The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:
- Economic Stability
- Health and Health Care
- Neighborhood and Built Environment
- Social and Community Context
Environmental Conditions is a key issue in the Neighborhood and Built Environment domain.
Polluted air, contaminated water, and extreme heat are 3 environmental conditions that can negatively impact population health. The World Health Organization attributed 11% of U.S. mortality in 2012 (nearly 300,000 deaths) to environmental causes.1 Identifying how environmental exposures vary by population and geographic location can improve our understanding of health disparities. This summary will examine how water quality, air quality, and air temperature affect health and contribute to health disparities.
Poor water quality places the public’s health at risk.2 For example, groundwater sources used for drinking water and crop irrigation may become contaminated.3 In 2011–2012, 47% of waterborne illnesses, such as Giardia, were due to untreated groundwater.2 Groundwater is the source of drinking water for nearly 1 out of 3 Americans, and in 1 study, 22% of public supply groundwater sources had at least 1 contaminant above recommended levels.4 Sources of groundwater contamination include agricultural runoff,5 landfills,6 septic tanks,7 and leaking underground storage tanks that contain hazardous materials.8 In 2011, there were nearly 6,000 reports of groundwater contamination from underground storage tanks leaking hazardous materials.9
Humans take millions of breaths over the course of their lives, so the cumulative impact of outdoor and indoor air quality can influence health. Chronic exposure to outdoor air pollutants, such as ozone and fine particulate matter, increases the risk of cardiovascular disease10 and death,11, 12 including death from lung cancer.13 People spend a substantial amount of time indoors for work, school, and sleep, so indoor air pollutants can also damage health.14, 15 Pregnant women, infants, and young children are particularly vulnerable to the damaging effects of outdoor and indoor air pollution.16, 17 Exposure to these toxins may disrupt fetal and child development.16, 17 For example, children with asthma exposed to high levels of environmental tobacco smoke have been shown to experience asthma attacks more frequently than children with asthma who have lower levels of exposure.18
Air temperature is another environmental condition that affects health.19, 20 According to recent reports from the National Oceanic and Atmospheric Administration (NOAA), many of the hottest years on record have occurred in the past decade.21, 22, 23 Older adults and children are at increased risk for heat-related disease and death.19, 20, 24 In addition, racial and ethnic minorities have higher rates of heat-related disease and death.19, 25 This association may be due to factors such as living in urban areas,26 lacking air conditioners,27 and working in agriculture.25, 28
Geographic location, race and ethnicity, and socioeconomic status affect an individual’s environmental exposures and subsequent risk of negative health outcomes.29, 30, 31, 32, 33 One feature of geographic location that affects environmental exposure is whether an area is rural or urban. For example, neighborhoods in rural areas often rely on private well water; this water can have high nitrate levels, which are linked to certain forms of cancer among susceptible populations.34, 35, 36, 37 In urban settings, individuals are exposed to traffic-related air and noise pollution, which are linked to hypertension.38
Racial and ethnic minorities may encounter more environmental hazards than non-minorities do. A national study of 215 U.S. Census tracts found that Hispanic individuals and non-Hispanic black individuals were more exposed than non-Hispanic white individuals to airborne particulate matter, such as chlorine, aluminum, and elemental carbon. This exposure is associated with adverse health outcomes.39
Economically disadvantaged communities are disproportionately affected by environmental conditions.31 For example, residents in high-poverty neighborhoods report living in poorer quality housing.40, 41 In 1 study, living in public housing was associated with the presence of cockroaches and environmental tobacco smoke, as well as a lack of air conditioning.42 In contrast, residents living in single-family homes reported the lowest levels of mold and of cockroach, rat, or mouse infestation, and were more likely to have air conditioning.42 The study also found variations in the prevalence of childhood asthma: 22% of children in public housing had asthma, compared to only 7% of children in single-family homes.42
Reducing harmful environmental exposures can improve population health and may contribute to decreases in health disparities.43 Further research is needed to better understand the distribution and prevention of hazardous environmental exposures, particularly among vulnerable populations.44 This additional evidence will facilitate public health efforts to address environmental conditions as a social determinant of health.
Disclaimer: This summary of the literature on environmental conditions as a social determinant of health is a narrowly defined examination that may not address all dimensions of the issue.i, ii Please keep in mind that the summary is likely to evolve as new evidence emerges.
i Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.
ii The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.
1 World Health Organization (WHO) [Internet]. Deaths Attributable to the Environment: Data by Country. Geneva: WHO. [updated 2016 Mar 09; cited 2017 Dec 19]. Available from: http://apps.who.int/gho/data/node.main.162
2 Beer KD, Gargano JW, Roberts VA, Hill VR, Garrison LE, Kutty PK, Yoder JS. Surveillance for waterborne disease outbreaks associated with drinking water-United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2015;64(31):842-8.
3 Reynolds KA, Mena KD, Gerba CP. Risk of waterborne illness via drinking water in the United States. Rev Environ Contam Toxicol. 2008;192:117-58.
4 Toccalino PL, Hopple JA. Quality of water from public-supply wells in the United States, 1993-2007: overview of major findings [Internet]. Washington: U.S. Geological Survey Circular 1346; 2010 [cited 2017 Dec 19]. 58 p. Available from: https://pubs.usgs.gov/circ/1346/pdf/circ1346.pdf
5 Sturchio NC, Beloso A, Heraty LJ, Wheatcraft S, Schumer R. Isotopic tracing of perchlorate sources in groundwater from Pomona, California. Appl Geochem. 2014;43:80-7.
6 Reyes-López JA, Ramírez-Hernández J, Lázaro-Mancilla O, Carreón-Diazconti C, Garrido MML. Assessment of groundwater contamination by landfill leachate: a case in México. Waste Manag. 2008;28:S33-S39.
7 Wallender EK, Ailes EC, Yoder JS, Roberts VA, Brunkard JM. Contributing factors to disease outbreaks associated with untreated groundwater. Groundwater. 2014:52(6):886-97.
8 Nadim F, Hoag GE, Liu S, Carley RJ, Zack P. Detection and remediation of soil and aquifer systems contaminated with petroleum products: an overview. J Pet Sci Eng. 2000;26(1):169-78.
9 Environmental Protection Agency (EPA). FY 2011 annual report on the underground storage tank program [Internet]. Washington: EPA; 2011 [cited 2017 Dec 19]. Available from https://www.epa.gov/sites/production/files/2014-02/documents/fy11_annual_ust_report_3-12.pdf
10 Kaufman JD, Adar SD, Barr RG, Budoff M, Burke GL, Curl CL, Kronmal R. Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): a longitudinal cohort study. Lancet. 2016;388(10045):696-704.
11 Dockery DW, Pope CA, Xu X, Spengler JD, Ware JH, Fay ME, Speizer FE. An association between air pollution and mortality in six US cities. New Engl J Med. 1993;329(24):1753-59.
12 Laden F, Schwartz J, Speizer FE, Dockery DW. Reduction in fine particulate air pollution and mortality: extended follow-up of the Harvard Six Cities study. Am J Respir Crit Care Med. 2006;173(6):667-72.
13 Turner MC, Krewski D, Pope III CA, Chen Y, Gapstur SM, Thun MJ. Long-term ambient fine particulate matter air pollution and lung cancer in a large cohort of never-smokers. Am J Respir Crit Care Med. 2011;184(12):1374-81.
14 Rostron B. Mortality risks associated with environmental tobacco smoke exposure in the United States. Nicotine Tob Res. 2013;15(10):1722-8. doi: 10.1093/ntr/ntt051
15 Gilmour MI, Jaakkola MS, London SJ, Nel AE, Rogers CA. How exposure to environmental tobacco smoke, outdoor air pollutants, and increased pollen burdens influences the incidence of asthma. Environ Health Perspect. 2006;114(4):627-33.
16 Wigle DT, Arbuckle TE, Walker M, Wade MG, Liu S, Krewski D. Environmental hazards: evidence for effects on child health. J Toxicol Environ Health B Crit Rev. 2007;10(1-2):3-39.
17 Poursafa P, Kelishadi R. What health professionals should know about the health effects of air pollution and climate change on children and pregnant mothers. Iran J Nurs Midwifery Res. 2011;16(3):257-64.
18 Chilmonczyk BA, Salmun LM, Megathlin KN, Neveux LM, Palomaki GE, Knight GJ, Haddow JE. Association between exposure to environmental tobacco smoke and exacerbations of asthma in children. New Engl J Med. 1993;328(23):1665-9.
19 McGeehin MA, Mirabelli M. The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environ Health Perspect. 2001;109(Suppl 2):185-9.
20 Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O'Neill MS. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992-2006. Environ Health Persp. 2014;122(11):1187-92.
21 National Oceanic and Atmospheric Administration (NOAA), National Centers for Environmental Information [Internet]. State of the Climate: Global Climate Report - Annual 2015. Washington: NOAA. 2016 [cited 2017 Dec 19]. Available from: http://www.ncdc.noaa.gov/sotc/global/201513
22 National Oceanic and Atmospheric Administration (NOAA), National Centers for Environmental Information [Internet]. State of the Climate: Global Climate Report - Annual 2016. Washington: NOAA. 2017 [cited 2017 Dec 19]. Available from: https://www.ncdc.noaa.gov/sotc/global/201613
23 National Oceanic and Atmospheric Administration (NOAA), National Centers for Environmental Information [Internet]. State of the Climate: Global Climate Report - January 2017. Washington: NOAA. 2017 [cited 2017 Dec 19]. Available from: https://www.ncdc.noaa.gov/sotc/global/201701
24 Basu R. High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health. 2009:8(1):40.
25 Gronlund CJ. Racial and socioeconomic disparities in heat-related health effects and their mechanisms: a review. Curr Epidemiol Rep. 2014;1(3):165-73.
26 Harlan SL, Brazel AJ, Prashad L, Stefanov WL, Larsen L. Neighborhood microclimates and vulnerability to heat stress. Social Sci Med. 2006;63(11):2847-63.
27 O'Neill MS, Zanobetti A, Schwartz J. Disparities by race in heat-related mortality in four US cities: the role of air conditioning prevalence. J Urban Health. 2005;82(2):191-7.
28 Stoecklin-Marois M, Hennessy-Burt T, Mitchell D, Schenker M. Heat-related illness knowledge and practices among California hired farm workers in the MICASA study. Ind Health. 2013;51(1):47-55.
29 Miranda ML, Edwards SE, Keating MH, Paul CJ. Making the environmental justice grade: the relative burden of air pollution exposure in the United States. Int J Environ Res Public Health. 2011;8(6):1755-71.
30 Wilson S, Zhang H, Burwell K, Samantapudi A, Dalemarre L, Jiang C, et al. Leaking underground storage tanks and environmental injustice: is there a hidden and unequal threat to public health in South Carolina? Environ Justice. 2013;6(5):175-82.
31 Evans GW, Kantrowitz E. Socioeconomic status and health: the potential role of environmental risk exposure. Annu Rev Public Health. 2002;23(1):303-31.
32 Clark LP, Millet DB, Marshall JD. National patterns in environmental injustice and inequality: outdoor NO 2 air pollution in the United States. PLoS One. 2014;9(4):e94431.
33 Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404.
34 Hoppe BO, Harding AK, Staab J, Counter M. Private well testing in Oregon from real estate transactions: an innovative approach toward a state-based surveillance system. Public Health Rep. 2011;126(1):107.
35 Ward MH, Rusiecki JA, Lynch CF, Cantor KP. Nitrate in public water supplies and the risk of renal cell carcinoma. Cancer Causes Control. 2007;18(10):1141-51.
36 De Roos AJ, Ward MH, Lynch CF, Cantor KP. Nitrate in public water supplies and the risk of colon and rectum cancers. Epidemiology. 2003;14(6):640-49.
37 Weyer PJ, Cerhan JR, Kross BC, Hallberg GR, Kantamneni J, Breuer G, Lynch CF. Municipal drinking water nitrate level and cancer risk in older women: the Iowa Women's Health Study. Epidemiology. 2001;12(3):327-38.
38 Fuks K, Moebus S, Hertel S, Viehmann A, Nonnemacher M, Dragano N, Hoffmann B. Long-term urban particulate air pollution, traffic noise, and arterial blood pressure. Environ Health Perspect. 2011;119(12):1706.
39 Bell ML, Ebisu K. Environmental inequality in exposures to airborne particulate matter components in the United States. Environ Health Perspect. 2012;120(12):1699.
40 Fauth RC, Leventhal T, Brooks-Gunn J. Short-term effects of moving from public housing in poor to middle-class neighborhoods on low-income, minority adults' outcomes. Social Sci Med. 2004;59(11):2271-84.
41 Bryant-Stephens T. Asthma disparities in urban environments. J Allergy Clin Immunol. 2009;123(6):1199-206.
42 Northridge J, Ramirez OF, Stingone JA, Claudio L. The role of housing type and housing quality in urban children with asthma. J Urban Health. 2010;87(2):211-24.
43 Tyrrell J, Melzer D, Henley W, Galloway TS, Osborne NJ. Associations between socioeconomic status and environmental toxicant concentrations in adults in the USA: NHANES 2001-2010. Environ Int. 2013;59:328-35.
44 Meehan August L, Faust JB, Cushing L, Zeise L, Alexeeff GV. Methodological considerations in screening for cumulative environmental health impacts: lessons learned from a pilot study in California. Int J Environ Res Public Health. 2012;9(9):3069-84.