Socioeconomic Status and Health Disparities Among Older Adults Lovell A. Jones, PhD Director, Center for Research on Minority Health Director, Reproductive Biology Program University of Texas M.D. Anderson Cancer Center Houston, Texas

What do we know and not know about environmental health disparities among older adults?

We don’t know much! F Insufficient research on geriatric environmental health issues in the US F No known studies on environmental health disparities for the elderly of minority or medically underserved populations F 2005 American Lung Association’s publication on air pollution did not include this population

What’s the problem? F Younger people are often easier to study than older people F Aggregated data –Everyone over age 65 is often put in the same category regardless of health status –Seniors are often grouped in the “susceptible population” category F Minority seniors are often ignored in studies

What we know F Overall, elderly population face greater health risks from environmental pollution because: 1.Chronic diseases can be exacerbated by environmental contaminants 2.Older bodies have less energy/immunity to combat environmental hazards 3.Some pollutants could accelerate aging 4.Older people have “collected” more toxins in their bodies than younger people 5.Seniors are more likely to have been exposed to toxic chemicals that were previously unregulated

For example F Asthma in the US: –Poverty is a strong risk factor for asthma mortality –Majority of the 5000 asthma-related deaths per year are among those age 65 and older Asthma-relatedBlacksWhites Hospitalization rate 35.6 admissions per 10, admissions per 10,000 Death rate 38.7% per 1 million 14.2% per 1 million Source: American Lung Association

Cost to society F Strong link between air pollution and increased health care cost for older adults F For every 10 mcg/m 3 drop in air pollution: –Medicare will save $76 per person for inpatient care –$100 per person for outpatient care

Outdoor air F Few studies of link between outdoor air pollution and the health of minority elderly in the US F European study – seniors exposed to air pollutants for 2 hours showed adverse changes in electrocardiogram F Korean study – Rising concentration of particulates, CO, SO 2, NO 2, and O 3 resulted in increased stroke death

Outdoor air and disparities F African-Americans are more likely than Whites to: 1.Live in households with incomes below the federal poverty line 2.Have children 5 years of age or younger 3.Live closer to the nearest industrial emission source 4.Live within 2 miles of multiple industrial emission source F Nationwide, 65% of blacks and 80% of Hispanics live in counties that do not meet federal air pollution standards, compared to 58% of whites. F No known studies on Asian-Americans’ and American Indians’ exposure to air pollution F In general, living in proximity to the sources of air pollution lowers environmental quality and worsens one’s health.

Why not relocate? 1. Not aware of the adverse health effects of polluted air 2. Acclimated to the polluted air 3. Difficult to sell home 4. Home prices in area are more affordable 5. Uncertain employment opportunities leading to unstable income 6. Older, retired adults can not afford to move out of the area

Indoor air F Few indoor air quality studies on older adults; none focused on the health of geriatric minorities F Elders stay indoors more than younger people. Increased risk of exposure to indoor air pollutants. F Smoking and second-hand smoke contribute to all major causes of death among the elderly

How do we fill the knowledge gap? RESEARCH! Community-based participatory research –Community empowerment and inclusiveness –Must involve the community at every level of research

Houston F is the oil refining and chemical manufacturing center of the U.S. F is one of the most polluted city in the nation –120 petrochemical industries –11 superfund sites –45 hazardous waste sites F has one of the largest medicals center in the world F has produced no research exploring link between air toxics and cancer in Houston F has grass-roots groups doing independent air-quality research

Addressing environmental issues in Houston F 1991 –The Mickey Leland National Urban Air Toxic Research Center F 2001 – NIEHS & Baylor College of Medicine’s meeting on environmental health F 2002 – EPA-Region 6 & Texas Southern University’s “Environmental Justice Listening Session” F 2004 – IOM & Center for Research on Minority Health’s environmental health workshop

Expanding the definition of Environmental Health

Listening is key to understanding Agenda planning based on results from: F Four community focus groups F One professional focus group F Advisory panel

Common Environmental Health Concerns in Houston

Northeast Houston

Northwest Houston

Southwest Houston

Southeast Houston

Guiding principles F Coordinate efforts in improving the collection of health information for minority communities. F Research related to health disparities should engender three principles: 1.improve the science base, 2.involve the affected populations, 3.and communicate the findings to all stakeholders F Exercise caution on behalf of the affected communities, particularly those that have the least access to medical, political, and economic resources, taking reasonable measures to safeguard against or minimize adverse health outcomes.

Recommendations 1. Recognize that low-income groups, which include a disproportionate number of ethnic and racial minorities, constitute a susceptible segment of society that deserves special attention and protection. 2. Advocate for clear state and federal industrial emission guidelines and develop enforceable standards. 3. Encourage research focusing on the specific health effects of toxic air exposure. 4. Examine air quality and pollution in the context of health disparities to include the interrelationships among race (disaggregate data), age, and poverty. Be inclusive of smaller ethnic groups such as Asian Americans and American Indians. 5. Train minority researchers in the area of environmental health disparities using the community-based participatory research model. 6. Design research projects that are culturally competent and linguistically appropriate when working with ethnic minority groups. Special considerations may be necessary to accommodate cognitive needs of the elderly population. 7. Educate the community, especially the elderly, on the ill effects of air pollution.

"If you want to change the world, be that change.” Gandhi

Remember…. No matter how hard you work…. No matter how right you are…. Sometimes the Dragon wins… However, the object is not to be eaten so that you can fight on another day