: National Academy Press, 1999; O’Neill MS, Jerrett M, Kawachi I, Levy JI, Cohen AJ, Gouveia N, Wilkinson P, Fletcher T, Cifuentes L, Schwartz J et al. Health, Wealth, and Air Pollution: Advancing Theory and Methods. Environ Health Perspect. 2003: 111: 1861-1870; Finkelstein MM; Jerrett M; DeLuca P; Finkelstein N; Verma DK, Chapman K, Sears MR. Relation Between Income, Air Pollution And Mortality: A Cohort Study. CMAJ. 2003; 169: 397-402; Ostro B, Broadwin R, Green S, Feng W, Lipsett M. Fine Particulate Air Pollution and Mortality in Nine California Counties: Results from CALFINE. Environ Health Perspect. 2005: 114: 29-33; Zeka A, Zanobetti A, Schwartz J. Short term effects of particulate matter on cause specific mortality: effects of lags and modification by city characteristics. Occup Environ Med. 2006: 62: 718-725.
- American Lung Association. Urban Air Pollution and Health Inequities: A Workshop Report. Environ Health Perspect. 2001: 109 (suppl 3): 357-374.
- Zeka A, Zanobetti A, Schwartz J. Individual-Level Modifiers of the Effects of Particulate Matter on Daily Mortality. Am J Epidemiol. 2006: 163: 849-859.
- Ostro et al., 2006; Ostro et al., 2008.
- Bell ML, Dominici F. Effect Modification by Community Characteristics on the Short-term Effects of Ozone Exposure and Mortality in 98 US Communities. Am J Epidemiol. 2008; 167: 986-997.
- Apelberg BJ, Buckley TJ, White RH. Socioeconomic and Racial Disparities in Cancer Risk from Air Toxics in Maryland. Environ Health Perspect. 2005: 113: 693-699.
- Zeger SL, Dominici F, McDermott A, Samet J. Mortality in the Medicare Population and Chronic Exposure to Fine Particulate Air Pollution in Urban Centers (2000-2005). Environ Health Perspect. 2008: 116: 1614-1619.
- Bell and Dominici, 2008.
- Babin S, Burkom H, Holtry R, Tabernero N, Davies-Cole J, Stokes L, Dehaan K, Lee D. Medicaid Patient Asthma-Related Acute Care Visits And Their Associations with Ozone and Particulates in Washington, DC, from 1994-2005. Int J Environ Health Res. 2008; 18 (3): 209-221.
- G, Filleul L, Segala C, Lefranc A, Schillinger C, Riviere E, Bard D. Influence of Socioeconomic Deprivation on the Relation Between Air Pollution and Beta-Agonist Sales for Asthma. Chest. 2009; 135 (3): 717-716.
- O’Neill et al., 2003.
- Miranda ML, Edwards SE, Keating MH, Paul CJ. Making the Environmental Justice Grade: The Relative Burden of Air Pollution Exposure in the United States. Int J Environ Res Public Health. 2011; 8: 1755-1771.
- Bell ML, Ebisu K. Environmental Inequality in Exposures to Airborne Particulate Matter Component in the United States. Environ Health Perspect. 2012; 120: 1699–1704.