The Impact of Systemic Racial Inequities on Asthma
Taylor Kaiser, PharmD
Minnesota Community Care
Background: While Minnesota is consistently ranked as one of the most livable states, it also ranks as one of the worst states for Black, Indigenous, and People of Color (BIPOC) to live in according to Schuler et al., 2022, in terms of unemployment rate gaps, income inequality, homeownership/housing quality disparities, increased exposure to pollution, reduced life expectancy, and much more. Each of these factors are part of a person’s social determinants of health. Looking deeper at increased exposure to pollution alone impacts a variety of conditions like ischemic stroke, lung cancer, hypertension, atrial fibrillation, and heart disease. Parfieniuk’s 2022 report focuses specifically on the links between asthma, air pollution, and systemic racism in the Twin Cities. While these disparities and racial injustices are well known, little has been done to act on mitigation and adaptation strategies which address the underlying racial, class, and income disparities in Minnesota.
Evidence and Discussion: Schuler et al., 2022, notes that Minnesota’s first racial covenant, a clause incorporated into property deeds to prevent non-White individuals from being allowed to buy or occupy land, occurred in the 1910s. From the 1930s onward, redlining practices increased as BIPOC were denied home loans/insurance in certain areas. According to Parfieniuk, I-94 was intentionally built through St. Paul’s predominantly Black Rondo neighborhood in the 1950s. In the 1960s, I-35W was built through a Black south Minneapolis neighborhood. Today, the racial distribution of Minnesota residents has changed little and air pollution maps show that these freeways produce significant pollution in these historically Black Twin Cities neighborhoods. Ninety-three percent of Minnesotan BIPOC live in an area above the Minnesota Pollution Control Agency’s air quality risk recommendation compared to the 51% statewide average. In 2015-2018, asthma emergency department visit rates were two to five times higher in these historically Black neighborhoods, as reported by Parfieniuk. Indigenous Minnesotans experience over double the rate of asthma than White Minnesotans, and Black Minnesotans are six times more likely to die from asthma than White Minnesotans. While compounding climate change factors and historical injustices have larger impacts still permeating the Minnesota community today, the disparities in asthma control alone demonstrates the need for change in policy.
Clinical Impact: Health professionals are in a great position to invest in their local communities and organizations, use their voices to support climate justice and equity policy, and bring patient stories to legislators.It is important for health professionals to educate themselves on these underlying disparities in order to recognize how their patients’ social determinants impact their health. Schuler et al. recommends health professionals promote policies that invest in neighborhoods hit hardest by climate change and reduce social inequities, such as the Next Generation Climate Act. This Act would update Minnesota’s current climate goals with a commitment to provide jobs and business opportunities within the clean energy sector to people living within at-risk communities, prevent further climate change, and invest in the neighborhoods most impacted (and least responsible) for climate change. Other local resources to address climate justice include Minnesota’s Climate Action Framework, Twin Cities Boulevard, the East Phillips Neighborhood Institute, 100%MN, and Community Members for Environmental Justice. Per Parfieniuk, one policy proposal that includes wind energy in the energy grid and increases use of plug-in electric vehicles would reduce environmental health impacts by 50%. With these actions, systemic racial inequities leading to poor public health can start to be corrected, allowing for all people in Minnesota to live in healthy communities.
References:
- Schuler K, Grant SL, Kim A, et al. Climate Justice and Public Health in Minnesota: Equitable solutions to the Climate Crisis. Health Professionals for a Healthy Climate; 2022.
- Parfieniuk U. Asthma and Air Pollution Emissions in the Twin Cities. Published June 8, 2022. Accessed July 29, 2022. https://storymaps.arcgis.com/stories/64edd9dd368e4c16885f20504a172818.