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Why the CDC’s Environmental Justice Index Holds the Power to Improve Health

It’s the First National Database to Measure the Impact of Environmental Factors on Health 

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The combination of environmental factors and social determinants plays a pivotal role in shaping health outcomes. The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry recently published the Environmental Justice Index (EJI), a nationwide, place-based instrument designed to measure the impacts of environmental burden “through the lens of human health and health equity.”  

The EJI represents a significant advance in identifying environmental injustices as it integrates data on exposures, health outcomes, and social vulnerability to provide detailed assessments of the burden communities face. This holistic approach helps to highlight areas where intervention is most needed, offering a clearer picture of the impacts on disadvantaged populations. 

The EJI’s comprehensive nature makes it an invaluable resource for studying social determinants of health. The environment is dynamic, shaped by human factors, policies, and cultural forces. Air and water quality, exposure to toxic substances, and access to green spaces are critical factors to overall health. By integrating EJI data with health outcomes, we can better respond to the environmental and social factors that contribute to health outcomes in a community.  

In a recent study, we used the EJI and its components to investigate the impact of environmental exposures on respiratory outcomes in preterm infants with bronchopulmonary dysplasia (BPD), which is the most common chronic illness of preterm birth. We found that increased scores on the EJI were associated with increased emergency department and hospital admissions for respiratory illness in the year after discharge from the neonatal intensive care unit. 

Further, we found that the air pollution and diesel particulate matter indicators showed the strongest associations with acute respiratory illness in this population. In the case of preterm infants with BPD, targeting place-based interventions that mitigate air pollution exposures may help to improve the long-term respiratory outcomes of preterm infants with BPD.  

Given the insights provided by the EJI and our research findings, we propose several targeted recommendations for policymakers. This is particularly salient for birthing parent and preterm infant health as the environment that contributed to preterm birth is the same one that the preterm infant will spend time in upon discharge from the hospital, affecting health across generations: 

Enact strict air pollution regulations: Air pollution exposure is associated with several adverse health outcomes, particularly in vulnerable populations, such as preterm infants. The Environmental Protection Agency (EPA) recently decreased the average annual limit of fine particulate matter exposure. Policies such as the Clean Air Act have been successful to decrease air pollution in the United States. It is imperative to build upon these achievements and enact policy that decreases the racial and community disparities in air pollution exposure. 

Targeted resource allocation: Distribute resources to neighborhoods with high vulnerability scores on the EJI. This could include funding for environmental cleanup projects, increased health care services, and community support programs. Foster greater community involvement in repairing environmental hazards. This can be achieved through public forums, community advisory boards, and partnerships with local groups based on EJI information. 

Health care delivery: Encourage hospitals and providers to consider environmental factors when treating patients from high-risk areas. This could involve specialized training for health care workers, developing tailored care plans that address environmental exposures, and using community health workers to interact with the community.  

Enhanced monitoring and research: Increase funding for research on the health impacts of environmental exposures, particularly in vulnerable populations. This includes an examination of the environment at a more granular level, the reporting of racial and community differences in exposures, and investigating areas of the EJI linked to adverse health outcomes, such as high levels of air pollution, less green space, extreme heat exposure, and housing insecurity. 

The CDC’s Environmental Justice Index is an important step forward in studying and addressing environmental and health disparities. By integrating the EJI with ongoing research and implementing targeted policy recommendations, we can make significant strides toward achieving environmental justice and improving health outcomes. 

The study, “Environmental Determinants of Post-Discharge Acute Respiratory Illness Among Preterm Infants with Bronchopulmonary Dysplasia,” was published on May 20, 2024 in the International Journal of Environmental Research and Public Health. Authors include Jonathan J. Szeto, Joshua K. Radack, Sara B. DeMauro, Erik A. Jensen, Kathleen Gibbs, Nicolas P. Novick, Kristan A. Scott, Daria C. Murosko, Heather H. Burris, and Timothy D. Nelin.   

Author

Timothy Nelin

Timothy Nelin, MD

Clinical Fellow, Pediatrics/Divison of Neonatology, Children’s Hospital of Philadelphia

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