by Keisha Ray PhD and Jane Cooper MBE
One of the inequities to come out of the Covid-19 pandemic is an increase in the disproportionate effects of environmental toxins on poor people and/or people of color. Additionally, during the pandemic Black, Latinx, and Indigenous people disproportionately experienced higher rates of Covid-19 infections, hospitalizations, and deaths from the virus. New research, however, has revealed a link between air pollution and likelihood of death from Covid-19; people who live in highly polluted areas are more likely to die once they have the Covid-19 virus. Given that poor people and people of color are more likely to live in polluted areas than wealthy and White people, and they are more likely to be infected and die from the Covid-19 virus, environmental toxins are one of the many obstacles to equitable health independent of race and wealth status.
Environmental toxins continue to prove to be a formidable threat to equitable access to health. This includes threats to vulnerable populations’ access to informed consent and justice. As such, if bioethics is to be a serious advocate for health justice it must take advantage of the lessons the Covid-19 pandemic has given us about the relationship between racism, classism, environmental toxins, and health equity and make environmental justice a cornerstone of our research and teachings on health justice. One way to do this is to integrate environmental injustice into our work on informed consent and justice, rather than putting the issue on the sidelines.
Informed Consent: From bioethics to toxic industry
Environmental racism and injustice is apparent in many countries and regions, including the United States. Poor and/or communities of color here carry a high burden of pollution and environmental toxins, while benefiting the least from resource extraction and its associated wealth. This is especially true with regards to hazardous waste storage and toxic emissions, and there is extensive data to support this. For example, a staggering 70% of hazardous waste sites that are listed on the National Priorities List (NPL) are located within one mile of a federally assisted housing complex. People of color are almost twice as likely to live near a dangerous chemical facility, and are over-exposed to dangerous ambient fine particulate air pollution “across states, urban and rural areas, income levels, and exposure levels.” Remembering the importance of intersectionality, it is important to name that communities that are both poor and primarily composed of people of colour (particularly Black and Indiegnous persons), often bear the heaviest burden.
Particularly salient for bioethicists is the number of Americans who lack meaningful consultation in licensing of dangerous industries in their communities. Impoverished communities are often more likely to agree to dangerous industry and waste storage, and are much more likely to risk their safety for jobs and economic opportunities than relatively affluent communities. This can not be considered meaningful consultation, or anything close to the standard of informed consent that is required by bioethics. Due to centuries of racism, a disproportionate number of such communities are Black communities and other communities of color. For Indigenous communities, this may even be illegal, as “Free, Prior and Informed Consent (FPIC) is a specific right that pertains to indigenous peoples and is recognised in the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP).”
Justice: The link between Covid-19 and environmental toxins
Researchers have found that people with Covid-19 who live in counties with high rates of air pollution have a greater chance of dying from the virus. Air pollutants breathed in over time weaken the immune system and promote diseases like hypertension, heart disease, respiratory illnesses, and diabetes, all which can raise mortality rates of Covid-19 infections and can be more prevalent in people of color. Researchers suspect that if pollution in some cities was just slightly less over the previous two decades, fewer people would have died during the 2020 Covid-19 pandemic. This research is especially disturbing because it doubles down on the threat that Covid-19 and environmental toxins both pose to poor people and people of color. Given that people of color are more likely to live, work, and go to school in areas with high levels of air pollution than White people and people of color are more likely to die from Covid-19 than White people, the link between Covid-19 and air pollutants is another hurdle to making proper health available to people independent of their skin color, income, and where they live.
Another link between Covid-19 and environmental toxins was revealed during the global lockdowns initiated at the beginning of the pandemic. Many countries across the world, including the US, China, India, and Italy saw declines in air pollutants when people were confined to their homes to slow the spread of the virus. Many people were no longer using their personal vehicles to travel to work, public transportation came to a complete stop, and some facilities that used energy and emitted pollutants were temporarily not in service. The resulting decrease in air pollutants, even if temporary, has been thought to have saved thousands of lives across the world during the Covid-19 pandemic. As many countries return to “normal,” people return to using vehicles, and facilities return to business as usual, air pollutants are once again a threat to health. The benefits we received from this short respite from extreme air pollution shows how imperative it is to eliminate environmental toxins for the sake of everyone’s health, but in particular for the sake of poor people and people of color who disproportionately bear the burden of environmental toxins.
What does this mean for bioethics?
Informed consent and justice are pillars of the bioethics profession. For better or worse, bioethics is a principlist profession; rather than put environmental injustice on the sidelines, we ought to make environmental injustice central to our work. We already implement and practice informed consent and justice in our research, in our clinical ethics consults, and we teach it to our students. Environmental injustice presents an opportunity for bioethicists to essentially “practice what we preach” and use our skills to address environmental toxins’ threat to our principles and to populations made vulnerable.
For example, bioethics places a lot of importance on informed consent, and for good reason. As such, bioethicists should be concerned with the persistent lack of information and meaningful consultation in licensing dangerous industries in systematically marginalized communities, and the policies that allow toxic waste and emissions to contribute to poor health for communities of color.
Secondly, there are many ways to conceptualize justice, and there is no doubt that environmental toxins violate at least one conception of justice–fair and equal distribution of goods. Who breathes in air pollutants and whose health and wellbeing is affected by pollutants is not equal, and therefore access to health is not equal, and unjust. And the Covid-19 connection to air pollutants should put some urgency in our step and show us just how important our commitment to influencing policy, contributing to public health, and writing for popular news sources to bring attention to the injustice of environmental toxins is to creating real change. We also should be preparing our clinical students to recognize and treat the effects of environmental toxins as well as be advocates for environmental injustices. This is a crucial component of anti-racism and justice work that is needed for a more equitable bioethics. If bioethics is to be an advocate of racial justice and health equity, it simply cannot afford to be passive on issues of environmental toxins.