The air we breathe: health inequity and environmental racism in the time of COVID19

Nature has presented us with a perverse, modern version of a textbook ethics dilemma. Who do you save, the planet or the people destroying it? If we are smart enough, can we do both?

Like Comment

It’s day 28 (or is it 29?) of shelter in place in California. I step outside for my first walk of the day - socially distanced exercise is still allowed if I keep 6 feet away from others. The sun hits my face and for a moment the crushing anxiety of an international pandemic fades slightly. As I walk a sensation comes over me, the deja vu of a memory struggling to escape from whatever folds of hippocampus retain its code. I take a deep breath and then it clicks - the air feels different.

 I reflexively pull up my phone and check the Air Quality Index - I got used to doing this during California’s Camp Fire, which blanketed smoke over the entire Bay Area for weeks. My area, and nearly all of the United States, are green on the map - good air quality. Even Los Angeles, an industrial pollution center that is usually reliably yellow-orange (‘unhealthy for sensitive groups’), is green with just a splotch of yellow. 

Nature has presented us with a perverse, modern version of a textbook ethics dilemma. This time it’s more nuanced than the classic trolley car problem, or the “Avian Flu” scenarios that won Kahneman and Tversky the Nobel Prize. We industrialized on a global scale, built cities up into the sky, and enabled a patchwork underfunded health care system in the United States. Each action has an equal and opposite reaction; a virus shut down our way of life in a matter of weeks. The long term repercussions from lives lost to economies destroyed remain to be seen.  However, climate scientists are well aware that by abruptly ceasing all but the essential functions of society, environmental impacts would largely be positive [1,2]. In fact, some estimates suggest that the lives saved due to improvements in air and water quality will outpace the number of deaths caused by the COVID19 virus [3]. It would be a cold calculus to say the positive side effects of COVID19 justify the disruption, suffering, and deaths - but it would also be irresponsible to ignore. Who do you save, the planet or the people destroying it? If we are smart enough, can we do both?

The virus has laid bare many harsh truths that American politicians and corporations would rather ignore - we do not have a “first world” health care system, we do not protect vulnerable communities like elders and people of color and those with disabilities, and all too often we value our own illusion of independence over public health and the greater good [4]. It’s not a coincidence that the worst environmental crimes are committed against the most vulnerable people in our society, particularly low-income persons of color.  This systematic exposure to unhealthy environments is called environmental racism. 

 What we are seeing now with COVID19 is enormous racial disparities in terms of fatal disease outcomes [5]. For example, research has linked lower air quality to higher rates of COVID19, and underprivileged communities are more likely to be exposed to poor air quality and other environmental stressors [6,7,8]. It’s not a large logical leap that a virus that invades via the respiratory system can do more damage to a system already under stress. Environmental racism is colliding with healthcare inequity, with deadly force. 

The incredible losses we are facing as a global community mean we are compelled to reimagine our way of life, and what society should look like going forward. Perhaps we can breathe in our cleaner air, enjoy the peaceful quiet of emptier roads, and watch the wildlife return to our parks, and realize these don’t need to be temporary benefits granted to only the privileged. Americans can vote for politicians who will fund the NIH, CDC, EPA, and the pandemic response team, and not threaten the jobs of leading scientists like Dr. Fauci through hashtags[9]. We can fight to remediate inequities in access to health care, clean and safe environments, and the basic necessities of life. We can continue to drive less, bike or walk more. Shop local. Check in on whether our neighbors are short on toilet paper. This historical, unprecedented event will rewrite history, but there is still a human hand to be played. When the next pandemic happens - when, not if - will we have learned anything from this? 

  This is a time for both reflection and action. So many of us are thinking of basic survival right now - the air we breathe. Let’s not forget how important it is when all of this is over.










Colleen Mills-Finnerty

Research Health Science Specialist, Veterans Administration Palo Alto/Stanford University Dept. of Psychiatry & Behavioral Science (affiliate)