The Health Emergency That’s Coming to West Louisville

In a few weeks, a tsunami is going to hit Louisville, Kentucky. It is going to be worse there than many other cities; and it’s going to be the worst in west Louisville. The tsunami, of course, is Covid-19. West Louisville could prove to be a case study in environmental and health injustice, showing what happens when a deadly virus collides with pollution, poverty and decades of segregation.

Louisville has the most polluted air of America’s hundreds of midsized cities, but the burden isn’t shared equally by all who live there. The predominantly black residents of Rubbertown — which is home to Louisville’s chemical industries — and those in nearby west-side neighborhoods are about twice as likely to have asthma as those on the city’s largely white east side, according to the Centers for Disease Control and Prevention. They’re also twice as likely to have high blood pressure, four times more likely to have chronic obstructive pulmonary disease, and six times more likely to have heart disease. Scientists agree that pollution is a major cause of these conditions.

This leaves Rubbertown uniquely vulnerable to Covid-19, which hits those with preexisting conditions hardest. A CDC study found that about 75% of victims who needed to be hospitalized had at least one such condition, and their outcomes tend to be worse. West Louisville’s high rates of respiratory diseases (such as asthma and COPD) are particularly worrisome, since Covid-19 can cause serious damage to the lungs. What’s more, scientists believe exposure to air pollution is itself a risk factor for Covid-19: In a recent study of 3,080 U.S. counties, Harvard University researchers found that those with dirtier air had higher death rates from the disease.

When the postmortem is done on who survived and who died because of Covid-19, the results won’t be equally distributed among races and places. Polluting industries are more likely to be sited in minority and low-income communities, as Dr. Robert Bullard, known as “the father of environmental justice,” has found in his classic book “Dumping in Dixie” and several other publications. Detroit, New Orleans and the Bronx are among those with skyrocketing Covid-19 deaths in part due to terrible pollution problems. Deaths will be higher in poor neighborhoods and those with lots of air, water and soil contamination. So it’s only a matter of time before the tsunami comes crashing into Louisville.

How do we know that Louisville has the worst air quality of any midsized city? The Environmental Protection Agency provides the most valid and reliable measures of poor air quality, which our team of researchers grouped together as one grand ranking: Louisville is No. 1 when you average out the four EPA measures. We considered Louisville’s air quality alongside more than 140 comparable cities. (Bowling Green, Kentucky, which is about 100 miles south of Louisville, has none of the chemical industries and some of the cleanest air in the country.)

Our research also shows that air pollution makes Louisville’s poorest residents die before their time. We compared the age of death for people in Louisville’s bottom income quartile with similar residents of the five cleanest cities, which all heavily regulated air pollution. We were shocked to find that poor men in Louisville died five years earlier and poor women died four years earlier than their counterparts in clean-air cities with strong pollution controls.

Interestingly, people in the top income quartile in Louisville and other polluted cities live just as long as their wealthy counterparts in cleaner cities. Why? Because the rich move far away from polluters. Poor air is not an issue for the rich and powerful to fight — they live, work and go to school many miles away from chemical companies. The poor don’t have that kind of choice. In Louisville, most affordable housing is near industries that create pollution.

People are affected by pollution even before birth; researchers have found toxic particles lodged in human placentas. And evidence shows it contributes to countless other problems, including higher rates of respiratory and heart diseases, more miscarriages and even cancer. It also results in unwalkable cities, lower housing values, greater risk of foreclosure, and reduced tax revenues to support essential services.

Add Covid-19 to this list. It is another factor directly threatening the lives of people residing in polluted neighborhoods.

But in Louisville, political authorities seem slow to connect the dots. Not long ago, a task force was convened by the mayor to understand why west Louisville residents were dying prematurely. It wound up downplaying the importance of air pollution, instead overemphasizing the influence of lifestyle factors such as smoking, drinking, obesity and education — a classic blame-the-victim approach. Industrial polluters were no doubt thrilled to be let off the hook. (For a further discussion, see our forthcoming article “Pollution, Place and Premature Death: Evidence from Louisville, Kentucky” in the urban policy journal Local Environment.)

More recently, Louisville’s leadership has blamed the lack of trees in neighborhoods. But our national study of cities has found no solid correlation between tree cover and lifespan. Indeed, we found that some of the cleanest air in the nation is in places like Yuma, Arizona, which has the lowest level of tree canopy of any American city. People there live up to five years longer in their counterparts in cities with dirty air. A tree on every lawn isn’t going to reduce rates of cancer, asthma or Covid-19. But clean air will.

Of course, air pollution isn’t just a problem in Louisville. President Trump has struck down 95 environmental regulations since taking office, making air, water and soil across the U.S. more dangerous, and in the wake of Covid-19, he has exempted industries from even a modicum of environmental oversight. Meanwhile, up to 9 million people die prematurely worldwide due to air pollution, according to the medical journal The Lancet. The World Health Organization says it is the second leading cause of noncommunicable diseases. Sadly, we will see even more deaths caused by the toxic mixture of pollution and Covid-19.

Back in Louisville, with the rise of Covid-19, the need for real science is more important than ever. Historically, Louisville has been the capital of bad science, starting with fraudulent smoking studies in the 1960s (see the 1999 film “The Insider”), and the trend continues today, with harsh lobbying against scientists who point the finger at pollution. West Louisville industries get a political pardon because they produce jobs with good incomes, even though they pose significant and deadly health risks.

But science can show Louisville how to solve some of its most pressing problems — problems that are all the more pressing due to Covid-19 — and other cities can learn from its example. Reduce air pollution, and you will see west Louisville blossom.

Powered by WPeMatico

How the U.K. Failed Its Black Health-Care Workers

Please don’t forget what we do for you when the pandemic is over. Such is the message of a video released in the U.K. last week that features essential health workers from migration backgrounds on the front lines of the fight against Covid-19. The video, trending on social media with the hashtag #YouClapForMeNow, begins by borrowing anti-immigrant rhetoric to make a point about the virus: “Something’s come from overseas, and taken your jobs, made it unsafe to walk the streets.”

The video is a nod to the higher proportion of black, Asian and minority ethnic people, known as BAME in Britain, in medical and other service roles. The group makes up about 20% of the National Health Service staff (compared with about 14% of the total U.K. workforce) and accounts for more than half of its Covid-19 casualties to date. They are understandably wary of the conflict between their status as national heroes, and the reality of their wider treatment as a minority by the U.K. government. In recent years, immigrant deportation policies have pushed thousands of people out of the U.K., health-care workers among them. Now, with the coronavirus overwhelming hospitals, the U.K. is asking people from the same groups whose lives have been made difficult by the policies to return and help.

Among those are members of what’s known as the Windrush Generation — named for the ship HMT Empire Windrush that in 1948 brought thousands of people to the U.K. from British colonies in the Caribbean, marking the start of large-scale migration to Britain from its Empire.

The U.K. needed British-Caribbeans to help rebuild the country after World War II. That included workers for the new National Health Service, which replaced a private hospital system with a comprehensive service that was entirely free at point-of-use. While the NHS jobs provided them better wages than they would have made had they stayed in their often-impoverished communities back on the colonized islands, the Windrush experience was still difficult in the U.K.

“There were tiers of nurses, and most white nurses were steered into what was called state registered nurses where you were given managerial training and progress up the ladder,” says Dr. Juanita Cox, who’s heading up an oral history project on the Windrush Generation for the Institute of Commonwealth Studies (ICWS). “Black nurses were put in particular kinds of hospitals, more on the clinical side as opposed to ward management. You also found white nurses wound up in general hospitals, whereas the black nurses wound up in psychiatric wards or wards that required particular care. And I think this is reflected still today with the coronavirus situation at the moment. A lot of black nurses still work within the intensive care units.”

Then in 2012, the British government, under then-Home Secretary Theresa May introduced the Hostile Environment Policy, intended to deter immigration by making life difficult for any non-European Union citizens living in Britain without dual British citizenship or residency granted without a renewal requirement. Caught in that dragnet have been dozens if not hundreds of people from the Caribbean, many of whom had been living in Britain for decades after arriving in the country while traveling on Commonwealth passports that granted them the right to settle, but who were treated as foreigners simply for not having white skin.

The Hostile Environment Policy ran deeper than deportations. In 2013, the Home Office started sending letters to many older citizens of Commonwealth countries living in the U.K., telling them they were in Britain illegally and should leave or face deportation. Frequently, this was not true. Anyone who arrived in Britain from a Commonwealth country before 1973 in fact has a legal right to permanent residency, and many letter recipients had received it or were in the process of applying. Others had no idea that retaining their original citizenship could place their residency in jeopardy. They had arrived in the U.K. legally, some during a period when their birth countries were still British colonies. Deterred by the fees and bureaucratic complexity of gaining British citizenship, many had kept Caribbean passports that, before the Hostile Environment Policy’s introduction, had posed them no problems in getting work or traveling.

Suddenly, people in this group applying for jobs or residency renewal found themselves in trouble. Victims of human trafficking appealing for help — in one case a pregnant woman reporting a rape — were deported, and sometimes killed after returning to unsafe countries. Tax-paying migrants found their access to health care, housing and education barred, while the Home Office’s approach seemed to be intentionally vindictive and inflammatory. It sent billboard-carrying vans around ethnically diverse neighborhoods, ordering undocumented migrants to “Go home or face arrest.”

Faced with demands for Kafkaesque levels of documentation by the Home Office to stay in the U.K., many lost their right to work and homes, and had their bank accounts frozen, ruining livelihoods built up over decades. Others gave up and left the U.K., voluntarily but under duress, while others found themselves barred from returning to the U.K. from trips back to their birth countries. Its approach to contesting people’s right to asylum, meanwhile, was so indiscriminate that when Home Office appealed court decisions granting the right to remain in the U.K., it lost 75% of cases. At least 160 people of Caribbean descent were actively but wrongly deported, but the exact size of the group is still unknown, according to an investigation by the U.K.’s Windrush Taskforce.

“There is an unknown number of people who might have been wrongly subjected to other compliant environment measures, an unknown number of people who haven’t contacted the Taskforce and could be affected in the future and an unknown number of family and friends who the scandal has also touched,” according to “Windrush Lessons Learned Review,” a report released in March as ordered by the House of Commons.

The stories of Windrush families affected by the hostile environment policy make for harrowing reading. Gloria, a 59-year-old care worker whose case is cited in the government’s own inquiry report, had come to the U.K. legally from St. Kitts and Nevis at the age of 10, was fired from her job and left in a seven-year limbo after being told she was in Britain illegally. This was because she couldn’t secure a replacement for a missing passport — although the original had actually been lost by British social services. Seventy-year-old Pauline, a former social worker who had arrived in the U.K at age 12, found herself barred from flying home from Jamaica in 2007, even though her Jamaican passport had posed no problems with travel in the past. Stuck in Jamaica for two years, she came close to death after falling into a diabetic coma for which she could not afford treatment — treatment she would have been entitled to for free in the U.K. Former factory worker Joseph experienced yet worse. Barred from returning from Jamaica to the U.K. — where he had moved in 1956 — because his British and Commonwealth passport was not deemed valid, he died on the island because he couldn’t afford treatment for prostate cancer that would have been free in the U.K.

Aside from the health risks, many deportees stood out due to their British accents and clothing, making them especially vulnerable to becoming victims of crime. After the scandal exploded in the British media in 2018, a chilling detail emerged from a leak that helps to explain why so many people were unfairly treated. As part of the Hostile Environment Policy, Home Office officials had actually been given targets for a minimum number of people they had to deport.

“The causes of the Windrush scandal can be traced back through successive rounds of policy and legislation about immigration and nationality from the 1960s onwards, the aim of which was to restrict the eligibility of certain groups to live in the U.K.,” according to the Windrush Scandal report. “The 1971 Immigration Act confirmed that the Windrush generation had, and have, the right of abode in the U.K., but they were not given any documents to demonstrate this status. Nor were records kept. They had no reason to doubt their status, or that they belonged in the U.K.”

The U.K. is currently taking measures to help Windrush victims and their families, and thanks to the coronavirus pandemic, there’s a whole new urgency to making things right: The U.K. needs more nurses to help them weather the Covid-19 storm. The National Health Service has been asking retired nurses to return to their jobs to help care for Covid-19 patients. While some from the Windrush generation have rejected this request, citing the racism they encountered in the U.K. and its hospitals, some have returned or are considering doing so, as HuffPost UK reports — though more out of call of duty to the people afflicted rather than as an obligation to the government.

People now congregate nightly on their doorsteps to clap for the NHS workers under the banner #ClapForCarers, but the celebration has been bittersweet for BAME care staff whose faces were mostly left out of the initial #ClapForCarers videos and pictures used to highlight the nightly applause sessions.This follows years in which the British government pursued policies that made life hard for people of color with a migration background. The British government is actually obligated to do better by its health-care workers of color, according to the Race Relations Act it passed in 2000, specifically under the Public Sector Equality Policy Duty clause of that law.

Those accolades come at a high cost. To date, at least 91 health-care staff in Britain have died from coronavirus, and BAME workers are being hit disproportionately hard. The first 10 doctors to die in the U.K. while tending Covid-19 patients were all from BAME backgrounds, as were at least 38 nurses, care and support workers that have passed away. When this is the effect on a community — often invited to Britain specifically to work in public services — it is hard for anyone to feel acknowledged or accepted.

As the author E. R. Braithwaite wrote about black workers brought to England from the British colonies in his novel, “Reluctant Neighbors,” “If like genies, they could have been summoned to perform those services, then conveniently commanded to return to invisible bottles, all would have been well.”

Powered by WPeMatico

Smart Cities & Public Health Emergency Collaboration Framework

Based on our observations and experiences, we’ve written a white paper describing a Smart City-Public Health Emergency collaboration framework. We define a structured approach to broadly consider and maximize collaboration opportunities between the smart city innovation community and municipalities for the COVID-19 outbreak. It integrates the CDC Public Health Emergency and Response Capabilities standards with components of a smart city innovation ecosystem. The CDC defined capability standards are organized into six domains. Each intersection in the framework represents a collaboration point where the smart city’s innovation ecosystem and digital capabilities can be used to augment the municipalities’ public health emergency response needs.

Powered by WPeMatico

In a Global Health Emergency, the Bicycle Shines

Speaking in Parliament in London earlier this year, Chris Boardman, the former Olympian cyclist and the walking and cycling commissioner of Manchester, said: “Pick a crisis, and you’ll probably find cycling is a solution.”

He was talking about climate, health and air pollution, but he also might as well have been talking about coronavirus.

As Covid-19 rages, almost half of the world’s population is under some form of restricted movement. In a bid to slow the spread of coronavirus, people must stay home, aside from strictly limited essential trips for food and medicine and a daily outing for exercise. We all need to comply with restrictions to bring this life-threatening virus under control. I believe the best way to keep a safe distance from others when we do move is by walking, and cycling.

Many experts view cycling as a safe way to avoid crowded public transportation systems — and the citizens in a number of world cities appear to agree. In New York, cycling spiked by 52% over the city’s bridges after social-distancing protocols were put in place. In Chicago, bikeshare use doubled in early March. In Dublin and London, advocates are offering support to new riders who are taking to the streets in droves.

Cycling can help communities in “food deserts” access shops that are farther than a walk away. It speeds the delivery of food and medicine for households without a car, or those who are quarantined at home. And it helps people avoid car trips, cutting air pollution and freeing up public transit for those who absolutely need it.

To protect people doing essential trips — including medical staff, who need to get to work — networks of emergency cycleways could be built quickly and cheaply, using easy-to-install temporary bollards and wands, as the city of Seville once did. Low-traffic neighborhoods can connect those routes, stopping shortcutting drivers using residential streets with low-tech planters and bollards, while allowing residents in and out by bike. During the crisis, and as society recovers, this network could keep residents active and healthy, where local restrictions permit. It would also be free to use — more valuable than ever amid a global economic disruption. Once we reach the other side, communities could decide whether to keep the new infrastructure or not.

This is hardly the first time that cities have used cycling as an emergency transportation solution. The usefulness of bicycles in disaster recovery was demonstrated anew after severe earthquakes in Mexico City in 2017 and Tokyo in 2011. A broader global crisis — the 1973 OPEC oil embargo — offered another opportunity for bicycles to step up. That shock to the gasoline supply dealt a severe blow to daily life in the U.S. and many car-dependent Western European nations. But in the Netherlands, where the country’s own mid-century car boom had driven up road fatalities and stoked widespread public protests, it helped trigger a transport revolution. The Dutch government enacted a mass program of cycle track construction that continues to this day. Now, nearly 30% of all trips nationwide happen on a bike, and cities are even connected by bicycle “superhighways.”

As with the oil crisis, city leaders around the world have responded in different ways to keep people moving during the coronavirus emergency. It is heartening to see many governments recognizing and uplifting the value of the bike: Bogotá, Colombia, is installing tens of kilometers of emergency cycleways to keep people moving while enhancing social distancing. The mayor, Claudia López, described cycling as “one of the most hygienic alternatives for the prevention of the virus.” Mexico City is now considering a similar plan. In the U.S., New York City leaders are looking at ways to accommodate new riders, and say they will build two emergency bicycle lanes to plug gaps in the network.

And even if they are not building new infrastructure, other places are protecting the right to cycle. Last week, Germany’s Federal Minister of Health, Jens Spahn, recommended that people walk or cycle to work rather than use public transport as states around the country impose lockdowns. Amsterdam residents, already avid cyclists, are being encouraged to ride to stay healthy while public gatherings are banned and social distancing orders are in place. In London, the city’s bikeshare system is now free for health workers to use. And in New York, San Francisco, Berlin, and across the U.K., bike shops have been allowed to stay open as essential services — but not so everywhere else.

Alas, not all nations are in the same lane. France and Spain, two European nations worst hit by coronavirus, are in the latter camp, having banned recreational cycling in attempts to contain the virus’s spread. In France, people are restricted to within two kilometers of home for exercise, and it is not clear whether cycling for essential trips is permitted. In Italy, only cycling for essential trips is permitted, and for physical activity, so long as people stay one meter apart. In Spain, riders flouting leisure cycling bans have been fined.

That is why, prior to the U.K.’s lockdown, more than 80 experts in transportation and public health signed a letter asking the U.K. government to allow safe walking and cycling to continue during the pandemic. “Confinement, sometimes in overcrowded accommodation with little or no private green space, and particularly during times of anxiety has health risks,” their letter states, adding that green spaces should be kept open for walking and cycling, to allow for exercise and the psychological benefits that accompany it. For trips such as shopping, and for those critical workers who still need to commute, walking and cycling should be supported. “We call on decision makers to protect the right to walk and cycle safely (from risk of infection and traffic injury) for those who are not symptomatic.”

Cycleways and pedestrian routes make transport more resilient, and fairer. They are immune to oil prices, and quite resilient to extreme weather and viruses. They don’t discriminate by income, gender or race. They make infinitely more sense than streets lined with public-subsidized private car parking. What’s more, without them we have little hope of tackling the other global crisis in our midst: climate change.

There could be something positive to come out of the tragedy of this pandemic — a means of transforming the way we travel, cleaning up our air, improving our health and tackling the climate crisis. It is our opportunity to take.

Powered by WPeMatico

How Racism Became a Public Health Crisis in Pittsburgh

A week after Pittsburgh’s city council signed an ordinance declaring racism a public health crisis in late December, a fog began to develop over the city. Or at least, people on Twitter and Instagram thought it was a fog and began posting photos of the ethereal mist blanketing the city over the Christmas holidays. It was actually soot—particulate matter (PM) 2.5, the kind of lung-prickling pollution that used to coat the sky regularly in Pittsburgh’s steel-making heyday. Pittsburgh has been trying to scrub that reputation for decades, but here the stuff was hanging in the air again, the result of temperature inversions on an unusually warm winter week, trapping air pollutants close to the ground across the region. It lingered in the air all the way into the new year, forcing the Allegheny County Health Department to explain its presence:

We know from research that inversions are expected to get worse with climate change. … While we will continue to advocate for residents to do what they can to reduce emissions, we must also explore new regulations that would impose corrective action requirements on industry during short-term pollution events. These extended exceedances and higher pollution levels are a clear threat to the health of the county’s residents, but ACHD’s current regulations do not provide options to address this issue.

This kind of environmental distress places that “it is precisely [Towne’s] ability to pack up, write this article, and move on to the next Google-sponsored town that is the problem. Because it’s not people like Dennis who are in danger; it is the people that he steps on as he makes his exit stage right.”

Melanie Meade, a black woman who lives near one of the U.S. Steel coke plants wrote in a recent op-ed for Public Source: “While I feel like I’m fighting for our basic rights to clean air, I’m living in a city that doesn’t seem to make a big deal over the pollution and its adverse effects on children and the community, especially people of color.”

There is little language on pollution and environmental justice in the public health crisis legislation. Instead, the ordinance refers to policy agendas that emphasize economic inequities, such as enhancing home ownership and entrepreneurship-employment among Pittsburgh’s black residents. As the ordinances were debated at hearings, town halls, and city council meetings through the winter, Jamil Bey, a local black activist who is helping steer one of those foundational policy agendas, Policylink’s All-In Cities strategy, began to wonder what was going on with the “public health” part of the equation.

After all, Pittsburgh is coming off a year where the air was deemed unsafe to breathe for three months, according to a report from the Penn Environment Research and Policy Center. It’s also the year the city’s air quality was graded an “F” by the American Lung Association. Meanwhile, black babies die in the region at four times the rate of white babies, and it’s disputable whether owning more houses and businesses will change that. Allegheny County Health Department maternal and child health program manager Dannai Wilson has said that “chronic exposure to structural and institutional racism, regardless of a mother’s socioeconomic status or educational attainment” is the primary culprit for high infant mortality rates among black women.  

“On the one hand you rightly identify that this is a public health crisis, but then you mostly propose economic solutions,” said Bey, the president of the local environmental justice-focused Urbankind Institute, which is one of the partnering organizations in Policylink’s All-In Cities Pittsburgh collaborative. “If we are going to attach it to the All-In effort, a better strategy would have been to include public health officials, scholars, and advocates in the process to think about the content of the legislation before it was drafted. Nothing that you propose addresses public health.”

Even the mayor’s grip isn’t exactly the tightest on the environmental-health justice issues. Just months after voicing opposition to petrochemicals, Peduto tweeted opposition to Green New Deal legislation, saying that it doesn’t “put people first.” The Green New Deal is rare among climate-change minded proposals in its focus on prioritizing workers left behind by new economies.

Burgess, the city council member, told CityLab that while air quality and pollution are important, “public health” is defined in these ordinances according to what’s called the social determinants of health—a somewhat amorphous term that carries varying definitions depending on the source. The Centers for Disease Control and Prevention defines them as economic stability, education, social or community context, healthcare, and neighborhood or built environment. But economic stability, says Burgess, is most critical.   

Pittsburgh has some of the lowest rates of black women participation in the labor force and black men have some of the lowest average incomes of most cities in the U.S., according to Pittsburgh’s race and gender disparity study. The Cleveland Federal Reserve reported last year that Pittsburgh experienced one the largest gaps in earnings between white and non-white workers of any major metro between 2007 and 2017. Minority earnings dropped 4 percent in that time period while earnings for white workers increased by 13 percent.

“So it’s not a policy. It’s lots of policies and lots of resources,” said Burgess of plans to address the city’s constellation of race problems.

The ordinance doesn’t yet have any funding attached. But the hope is that funding will come from nonprofits—specifically large institutions such as the University of Pittsburgh’s medical system—and private corporations. Burgess said they would also reach out to “wealthy African Americans who live in and outside of the city” to contribute.

“We didn’t get here overnight. It took hundreds of years of systemic disinvestment and redlining,” Burgess added. “Now it’s going to take us multiple years—maybe 50 to 100 years—to undo this.”

Powered by WPeMatico

What’s Really Behind the Native American Health Gap?

Growing up as a member of the Ojibwe tribe, Melissa Walls knew that that diabetes ran in her maternal family. “I’ve lost two very close family members, my great grandfather and an uncle, to complications related to type 2 diabetes,” she says. But it wasn’t until she began studying American Indian health in graduate school, at the suggestion of another uncle who served as a liaison between academics and local tribal communities, that she understood that her family’s plight was part of a much larger problem.

American Indian adults are more than twice as likely as white adults to be diagnosed with type 2 diabetes, according to the Office of Minority Health at the U.S. Department of Health and Human Services. Native American youth experience the highest and fastest-growing rate of the disease of any racial or ethnic group. But those statistics only scratch the surface of the kinds of health disparities that indigenous people face.

Nationally, the average life expectancy for a Native American person born today is 73 years—5.5 years below that for all other races. Members of this community, adolescents in particular, also experience much higher rates of depression, substance abuse, and suicide and suicidal behaviors. In fact, while the national suicide rate has gone up 33 percent since 1999, the rates for Native American women and men have jumped by an alarming 139 percent and 71 precent, respectively, according to a recent report from the Centers for Disease Control and Prevention.

“You could take almost any health outcome and find health inequity for tribes,” Walls says. “I mean, take your pick.”

The health statistics reflect a dire economic reality—1 in 4 Native Americans live in poverty, the highest rate compared to all other races—and the massive gap in medical resources available to this population. The Indian Health Service, which runs clinics and hospitals for Native Americans, spent $3,332 per person in 2017, compared to $9,207 spent on each person in the national health care system, according to a 2018 report on funding shortfalls by the U.S. Commission on Civil Rights.

Walls knows from experience: Like the majority of American Indians, she grew up outside a reservation. Her family lived in International Falls, Minnesota, a town of about 6,000 people—mostly white—near the Canadian border. But to access health services, her family had to go to the nearest reservation. “We drove an hour literally to go to the doctor, to go to the dentist, to get our eyes checked,” she says. “But when you grow up in that context, you don’t label it as an inequity or disparity. It’s just sort of your reality.”

More than two-thirds of Native Americans now live in urban areas, not reservations. That reflects 1950s-era federal policy designed to encourage American Indians living on reservations to urbanize, in the name of speeding “assimilation” (and freeing up tribal lands for federal exploitation). The Bureau of Indian Affairs’ Urban Relocation Program of 1952 and the federal Indian Relocation Act of 1956 offered promises of job training and housing for the new arrivals; the hope was that moving to cities like Chicago, Los Angeles, and Minneapolis would allow more Native Americans to participate in the postwar economic boom. But in practice the relocation policy was “essentially a one-way bus ticket from rural to urban poverty,” as former Indian Affairs Commissioner Philleo Nash admitted in the 1960s.

Walls is now the head of the new Great Lakes hub of Johns Hopkins University’s Center for American Indian Health in Duluth, Minnesota, the city of 86,000 located three hours south of where she grew up. Her team currently works with 11 different tribal communities to better understand the health inequities that Native Americans experience, and try to correct them. The hub is just a 15-minute drive from the Fond du Lac band of Ojibwe tribe, with whom Walls has been working closely on diabetes prevention. Among her research interests: how stress impacts can affect type 2 diabetes, and how culture and community can help to buffer the negative effects of modern lifestyles among Native Americans.

CityLab recently caught up with Walls to talk about possible solutions to health inequities among American Indians, and why the damage that government policies inflicted on this population has been so far-reaching. Our conversation has been edited and condensed.

Can you explain how government policy induced historical trauma in the indigenous population?

The historical trauma encompasses a lot of government actions like setting up reservations and marching people across the country. Then in the the 1950s and ’60s, the government started a relocation program to get [Native Americans] into urban areas, and give them job training programs. It failed miserably, like most of these things did, in part because the job training was woefully inadequate, and often [the jobs available] were temp work or summer employment, if anything.

People were taken out of their family support systems or cultural safety nets, thrown into these urban environments, and expected to survive. Certainly in some cities, native people have worked to try build those kinds of networks. But you are very much a minority in the urban context. I think the idea of not having access to not just your friends and your family, which we all need, but those particular aspects of cultural teachings of ceremony that creates a sense of spirituality, purpose, and belonging would be scary to anybody.

[The relocation policy] was rooted in this flawed idea that all people need to look and act like European Americans, and live the way they do. It’s shocking, if you go into some of these government records, just how blatantly plain the language is about how the goal was really to exterminate or assimilate.

That has impact on communities, and we see it play out in terms of mental health, substance abuse, suicide, and other chronic diseases.

You’ve been largely looking at diabetes—how does historical trauma fit into that story?

In the case of diabetes, one really tangible thing is what we call nutrition transition. In the Midwestern U.S., Ojibwe people once had a thing called a seasonal round, where with each season came new sources of food. In the springtime, you tap trees to get maple syrup. In the fall, you gather wild rice off the lake and you hunt deer. Every season had ways of getting [food] that burned a lot of calories.

Moving away from these ways of eating and getting your food, and suddenly relying on government-sponsored commodity programs [that included] flour, sugar, lard, butter, we start to see rates of obesity kind of going off the charts. And we continue to suffer the consequences.

And this trauma has affected multiple generations?

Some of the research we’ve done is really trying to link up negative health outcomes with specific policies. We’ve published a paper that demonstrates how families who’ve gone through those relocation programs have the worst health outcomes that we can track across three generations.

It’s based on survey data from members of eight tribal communities. We were able to track parents’ reports of their parents going through relocation. If they did, we saw a significant pathway where those [first-generation] parents might have had substance abuse issues, which led to substance abuse and depression in the [second-generation] parents. That led to them being not very good parents of their own kids—the third generation—who at the time were in adolescence. They had bad outcomes like delinquency and depression.

The article was published in 2012, but we continue to collect new data every year from that same cohort, so it’s an ongoing study.

Your research is mostly on communities that live within reservations, but what can you tell us about the current urban Native American population so far?

In our cohort study, the kids who grew up on the reservation, a good chunk of them now have moved on to cities, which is another thing that happens. People tend to migrate between cities and reservations. With our new data that’s being collected from that cohort, we’re going to be able to examine urban-rural differences.

What I do know is that the health issues that hit tribal people on reservations, some reports say they’re actually compounded and worse for people in the cities, for reasons like the lack of access to cultural protective factors and social networks. People are more likely to experience discrimination when they’re in an urban area. And there’s tons of research talking about how that hurts health.

What’s a common misconception about the indigenous community that you hope to dispel?

One of the big stories I’ve helped to push forward is that yes, we have these health inequities, but people on reservations and in urban areas also have really amazing positive stories. Like with positive mental health, when we started measuring it, our communities were off the charts compared to non-native people.

We found this measure created by a sociologist called Corey Keyes [that] assesses emotional well-being, psychological well-being, and social well-being across three domains using 14 different indicators. These items assess basically how much you’re flourishing or languishing in those domains. And the outcome was that the percentage of people in our sample who [reported] flourishing was much higher than what we had seen in other studies with non-Native samples.

So you can have these [inequity] issues, but also have vibrant and cultural richness, family centric [communities] with communal, take-care-of-one-another thinking.

And that has implications for all humans: that being embedded in your community is good for you, that being tied culturally to other people is good for you. It’s not just a dismal doom-and-gloom kind of story.

Powered by WPeMatico

Using Data to Reduce Public Health Risk

Addressing the impact of heat on health is well-aligned with MCDPH’s vision and mission “to make healthy lives possible” by protecting and promoting the health and well-being of MC residents and visitors. The climate has significant impacts on our community’s health. Through extensive surveillance and community surveys, we have demonstrated the importance of local public health data to increase buy-in from new and existing partners and obtain funding to address this significant public health issue. We encourage other health departments to consider the power of data and collaboration as they seek methods for protecting the public’s health from a changing climate.

Powered by WPeMatico

Cities Are Worried About the Health Effects of Glyphosate

When invasive Himalayan blackberry creeps into one of Seattle’s wooded parks, it takes over, conquering native plants. In the past, Seattle park managers may have sprayed the noxious plant with the weed killer Roundup. But Seattle is the most recent in a wave of U.S. cities turning away from Roundup because of growing concern that it could be giving people cancer.

Roundup’s active ingredient, glyphosate, has helped grow food and stamp out weeds since it was introduced by Monsanto in 1974. Its popularity swelled in the 1990s, when Monsanto began also to sell specially designed crop seeds, including soybeans, canola, and corn, that could withstand the herbicide when it was sprayed on surrounding weeds. The company’s patent on glyphosate expired in 2000, and then other companies entered the market; today, several hundred products for sale in the U.S. contain glyphosate.

Public concerns about glyphosate’s safety grew in the years that followed, so the World Health Organization’s International Agency for Research on Cancer reviewed the scientific evidence. In a 2015 report, it classified glyphosate as “probably carcinogenic to humans,” based on the most reliable studies at the time, which were carried out on animals. Since then, people diagnosed with the cancer non-Hodgkin’s lymphoma sued Monsanto (now owned by Bayer), blaming their disease on their exposure to glyphosate.

Juries have sided with plaintiffs, forcing Bayer to pay millions of dollars in damages each time. (Bayer maintains that the chemical “can be used safely and [is] not carcinogenic,” but recently announced it will spend $5.6 billion to develop glyphosate-free alternatives to Roundup.)

While the court cases emerged, the U.S. Environmental Protection Agency carried out its own review of the evidence. In April, the agency announced its conclusion that the chemical does not cause cancer in people.

In the wake of mixed evidence and court rulings, cities including Seattle are taking a defensive stance against glyphosate.

“The concern was mainly for the people who are applying it,” says Patricia Bakker, natural resources manager at Seattle’s Parks and Recreation Department. The department stopped using glyphosate last fall, Bakker said, because parks managers worried they were putting employees in harm’s way. It became official policy on August 23, 2019, when Mayor Jenny Durkan signed an executive order restricting Seattle city departments’ use of glyphosate-containing pesticides.

The executive order designates glyphosate as a last-resort option, to be used only to battle the worst weeds—weeds the state requires the city to remove—after other methods have been exhausted. Mowing, mulching, and a plant-killing fungus called rust are some of the first lines of defense. Other herbicides, like those containing the active ingredients triclopyr and imazapyr, can also be used.

Without the power of Roundup, Bakker expects her staff won’t be able to tame non-native plants with the same vigor. “There are just going to be some areas that look a little weedy,” Bakker says.

However, Seattle’s native plants may have a better chance of survival because of the glyphosate restriction, according to one expert. Viktoria Wagner, a plant ecologist at the University of Alberta in Canada, says that because glyphosate is non-selective, it can hurt native plants when it’s targeted at nearby weeds. Hurting native plants deprives them of their ability to compete, and “this gives an opportunity to fast competitors to get a head start and take over,” Wagner says.

When Seattle officials were considering cutting back on glyphosate, they sought advice from San Francisco, which began rolling out restrictions on chemical pesticides in 1997. Seattle’s not alone—tens of cities across the U.S. have recently cracked down on glyphosate use. In 2018, Portland, Maine, banned the chemical, and Austin, Texas, restricted it. This year, Miami and Los Angeles County approved their own bans on city property. Some cities, like Boston, avoid glyphosate on an unofficial basis. Others, like New York City, may be poised to ban it in the near future.

New York City Council Member Ben Kallos first introduced legislation to ban glyphosate (and all chemical pesticides) from city parks in 2015, shortly after the World Health Organization’s verdict that it’s unsafe. During the legislation’s hearing in September 2017, dozens of elementary-school children crowded City Hall to testify their support. The legislation failed, but Kallos and Carlina Rivera reintroduced it in April, just before the EPA classified the chemical as safe. The bill has 24 sponsors; it needs 34 to guarantee a hearing.

Whereas Seattle’s city managers restricted glyphosate out of an abundance of caution amid conflicting opinions from scientific agencies, Kallos said he introduced his legislation with confidence that the science is settled—that glyphosate is endangering park-goers. When he and his toddler daughter want to play outside, they sometimes take a ferry to pesticide-free Battery Park.

“I will not let her play in city parks unless I see dandelions and other weeds that glyphosate would otherwise kill,” he says.

Powered by WPeMatico