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Environmental Injustice: Dispatches From a Black Trauma Surgeon on Health Inequity

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Wednesday, September 11, 2024

An adapted excerpt from The Bodies Keep Coming: Dispatches from a Black Trauma Surgeon on Racism, Violence, and How We Heal (Broadleaf Books) I did not plan to become a doctor. It did not occur to me that I, a loner with an intense stare and a disheveled afro, could become a doctor like the elderly white male doctors who cared for me. As a youth I saw no one who looked like me dressed in a long white coat adorned with a stethoscope. One of my earliest childhood memories is the feeling of impending death from lack of oxygen. “You’ll be all right, Brian,” my mother consoled, eyeing me in the rearview mirror. Wheezing like a tortured seal, I bobbled my head in acknowledgment, unable to move enough air through my lungs to speak. My father, a career Air Force noncommissioned officer, was deployed to some unknown locale, so my mother piloted this run to the hospital on her own. “You’re gonna be okay. We’ll be there soon.” I hungered for air, and seconds seemed like hours, but I knew she’d get me there. She always did. Living on an Air Force base, we didn’t have far to go, and minutes after burning rubber from home, we scurried into the emergency room. After the usual routine — a breathing treatment to loosen the vice grip on my lungs, height, weight, vitals — I sat hunched in an exam room, feet dangling two feet from the floor, as the doctor gently pressed here and felt there along my shirtless torso. Like all the doctors I visited as a child, he was an elderly white man who resembled Marcus Welby, MD, from the famous 1970s television series. And like all those doctors, he inspired my awe. As a military kid I always had access to healthcare, and I assumed that was true for everyone. To be sick and unable to see a doctor? I couldn’t fathom it. Because of my childhood asthma — a condition afflicting, hospitalizing, and killing Black children at a much higher rate than white children — I made many breathless trips to the emergency room. For many Black children, environmental injustice is an ever-present companion in neighborhoods located near municipal dumps, factories, and highways, resulting in increased exposure to respiratory toxins. My situation differed; my sister and I were trapped in a house with parents who smoked. I wonder if the white doctor judged my parents for that reason. Or because we were Black. Or both. “Open up and say ahhh.” I coughed as the doctor gagged me with a popsicle stick and gasped when he placed an ice cube masquerading as a stethoscope to my back. “Cold, huh? Sorry about that.” My mother hovered, not saying a word as the man with the soothing voice in the long white coat poked and prodded while asking me about sports and school. “Well, we’re done,” the doctor said, smiling again. He gave my mother instructions about when to return to the hospital, said something to her about smoking, wished me luck in my upcoming game, and walked out. Squirming into my shirt, I asked: “Are there any Black doctors?” A decade before Bill Cosby reigned as America’s favorite TV dad, Dr. Heathcliff Huxtable — and decades before it became known that he was drugging and sexually assaulting women — my mother smiled like any parent deflecting an uncomfortable truth. I couldn’t articulate it yet, but I felt it just the same. To me the smiling man in the long white coat, with the fancy degrees and plaques and awards broadcasting greatness from his office walls, was a god. And like the Eurocentric religious ideals force-fed to me in Sunday school, his profession of medicine did not seem like somewhere I belonged. From that early age, I knew an unspoken truth: No matter how smart, articulate, or well-behaved I would become, there were always places Black boys would not be welcome. Black men in medicine represent less than 3% of doctors, and I know future Black men attempting to cross the threshold are depending on Black doctors like me. Patients have told me to get their “real” doctor, leave the room, remove their tray of half-eaten food, or empty the trash bin. Some have ignored me and others have spat at me. Some have prayed for me and others have wished me dead. I have been called a racist and a healer, a nigger and a sellout, a hypocrite and a hero. No matter our social status, from gang members to doctors, Black men still serve as a mirror for people’s fears. A screen on which to project one’s anxiety — and disgust.  An endangered species navigating a world both hostile to and dependent upon our existence. Even with this backdrop, who is more poised to address the realities of our health inequities than those who have had to survive it? Childhood asthma does kill Black children at higher rates than white children. But so do other respiratory diseases, cardiovascular disease, neurological diseases. All of this ties back to environmental injustice.  And those environmental injustices are inextricably linked to larger societal disparities that position Black and brown communities to be most likely affected. Photo: Gulshan Khan Climate Visuals As a trauma surgeon, I learned to compartmentalize. The trauma team must move on. The hospital must move on. I must be ready for another victim, arriving with lights and sirens. I file away a mother’s son’s death in the emotional lockbox, straining to contain the feelings of injustice for the countless others like him. In these moments I reckon with the role I play as a Black doctor in a society that devalues Black lives. I wrestle with the futile feeling that the nobility of my work doesn’t have a sustainable impact. Is the essence of my job plugging bullet holes in young Black men and women, or watching them unable to breathe properly, or develop healthily? I can’t help but think that the histories and policies designed to quarantine Black people from mainstream American society have somehow managed to reach across generations and plague us today. I write and act so that other five-year-old wheezing Black boys might be seen as part of a bigger picture that needs attention. I write and act to show you the world of a Black trauma surgeon, in a profession lacking role models, who routinely deals with the human toll from the implications of environmental injustices. I write and act to remind us all that if Black lives actually mattered to policymakers in the United States, they would take action that mattered. Previously in The Revelator: Compounding a Crisis: When Public Health Solutions Worsen Climate Change The post Environmental Injustice: Dispatches From a Black Trauma Surgeon on Health Inequity appeared first on The Revelator.

For many Black children, asthma and other health problems are ever-present companions in neighborhoods located near dumps, factories, and highways. The post Environmental Injustice: Dispatches From a Black Trauma Surgeon on Health Inequity appeared first on The Revelator.

An adapted excerpt from The Bodies Keep Coming: Dispatches from a Black Trauma Surgeon on Racism, Violence, and How We Heal (Broadleaf Books)

I did not plan to become a doctor. It did not occur to me that I, a loner with an intense stare and a disheveled afro, could become a doctor like the elderly white male doctors who cared for me. As a youth I saw no one who looked like me dressed in a long white coat adorned with a stethoscope.

One of my earliest childhood memories is the feeling of impending death from lack of oxygen. “You’ll be all right, Brian,” my mother consoled, eyeing me in the rearview mirror. Wheezing like a tortured seal, I bobbled my head in acknowledgment, unable to move enough air through my lungs to speak. My father, a career Air Force noncommissioned officer, was deployed to some unknown locale, so my mother piloted this run to the hospital on her own. “You’re gonna be okay. We’ll be there soon.” I hungered for air, and seconds seemed like hours, but I knew she’d get me there. She always did. Living on an Air Force base, we didn’t have far to go, and minutes after burning rubber from home, we scurried into the emergency room.

After the usual routine — a breathing treatment to loosen the vice grip on my lungs, height, weight, vitals — I sat hunched in an exam room, feet dangling two feet from the floor, as the doctor gently pressed here and felt there along my shirtless torso. Like all the doctors I visited as a child, he was an elderly white man who resembled Marcus Welby, MD, from the famous 1970s television series. And like all those doctors, he inspired my awe. As a military kid I always had access to healthcare, and I assumed that was true for everyone. To be sick and unable to see a doctor? I couldn’t fathom it.

Because of my childhood asthma — a condition afflicting, hospitalizing, and killing Black children at a much higher rate than white children — I made many breathless trips to the emergency room. For many Black children, environmental injustice is an ever-present companion in neighborhoods located near municipal dumps, factories, and highways, resulting in increased exposure to respiratory toxins. My situation differed; my sister and I were trapped in a house with parents who smoked. I wonder if the white doctor judged my parents for that reason. Or because we were Black. Or both.

“Open up and say ahhh.” I coughed as the doctor gagged me with a popsicle stick and gasped when he placed an ice cube masquerading as a stethoscope to my back. “Cold, huh? Sorry about that.” My mother hovered, not saying a word as the man with the soothing voice in the long white coat poked and prodded while asking me about sports and school. “Well, we’re done,” the doctor said, smiling again. He gave my mother instructions about when to return to the hospital, said something to her about smoking, wished me luck in my upcoming game, and walked out.

Squirming into my shirt, I asked: “Are there any Black doctors?” A decade before Bill Cosby reigned as America’s favorite TV dad, Dr. Heathcliff Huxtable — and decades before it became known that he was drugging and sexually assaulting women — my mother smiled like any parent deflecting an uncomfortable truth. I couldn’t articulate it yet, but I felt it just the same. To me the smiling man in the long white coat, with the fancy degrees and plaques and awards broadcasting greatness from his office walls, was a god. And like the Eurocentric religious ideals force-fed to me in Sunday school, his profession of medicine did not seem like somewhere I belonged.

From that early age, I knew an unspoken truth: No matter how smart, articulate, or well-behaved I would become, there were always places Black boys would not be welcome.

Black men in medicine represent less than 3% of doctors, and I know future Black men attempting to cross the threshold are depending on Black doctors like me. Patients have told me to get their “real” doctor, leave the room, remove their tray of half-eaten food, or empty the trash bin. Some have ignored me and others have spat at me. Some have prayed for me and others have wished me dead. I have been called a racist and a healer, a nigger and a sellout, a hypocrite and a hero. No matter our social status, from gang members to doctors, Black men still serve as a mirror for people’s fears. A screen on which to project one’s anxiety — and disgust.  An endangered species navigating a world both hostile to and dependent upon our existence.

Even with this backdrop, who is more poised to address the realities of our health inequities than those who have had to survive it? Childhood asthma does kill Black children at higher rates than white children. But so do other respiratory diseases, cardiovascular disease, neurological diseases. All of this ties back to environmental injustice.  And those environmental injustices are inextricably linked to larger societal disparities that position Black and brown communities to be most likely affected.

A Black woman's hand next to several asthma inhalers, with a colorful blanket underneath
Photo: Gulshan Khan Climate Visuals

As a trauma surgeon, I learned to compartmentalize. The trauma team must move on. The hospital must move on. I must be ready for another victim, arriving with lights and sirens. I file away a mother’s son’s death in the emotional lockbox, straining to contain the feelings of injustice for the countless others like him. In these moments I reckon with the role I play as a Black doctor in a society that devalues Black lives. I wrestle with the futile feeling that the nobility of my work doesn’t have a sustainable impact. Is the essence of my job plugging bullet holes in young Black men and women, or watching them unable to breathe properly, or develop healthily? I can’t help but think that the histories and policies designed to quarantine Black people from mainstream American society have somehow managed to reach across generations and plague us today.

I write and act so that other five-year-old wheezing Black boys might be seen as part of a bigger picture that needs attention. I write and act to show you the world of a Black trauma surgeon, in a profession lacking role models, who routinely deals with the human toll from the implications of environmental injustices. I write and act to remind us all that if Black lives actually mattered to policymakers in the United States, they would take action that mattered.

Previously in The Revelator:

Compounding a Crisis: When Public Health Solutions Worsen Climate Change

The post Environmental Injustice: Dispatches From a Black Trauma Surgeon on Health Inequity appeared first on The Revelator.

Read the full story here.
Photos courtesy of

Air Quality, Not Just Fitness Level, Impacts Marathoners' Finish Times

By Dennis Thompson HealthDay ReporterTHURSDAY, Dec. 26, 2024 (HealthDay News) -- Runners put a lot of thought into how much they must eat and drink...

By Dennis Thompson HealthDay ReporterTHURSDAY, Dec. 26, 2024 (HealthDay News) -- Runners put a lot of thought into how much they must eat and drink to endure a 26.2-mile marathon, properly fueling their bodies to sustain a record-setting pace.But the quality of the air they huff and puff during endurance events could also play a key role in their performance, a new study says.Higher levels of air pollution are associated with slower average marathon finish times, according to findings published recently in the journal Sports Medicine.“Runners at that level are thinking about their gear, their nutrition, their training, the course, even the weather,” lead researcher Elvira Fleury, a doctoral student at Harvard University, said in a news release. “Our results show that those interested in optimizing athletic performance should consider the effect of air pollution, as well.”Runners’ average finish times on a marathon steadily decreased for every increase in particle pollution of one microgram per cubic meter of air, results show.Men finished 32 seconds slower on average for every increased unit of air pollution, and women finished 25 seconds slower, researchers found.These effects also appeared to be more pronounced in faster-than-average runners, researchers said.“This means that air pollution can be a health risk not just for those who are elderly or susceptible — it can negatively affect even the most healthy and well-trained among us,” senior researcher Joseph Braun, a professor of epidemiology at Brown University, said in a news release from the college.For the study, researchers analyzed data from U.S. public marathons conducted between 2003 and 2019, involving more than 1.5 million male runners and more than 1 million female runners.The research team compared the runners’ finishing times with air quality data captured on event days, including the amount of particle pollution in the air along different points of the marathon route.“This really sophisticated spatial-temporal model of particulate matter allowed us to plot pollution at every mile of every course,” Fleury said. “Without a model like this, it wouldn't have been possible to look at so many different marathons in different states across different years.”Researchers specifically looked at levels of fine particle pollution, which are airborne particles smaller than the width of a human hair or grain of fine beach sand, according to the Environmental Protection Agency.These airborne particles are typically generated by fossil fuels burned by cars and power plants, although in recent years, wildfires have contributed to such pollution.Previous studies have shown that particle air pollution is associated with overall risk of death, as well as risk of heart disease, breathing problems and lung cancer, researchers said.Air pollution could be harming marathon runners’ performance by causing increases in blood pressure, constricted blood vessels, impaired lung function, and perhaps even short-term changes in brain function, researchers speculated.“People who can complete a marathon are generally quite healthy, and we can assume they have honed their cardiorespiratory fitness,” Braun said.“This study revealed a negative impact from air pollution, even at levels below current health-based standards, on these very healthy people,” Braun continued.These findings support efforts to reduce pollution emissions by shifting motor vehicles and power plants away from fossil fuels, researchers concluded.SOURCE: Sports Medicine, journal study, Dec. 18; Brown University, news release, Dec. 18, 2024Copyright © 2024 HealthDay. All rights reserved.

Forty Years After the Bhopal Disaster, the Danger Still Remains

In many ways, we all live in Bhopal now. We must continue to fight for a future in which we all have the right to live in healthy environments.

Forty years ago this month, a Union Carbide pesticide factory in Bhopal, India, sprung a toxic gas leak, exposing half a million people to toxic fumes. Thousands of people lost their lives in the immediate aftermath, with the death toll climbing to more than 20,000 over the next two decades. Countless others, including children of survivors, continue to endure chronic health issues. In the United States, the events in Bhopal ignited a grassroots movement to expose and address the toxic chemicals in our water, air, and neighborhoods. In 1986, just two years after the disaster, this growing awareness led Congress to pass the first National Right to Know Act, which requires companies to publicly disclose their use of many toxic chemicals. In India, Bhopal victims have had a long struggle for justice. In 1989, survivors flew to a Union Carbide shareholders meeting in Houston to protest the inadequate compensation for the trauma they’d suffered. The settlement awarded each Bhopal victim was a mere $500—which a spokesperson for Dow Chemical, Union Carbide’s parent company, called “plenty good for an Indian.”  Union Carbide had the survivors arrested before they could enter the meeting. Meanwhile, their abandoned chemical factory was still leaking toxic chemicals into the surrounding neighborhoods and drinking water.  Nevertheless, Bhopal survivors never stopped fighting. They opened a free clinic to treat the intergenerational health effects caused by the disaster. They marched 500 miles between Bhopal and New Delhi. They staged hunger strikes. They created memorials to the disaster and established a museum to ensure that the horrors of their collective past are not forgotten.    The survivors even obtained an extradition order for Union Carbide’s former CEO, Warren Anderson, but the U.S. government never acted on that request. Forty years later, the factory in Bhopal has never been properly cleaned and is still leaking poison.  Unfortunately, the kinds of chemicals that flow through the veins of Bhopal survivors also flow through ours. The petrochemical industry has brought us together in a perverse solidarity, having chemically trespassed into places all over the world. According to one figure, Americans are exposed to dangerous chemical fires, leaks, and explosions about once every two days. In one dramatic example in early 2023, a rail tanker filled with vinyl chloride derailed in East Palestine, Ohio, forcing the evacuation of 2,000 residents.  Nearly all Americans now carry toxic substances known as PFAS in our bodies. These have been linked to cancer, liver and kidney disease, and immune dysfunction. And the continued burning of fossil fuels is killing millions of people each year around the world through air pollution.  Petrochemical and fossil fuel companies know they can only survive if they avoid liability for the damage they are doing to our health and the planet’s ecosystems. That’s why they are heavily invested in lobbying to prevent any such accountability. Polluting industries are certain to have strong allies in the coming Trump Administration, which plans to open even more land to fossil fuel production and, under the blueprint for conservative governance known as Project 2025, to slash environmental and public health regulations. But we can take inspiration from the people of Bhopal, whose fierce commitment to health and justice sparked a global movement. Earlier this month, on the fortieth anniversary of the Bhopal disaster, congressional allies of this movement including U.S. Senator Jeff Merkley, Democrat of Oregon, and U.S. Representatives Pramila Jayapal, Democrat of Washington, and Rashida Tlaib, Democrat of Michigan, introduced a resolution designating December 3 as National Chemical Disaster Awareness Day. “Chemical disasters are often the result of corporations cutting corners and prioritizing profits over safety,” said Merkley, who chairs the U.S. Senate Environment and Public Works subcommittee. “These catastrophes cloud communities with toxic fumes, upending lives and threatening the health and property of those living and working close by.” He called for “stronger laws to prevent chemical disasters and keep our communities and workers safe.” This growing global alliance, which has been called the largest movement for environmental health and justice in history, is fighting for a future in which everyone has the right to live in a healthy environment. It’s a movement that unites us all. Because in many ways, we all live in Bhopal now. This column was produced for Progressive Perspectives, a project of The Progressive magazine, and distributed by Tribune News Service. Gary Cohen is the president of Health Care Without Harm and a long time member of the International Campaign for Justice in Bhopal. Read more by Gary Cohen December 18, 2024 3:25 PM

Study Miscalculation Has Everyone Talking about Black Plastic Spatulas Again. Experts Are Still Concerned

The scientists behind a popular study on the health effects of flame retardants in black plastic cooking utensils and toys made a calculation error but still say their revised findings are alarming

Should you throw out your black plastic spatula? A recent study that reported alarming levels of several flame retardants in common black-colored plastic items (including cooking utensils, toys and hair products) had many people suddenly taking stock of their inky array of plastic kitchenware and considering wood or metal alternatives. And the reasons for the concern were understandable: the study’s findings, published in Chemosphere, highlighted potential health effects from exposure to the flame retardants, particularly decabromodiphenyl ether (decaBDE)—a chemical the U.S. Environmental Protection Agency banned in 2021 for its apparent links to cancer and reproductive, developmental and immunologic toxicity effects.But this week the study’s authors issued a correction that suggests exposure to decaBDE from the tested products isn’t as close to the EPA’s safety reference level as they initially thought. The decaBDE exposure they estimated from the screened products is still correct, but it’s one tenth of the reference dose. The study had miscalculated the comparison by an order of magnitude.The amount of flame retardants in such products is “not as harmful, with respect to the EPA guidance, as [the researchers] originally stated, although, with these chemicals, they may be harmful when you’re exposed to small amounts over a long period of time,” says Andrew Turner, a biogeochemist at the University of Plymouth in England, who wasn’t involved in the research and studies the disposal and recycling of plastic consumer goods. “It’s difficult to put numbers on these chemicals.”On supporting science journalismIf you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.The study authors issued an apology for the mistake in which they maintained that the “calculation error does not affect the overall conclusion of the paper.”“Our results still show that when toxic additives are used in plastic, they can significantly contaminate products made with recycled content that do not require flame retardancy,” says Megan Liu, a co-author of the recent study and science and policy manager at Toxic-Free Future, an environmental health research and advocacy group. “The products found in this study to contain hazardous flame retardants included items with high exposure potential, such as things that touch our food, as well as toys, which come in contact with kids.”Why might some black plastics contain flame retardants? Flame retardants are required in certain products (often including computers, TVs and other common electronic items) to meet fire safety regulations. To reduce the amount of e-waste and fossil fuels needed to make new plastics, some of these items are recycled into black plastics. But the problem is that “you could also recycle the flame retardants and other chemicals that are associated with that plastic,” says Stuart Harrad, an environmental chemist at the University of Birmingham in England, who wasn’t involved in the paper. “Now that’s fine to some degree, I suppose, if you’re only recycling the plastic into uses like TV sets, where you need to meet fire safety regulations. But the point is here is that that isn’t happening.”The new study’s main goal was to identify any flame retardant chemicals in various common products. The researchers screened 203 items, ranging from plastic sushi take-out trays to toy necklaces—and found 17 of them were contaminated with high levels of flame retardants. Fourteen of those products contained high levels of decaBDE.The U.S. has largely banned decaBDE and other polybrominated-diphenyl-ether-based flame retardants. New electronic goods use safer flame retardants, but older electronics that contain decaBDE could still be in many households or might have been only recently tossed out for recycling, Turner says. “When you talk about some electronic devices, they last quite a long time,” he adds. These older devices might only be reaching recycling plants now.The new study’s findings generally line up with past evidence that recycled plastics—and flame retardants—can end up in toys and cooking utensils, Harrad says. But it’s been unclear whether the mere presence of flame retardants in a cooking utensil pose any health threat to humans; there are many contributing factors, including the source, the dose, the duration of exposure and any other chemicals that may be present. In a 2018 study Harrad and his colleagues tested potential exposure from black plastic cooking utensils and found that uptake through the skin from simply holding them was negligible. But when they tested them in prolonged cooking experiments with hot oil, about 20 percent of the flame retardants in a utensil transferred into the oil on average. “That’s really because the oil, particularly hot oil, is going to be a pretty good way of extracting these chemicals,” Harrad says.How did the miscalculation occur?The authors of the new study estimated humans’ potential exposure to decaBDE from the plastic products by using the calculation in Harrad’s 2018 study. They applied this calculation to the median levels of decaBDE detected in the products they tested. This wound up being an estimated 34,700 nanograms per day of decaBDE. They then compared that figure with the EPA’s reference dose of 7,000 nanograms per kilogram of body weight per day. (Some researchers note that this measurement was derived from lab tests and animal models, not direct human testing). To better assess human risk, the scientists calculated a reference dose based on a 60-kg (132-pound) person and initially found 42,000 ng per day, a value alarmingly close to the 34,700 ng per day of exposure they estimated from the new data. But 7,000 multiplied by 60 is actually 420,000. This may have been a simple math error, but the correction massively reduces how close the amount of exposure is to the maximum acceptable limit.The figure with the miscalculation was “contextualizing the levels that we saw in our study, thinking that it could be helpful for people,” Liu says. “This was really just one part of our study that isn’t even part of our key findings.”She and her co-authors have emphasized that the error shouldn’t detract from one of the study’s main conclusions: that none of these flame-retardant chemicals, especially those that have been banned, should be found, in any amount, in these products in the first place.“They're probably banging their head in frustration when they found out they made that calculation error,” Harrad says, adding that the rest of their findings “were perfectly plausible.”“The study does highlight the fact that we’ve not sorted this out yet—that we’re still finding these chemicals coming through into new goods that contain recycled plastics,” Harrad says. “We do need to step up our efforts to isolate these chemicals from waste and make sure that they don't get recycled.”So should you really ditch your black plastic spatula? Harrad says you should avoid leaving it in a hot pan or pot for long periods of time. Some experts don’t recommend reheating food in black plastic containers, although studies haven’t confirmed if this causes chemicals to leach into food. Importantly, “if you see that your black utensil is damaged in any way, just [get rid of it] and go for something else,” Turner says—pieces of the plastic could potentially break off into food.When looking for new cooking ware, Turner says that it’d be more sustainable, and potentially safer, to reduce the use of black plastic items and opt for a material or color that’s more easily recyclable. Liu says wood, stainless steel or silicone products are some safer alternatives. She adds, however, that people can’t “shop” their way out of a larger societal issue. “We can’t expect that everyone can immediately switch over to safer alternatives,” Liu says. “That’s ultimately why we’ve been calling on greater regulatory action at both the corporate and government level to regulate and restrict these harmful chemicals.”

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