“We must listen more to the people we serve, have uncomfortable conversations, and increase our push for social justice.” –Georges C. Benjamin, MD, Executive Director, American Public Health Association
Public health officials are tasked with one of the most critical jobs in our modern risk society: to research, understand, educate, and help prevent the multiple and complex ways in which people are exposed to and suffer from disease. But when public health officials deflect attention away from significant sources of toxic pollutants that put people at risk (and instead blame the overexposed population’s race, lifestyle, or genetics), they do a disservice to the people they are supposed to protect.
Such tactics are expected from industry groups like the American Petroleum Institute, who recently engaged in a classic “diversion” disinformation play to baselessly argue there’s no link between elevated risk of cancer from air toxics and oil and natural gas industry emissions among African American populations, as a new NAACP, Clean Air Task Force, and National Medical Association report finds (see my colleague Charise Johnson’s blog takedown of API’s feeble attempt at refuting the report’s scientific claims). But to see the same sort of diversionary tactic in a worrisome op-ed by Dr. Karyl Rattay—director of the Delaware Division of Public Health (DPH)—raises the question of whose interests the DPH is looking after.
The target of Dr. Rattay’s column was a report recently released by the Union of Concerned Scientists, in which, together with our environmental justice (EJ) partners in Delaware, we reported on air toxics and associated cancer risks in selected EJ communities in the state. We utilized the EPA’s latest (2011) National Air Toxics Assessment (NATA), an “ongoing comprehensive evaluation of air toxics in the United States”. These data represent the state-of-the-science in air quality modeling of air toxics. In our report, contra what Dr. Rattay argues, we have been careful not to overrepresent what the pollutant concentrations mean and have been consistent with EPA’s own statements about appropriate use of the data:
- We identify pollutants of greatest concern
- We provide improved understanding of health risks posed by air toxics
- Additionally, in our recommendations we are contributing to helping set priorities for the collection of additional information, improving emissions inventories, and informing community and local air toxics program in the context of both acute exposures that can be reduced through the Risk Management Program (RMP) rule, and chronic exposures that can be addressed through local toxics reductions programs.
Dr. Rattay claims that “the way [UCS] interpreted the data, and the conclusions they have drawn, artificially inflated a person’s risk of cancer from environmental air pollution”. In fact, we did not inflate (artificially or otherwise) a person’s risk of cancer from environmental air toxics pollution. On page 11 of the report, we carefully adhered to the EPA’s NATA disclaimers by noting that “the health estimates represent average risks and hazards affecting a community rather than exact risks or hazards for a particular person”. Furthermore, the DPH director’s claim that many of the health outcomes we report on can be explained by “lifestyle” choices individuals make is very perplexing. At best, Dr. Rattay is engaging in the ecological fallacy of extrapolating the putative unhealthy lifestyle choices of a few individuals (e.g., smoking) to a population that is demonstrably exposed to undue burdens of air toxics. At worst, Dr. Rattay is echoing the very offensive and debunked claims that low-income people of color make bad lifestyle choices like smoking and barbequing that account for higher cancer rates, and simultaneously downplay the role of the acute and chronic toxic exposures that we have documented.
Public health professionals wield a comprehensive and holistic science-based understanding of the complex ways in which disease affects human health. As health, environmental justice, and scientific advocates, we could and should have an open dialogue to better understand the causality chain of various factors that influence cancer and other diseases, which should include individual or collective lifestyle practices, as well as indoor and outdoor environmental exposures to pollutants. But to that, we must include understanding of the structural socio-economic conditions that restrict the range of healthy lifestyle choices that individuals can make. Two examples spring to mind: we know that low-income populations’ access to healthy foods is a growing challenge in Delaware, and that tobacco companies aggressively market to low-income populations.
To be sure, establishing the epidemiological causality between specific health outcomes and pollutants is a difficult task and there’s often not much data to do this reliably and systematically. As a matter of scientific data and methods reliability and accuracy—and by their own admission—there is room for improvement in the EPA’s NATA dataset. But the DPH director chooses to “shoot the messenger” (UCS) instead of making the right call on the limitations of the data, which would be to urge the EPA to improve and increase air toxics data collection, air quality modeling, as well as fine-scale assessments of what these imply for cancer risks related to air toxics exposure.
But to entirely discredit the role of outdoor air toxics obscures the science-based knowledge that low-income communities of color are more exposed to these toxics and are thus at higher risks. This anti-scientific posture does not advance the dialogue that Dr. Rattay says should take place. As I have argued before, deflection away from social and scientific reality contributes to the “legacy of distrust” between low-income populations of color snd our scientific and health institutions, who have not always acted in the best interest of populations at the intersection of unfair environmental hazards burdens and political and socio-economic marginalization. The dialogue begins with taking their concerns seriously—not dismissing them outright.
 National Air Toxics Assessment: NATA Frequent Questions. Q3: How can NATA information be used?