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Truth, justice, and the American wayWhere is Superman when you need him?  If only it were that easy.  Facing one of the greatest environmental disasters of our time, the citizens of New Orleans could sure use a caped superhero capable of turning back time by spinning the world in the opposite direction.  While he’s at it, why not go back five years, before the onslaught of Katrina, which plunged families in the Gulf into a dark abyss that has destroyed lives and continues to ruin both homes and health.  One of the dark truths made evident by the response to Katrina and to the Gulf oil spill is that there is a sector of the American population – specifically poor children –increasingly victimized by what is termed environmental injustice.

What is environmental justice?  It is one of the top priorities of the U.S. Environmental Protection Agency (EPA), defined as follows:

“Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. EPA has this goal for all communities and persons across this Nation. It will be achieved when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.”

Environmental injustice, then, is done when there exist health disparities based on these same factors.  The National Environmental Justice Advisory Council, in response to the BP/Deepwater Horizon oil disaster, challenged the EPA to “do a better job of targeting communities that have historically been underrepresented in disaster response, including people of color and Native Americans.”

Children, in fact, are a unique population susceptible to unfair treatment based simply on one factor – their age. As noted in a recent editorial by Dr. Philip Landrigan, Director of the Children’s Environmental Health Center at the Mount Sinai Medical Center in New York, “Infants and children, because of their unique biological vulnerabilities and age-related patterns of exposure, are especially vulnerable to the health impacts of environmental injustice.”  And certain children – victims of poverty and often those of certain racial groups – are particularly at risk.  They are the most vulnerable of the vulnerable.

The children of the Gulf, especially in New Orleans, unfortunately epitomize this description.  Plagued by poverty and its attendant ills, these kids suffer from poor access to health care, poor nutrition and lack of safe, healthy locations to play.  Asthma rates prior to Katrina were already reported at several times the national rate.  Lifetime prevalence of asthma among children in New Orleans was reported at nearly 25%.  One in four of children.  And the rate of asthma among all children in the U.S. in general is skyrocketing.  Most recent estimates by the Centers for Disease Control are that 9.1 % of children suffer from asthma, a 250%  increase since 1980.  Certain racial groups had significantly higher rates reported, even when accounting for other factors.   These disparities are the very model of environmental injustice.

When Katrina hit, these children already at high-risk were exposed to a massive double-whammy.  Two of the most researched asthma triggers – mold and stress – were at all-time highs.  Researchers from the Tulane University Health Sciences Center and the New Orleans Department of Health have led a collaborative, federally-supported study of the effects of Katrina on children’s asthma nick-named HEAL, or the “Head-off Environmental Asthma in Louisiana” Project.  According to the NIEHS HEAL web site,

“Childhood asthma is on the rise in the United States, especially among minority inner-city children. Up to 24 percent of minority children living in cities like New Orleans may have asthma. Asthma is the number one reason children miss school due to chronic illness, and the second leading cause of children’s emergency department visits. The rapidly increasing rates of asthma are thought to be related in part to increases in allergies and environmental exposures, such as mold, moisture and other allergens. Another factor that worsens asthma is the lack of access to health care. In New Orleans and in many other cities, both poor access to health care and environmental exposures to mold and allergens are likely to contribute to asthma at the same time.”

The HEAL Project is a massive undertaking and now, even five years later, researchers are still struggling to make sense of data collected.  We have no answers yet as to the true impact of Katrina on the health of the children of the Gulf.  And we have little way of truly healing these families.  Families that have been displaced from their homes and lost their jobs, families that were forced to leave the area entirely or live in FEMA trailers.  The same trailers that we now realize were exposing inhabitants to toxic levels of formaldehyde. I will now quote directly from the EPA’s site on formaldehyde: “High concentrations may trigger attacks in people with asthma.”  Oops.

Let’s talk about stress.  Stress is a proven trigger of asthma, not to mention other ill health effects.  As Jane El-Dahr, M.D., Chief of Pediatric Immunology, Allergy, and Rheumatology at Tulane University School of Medicine notes, “The lack of mental health care for both children and adults – which was inadequate before Katrina but much worse since – is the main challenge I see right now and where the most help is needed.” Could one envision a more stressful scenario right here in these United States of America?

Well…. let’s fast-forward to the summer of 2010. Crude oil spewing a mile below the surface of the Gulf of Mexico.  Making its way up and in, towards the beaches of Louisiana.   Birds and fish dying by the thousands.  Toxic fumes from both the oil spill and attempts to clean up the mess wafting over the entire Gulf region.  Once again, lives disrupted and destroyed.  With much attention initially paid, necessarily so, to the immediate impacts of the spill, we now find ourselves wondering how, if ever, will the lives of families in the Gulf be restored and made whole?  What about the children?  Who is watching out for them?

Finally, on June 22, two months after the Deepwater Horizon drilling rig explosion, we had a national hearing on the human health effects of the oil spill, hosted by the NIH Institute of Medicine. Thankfully, two of the presentations by esteemed experts specifically addressed children as an especially vulnerable population.  Irwin Redlener, M.D., Director of the National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health and President of the Children’s Health Fund, highlighted both the physical and emotional impact on these already hard-hit kids, echoing Dr. El-Dahr’s concerns that “toxic stress – round 2” may be the biggest challenge for children and their families.   Brenda Eskenazi, Ph.D., Professor, School of Public Health at the University of California – Berkeley, discussed the unique exposures of children to the toxic effects of the hundreds of individual chemicals present in crude oil.  She also went one much needed step further, voicing a concern for pregnant women and their offspring.  We now know that prenatal and even preconceptual toxic exposures to both mothers and fathers may lead to short- and long-term ill health effects for their children.   What havoc have we wreaked upon generations of Gulf inhabitants?  Will it be enough to be the voice for the children of New Orleans?  What about their children?  And their children’s children?

One thing is certain.  We must be their advocates.  Children are victims of environmental injustice in part due to their lack of political voice.  Led by advocates like Drs. El-Dahr, Redlener and Eskenazi, we need to be the voices for these children.  What can we do?  We can support efforts to track the effects of the oil spill on children and their families – it is only through these efforts that the truth will be known.

And we must act to develop and fund programs to provide family support, both for physical and emotional health needs.  As Dr. Redlener noted in his IOM presentation, we must protect these most vulnerable children via “sufficiently-funded, coordinated and timely intervention and assessment services (medical, mental health) for affected families.”  Only then will justice be done.

Why should we make this a national priority?  Because these children are the future of our country.  Because that’s the American way.  Because, as author and children’s rights advocate Pearl S. Buck warned, “If our American way of life fails the child, it fails us all.”

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