Environmental justice, SES and health, place and health, theories of inequality Mike Buzzelli and Gerry Veenstra Univer

1. Environmental justice, SES and health, place and health, theories of inequality Mike Buzzelli and Gerry Veenstra University of British Columbia

2. Problems with the Environmental Justice Literature • The working hypothesis of environmental justice research • Methodological issues • Where’s (the health) study? • Conceptualising equity and justice

3. Working hypothesis of environmental justice • Disadvantaged social groups face disproportionate exposures to environmental health hazards despite benefiting least from the production and consumption sectors that produce those hazards • ‘Equity’ and ‘justice’ • Process and outcome studies

4. Two decades of research…

5. Methodological problems Lack of data • Usually aggregated sociodemographic data • Reliance on proxies for environmental data • These result in poor exposure classification…

6. Methodological problems Exposure classification 1. Proxies for environmental hazards • Spatial coincidence (buffering) • Proximity measures 2. Where monitoring data exist • Plume dispersion models • Spatial interpolation techniques • Toxicity indexes

7. Methodological problems So after two decades of research: • Still plagued by the modifiable areal unit problem (MAUP) • Not always using real environmental monitoring data • A mixed bag of one-off cross-sectional studies

8. Where’s the (health) study? Classifying recent research (post-1995; N = 78 studies)

9. A way forward • Linked social, environmental and health data • Combined process and outcome analyses • Multi-level analysis

10. What is needed? • A data and methodological leap forward • A health connection • International, and ideally, directly comparable research • To build this from the ground up will also require meaningful infusion of critical social theory (‘justice’, ‘SES’, etc.)

11. 1. Environmental justice • 2. SES and health • 3. Place and health • 4. Theories of inequality

12. SES and health Description: - explores the relationship between socio-economic status and health, and tends to focus on such issues as: (I) direction of causality, and (ii) neo-material versus psycho-social explanations Methods: - tends to use traditional statistical techniques

13. Relationship between income and health at the individual-level Health Status Income

14. SES and health Spuriousness explanation: - that some other factor (e.g. genetically determined intellectual ability or physical size) influences both SES and health Drift hypothesis: - that poor health contributes to lower SES standing Neo-materialist explanation: - the purchasing power of income secures those essential material resources that subsequently influence health Psycho-social explanation: - the perceptions and interpretive meanings that accompany social status influence health (perhaps via levels of stress)

15. SES and health Overlap with EJ: - both discourses explore the health effects of socio-economic standing Advantages of EJ: - expressly considers the health effects of environmental pollutants; locates health effects of SES in place/space Advantages of SES-health: - considers multiple measures of ‘objective’ socio-economic standing (e.g. occupational prestige); also considers ‘subjective’ measures of social status (e.g. perceived relative standing)

16. Place and health Description: - explores the health effects of place (e.g. neighbourhood and community), focusing specifically on aspects of the material and socio-cultural infrastructures (i.e. the context) above and beyond characteristics of the people living in places (i.e. composition) Methods: - uses traditional statistical techniques at the individual or community level and multilevel models (at both levels) to model the health effects of places

17. Place and health Material infrastructure: - ‘opportunity structures’ in places, socially-constructed and socially–patterned features of the physical and social environment that can affect health (Macintyre et al. 2002) Examples: - availability of healthy environments at home, work and play (such as decent housing and safe employment) - health, human and social services (such as education, health-care, transport and policing) - nature of economic industry - social class dynamics - community wealth - inequality in the distribution of wealth

18. Place and health Collective social functioning: - socio-cultural and historical features of the social worlds of communities (Macintyre et al 2002) Examples: - shared norms, traditions, values and interests - political, economic, ethnic and religious histories - levels of crime - networks of community support - the reputation of an area - mobility into and out of communities - social trust, political trust and social networks (i.e. social capital)

19. Place and health Overlap with EJ literature: - both pay attention to the health effects of properties of places - both use multilevel modelling to distinguish individual from contextual effects Advantages of EJ: - sophisticated use of GIS - includes environmental pollutants - considers differential health effects of pollutants by socio-economic position Advantages of PH: - considers socially-constructed attributes of places - distinguishes individual from contextual socio-economic effects

20. Discussion points Point 1: - in EJ research, socio-economic position (i.e. income and education) is the primary measure of inequality Point 2: - in SES-health research, physical and social characteristics of places (and their differential health effects by socio-economic standing) are seldom considered Point 3: - in place-health research, physical characteristics of places (e.g. environmental toxins) are seldom melded with socio-economic, socio-political and socio-cultural attributes of places

21. Points of entry for social theory Point 1: - SES-health relationships may interact with other dimensions of social inequality (e.g. gender, racial/ethnic differences, sexual orientation, disability, immigrant status, religious beliefs) Point 2: - SES-health relationships may be reflective of social class dynamics, i.e. reflective of group-level dynamics based upon control over the means of production, for example (in a Marxian sense, at least) Point 3: - physical space and social space may overlap with one another, with apparent physical space health effects actually reflective of underlying social space health effects

22. Workshop participants Environmental justice: David Briggs, Imperial College London Eva Rehfuess, World Health Organization Kee Warner, University of Colorado at Colorado Springs Michael Buzzelli, University of British Columbia Michael Jerrett, McMaster University Keith Warriner, University of Waterloo SES-health: Shona Kelly, University of Nottingham Gerry Veenstra, University of British Columbia

23. Workshop participants Place and health: Tony Gatrell, Lancaster University Michael Hayes, Simon Fraser University Social determinants of health: John Cairney, University of Toronto Tony Blakely, Wellington School of Medicine

24. Workshop goals • Learn about the different discourses • Speculate on potentially fruitful ways of conceptualizing and measuring inequality (above and beyond SEP) • Conceptualize theoretical models that incorporate these conceptions of inequality, their manifestations in space, and their relationships with both environmental factors and health • Speculate on interesting ways of using funky analytical and statistical techniques (e.g. GIS, multilevel modelling, correspondence analysis) to test such models • Identify relevant international data sets that may facilitate mutual empirical exploration along these lines • Build relationships with like-minded researchers, pursue subsequent research projects • Think thoughts that have never been thought before

25. Environmental justice, SES and health, place and health, theories of inequality The End