the health disparities podcast

190: How pollution and climate change impact health disparities

Across the globe and in the U.S., environmental crises loom large and threaten our most vulnerable populations.

“There’s a lot of dying that’s happening now, and it’s primarily among poor, Black and Brown people,” says Dr. Cherly Holder, who’s on a personal mission to inspire clinicians to act on climate change.

Holder explains that a person’s health and well-being is directly impacted by the environment they’re surrounded by.

“In celebrating and recognizing the environment, we recognize that this is how we define humanity, and how we create the environment for us to grow and thrive,” she says.

In honor of Earth Day, which is coming up this month, we’re dipping into our archives to bring you a conversation with Dr. Cheryl Holder.

She’s now retired, but at the time this conversation was recorded and produced for the Health Disparities podcast in 2021 with host Elise Tolbert, Dr. Holder was serving as the Interim Associate Dean for Diversity, Equity and Inclusivity and Community Initiatives, and associate professor at the Herbert Wertheim College of Medicine, Florida International University.

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The transcript from today’s episode has been lightly edited for clarity.

Dr. Cheryl Holder: Right now we have people who are dying because of the pollution, dying because of the climate has changed, dying because our crops are dying, dying because the water has dried up across the world, and dying because of the infections that come as all these insects are moving all over our planet and infecting us. So there’s a lot of dying that’s happening now, and it’s primarily among poor, Black and Brown people.

Jerry Fennell: You’re listening to the Health Disparities Podcast from Movement is Life – featuring conversations about health disparities with people who are working to eliminate them. I’m producer Jerry Fennell. In honor of Earth Day – which is coming up this month – we’re dipping into our archives to bring you a conversation with Dr. Cheryl Holder from 2021.

Dr. Holder has a personal mission to inspire clinicians to act on climate change. She’s now retired, but at the time this conversation was recorded, Dr. Holder was serving as the Interim Associate Dean for Diversity  Equity and Inclusivity and Community Initiatives, and Associate professor  at the Herbert Worth-hime College of Medicine, Florida International  University.

Dr. Holder speaks with Elise Tolbert, the former Deputy Director of Public Engagement at  the Climate Action Campaign of DC. Before we dive in, I want to let you know that Movement Is Life is now on TikTok and Instagram. Be sure to follow us to stay engaged and connected by following Movement is life, underscore, inc. Here’s Elise Tolbert:

Elise Tolbert: I appreciate you for being here and believe that we’ll have a really  deep and meaningful conversation about the environment, environmental  justice and how that connects to health. So, I want to kick off the conversation by just defining what the environment is and loosely, how the  interconnectedness of the environment and our experiences with the  environment impact our health.

Dr. Holder: When you think of the environment, you know, everybody, it’s where you  live, it’s where you work, it is where you play. It’s where you share each  other’s experiences. You go outside, you’re in an environment, in your  home there’s an environment. In every aspect of what we do worldwide,  we create our environment. And that’s what defines how we stay well, and  all the studies show that it’s your environment, all your economic conditions within your environment, your built environment. What’s going  on in the world, how much pressures you have in living in that environment. That drives your illness much more in your well-being much  more than your genetics. So, in celebrating and recognizing the environment, we recognize that this is how we define humanity, and how  we create the environment for us to grow and thrive.

Elise: Right. It’s so important to just understand that everything or everywhere  that we are is our environment. And often among environmentalist, we  have this separation between climate change and the environment. I think  many may not understand how climate change relates to the environment,  how these two are interconnected?

Dr. Holder: I’ll give a quick, Climate Change 101 that I often do, because I’m not sure  how much your audience and everyone’s new to the climate, how we talk  about climate. I’m an internist and you guys know about diabetes, and I  can check your blood sugar if you have diabetes, I can check your blood sugar that one day and I could see it could be high, it could be low, it could  be normal. But to really tell me how you are doing with diabetes, I check  another number that takes over time. And that number will tell me that  over the last three months, this is really how you’ve been. So, that’s where  weather is and climate. So, the weather is yes, sometimes it’s hot outside  in the summer, sometimes it’s cold outside in the winter and that’s the  weather and that can vary, but the overall trending over the last few years,  and we know over the last 20 years, we have had significant warming.  And where did that warming come from? We fully know that when you put  these particles and we can’t see them, they’re invisible particles, really,  really tiny things that we can’t see, but we know when we burn our fossil  fuels and when the cows burp and when we use multiple things that we  make from fossil fuels and plastic, and we use our cars and we put out  exhausts, these things stay in our atmosphere. Instead of causing to go  out in the atmosphere and just stay out there, they get the sun that comes  down and then they deflect back some of the sun rays back onto our  planet. And it is that deflection, so, think of our planet sort of now snuggled  up in a nice little blanket, but that blanket is really the greenhouse gases  that’s creating that blanket and that blanket is warming our planet. And  with that warming, it’s what’s causing the climate, as the winds change  and the Arctic melts and the different changes that happen around our  environment, then we have the climate change. So, it is changing our  planetary environment that then leads to some changes in our immediate areas, where we go out and where we breathe and what happens to us.  And then the pollution that’s in there that all comes together to impact our  health. So, it all linked together in what we do in the air and how that then  warms the planet, which then sets off a series of events that then puts our  planet at risk and put us at risk. The direct effects from the actual pollution  on our bodies and in our environment and anybody who’s been at a fire,  and you saw those wildfires that happened in California, where all the  smog, those are bigger particles and that filled our atmosphere, and, you  know, that caused the problems in the lungs. Well, the smaller particles  are also damaging us and that can trigger many of our asthma. It can  trigger our worsening of our breathing over time. So, we have those direct  effect from the pollution. Then as the climate warms, it causes heat. May  28th is Heat Day and that day we hope to bring the awareness to say that  heat is the number one killer of environmental damage to our society. So, heat kills, just the direct impact of heat. Heat causes our skin to get more  rashes. Heat causes us to have various illnesses heat strokes. Heat  exhaustion. Heat sends up our blood pressure. Heat makes us not sleep  well at night. Heat makes us get angrier. So, many impacts that we could  just endless, just the direct effect and the indirect effect. And then, our  mental health issues. I mean, there are just so many more things that’s  happening as our climate warms and all the changes happen. And like you  said, black and brown people worldwide are feeling the brunt of it, right  now. This is not 20 years from now. It’s not 50 years from now. Right now, we have people who are dying because of the pollution, dying because  the climate has changed, dying because our crops are dying, dying  because the water has dried up across the world and dying because of the  infections that come as all these insects are moving all over our planet  and infecting us. So, there’s a lot of dying that’s happening now and it is  primarily among poor black and brown people.

Elise: That’s a really helpful description to understand how the climate is  changing, why the climate is changing and what the effects are, the  impacts are of living in a changing climate. And so, it sounds like because  the world is warming at a rate at which it has not warmed before that that  is changing all of the way that life operates on earth and the chemicals  and ecologically and it’s impacting human health and so much more. I  want to touch a little bit more on the last point that you made. You said  that the climate crisis is disproportionally impacting communities of color  and disproportionately impacting low wealth communities. Could you  speak more specifically to the ways in which the climate crisis and climate  change are impacting black communities, communities of color, low  wealth communities differently than white communities and higher wealth  communities?

Dr. Holder: You know, we would think that this sort of just happened overnight and it’s  just by chance, these things happen, and we just happened to be living in the wrong places. People would think, “Oh, poor black folks. Why did they  choose to live there?” But when you look at the history, I started in the  environmental justice side of this whole issue before I went on to climate  change, because I would often look at the damage that was happening because black people on a whole, in the US, we live closest to all the  things that degrade our environment. We live close to the highways. We  live closer to polluting plants. We live closer to toxic dumps. We live  closer, if you look along the Mississippi on Cancer Alley, much of that  industry was developed in poor communities. Now, that wasn’t by chance.  And so, when the environmental justice screamed that our people, the  poor people along these areas are dying from cancers, they’re dying from  asthma, they’re having too much lung cancer, blood cancers, just so many  illnesses from the pollution that the push was to clean up the pollution and  stop and not really stopping the pollution, but there was a real push to  clean it up. And over time, as the climate warm, then we realized that the  black folks have been screaming something, not so much that it was just  their health, but there was a deeper message that was happening that this  damage that we’re feeling was harming all of us, and that harm was in that  all that pollution and the fossil fuel was warming our planet. So, instead of  us fighting about not in my backyard, we should have been fighting about  not at all. So, that’s when I became more involved in the climate change  and warming. And then, like I said, we’re not sick because genetically  black folks and brown folks are different. The genetic variations of people that we call black and white is minuscule, and it’s not significant, but the  environment we end up living in is a direct result of the policies that have  been imparted on people. And if you look at policies again with the social  determinants, it is where you live, where you work, where you play, your  access to money and power, which is determined by the policies under  which you’re governed. People in power, the dominant group created a  system that devalued people and we’re talking, going back to slavery, and  in that devaluation of people, they created a system to maintain the  devaluation, which meant that when you’re devalued, you are assigned  places to live. And if you come up, I’m in Miami and in Jim Crow law,  because it’s a city that was developed under Jim Crow, black folks were  subjugated to live by the railroad tracks or to live by dumps and across the  South and in the North and everywhere that’s where black folks were  forced to live. Every policy that came between Jim Crow in the 1800s,  right through to the 21st century, we continued to see policies that caused  redlining that gives less access to money to be able to move and less  access to education, so you can get better jobs, so you can put yourself in  a healthier environment. So, what we see in environmental damage and  degradation is environmental injustice, which were based on policies that  forced black people to be in these locations. And now, we’re paying the  huge price, if you look at the death rates, the life expectancy of the black  and the poor population, it is much shorter than whites.

If you look at what happened with coronavirus, anyone who lived in more  polluted environment, because the coronavirus will hop onto the pollution, and you get a higher dose of the virus when you inhale. So, of course, we  saw higher death rates of black and brown people in polluted environment.  And that was already proven back in 2020. So, policies that have driven  the US to discriminate against black and brown people had left us as we  call in the medical world, we use weathered. So, we are left with a population that is weathered, and this population has been weathered by  the policies and the injustices that has created environments that has  caused their health to be worse than others and caused this decline.  When you even think, this is a movement podcast about movement. And  when you think of something as simple as osteoarthritis and obesity and  other things that we relate to keeping people movement and getting  physical activity, you may want to bring it down to, oh, that person just  needs to go out and exercise, or that person needs to stop eating. But  when you look at the deeper issue, there are so many underlying policies,  and environmental things that stop that person from moving. And you look  at, if you did not have access to education, you end up in neighborhoods  like in South Florida, we’re always fighting for neighborhoods to put  sidewalks in. They will develop a community that’s rich and put sidewalks  in. In the poor community, there are no sidewalks. So, when I send my  patients out to walk, they have to walk in the streets. That’s not safe  because if you look at pedestrian injuries and pedestrian deaths in South Florida, so they can’t even go out and walk. So, when we’re moving  towards movement, it has to be deeper than just saying, oh, let’s go  exercise. Let’s go do Zumba. You have to look at again, all the social  determinants, are there sidewalks, are there even shaded areas?

Because down here it is hot, it is too hot to just go outside and exercise.  And then our kids, especially children who can’t manage heat as well,  physiologically, you send them out to exercise. It is too hot for them and  they’re going to get dehydrated and sick, they will come inside. So, just the  concept of moving is much more complicated. And so, all these groups  that are working on movement have got to join the climate fight because  you cannot move if your environment works against you to be able to stay  well. So, when my patients come in with the obesity, I go through, how  much do you work? Where do you work? I don’t ask them about how  much food they’re eating, because they are usually not overeating, but the  environment in which they exist, where they live and work, works against  them to be able to stay well.

So, that’s the interconnection. As you guys say, intersectionality, which is  a 21st century word that I’ve learned since in my time we didn’t have  intersectionality, but I love it. So, it’s the intersectionality that climate does,  and it’s the underlying pinning of everything that if your environment and  your climate cannot support you, you’re not going to be able to move.  You’re going to end up with diabetes, obesity, osteoarthritis, and all the complications. And so, what we need to fight, is to fight for that environment and fight for the climate, so my patients can go out there and  walk and it’s not too hot and it’s not polluted, and they can get better jobs  and get better education. They can sleep at night, so when they wake up  in the morning, they’re not so tired and they can keep on going. It’s not  that complicated, it’s just facts and it’s for us to let go of our biases and let  go of trying to blame the individual and look at the systems under which  we live and look at those policies and make those changes.

Elise: And you touched on something very deep and very meaningful and  important. And that is policies and the framework and the setup and how  the health conditions we see, the climate, the environment are all a  manifestation of the policies that are created by people. Intuitively, one  would think that this type of setup is illegal that it is illegal to pollute in  communities and to overburden people with pollution and poor-quality  environments. Is this type of pollution illegal in some way? And is there  some type of legal framework that exists to protect people?

Dr. Holder: You know, legality is an interesting word because we have the EPA and  the different folks who determine what level of pollution is safe. And if the  energy companies and the other people can come up with the data to  show that it’s not happening, then it remains legal. In Palm Beach County,  they burn sugar and they burn sugar before harvesting to make it a lot easier. It is one of the highest producers in that sugar burning of pollution  particle 2.5 in South Florida. Yet when they do the monitoring, it shows  that they’re at the legal limit. So, it is legal, and it continues to be legal to  burn. So, the push, as we see it, and I tell folks legal is a societal thing  because remember slavery was legal. It was the most amoral, unethical  thing to have ever done to humans, and that was legal. So, we have to  move beyond legal and understand that this is harming all of us. So, when  we talk about pollution and we talk about what’s happening to black and  brown people, for me, it is for us to say, we’ve been the canary in the coal  mine. One person said maybe I have been put out to slaughter. But for  whatever way you want to characterize it, the message is clear that  whether it’s legal or not, it is warming our planet. And if we don’t within the  next 10 years, stop the temperature rise and keep it at 1.5 degrees  centigrade, we are going to have a cascade of events that is going to be  even more disastrous for our planet. And yes, poor people will die more  just like we saw with coronavirus. 

Not all of us are going to be as affected as others because again, like our  data clearly shows the richer you are, the wealthy you are, the longer you  live and no accident. So yes, probably the richer countries will make it  through, okay, better because they’ll be able to build domed air  conditioning places, so they can go out and exercise and have fun in their  domed air conditioned, exercise, places, whatever you want to look at it.

But then, there will be places on our planet that will be suffering from  drought and disaster. Even where I am in South Florida, sea level rise, I’m  already seeing changes. I told you that black folks were sent to live by the  railroad tracks. So, they were getting the pollution from the train and in  that bad neighborhood. But it turned out that engineers knew that railroads  are high ground and the best ground to put down railroad tracks. So now,  21st century, that less desirable land in South Florida is now desired. So, what we’re seeing is climate refugees. They’re internal climate refugees  that are experiencing climate migration because they’re being displaced  from the high ground in South Florida because the rents have risen and  they’re being moved down to the low ground now because that’s all they  can afford. The hurricanes, they’re not getting more, but they’re getting  more intense, and they’re starting earlier because the oceans are warmer.  When that intense storm comes through the population that for many,  many years never experienced flooding because they lived on high ground  by the railroad tracks are now moved into the low ground, which puts a  larger group at risk for flooding and dying that never happened before. So, we’re seeing that in the US, and it’s going to happen worldwide. So, yes,  the richer will find a way, but if we don’t there are a lot of us will suffer. And  so, the poor people who have been experiencing climate change now  have been telling us, learn from us. If we find solutions that help us now,  those solutions will save you, too and use that to really mobilize your  energy and act urgently because we only have 10 years.

Elise: That’s powerful and it’s a powerful example. There are so many examples,  very similar to the example that you gave in Miami about climate migration  and gentrification and the ways in which gentrification intersects with  climate and environmental justice. I think that what you’ve pointed out is a  very clear problem. A problem of the ways in which the environment in  particular policies and decisions are directly, negatively impacting poor  people, people of color, and there’s a need for taking action on this. I know  that there are a lot of people who are listening today, who wonder, what  can we do about this? And what kind of framework has there been  historically for taking mass action on an issue of this sort? Could you  speak to some type of framework that’s been used before and or what  clinicians or the general public can do about taking action on climate  change and environmental justice?

Dr. Holder: Well, you know, the framework exist repeatedly in the history. If you think  about ending World War II, that was the entire world coming together to  defeat Nazi Germany. So, it’s like you said earlier, political will. When I  think of infections, I think of HIV, and when you look at HIV, which started  1980s, we found out the virus in the ’80s and now 40 years later, by 30  years, we found a way to make it that you did not have to get infected with  this virus, where if we could treat you, we got no transmission because  your viral load stay undetectable. Now, how did that happen? Early on, we saw the activists. I have as they say, shout out to the activists, and them  all in the HIV world, because had it not been people who spoke up and  said, people are dying, we must act now, and one of the groups were Act  Up. With the acting up and the different non-governmental organizations,  and everyone speaking out about it, we were able to get the governments  to come together. We got the researchers to come together. We got the  governments and private foundations and everyone saying let’s work  together to be able to find out what’s causing this infection, and then how  do we treat it? A lot of what we saw with the vaccine, the corona vaccine  came from policies that went in during HIV. The Emergency Use  Authorization Act that came in because the AIDS activists and the  physicians were screaming and we were saying, you cannot wait 10, 15  years to test a drug when I have patients who are dying now. If the drug  has some promise that we have done enough data, move that research  rapidly, let’s get it out to the people. That’s what brought HIV under control  and save so many people. I mean, I still remember my patients when the  first drug came out and we were like setting your alarm, you got to get up,  you got to take it and don’t miss a dose because we can save you. And we  saw people come back to life by following these drugs and all the new  regiments, but it was political will, political will with dollars. You can’t have  political will without the money. The money has got to flow with the  political will and the community has to speak together. So, we also  insisted that the world should get HIV medicines, not just the rich countries. And so, the big push to get HIV medications across the world,  they were saying that, oh, poor people won’t be able to come in and take  medicines and poor countries wouldn’t be able to make sure their viral  loads are undetectable. Yet, we were able to prove that when you brought  the education, you brought trusted messengers, you brought people out,  we got better undetectable levels in the poorest countries in Sub-Saharan  Africa. The women got treated, the babies got treated, and we were able  to bring this infection under control. So, it can be done but it has to be that  we have the political will, we’re able to face the facts and this is what  happened with HIV. We’re able to face the facts of how this was  transmitted and what we had to do. With climate change, it took us forever  to accept that it even happened. And now that it’s happening, to get folks  to accept the urgency, so we can save lives that’s our challenge, but we  have lots of examples. You gave an example with the ozone, it’s all  political will dollars and the community coming together to say, we are all  affected, and we all want each of us to survive this. Coronavirus is an  example of what doesn’t work. And so that’s sort of a little scary in that we  didn’t get the political will to really harness those resources like we  should., We had the science, but you can’t do the science without the  political will. You can’t do the science without the trusted messengers. You  can’t do the science without bringing all together where we feel we all  benefit. And coronavirus shows us that just science alone is not going to  be the answer. And with climate change, we know already the science has already been there for many, many years, but we weren’t able to get all  the other pieces together. I want clinicians to get involved because we see  these sick people, we see them early and we can bring that message. We  can alert them, we can prepare them for what’s coming and we can push  the community to start speaking up and acting to save all of us. So, that’s  what I see that can be done. We have lots of precedents that it can be  done. We just have to know, really accept urgency and find a strategy that  will get us there.

Elise: It’s so powerful to know that there is a framework. Also, kind of sad to see  that that framework is not working in our current context in terms of  galvanizing the political will to follow the science, to work with the trusted  messengers, but also inspiring to know that there is potential and there’s  energy. There is a movement to take action, to produce a better society, a  better world. So Dr. Holder, I want to thank you so much for providing your  expertise here on this podcast today. I think we have all learned so much  from you.

Dr. Holder: Thank you, Elise, and thank you, Movement is Life, and, of course, the  National Medical Association for making this possible.

Jerry: Thanks so much for listening — and be sure to subscribe to the Health Disparities podcast, wherever you get your podcasts. We’re on Apple, Spotify, and all major podcasting platforms.

Also, give us a follow on social media – including new accounts on Instagram and TikTok. Find us at Movement is life, Underscore, Inc on both platforms.

I’m Jerry Fennell. Until next time, be safe and be well.