Environmental Injustices: Research and Action to Reduce Obesity Disparities

Healthy People 2010¹ and the World Health Organization Global Strategy on Diet, Physical Activity, and Health ² have made major calls for attention to health disparities stemming from environmental factors. There is a great need for research and funding to support reduction and elimination of health disparities related to obesity, physical activity, and nutrition. Although other policies have addressed obesity per se, none have directly addressed environmental determinants of diet and physical activity. The distinction between individual and broader environment-level determinants is that the macro-level food and physical activity environments must be addressed directly to provide the resources necessary for individuals to maintain healthy lifestyles. Thus, the provision of a healthy environment is a prerequisite to any effort to reduce obesity.

Introduction
We present a brief history of the environmental justice movement to illustrate the disproportionate and negative impact that environmental factors can have on disadvantaged communities. Then we review the literature related to physical activity, healthy eating, and the environment. We make the case that the environment has a disproportionate and negative impact on disadvantaged communities, thus contributing to greater rates of obesity in these communities.

Brief History of the Environmental Justice Movement
An extensive scientific literature has reported environmental injustices related to hazardous waste facilities disproportionately placed in poor and predominantly racial and ethnic minority neighborhoods. A ground-breaking study in 1987, Toxic Waste and Race in the United States, documented environmental injustices across the country and helped mobilize a grassroots movement.^3,4 Twenty years later, using new methods, researchers found that racial and ethnic disparities in the location of hazardous waste facilities were greater than previous studies had shown.⁵ As a result of these injustices and the grassroots movement, environmental justice principles have been codified by legislation. The Environmental Protection Agency⁶ mandate includes the following:

• Achieving environmental justice is part of our mission by identifying and addressing, as appropriate, disproportionate high and adverse human health and environmental effects of programs, policies, and activities on racial and ethnic minority populations and low-income populations.
• Meaningful involvement of all people regardless of race, ethnicity, income, national origin, and educational level with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.  

Physical Activity and the Environment
Recently, environmental justice principles have been extended to environmental influences on obesity, healthy eating, and physical activity in low-income and racial and ethnic minority communities.^7–10 A primary concern is “deprivation amplification,” described as such: in places where people have fewer personal resources, the local facilities that enable people to lead healthy lives are poorer compared with nonimpoverished and nonsocially deprived areas.¹¹ Several empirical studies support “deprivation amplification” as it relates to physical activity and the environment. Estabrooks et al.¹² found that low–, medium–, and high–social economic status (SES) neighborhoods did not differ on the number of pay-for-use facilities; however, low-SES and medium-SES neighborhoods had significantly fewer free-for-use resources (i.e., walking paths, parks, and playgrounds) than high-SES neighborhoods. Other studies have shown major disparities in access to facilities to support physical activity, with poor, racial and ethnic minority communities at a disadvantage. In a national study covering 19% of US census block groups, Gordon-Larsen et al.¹³ provided the first empirical evidence that at a national level all major categories of physical activity facilities are inequitably allocated, with low SES, racial and ethnic minority neighborhoods at the greatest disadvantage. Further, this inequitable distribution of facilities was significantly associated with subsequent disparities in physical activity and obesity patterns in US adolescents. In addition, Nelson et al.,¹⁴ using the same database, found that elements of the built environment beyond race and ethnicity and SES had an impact on physical activity and obesity. Further research suggests that public parks, particularly those within 1-mile of the residential locations, are critical resources for physical activity in racial and ethnic minority communities.¹⁵

Retail Food Outlets and the Environment
Research indicates that the food environment might directly affect individual dietary behaviors, in particular patterns of away-from-home food eating, through targeted placement of food stores.^16,17 Numerous studies have demonstrated differential access to retail food outlets, including supermarkets, smaller grocery stores, restaurants, and fast food restaurants, by neighborhood deprivation,^18,19 ethnic composition,²⁰ and area-level wealth.²¹ Neighborhoods with lower income and higher percentage Black and racially mixed residents had significantly fewer supermarkets and a higher density of fast food restaurants than wealthier, predominantly non-Hispanic White neighborhoods.^16,20,22

Relevance of Environmental Justice Principles for the Obesity Epidemic
The environmental justice movement which addresses inequality of environments, is highly relevant to the obesity epidemic and the importance of the “toxic environment” in terms of readily available and affordable energy-dense, high-fat foods and lack of availability and affordability of (1) physical activity resources and facilities and (2) healthy eating options. Because Healthy People 2010 ranks physical activity, overweight, and obesity as leading health indicators, environmental justice and the physical environment must become a priority research area to address the epidemic of sedentary behavior, unhealthy eating patterns, and high rates of obesity. In the absence of addressing environmental justice issues, the research agenda is incomplete and undermines the objectives of eliminating health disparities and improving the health of all communities. The unfair and disproportionate distribution of health-promoting features among various communities and the consequent disease burden are comparable to the unfair and disproportionate distribution of hazardous waste landfills that sparked the environmental justice movement. These similarities are important concerns of social and environmental justice.

APHA supports the mobilization of federal, state, and local governments and community organizations working together to develop environmental justice research-based programs, policies, and infrastructures to eliminate health disparities related to obesity, healthy eating, and physical activity. Thus, the APHA urges —

1. The National Institutes of Health and the Centers for Disease Control and Prevention to undertake or fund extramural studies that lead to solutions for eliminating health disparities related to environmental injustice, obesity, healthy eating, and physical activity. In particular, there is a need to increase research in the area of macro- and micro-level environmental factors using objective and subjective assessments to increase understanding of the effects of built and social environmental factors on health disparities. A critical area for research includes longitudinal and intervention studies on this topic. 
2. The National Institutes of Health and the Centers for Disease Control and Prevention to undertake and fund extramural studies to invest in programs that lead to solutions for eliminating health disparities related to environmental injustice, obesity, healthy eating, and physical activity. 
3. The National Institutes of Health and the Centers for Disease Control and Prevention to undertake and fund extramural studies to develop comprehensive and environmentally focused, obesity prevention interventions for economically and racially and ethnically diverse communities and evaluate their effects. 
4. The US Congress and state legislatures to enact appropriate policies ensuring “procedural justice,” which means that decisionmakers should represent diverse segments of the community. Decisions related to neighborhood design features, park location and quality, physical activity resources, and healthy eating opportunities should include representatives from all stakeholders and community residents.
5. The US Congress and state legislatures to enact appropriate policies to establish state and community surveillance systems to monitor community conditions related to environmental injustices, obesity, healthy eating, and physical activity that will identify geographic areas in need of targeted interventions (e.g., disparities in access to parks and affordable healthy foods, such as in supermarkets).
6. The US Congress and state legislatures to enact appropriate policies to promote healthy diet and physical activity resources and messages across the following arenas: the food and beverage industry, agriculture, education, media, government, health care, and the built environment.
7. The US Congress and state legislatures to enact appropriate policies to provide healthy diet and physical activity environments across homes, schools, communities, work sites, and health care arenas. 
8. State and local health departments to ensure that development, transportation, and park and trail projects allocate resources to mitigate environmental disparities that adversely affect socially or economically disadvantaged groups.

References

1. Healthy People 2010: Understanding and Improving Health. Washington, DC: US Department of Health and Human Services; 2000. Also available at: http://web.health.gov/healthypeople/document/. Accessed December 7, 2007.
2. Global Strategy on Diet, Physical Activity, and Health. Geneva, Switzerland: World Health Organization; 2004.
3. Commission for Racial Justice and United Church of Christ. Toxic Wastes and Race in the United States: A National Report on the Racial and Socioeconomic Characteristics of Communities with Hazardous Waste Sites. New York: United Church of Christ; 1987.
4. Bullard RD, Johnson GS. Environmental justice: grassroots activism and its impact on public policy decision making. J Soc Issues. 2000;56:555–578.
5. Bullard, RD, Mohai P, Saha R, Wright, B. Toxic Wastes and Race at Twenty: 1987-2007 Grassroots Struggles to Dismantle Environmental Racism in the United States. Cleveland, OH: The United Church of Christ, 2007. 
6. Institute of Medicine. Toward Environmental Justice. Washington D.C., National Academy Press, 1999; 119-120.
7. Floyd MF, Johnson CY. Coming to terms with environmental justice in outdoor recreation: A conceptual discussion with research implications. Leisure Sciences. 2002;24:59–77.
8. Greenberg MR, Renne J. Where does walkability matter the most? An environmental justice interpretation of New Jersey data. J Urban Health. 2005;82(1):90–100.
9. Taylor WC, Poston WSC, Jones L, Kraft MK. Environmental justice: obesity, physical activity, and healthy eating. J Phys Act Health. 2006;3(suppl 1):30–54.
10. Taylor WC, Floyd MF, Whitt-Glover MC, Brooks J. Environmental justice: a framework for collaboration between public health and parks and recreation fields to study disparities in physical activity. J Phys Act Health. 2007;4(supp 1):S50–S63. 
11. MacIntyre S. The social patterning of exercise behaviours: the role of personal and local resources. Br J Sports Med. 2000;34:6.
12. Estabrooks PA, Lee RE, Gynresik NC. Resources for physical activity participation: does availability and accessibility differ by neighborhood socioeconomic status? Ann Behav Med. 2003;25:100–104.
13. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117:417–424. 
14. Nelson MC, Gordon-Larsen P, Song Y, Popkin BM. Built and social environments associations with adolescent overweight and activity. Am J Prev Med. 2006;31:109–117. 
15. Cohen DA, McKenzie TL, Sehgal A, Williamson S, Golinelli D, Lurie N. Contribution of public parks to physical activity. Am J Public Health. 2007; 97:509–514.
16. Block JP, Scribner RA, DeSalvo KB. Fast food, race/ethnicity, and income: a geographic analysis. Am J Prev Med. 2004;27:211–217. 
17. Austin SB, Melly SJ, Sanche BN, et al. Clustering of fast-food restaurants around schools: a novel application of spatial statistics to the study of food environments. Am J Public Health. 2005;95:1575–1581.
18. Cubbin,C, Hadden W, Winkleby MA. Neighborhood context and cardiovascular disease risk factors: the contribution of material deprivation. Ethn Dis. 2001;11:687–700.
19. Cummins S, Stafford M, Macintyre S, Marmot M, Ellaway A. Neighbourhood environment and its association with self rated health: evidence from Scotland and England. J Epidemiol Community Health. 2005;59:207–213.
20. Moore LV, Diez Roux AV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006; 96:325–331.
21. Reidpath DD, Burns C, Garrard J, Mahoney M, Townsend M. An ecological study of the relationship between social and environmental determinants of obesity. Health Place. 2002;8:141–145.
22. Morland K, Wing S, Diez Roux A. The contextual effect of the local food environment on residents' diets: the atherosclerosis risk in communities study. Am J Public Health. 2002;92:1761–1767.

Back to Top