Last week, I had the pleasure of interviewing Dr. Sacoby Wilson (hereinafter SW), associate professor of public health at the University of Maryland, in the Institute for Applied Environmental Health. Dr. Wilson is a trained environmental health scientist and works primarily with communities on environmental justice issues. Through his work, he brings science to civic engagement and community organizing and makes sure that the science leads to action.
His responses illustrate five key takeaways for me from this interview:
Takeaway #1: Protect your most vulnerable first
Takeaway #2: We did not implement lessons learned from Hurricane Katrina to adequately prepare for subsequent, inevitable disasters. We keep failing over and over again on protecting the most vulnerable during times of crisis.
Takeaway #3: Conduct more air monitoring where people have additional or compounding hazards.
Takeaway #4: Change the way enforcement is done. Instead of doing less, you need to do more to truly limit harms.
Takeaway #5: When it comes to environmental laws, the best we had was not good enough; it is not good enough now and it definitely isn’t good enough for the future.
As Dr. Wilson states, it is important that science is not just for science’s sake, but that science is for action, science is to empower people and science is for social change. So, science is not the end, it is a means to an end and can be used for transformation, reformation, and revolution.
AH: Thank you for agreeing to speak with me Dr. Wilson. Because environmental justice (EJ) is the focus of your work, I wanted to talk about what is going on with COVID-19 and the African American community. Is there any one thing that you want people to know?
SW: Regardless of the type of disaster, biological, natural, technological, or man-made, the same folks are going to be most impacted and most at risk due to vulnerabilities pre-disaster, like social vulnerabilities, economic vulnerabilities, or hazard vulnerabilities – having too many hazards in your community. Having too much traffic is hazardous to your health. Having too many factories is hazardous to your health, not having access to amenity disparities, not having access to grocery stores and supermarkets, health care infrastructure issues are all hazardous to your health. Those are going to be the folks who are always at risk, most at risk, more at risk, differential risk. So, we have to focus on those populations when it comes to our preparedness, when it comes to our response and when it comes to recovery.
AH: The recently-released Harvard study discussing air pollution and higher COVID-19 death rates found that people breathing polluted air for a long time and long-term exposure to fine particulate matter (PM2.5) increased inflammation in the lungs and potentially in the cardiovascular system. PM2.5 largely comes from fossil fuel combustion in power plants, refineries, and cars. What does that mean for EJ communities?
SW: The study verifies some thoughts around ‘who’s at risk’, why they are at a higher risk, and why you have these different mortalities–these racial mortality differences due to COVID-19 infection. It is informative because you see how important air pollution is and how exposure could increase your risk of mortality. So, if you live in the community that has multiple environment hazards, you have been exposed to pollution emissions. You have a lot of traffic and you have been exposed to combustion by-products like PM2.5.
Your respiratory system has been attacked, your alveoli – your lung sacs – have been attacked. You have lung scarring. That means that you do not have the same lung capacity, the same level of respiratory health that you had pre-exposure to PM2.5 and pre-asthma. So, long term, across your life course, you are going to be at higher risk of morbidity, of hospitalizations associated with asthma, and hospitalization associated with additional exposure to pollution. During peak exposures you may have an asthma attack or need hospitalization. And exposure to PM2.5 increases your risk of heart disease, stroke, cancer, premature mortality and reduces life expectancy, leads to higher infant mortality rates and birth defects and it contributes to diabetes and Alzheimer’s disease.
But that is only exposure to PM2.5. What about PM10 and PM1 ultrafine particles? I believe that the risk the authors discuss in that study is actually conservative because it is not capturing the true exposure profile of folks who live in neighborhoods with all these air toxicants. [No one is] talking about volatile organic compounds, which are combustion byproducts. What about polycyclic aromatic hydrocarbons and black carbon – associated with diesel exhaust (and the major contributor to PM2.5)? I think it [the paper] is probably significantly under-reporting the potential risk of mortality associated with COVID-19.
AH: How does historical racism play a role in what is going on with COVID-19?
SW: You have to think about historical and contemporary racism – because how racism is embedded in our housing policies, our transportation policies, our zoning/planning policies drives the conditions that lead to people living in communities that have an overabundance of fast food restaurants or lack of access to grocery stores or supermarkets when it comes to food and not having access to healthy and safe housing.
One of the things about the stay at home order that I don’t think folks are thinking about is that when you think about infectious disease spreading, when you have overcrowded spaces with poor ventilation systems, that is a recipe for super-spreading of infectious diseases. Look what has happened at our nursing homes. Nursing home patients are already at high risk for mortality due to their age, their fragility and also co-morbid conditions, so you should protect them first.
AH: Yes, folks on the border, homeless people
SW: Homeless populations–that is another population that should be protected. Another set of workers is your front line environmental health workers including folks working in restaurants and grocery stores, folks who work in transportation, any environment where you are going to be in an enclosed space for a long duration of time with limited opportunities to have passive ventilation, you are creating an environment for this type of infection to spread.
AH: Would you say most people of color have those types of jobs?
SW: Yes, when you think about the gig economy, you think about retail and service jobs, people of color disproportionately have those jobs. So, when you have a stay at home order, they say “no, I gotta go work, I can’t stay at home”. Because I may be from a low wealth community, I am not going to have my own car. I am taking mass transit. I am going to be in a micro-environment, for a certain amount of time, a certain frequency, so my exposure risks are increased.
AH: That same Harvard report pointed out that there is an enormous amount of work that needs to be done. Do you see a role for community science here?
SW: Yes. Community science is translation to action, community-driven research–of the community, for the community, by the community. The community may or may not have an academic partner, but the research is coming from and driven by the community. It is using science to empower communities and using science for action.
AH: Are the results that we are seeing across the country surprising to you, given the work you engage in with environmental justice communities?
SW: This virus is showing you the difference between ‘the Haves’ and the ‘Have Nots’. The Haves are staying home, and they are doing good. They can have somebody drop their food or groceries off. They can go outside and bike and walk and play in their neighborhoods because they have access to natural amenities and built environment amenities.
The Have Nots live in overcrowded housing, they have poor transportation infrastructure, they have poor food infrastructure. Due to poor economic policies, they do not have the same economic opportunity structures that others do so they are going to lose their jobs, they are going to be unemployed, compared to the Haves who are not losing their jobs. Yes, they may be stressed out a little with social distancing, but they still have their jobs. They are still employed. They still have a modicum of quality of life that does not lead to adverse health outcomes, whereas the Have Nots’ quality of life was already depressed pre-COVID-19 and has actually been made worse.
AH: Can you talk about the impact of the EPA’s recent decision to lift enforcement regulations for polluting facilities? What impact do you expect that to have on communities?
SW: How dare they do that! Basically, they are giving industries the right to poison people. The previous regulations gave industries the right to poison people, but now it poisons without any oversight. So, it is business as usual, but man, business is good now!
AH: What do you think about the EPA in its role to protect people from environmental challenges?
SW: EPA has dropped the ball. They have dropped the ball worse under the current administration. Real talk, the regulatory schema that we have through EPA – the Clean Air Act, NEPA, TSCA, RCRA, Superfund – if they were protecting everybody equally, we would not have environmental injustices!
They were already dropping the ball on the job before this regulatory schema created gaps, not protecting the most vulnerable and most susceptible – pre-Trump.
AH: What lessons can be learned from where we are now?
SW: We did not learn the lessons of how do you protect your most vulnerable when you have biological stress – those lessons are applicable to protecting your most vulnerable–people who are older, who are fragile, immobile, who are immunocompromised or who have underlying co-morbid conditions. How do you make sure you protect them first?
We should be learning how we protect the most vulnerable and we keep failing over and over again. I think that is the point. There were social, economic, geographic, and healthcare vulnerabilities pre-Katrina. Economic and racial segregation. The cumulative impacts of exposure on them pre Harvey, and when they were escaping during Harvey, they did it through a toxic soup, escaping during Katrina – through a toxic soup, escaping through Hurricane Florence – through a toxic soup, escaping through Superstorm Sandy – escaping through a toxic soup. It is the same people disproportionately escaping through these toxic soups. Poor folks, immigrants, black folks, Latinos, over and over, young children who come from communities with limited resources. So, those lessons were not learned but should have been to inform our preparedness for these types of disasters.
We should have learned from H1N1. We should have learned from SARS. We should have learned from Ebola. But we think “it’s over there” – out of sight, out of mind, not in my backyard so it does not matter. We [the United States] were not impacted by those things so we did not have to learn lessons, best protocols as related to pandemics in this country. I am not saying that public health was not thinking about it. You heard about the Pandemic office that was dismantled. You have seen some of the power taken away from the Health and Human Services Administrator under this administration. The CDC Director has been missing in action. You have not heard from the Director during this pandemic. You have seen the elevation – it is not a bad elevation – of the Surgeon General who has become more vocal, but he has had some miscommunications behind why this pandemic has racial disparities in mortalities.
Even Dr. Fauci has had some missteps. He talked about people at risk because of underlying health conditions. Yes, that is true Surgeon General, that’s true Dr. Fauci, but you are coming from a biomedical model. What he is not considering is the social determinants. What is the social context? Context matters. My diet and co-morbid conditions just did not happen overnight or by accident. It is there due to structured inequalities, like the fact that I live in a food desert or the fact that my community has been segregated. That structured inequality is the reason why you see these differences and racial disparities in morbidity and mortality. The fact that more black people are dying from COVID-19 complications is not by accident. So, the pandemic has made what was invisible due to racism in our country, visible.
AH: Do you think, given that and other climate crises situations like extreme heat, that we should have been a little bit more prepared?
SW: We can go through the list of natural disasters and man-made disasters that should have been lessons learned, that should have been new protocols that emerged from those disasters. We are coming up on the 15th Anniversary of Hurricane Katrina. There are some major lessons that we did not learn from Hurricane Katrina, that we saw in Hurricane Harvey and Hurricane Maria. How do you prioritize the most vulnerable? When the susceptible populations are children and the elderly, sick, shut in, folks in nursing homes, folks in hospitals, people who don’t have access to vehicles, folks who have been marginalized and folks who have been invisible? One thing that COVID-19 has done is made populations – due to politics, due to economics, due to other issues – that have been made invisible in our country, visible.
AH: What are your thoughts about the intersection of climate change and this pandemic? For example, the result of the recent early-season heat wave in Florida?
SW: I think climate change is an effect modifier. What does it mean when you’re in the middle of a heat wave and you may be in a nursing home or rental housing, you know, multi-family housing, where you have poor HVAC systems or you don’t have air conditioning? Are you going to stay inside your house or are you going to go somewhere you can get cooler? You are going to go somewhere to get cooler! Think about what heat stress does when you have folks exposed to or having a higher risk of exposure to a biological agent? People are going to move from one micro-environment where they may have limited opportunity for exposure to COVID-19 because they’ve been practicing social distancing. Now they must move to other environments because of the heat wave to stay cool. It is going to increase their risk of exposure to COVID-19 and increase their risk of mortality. Those risks will be more significant for folks who are already immunocompromised, folks who already have co-morbid conditions–overweight and diabetic or asthmatic. It is going to increase exposure and health risks for front-line workers, healthcare workers and transit workers. Although I am not sure about the physics of COVID-19 movement in bioaerosols, what if you are on a bus or train because it’s cooler. The air conditioner is on, but it is not killing COVID-19. It may better circulate COVID-19.
AH: Do you have any recommendations on the best way to move forward?
SW: We need transformative, new thinking about how we build our built environment. How do you mitigate, reduce exposure to biological agents like COVID-19, in closed settings? Will it be housing? You have to transform the way we engineer our buildings. How do you create surfaces that viruses and other agents cannot adhere to? Maybe the use of UV lighting, or air exchange where we can remove exhaled breath and environmental assaults in a more efficient way and have a better way to clean the air when it comes in.
We focus too much on the Haves and not enough on the Have Nots. We focus too much of those who have a voice and not enough people who do not. We need to invest in those communities more when it comes to preparedness. We need to invest in our infrastructure more. We cannot rely on a profit-based healthcare system to protect us. We have learned from this pandemic that a profit-based healthcare system cannot save lives in an effective way during a pandemic. We need a Care First healthcare system. We need a People First Healthcare system
We need to reclaim some of our street spaces for pedestrians. Because if we can reduce the number of cars and traffic in our urban areas, that is a benefit when it comes to improving air quality and improving quality of life. So, there may be some changes that are made during this Pandemic that may become permanent.