Natasha DeJarnettIn the second 2020 “Fresh Perspectives” blog post presented by the de Beaumont Foundation, Natasha DeJarnett, PhD, MPH, the interim associate director of Program and Partnership Development at the National Environmental Health Association, powerfully explains the intersection of the coronavirus pandemic, racism, and environmental health. Previously an APHA policy analyst leading the Association’s Natural Environment portfolio, DeJarnett is an adjunct professor at George Washington University, a member of the Governing Board of Citizens Climate Education and the Board of Directors for Physicians for Social Responsibility, serves on the steering committees of the International Transformational Resilience Coalition and the Emerging Leaders Initiative of the Environmental Law Institute and is a member of the Climate and Health Advisory Panel of the National Recreation and Parks Association.

"If I get it, the hospital may decide to let me die."

This was the heartbreaking concern a woman of color shared with me shortly after the coronavirus pandemic reached the United States. She explained that because she was both older and African American, decisionmakers may opt to reserve life-saving resources in favor of someone whose life they deemed more important.

Little did either of us know at the time that the pandemic was only one of the numerous health crises we would be facing within just a few short months.

While COVID-19 has caused catastrophic health and economic challenges, climate change continues to be the greatest threat to public health, with a record number of named storms expected for 2020. In addition, systemic and structural racism is increasingly being recognized as a public health issue, following the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, Rayshard Brooks, and countless other African Americans. Environmental health and justice intersect at the juncture of COVID-19, climate change, and racism.

If these concurrent disasters have taught us anything, it is that there is an urgent need to provide equitable and just distribution of environmental health services to effectively prevent and mitigate environmental health risks and diseases for everyone.

Illness and death resulting from COVID-19 have laid bare health disparities, with higher hospitalization and mortality rates among African Americans, Native Americans, and Hispanic or Latinx populations. These health disparities are the systemic consequences of social determinants of health that have left these groups with an elevated risk of heart disease, diabetes, and obesity — all factors that increase susceptibility to COVID-19's harmful outcomes.

Environmental health factors, which also discriminate, can influence the spread of COVID-19 because the virus has an airborne transmission pathway and requires environmental sanitization and disinfection for mitigation. Environmental health exposures also exacerbate the risk factors for COVID-19. For example, exposure to air pollution can raise the risk of cardiovascular disease death by 5-15%. The relationship between air pollution and COVID-19 exposes a hypothesis for the relationship between climate change and the virus.

Climate change decreases the quality of air we breathe, which raises our risk of heart and lung diseases. A recent Harvard University study identified that a 1-unit increase in fine particulate matter exposure was associated with an 8% increase in COVID-19 mortality. And in yet another example of why this is worse for some of us, poor air quality is much more likely to be found in communities of color. In fact, the most powerful predictor of hazardous exposure is race. Beyond that, cities with dirtier air are reporting higher COVID mortality, and in more polluted cities, COVID-related mortality is higher in communities of color.

Though there have been significant improvements in air quality since 1970, these gains have not been experienced universally, leaving communities of color more exposed to hazardous polluters. Racism is at the root of differing exposures for different populations based on race and in the uneven delivery of environmental services.

The National Environmental Health Association has declared that racism is an environmental health issue. Numerous public health and medical groups, states, and jurisdictions have declared that racism is a public health issue. Many of these groups often unify around the value statement that we all deserve clean air to breathe.Environmental health advancements mean little when not all people benefit from them, giving George Floyd's last words, "I can't breathe," added weight.

Communities of color across the nation that face dangerous levels of air pollution and other environmental injustices have been crying out for decades over contaminated air that impairs their breathing and systems that choke them out of needed environmental health services. I receive Mr. Floyd's last words as a sounding cry for social justice as well as environmental health and justice.

We need to employ strong solutions that advance environmental health equity now. These may include utilizing a Health in all Policies Framework, which systemically allows for environmental health to inform decisionmaking that will advance health and equity. In addition, Community Based Participatory Research is a powerful tool that allows for the meaningful participation of community members in research that affects their health and communities.

By looking to solutions that promote health equity, we have the power to bounce back better with environmental health and justice at the center of resilience.

Throughout the pandemic, I have continued to replay the heartbreaking quote, "If I get it, the hospital may decide to let me die." It has an added sting because these were the words of my very own mother. She is the strongest woman I know, and through many years as a public servant in social services, she has changed the lives of thousands of young women — yet certainly, none more so than my own.

My mom's life matters, unequivocally. Her fears about the potential of her life being triaged out due to this pandemic speaks to a profound burden encountered by many people of color as we contemplate medical needs. As heartbreaking as it was to hear her speak those words, there is a stark reality in how the widespread progression of COVID-19, exacerbated by climate events and the injustices of systemic racism, leaves my amazing mom and countless others at great risk.

Don't miss the APHA Center for Climate, Health & Equity's lineup of APHA Annual Meeting sessions. Check out the program hereAnd join Natasha DeJarnett at these sessions:

4117.0 — Climate Changes Health: Examining Co-Benefits While Cultivating Resilience and Equity
Tuesday, Oct. 27, 12:30-2 p.m.

5119.0 — 70 Years after Nuclear Bomb Testing: How Radioactive Waste Still Plagues a San Francisco Community and Threatens Public Health
Wednesday, Oct. 28, 2:30-4 p.m.