BY DR. SHELLEY FRANCIS
In the age of COVID-19, What’s driving the mortality rates?
Frontline communities, defined as those who experience worst and first the consequences of climate change, are often communities of color, lower-income areas or neighborhoods that often lack the basic infrastructure support. These same communities are disproportionately impacted by transportation vehicle emissions, air pollution, poor air quality and are the same communities disproportionately impacted by COVID-19. Why is the number of cases and deaths so high in these communities? Could electric vehicles and other clean transportation options be a potential solution to reduce exposure to transportation emissions and improve the communities’ public health?
From New Orleans, Detroit, to Chicago, headlines glare about the devastating impact that COVID-19 is having on African American and Latin X communities. Public health data shows that COVID-19 is disproportionately impacting the most vulnerable populations. Michigan was one of the first states in the nation to release mortality data by race - this data indicated that African Americans are dying at a significantly higher rate compared to other groups.
In Michigan, 14% of the population identifies as African American/Black yet 40% of COVID-19 deaths are among African Americans/Blacks.
In Louisiana, 70 % of people who have died are Black compared to only a third of the state's population which identifies as African American.
In Illinois, 43% of people who have died and 28% who have tested positive for COVID-19 are African American - compare that to the fact that only 15% of the state’s population is African American.
What’s even more alarming is that the same Frontline communities that are overexposed to vehicle emissions are now disproportionately impacted by COVID-19.
The transportation sector, powered by fossil fuels used in cars, trucks, and buses, are major contributors to air pollution and is the number one cause of climate change. Passenger vehicles and heavy-duty trucks are the major source of this pollution which includes ozone, particulate matter, and other smog-forming emissions. Numerous research studies have confirmed that exposure to these toxins poses significant risks to public health. Poor air quality increases respiratory ailments such as asthma and bronchitis. It also increases one’s risk for cancer, puts a substantial burden on our health care system, and is responsible for thousands of premature deaths annually. Long-term exposure to particulate matter and ozone impacts every major organ system from brain development and fertility to lung functioning. Beyond the financial insulation EVs and other multimodal clean transportation options provide (e.g. not impacted by fluctuating gas prices), they also provide a significant public health opportunity to mitigate frontline communities' exposure to vehicle emissions. This backdrop helps craft the narrative for what’s driving the trends that we are seeing in who is most severely impacted by COVID-19.
What’s driving the high rates of mortality? Ever hear of health disparities or social determinants of health (SDH)? What’s driving the transmission rates has been right in front of our face the whole time, just like the bus that goes from one end of your town to the other. You get so used to seeing it that you don't even acknowledge it anymore.
Health disparities are defined as preventable differences in the burden of diseases or illness, disability or mortality experienced by one group compared to another. Health disparities are nothing new, especially to those who are part of African American and Latin X communities who bear the brunt of the disparities or for those who work in public health. As a former Medical School professor who studies health disparities in communities of color, this narrative of African American and Latin X communities disproportionately impacted by diseases, is something I have seen play out over the course of my career. COVID-19 is forcing us to pull back the curtain and it’s not a pretty sight. What’s driving mortality rates are health disparities and social determinants of health – facilitated by exposure to air pollution and poor air quality.
SDH can be explained as the conditions that people are born in, grow and live, work and age in. Factors include socioeconomic status, discrimination, education, employment, social network, access to health care, neighborhood, and physical environment such as poor air quality, living in communities with high levels of pollution. Addressing the SDH is important in improving health and reducing long-standing disparities in healthcare. For far too long, frontline communities have been plagued with disparities facilitated by historic and systemic pre-existing conditions such as redlining, discrimination, lack of access to care, high rates of exposure to pollution from vehicle emissions. As a result, it’s no surprise that COVID-19 is having such a devastating impact. Recently researchers from Harvard University, T.H. Chan School of Public Health shared findings from a recent study that found tiny, dangerous particles known as particulate matter (PM 2.5) were associated with higher death rates from COVID-19. The study results indicate that long term exposure to air pollution increases one's chances of experiencing the most severe and worst COVID-19 outcomes. So in essence, communities with higher levels of air pollution are going to see much higher levels of hospitalizations and death.
Recent news reports have suggested that the factors driving high mortality and morbidity rates in frontline communities include pre-existing conditions such as hypertension, heart disease, and chronic lung disease. However, what has not frequently been reported is that numerous scientific studies have linked particulate pollution to premature death in people with heart or lung disease, nonfatal heart attacks, aggravated asthma, decreased lung function and other respiratory ailments. Individuals with lung or heart disease, children and older adults are most vulnerable to air pollution. The World Health Organization reports that globally, air pollution from transportation emission leads to nine million premature deaths. By comparison, smoking tobacco causes 7.2 million deaths. Living in a heavily polluted community is bad for your health and is a prime target for COVID-19. For those of us working at the intersection of transportation and environmental health equity, this association is no surprise and highlights everything that environmental and social justice advocates have been saying for decades---your zip code and race/ethnicity should not determine your life expectancy and health outcomes.
Other factors facilitating the spread of COVID-19 include initial stories that indicated health care providers are less likely to refer African Americans for testing when they visit clinics with COVID-19 symptoms. With a disease that spreads as quickly as COVID-19, disparities in testing access lead to significantly worse health outcomes. Furthermore, as word of the impending pandemic spread, there were mixed messages about the severity of the disease, followed by very limited information about who was at risk and how it was spread. There were even rumors that African Americans couldn’t contract it. When you combine these factors with institutional and systemic barriers such as facing racial bias when presenting for health care, lack of insurance, sustained exposure to particulate matter from air pollution, inability to social distance, stressors such as racism and discrimination which have been well documented to cause a type of accelerated aging known as weathering. Then when you consider that pre-existing health conditions such as chronic diseases increase mortality risk and make one more susceptible to COVID-19, African Americans are facing a formidable battle….a battle for life or death….and too often, in this case, death is winning.
Organizations like EVHybridNoire (EVHN), the nation’s largest multicultural network of diverse EV owners and enthusiasts with members and chapters from Los Angeles, to Atlanta, to Detroit and New York City, works to educate Frontline communities, including African American, Latin X and more about these very issues. EVHN advocates for policies that mitigate the impact of transportation emissions on these communities. However, EVHN is one organization, and we need “all hands on deck” to dismantle the systems that help fuel these disparities. What can we do?
First, we need to push policymakers to collect and provide data on the race/ethnicity of COVID-19 cases so that we can have a better understanding of these disparities. Next, we need to concentrate on testing on communities at increased risk. So, that means establishing drive-through clinics in African American communities, Latin X communities, and other places where there are “high incidences'' of COVID-19 and make sure that if an individual tests positive that they are connected with resources/services to facilitate their recovery. Then, we need to reduce communities' long term exposure to particulate matter and air pollution. In other words, put policies and measures in place that reduce exposure to tailpipe emissions e.g. increase access to multimodal, clean transportation, provide incentives/rebates to defray purchase costs.
We need more clean-air regulations and focused education for communities about the correlation between air pollution, transportation and the public health impacts on their health and well-being. We also need to infuse and amplify the public health narrative and how it impacts frontline communities. For instance, transitioning away from fossil fuels to electric transportation is a proven strategy to mitigate air pollution. In our work to increase EV adoption and access in frontline communities, we often present the fact that for some communities the transition to clean transportation can be gradual, over time but for other communities such as African American and Latin X communities, who are impacted worst and first by air pollution and in this case COVID-19, this is a life or death matter. In addition, beyond the financial insulation from varying gasoline/fuel costs, EVs and other multimodal clean transportation options provide a significant public health opportunity to mitigate frontline communities' exposure to vehicle emissions.
The current federal administration has been rolling back clean air policies over the last three years - however, COVID-19 is a perfect example of why it is important to have these measures and strong policies in place to protect the public’s health, particularly those of Frontline communities who for far too long have had to bear many social and environmental injustices. In a country that has so much wealth and technology and that can provide the most cutting edge medical interventions, we have to protect the health of the most vulnerable populations and we have to start now. Opportunistic viruses like COVID-19 are the perfect example of what happens when systemic and institutional pre-existing conditions are left untreated.
Dr. Shelley Francis, Co-Founder, EVHybridNoire
Co-Founder of EVHybridNoire (EVHN), Dr. Shelley Francis is a nationally recognized E-mobility and Public Health professional focused on equity initiatives with electric, connected, autonomous & shared vehicles. Previously, her public health work included leadership roles at the Georgia Department of Public Health and Faculty positions at The Ohio State University and Case Western Reserve University School of Medicine, where she published over 20 peer-reviewed manuscripts and mentored medical and graduate students. In addition to her work with EVHybridNoire, Dr. Francis also serves as a Board Director for the Electric Auto Association, a National 501c3 advocacy group.
