Environmental Racism and Climate Change — Missed Diagnoses
Environmental Racism and Climate Change — Missed Diagnoses
Introduction: The Case of Pediatric Asthma
The article opens with a clinical vignette involving a young girl experiencing frequent, severe asthma exacerbations, necessitating numerous emergency department (ED) visits and home treatments. Despite diligent adherence to medical advice, her condition continues to worsen, leaving her mother and clinicians perplexed as to what vital factor might be overlooked.
Beyond Primary Diagnosis: The Role of Environmental Factors
In emergency medicine, practitioners often focus exclusively on the primary diagnosis, thereby neglecting crucial secondary diagnoses that significantly impede the effective treatment of a patient's main condition. A growing body of evidence strongly links pediatric asthma exacerbations to various environmental exposures, including traffic-related air pollution, particulate-matter (PM) air pollution, ground-level ozone, and pollen. Specifically, sources like citations support these connections.
While precisely attributing a disease in an individual patient to a specific environmental exposure can be challenging, the author draws an analogy to the established link between a history of pack-years of tobacco use and lung cancer, suggesting that certain environmental exposures should be viewed with similar causal gravity.
Over a decade ago, the American Heart Association concluded a causal relationship between exposure to fine particulate matter with an aerodynamic diameter of or less (PM2.5) and cardiovascular illness and death. More recently, the American Thoracic Society documented that long-term air pollution exposure is a cause of childhood asthma (citation ), and a United Kingdom coroner officially listed air pollution exposure as a cause of death for a -year-old asthmatic girl. The escalating evidence, including the application of detection and attribution methods from climate science to health research, necessitates an evolution in our understanding of contributing diagnoses. Notably, the International Classification of Diseases already includes a code for air-pollution exposure ().
The Unveiling of Environmental Racism
After considering air pollution, ground-level ozone, and pollen as potential secondary diagnoses, the author investigates the patient's home address. This leads to the realization of an even deeper, previously missed diagnosis: environmental racism. Defined as a subtype of structural racism, environmental racism involves the implementation of discriminatory practices that determine which communities receive health-protective infrastructure (e.g., green spaces) and which are burdened with health-harming infrastructure (e.g., highways, industrial complexes).
It is discovered that the patient resides in a redlined neighborhood. Redlining, a now-outlawed racist housing practice, historically enforced segregation and restricted economic opportunities for Black families. The patient's home is situated in close proximity to a highway, which has resulted in chronic and disproportionate exposure to high levels of traffic-related air pollution from fossil fuel combustion (citation ). Additionally, many communities subjected to redlining are now hotter than non-redlined areas (citation ) due to a scarcity of green spaces and an abundance of human-made materials such as asphalt, which contributes to the urban heat-island effect. This is particularly relevant given recent extreme spring heat events.
Interconnectedness with Climate Change
Heat critically influences exposure to ground-level ozone, which forms through a chemical reaction between air pollutants, heat, and sunlight. Climate change is identified as a major exacerbator of these environmental health disparities and a critical factor in the formation of ground-level ozone.