ARTICLE IN PRESS
Health & Place 13 (2007) 3–13
www.elsevier.com/locate/healthplace
Bourdieu does environmental justice? Probing the linkages
between population health and air pollution epidemiology$
Michael Buzzelli
Department of Geography, University of British Columbia, 1984 West Mall, Vancouver, BC, Canada V6T 1Z2
Abstract
The environmental justice literature faces a number of conceptual and methodological shortcomings. The purpose of
this paper is to probe ways in which these shortcomings can be remedied via recent developments in related literatures:
population health and air pollution epidemiology. More sophisticated treatment of social structure, particularly if based
on Pierre Bourdieu’s relational approach to forms of capital, can be combined with the methodological rigour and
established biological pathways of air pollution epidemiology. The aim is to reformulate environmental justice research in
order to make further meaningful contributions to the wider movement concerned with issues of social justice and equity in
health research.
r 2005 Elsevier Ltd. All rights reserved.
Keywords: Environmental justice; Population health; Air pollution epidemiology
Introduction
Environmental justice research has coalesced
around concern over the societal distribution of
environmental hazards and their health effects. The
following working hypothesis underlies this literature: health hazards are disproportionately, or
unjustly, distributed among social groups, particu$
This paper grows out of an international workshop held at
the Peter Wall Institute for Advanced Studies at The University
of British Columbia, Vancouver, Canada. The workshop was
aimed at exploring the linkages between critical social theory,
health and place, environmental justice and geographic information science. The author wishes to acknowledge the generous
support of the PWIAS for this event (see http://www.geog.ubc.ca/buzzelli/Internationalworkshop.htm) and the participation
of all workshop attendees.
Tel.: +604 822 5870; fax: +604 822 6150.
E-mail address: [email protected].
1353-8292/$ - see front matter r 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.healthplace.2005.09.008
larly the poor and visible minorities. However, after
2 decades of research, the literature has been stalled
by persistent methodological and conceptual problems, casting significant doubt over what, otherwise, is a theoretically intuitive working hypothesis.
The purpose of this paper is to probe ways in which
environmental justice research can move forward
with recent developments in related literatures,
namely population health and air pollution epidemiology.
Air pollution epidemiology has come to incorporate social stratification as a health effect modifier,
usually based on single variables such as educational attainment. This has occurred alongside a
new intra-urban focus, whereby exposure assessment and health effects are being examined at finer
(neighbourhood and individual) spatial scales. At
the same time, population health has long debated,
and now arguably refuted, the use of single variables
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4
M. Buzzelli / Health & Place 13 (2007) 3–13
Amidst increasing calls for equity and social
justice1 as priority themes in health research (Evans
and Kantrowitz, 2002; IOM, 2002; Hofrichter,
2003; Macinko and Starfield, 2004), the environmental justice agenda has begun to spread across
the developed world. At the same time, there are
repeated calls to integrate population health and
environmental epidemiology (Krieger, 2003). ‘‘It is
axiomaticy,’’ writes Eyles, ‘‘ythat integration
within a population health framework points to
the need for shared responsibility to develop ways of
knowing and tools to understand, explain and
manage health concerns and to enhance health of
populations in specific environments’’ (Eyles, 1999,
s33). Indeed, we have seen recent arguments for a
merger focussed specifically on air pollution exposure and health effects (O’Neill et al., 2003; Bell et
al., 2004). Can environmental justice bring these
priorities together? The argument in this paper is
‘yes’, if we incorporate advancements in cognate
fields.
The conceptual appeal of environmental injustice
has resulted in a massive, though internally problematic literature. Sparked by civil libertarian and
minority rights movements in the US, this agenda
flies in the face of consensual environmentalism to
uncover systematic disadvantage by socioeconomic
position (SEP),2 a disadvantage usually accruing to
the poor and to African- and Latin-Americans. The
aim is to expose the nature and extent of any
disproportionate exposures to health hazards, ranging from toxic waste sites and air pollution to the
land use siting process and environmental decisionmaking (Hamilton, 1993; Chakraborty and Armstrong, 2001; Maantay, 2003). The term ‘disproportionate’ refers to the hypothesis that disadvantaged
communities ‘consume’ the disbenefits of economic
growth and development but do not share equally
(proportionately) in the benefits such as employment and rising living standards.
Following a number of foundational studies (e.g.
UCC, 1987; Bullard, 1990), two types of empirical
research have ensued (Cutter, 1995): ‘process’
studies of the creation of unjust health hazard
exposure, usually addressed historically; and ‘outcome’ studies of the extent of injustice usually
located at single points in time. In addition, we have
also seen a number of conceptual treatments of such
notions as equity and justice (e.g. Pulido, 1996;
Holifield, 2001). The focus here is on outcome
studies, i.e., cross-sectional cases located at a single
point in time that examine the unequal spatial
distribution of hazards. Fig. 1 is a schematic of the
environmental justice conundrum, indicating that as
SEP rises, the corresponding exposure to environmental health hazards among individuals and
neighbourhoods diminishes. Although we may
formalise the notion of disproportionate exposures
in this simple manner, and although the research
agenda has begun to take shape in Australia,
Canada, the United Kingdom and elsewhere (Jerrett
et al., 2001; Buzzelli et al., 2003; Lloyd-Smith and
Bell, 2003; McCleod et al., 2000; Brainard et al.,
2002; Mitchell and Dorling, 2003), the environmental justice literature continues to draw a range
of criticisms.
1
Notions of ‘equity’ and justice’ have quite disparate meanings
and substantive foci across disciplines. Recent calls for equity and
social justice in health research encompass environmental health
hazards as one of a number of wider social structural relations.
Environmental justice research is conceptually similar to environmental economics, though ‘justice’ flags a particular emphasis
on health hazards and their effects.
2
As discussed by Lynch and Kaplan (2000, p. 14) SEP is used
as an all-encompassing notion in social epidemiology, including
‘‘ysocial class, social stratification, social inequality, social
status, and socioeconomic status.’’ SEP is also meant to flag
the significance of race more so than these other measures
including the commonly used socioeconomic status (SES). See
also Krieger et al. (1997).
to represent social stratification. Treatment of
health and social status gradient has become much
more sophisticated than it was in the past, particularly recent incursions using the social theories of
Pierre Bourdieu. I argue that if combined, the relative advantages of these cognate literatures can help
to mount a reformulated environmental justice
research agenda.
This paper first describes the environmental
justice literature in order to highlight its principal
shortcomings. This is followed by a discussion of
recent developments in air pollution epidemiology
and population health, and means by which these
literatures may be merged. By mounting a new
environmental justice research framework, this
agenda can become a meaningful constituent of
the wider movement toward social justice and
equity in health.
Environmental justice as unwitting interlocutor
Limitations of environmental justice research
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M. Buzzelli / Health & Place 13 (2007) 3–13
c.)
t
Socioeconomic
Position
me
(e
o
Inc
ty
ali
e
Lin
of
u
Eq
Corresponding
Exposure
Individuals/ neighbourhoods
across space
Fig. 1. Schematic of environmental (in)justice.
Data limitations have resulted in two principal
problems: exposure misclassification and aggregation/scale effects. Absence of real environmental
monitoring data has resulted in a proliferation of
exposure surrogates such as buffering and proximity
techniques. Symptomatic of this continuing problem is the growing list of papers validating and/or
refining surrogates of hazards exposure in the
absence of monitoring (Glickman, 1994; Chakraborty and Armstrong, 1997; McMaster et al., 1997;
Sheppard et al., 1999; Cutter et al., 2001; Bolin
et al., 2002; Harner et al., 2002). To be sure,
monitoring data are not entirely absent from the
literature, but the application of surrogates has not
proceeded with due consideration of either assumptions or local circumstances (Buzzelli and Jerrett,
2004; Maantay, 2002).
Scale effects also raise the uncertainty of conclusions because associations are subject to the
ecological fallacy—the arrangement of alternative
levels of association at different spatial scales of
analysis. Anderton et al. (1994) fired a significant
salvo by demonstrating that the strong spatial
association of minority communities and toxic
waste sites found in an early flagship study (Bullard,
1990)3 changed at different spatial scale of analysis.
Together, exposure misclassification and scale
effects have resulted in a blanket of doubt wrapped
around nearly two decades of research (Bowen,
2001). To be sure, the tall stack of case studies
supports the notion that environmental injustice
3
This study, and much of the literature, would normally refer
to ‘environmental racism’ to flag the priority of race over other
measures of socioeconomic position. ‘Environmental justice’ is
used inclusively here (see Buzzelli and Jerrett, 2004a).
5
exists. But how, for example, should public policy
respond to any particular study?
Finally, a broader blind spot exists. Without
monitoring data, health outcomes may only be
assumed but never tested directly. In a recent
literature search by the author using the ISI Web
of Science and Geobase databases, 78 studies dated
between 1995 and 2003 had the term ‘environmental
justice’ located in their titles and/or abstracts: 41
could have tested for a health association (as to say
they were outcome studies), but none did, and only
9 (12%) of these discussed health implications at
all.4 The lack of attention to health is remarkable
given that health impacts are one of the principal
rationales for undertaking environmental justice
research. One exception, the work of Harner et al.
(2002), makes use of relative risk ratios but is again
limited by the absence of monitoring and health
data; proxies are used instead. Alongside methodological scepticism, then, is the unanswered question
of health effects.
How are we to move environmental justice
research forward? In spite of the problems above,
it bears repeating that the focus of environmental
justice research is the societal distribution of the
burden of hazards and their impacts. Equity and
social justice are therefore foundational to the
particular question of the distribution of environmental health hazards, especially as these occur
across space. In this context, we find meaningful
intersections with recent developments in air pollution epidemiology and population health.
Recent developments in air pollution epidemiology
Amidst rising concerns over environmental health
hazards and their effects (Eyles, 1997), air pollution
has arguably become a core theme in epidemiology
(Pope et al., 2002; Burnett et al., 1998). Air
pollution health research seeks to uncover the
impacts of criterion pollutants such as fine particles,
ozone, carbon monoxide, sulphur dioxide and
nitrogen oxides. Impacts range from morbidity
and mortality of lung cancer, impairment of lung
function, myocardial infarction and reproductive
disorders to the associated hospitalisations and
health care costs (Brunekreef and Holgate, 2002).
However, the recent discovery of faulty modelling
algorithms (Knight, 2002) underscores both grow4
See http://www.geog.ubc.ca/%7ebuzzelli/pwias/Mike_Buzzelli/
proceedings.html).
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M. Buzzelli / Health & Place 13 (2007) 3–13
ing criticism of traditional approaches and interest
in alternative study designs. Major cohort studies—
typically regarded as ideal—have been criticised for
non-representative samples (Gamble, 1998), potential ecologic confounding (Lipfert and Morris,
2002), short follow-up time for assessing effects
(Vedal, 1997) and potential spatial autocorrelation
(Krewski et al., 2000; Finklestein, 2002). All of this,
some argue, may influence the size and significance
of air pollution health effects (Burnett et al., 2001).
In this context, two emergent trends represent
potential connections with, and support for, environmental justice.
First, alternative study designs have arisen, many
based on finer spatial scales of analysis. Setting the
standard over the last twenty years is observational
time-series analysis. (Evans et al., 1984; Zidek and
Bates, 2002). These typically use a single regional
monitoring station to assign the same exposure to
all residents of that region to examine temporal
correlations of morbidity and mortality with acute
events, or pollution spikes. But the ‘new science’ of
human exposure assessment (Ott, 1995) has diversified to include the intra-urban (i.e. spatial) variability of pollution based on networks (not single) of
monitoring stations, proximity to roadways and
personal monitoring (Brauer et al., 2003; Hoek
et al., 2001; Briggs et al., 1997; Brunekreef et al.,
1997). Even the ecological study design has reemerged: usually maligned for potential ecological
fallacy (see Morgenstern, 1995; Wakefield, 2001),
Ayers (2002) notes that cross-sectional ecologic
studies of chronic exposure have proven effective,
inexpensive and timely. As Bates and Vedal
(2002, 111) note in their review of air pollution
epidemiology, ‘‘Although it is easy to raise objections to one particular type of study design, it is
difficult to deny the impact of the studies considered
as a whole’’.
Accompanying these trends is the growing interest in socioeconomic confounding and/or effect
modification (e.g. Weed and McKeown, 2003).5 For
example, some flagship studies have shown that
5
We would expect confounding when we know, or can
hypothesise, that the study population has inherently greater
susceptibility to air pollution health effects, such as pre-existing
respiratory disorders. This requires statistical control in equity/
justice and health effects models. On the other hand, effect
modification—the main focus of this paper—suggests that
intrinsic features such as race are at some level causally related
to susceptibility, independent of/in addition to air pollution
exposures.
individuals with low education are most susceptible
to health effects of ambient particulate matter (e.g.
Krewski et al., 2000; Pope et al., 2002; see O’Neill
et al., 2003 for an overview). This pushes epidemiology past individual risk factor epidemiology to a
broader concern with social stratification and equity
issues (Coughlin, 1996). Use of variables such as
educational attainment necessarily brings air pollution epidemiology into contact with population
health. How this interface is developed in future can
pay dividends not only for air pollution epidemiology but also for environmental justice.
Incorporation of SEP and use of finer spatial
scales provides a direct link with environmental
justice. From the environmental justice literature we
know that proximity to hazards is influenced by a
host of (often debated) social processes including
housing market dynamics and discriminatory real
estate practices (see Been, 1993; Pulido, 2000). The
net effect is that disadvantaged communities usually
constitute the urban spaces of greatest risk. Air
pollution epidemiology is increasingly concerned
with the social composition of these spaces, leading
to the basic question: does socio-spatial stratification not only influence exposure to health hazards
but also modify their impacts? In their call for a
merged air pollution–social epidemiology programme, O’Neill et al. (2003) pose the same
question. For a merger to be meaningful, however,
social stratification must receive critical treatment.
Consider the following conclusion of the influential
Health Effects Institute’s landmark Reanalysis
Project:
The Reanalysis Team did find evidence of
variation in risk among population subgroups:
the most important was that the relative risk of
mortality association with fine particle air pollution decreased with increasing educational attainmentyAlthough the interpretation of this
finding is unclear, it is possible that educational
attainment is a marker for socioeconomic status,
which in turn may be correlated with exposure to
fine particle air pollution (Krewski et al., 2000,
p. 232).
For our purposes, the tentative interpretation is
just as important as the finding itself. For environmental justice to advance, treatment of social
structure cannot rely solely on simple markers of
SEP.
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M. Buzzelli / Health & Place 13 (2007) 3–13
Multiple forms of capital
While recent developments in air pollution
epidemiology open a window on disease aetiologies
at finer spatial scales, how the effects are associated
with social structure requires careful consideration.
Theory and empirical treatment of social structure
is central to population health, especially in recent
work applying the insights of the social theorist
Peirre Bourdieu. These interpenetrating benefits
present two important opportunities—both necessary I argue—for advancing environmental justice.
First, a focus on a specific health hazard allows us
to address biological pathways between social
structure and a population’s health. This is an
important connection not only because environmental justice research has failed to analyse health
effects but also because biological pathways continue to be debated without consensus within the
population health literature. The latter literature
was founded initially on the supposition that social
structure fosters differential health via psychoneuroimmunology; that the immune system is somehow
in dialogue with one’s social environment and that
social stressors in particular manifest as ill-health
(Mustard and Frank, 1991). Accordingly, psychosocial stress and stress response models have
flourished as explanations of the social patterning
of disease (Lynch et al., 2003; Wilkinson, 1996) but
the biological linkages are still regarded as tenuous
(Berkman and Kawachi, 2000; Brunner, 2000).
Indeed, SEP itself has been labelled a ‘cause’ of
health states. While the association is irrefutable
given the mountain of evidence accumulated to
date, this is not an explanation of how ill-health
manifests biologically (cf. Link and Phelan, 1995;
Kaplan and Lynch, 1997). Within environmental
justice, the relationship has
ytwo necessary prerequisites—namely that ‘‘socioeconomic status (SES) is associated with
environmental quality and, in turn, environmental quality affects health. This is not equivalent,
however, to the conclusion that SES effects on
health are caused by differential exposure to
environmental quality. There are few if any data
directly testing this proposition. What is necessaryyis that the SES health link is mediated by
environmental quality (Evans and Kantrowitz,
2002, 303–304).
Within air pollution epidemiology ‘‘few studies
have looked carefully at how these factors interact
7
with one another’’ (O’Neill et al., 2003, 1862). The
opportunity for environmental justice researchers to
incorporate all of these factors and make new
contributions therefore exists.
A second opportunity arises from population
health’s more critical treatment of social structure.
While air pollution epidemiology now routinely
includes SEP, treatment of social structure has been
mostly undynamic. Viewpoints on the association of
‘the social’ with health include level of economic
development, economic growth trajectory and
political organisation. The influential work of
Wilkinson (1996) both underscored and further
popularised the view that social structure and health
are related by the nature, and magnitude, of social
inequalities (Feinstein, 1993; BMJ, 1996; Bartley et
al., 1998; Wagstaff and van Doorslaer, 2004).
However, how inequality and social structure are
theorised is subject to much disagreement and
debate (e.g. Hayes, 1994; Poland et al., 1998;
Raphael and Bryant, 2003), and there is a rising
consensus that use of single variables as proxies for
social structure is insufficient (e.g. Duncan et al.,
2002; Lynch and Kaplan, 2000). For example,
income, education and occupation can be highly
inter-correlated and have strong associations in a
range of morbidity and mortality studies but each
represents trade-offs. Income captures the health
status gradient best in its inter-quartile range but
does a poor job of explaining variations at the
extremes. Also, income measured at one point in
time is not necessarily representative of the life
course, nor can we assume a strong correlation with
wealth (Davey Smith and Hart, 1997).
From this ferment has grown recognition that
social structure is a complex web of intersecting
forms of capital, each implicating health separately
and in various combinations (Oakes and Rossi,
2003). Income, education and occupation are the
basic ingredients of economic capital while social
integration and trust are constituents of the
burgeoning social capital health literature. According to Kawachi (2000, 90):
ythe process of social stratification takes place
along a vast array of dimensions, including (but
not limited to) political power (household authority, workplace control, legislative authority),
cultural assets (privileged lifestyles, high status
consumption practices), social assets (access to
social networks, ties, associations), honorific
status (prestige, respect, ‘‘good reputation’’), and
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M. Buzzelli / Health & Place 13 (2007) 3–13
human resources (skills, expertise, training). A
major objective of social epidemiology [qua
population health] is to elucidate the patterning
of health through differential access to the diverse
forms of capital—not just economic capital but
also social, human, political, cultural, and symbolic capital.
Social
capital
Economic
capital
Arguably, the most sophisticated integration of
various forms of capital is found in sociological
health research that uses the theories of the late
Pierre Bourdieu (Bourdieu, 1985, 1986; Gatrell,
1997; Frohlich et al., 2001). Bourdieu’s relational
framework seeks to uncover the complexity of social
stratification by classifying the various forms of
capital into a ‘social space’.6 Individuals and
communities are endowed with various forms of
capital, each in different amounts, constituting their
position in social hierarchy. ‘‘Bourdieu has demonstrated in exquisite detail how position in the social
hierarchy is consistently related to almost every
aspect of life from home décor, to taste in music and
food, to opinions on art and desirable vacations, let
alone dietary, exercise, and other behaviours’’
(Lynch and Kaplan, 2000, 21).
Fig. 2 presents a stylised model of what Bourdieu
envisioned, and how some health researchers have
implemented, the treatment of individuals and
communities in the social space of capitals. Social
structure is represented as a composite ‘social space’
that may be associated with the health status of
individuals and their neighbourhoods/communities.
In this figure, the social space of capitals is reduced
to a small number of dimensions—social, economic
and cultural; as we see below, a set of dimensions
that are not exhaustive but nonetheless recurring in
health research. The shaded blocks in Fig. 2 can be
thought of as collections of individuals displaying
varying quantities and mixes of capital. Collections
of like individuals may constitute at-risk communities for exposure to air pollution, perhaps in the
same neighbourhoods, and as we shall see this
approach also allows us to tease out the nuances of
identity, social structure and place of residence.7
This treatment of social structure sharply contrasts with the single monological variables typically
found in air pollution epidemiology. And it is not
armchair theorising: as Bourdieu did, health researchers have begun to implement this framework
empirically (Williams, 1995; Poland, 2000; Lovell,
2002). For example, Gatrell et al. (2004) use
questionnaire survey data from one lower status
and one higher status community each in Lancaster
and Salford, England, to classify respondents.
Analysing the determinants of psychological morbidity, they step through various stages of data
exploration and modelling to derive a small set of
variables to classify individual respondents and
their communities (using mean respondent scores)
with dimensions of social and material capital, in a
social space much like Fig. 2.8
Two points emerge from locating individuals and
communities in the social space of capitals. First,
individuals and their neighbourhoods are assigned
scores to test the health and SEP relationship.
Bourdieu’s relational framework provides a richer
picture of social structure than does the usual army
of stand-alone variables. Income is one of a series of
variables reduced by associations among individuals
for the construction of a multi-faceted social
6
Another key feature of Bourdieu’s approach to social
stratification, treatment of ‘structure vs. agency’, is noted but
not addressed directly here. While this also holds promise for
insights into the health effects of social hierarchy, the focus here
is on how social structure is treated analytically.
7
Analytically there is no reason to assume a priori that these or
any other forms of capital are orthogonal. Indeed we might
expect some overlap. However as we see below, the use of this
framework has been to produce mutually exclusive dimensions of
(footnote continued)
capital. This figure and paper are meant to demonstrate the
usefulness of the approach and the author hopes that future work
will engage the implications of how, analytically, to treat
dimensions in the social spaces of capital!
8
As one would classify units of observation in a principal
components analysis using component scores, except they use
multiple correspondence analysis for their categorical survey
data.
Cultural
capital
Fig. 2. Locating individuals and communities in the social space
of capitals.
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M. Buzzelli / Health & Place 13 (2007) 3–13
hierarchy. Oakes and Rossi (2003, 775) make a
similar argument in their prescription for more
critical and analytical treatment of social structure,
stating that ‘‘Although separate variables, such as
education and income, are preferred when statistically controlling for SES in a regression model, we
believe a single composite measure remains best for
stratified analyses, graphical presentations, and
explanations to lay audiences—tasks common in
health-related research.’’9 If traditional variables
capture only part of this fine-grained social stratification, then a fuller picture can yield more
meaningful insights into the independent role of
SEP in air pollution health effects. This is fundamental to a reformulated environmental justice
research agenda. Second, the geographical location
of individuals in the social space is also apparent
and can therefore be linked to a host of material
conditions such as air pollution itself. For example,
via deliberate inclusion of different types of communities in their study design, Gatrell et al. (2004)
could ‘see’ whether social relations, income levels
and other indicators of material circumstances,
varied with geographical setting (Gatrell et al.,
2004, p. 11).
Bourdieu does environmental justice?
We have seen how developments in air pollution
epidemiology and population health represent
relative strengths: enhanced air pollution exposure
classification and refined social stratification. Each
separately would advance environmental justice but
they can also be brought together for a reformulated environmental justice framework. What would
this framework look like? It would be based on the
creation of new points of contact along the health
and SEP gradient; points connecting individual and
community position in a fine-grained social structure with sophisticated air pollution exposure
assessment and health effects testing also included.
New contact points are created with a Bourdieuvian approach because individuals and neighbourhoods are arrayed differently along the health and
SEP gradient. If income alone produces an order/
ranking of individuals and neighbourhoods, other
9
While it is a minor point, I would object to the argument that
composite measures may be easier to convey to lay audiences.
Deriving composite measures often involve sophisticated data
reduction techniques, e.g., that are not always straightforward;
nor are the composite ‘indexes’ themselves straightforward to
interpret and understand.
9
forms of economic capital—of which income is one
constituent—will re-shuffle that order. In turn,
economic capital is one dimension of a broader
social composite in a Bourdieun approach to the
health–SEP gradient. Gatrell et al.’s (2004) study is
again a good example. While they set as their
primary target the visualisation of the social space
of psychological morbidity, their geographical study
design enables them to conclude thus:
‘‘Mapping the survey respondents inysocial
spaces reveals a social landscape that is complex
and heterogeneous, in that members of relatively
deprived areas and neighbourhoods [sometimes]
find themselves ‘neighbours’ of those drawn from
more affluent areas, and vice versa. This is an
important finding; mere co-location in geographical space does not mean that individuals have
near-identical stocks of social and material
capital’’ (Gatrell et al., 2004, 11).
Considering their argument closely, the conclusion is more than a cautionary note on data
aggregation and scale effects: it speaks to how
individuals, neighbourhoods and their relative
positioning are bound to change with a more
textured picture of social structure.
Because air pollution varies spatially it can be
linked to individuals and neighbourhoods arrayed
within the Bourdieuvian social space of capitals via
their geographic location. At a basic level, then, new
contact points along the health–SEP gradient
facilitates exposure analysis and health effects
testing—an approach that is absent to date in the
environmental justice literature. And it does more:
by connecting social structure and air pollution
exposure in new ways, we can ask whether SEP
plays some relative, joint, independent or confounding role, and to what degree (e.g. holding air
pollution exposures equal)? This goes to the
question of whether effects are proportionate to
exposure, or perhaps amplified or diminished by the
mix and quantities of capital.
Fig. 3 illustrates scenarios that expand on the
modification of air pollution health effects by the
social space of capitals. This is built on the notion in
air pollution epidemiology that air pollution exposures are not associated with threshold health
effects: that the dose–response is reasonably linear
and not significantly attenuated, or modified, as
exposure changes, even at very low concentrations (Dominici et al., 2002; Daniels et al., 2000;
Schwartz and Zanobetti, 2000). Yet there is a
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M. Buzzelli / Health & Place 13 (2007) 3–13
10
Health hazard effects
Harvesting: Triple
jeopardy?
Host resistance?
Socioeconomic status
Fig. 3. SEP and environmental health hazard effects.
well-documented ‘‘health ceiling effect’’ within
population health (see House et al., 1994). Has the
use of single monological variables in air pollution
epidemiology masked threshold effects? Consider
how trust and social integration—meat and drink to
social capital—may raise ‘host resistance’ to air
pollution insults despite working class occupational
status and low income. Either of these measures
alone might mask the protective benefits of social
capital. Similarly, an income variable alone could
conceal the effect modification associated with
being of lower status: a ‘triple jeopardy’ effect,
whereby low status and exposures, when combined,
result in amplified disease rates (see Jerrett et al.,
2001). In his now classic overview of the health
inequalities literature, Wilkinson (1996, pp. 58, 70)
underscores these points:
‘‘yeven within any occupation there are very
large differences in things like education and
incomeyA purely occupational classification
will be blind to many of the differences that exist
within occupational categoriesyinaccurate social classification makes health differences look
smaller than they really are.’’
Of course any prescription for research comes
with limitations. In this context it bears noting that
whether we adopt a Bourdieun air pollution
epidemiology strategy or some other approach,
better data are needed (see Oakes and Rossi
(2003) and Krieger et al. (1997) for similar arguments with respect to treatment of social structure
in social epidemiology). Monitoring data, data
aggregation and health effects testing will continue
to be sticking points unless a meaningful effort is
made to rectify the data gap; the stack of environmental justice case studies will grow heavier while
simultaneously adding to the groundswell of uncertainty and scepticism. Second, the population
health literature would have us consider air pollution as one of several types of environmental
exposures; these in turn constituting one class of
exposures that reproduce the health and SEP
gradient (Evans and Kantrowitz, 2002). Thus, while
advancements in air pollution epidemiology provide a focus for SEP–disease pathways, they also
limit the analytical scope of analysis to one kind
of hazard. Third, the notion of multiple forms of
capital may be less relevant at the very bottom
of the health–SEP gradient. A neo-materialist
would correctly argue that simpler measures of
social structure such as income and wealth capture
the fundamental problem at this segment of the
gradient: deep material deprivation. Alternative
approaches to social structure in this case may be
less applicable.
Having said this, some environmental justice
researchers have begun to develop techniques, albeit
focussed strictly on environmental hazards, that
provide the scope for integrating a range of
exposures (e.g. Bolin et al., 2002). In terms of neomaterialist exceptions, it is interesting to note that
Lovell (2002), in her study of injection drug users,
finds that alternative forms of (Bourdieuvian)
capitals are in fact useful for understanding
infectious disease risk for a cohort characterised
by deep material deprivation. She writes:
Forms of capital should thus be particularly
useful for differentiating between life circumstances among individuals who might otherwise
appear similar, according to a single measure,
such as employment level or education, as might
be the case for serious substance abusers,
chronically homeless persons, or single, unemployed mothers (Lovell, 2002, 806).
More generally, the argument of the present
paper is that a merger between population health
and air pollution epidemiology represents a meaningful way forward because it combines the foci and
strengths of cognate literatures that directly address
the shortcomings and priorities, of environmental
justice. Perhaps the best indication of this potential
is how these literatures throw each others’ weaknesses—disease aetiologies and treatment of social
structure, respectively—into high relief. The effective marriage of air pollution epidemiology and
ARTICLE IN PRESS
M. Buzzelli / Health & Place 13 (2007) 3–13
population health represents an opportunity for
environmental justice to provide its own insights
into the wider movement toward social justice and
equity and health research.
References
Anderton, D., Anderson, J., Oakes, J., Fraser, M., 1994.
Environmental equity: the demographics of dumping. Demography 31, 229–248.
Ayers, J., 2002. Chronic effects of air pollution. Occupational and
Environmental Medicine 59, 147–148.
Bartley, M., Blane, D., Davey Smith, G., 1998. The Sociology of
Health Inequalities. Blackwell, Oxford.
Bates, D., Vedal, S., 2002. Adverse health effects. In: Bates, D.,
Caton, R. (Eds.), A Citizen’s Guide to Air Pollution. David
Suzuki Foundation, Vancouver, pp. 67–152.
Been, V., 1993. What’s fairness go to do with it? Environmental
justice and the citing of locally undesirable land uses. Cornell
Law Review 78, 1001–1036.
Bell, M., Davis, D., Cifuentes, L., Cohen, A., Gouveia, N.,
Grant, L., 2004. International expert workshop on the
analysis of the economic and public health impacts of air
pollution: workshop summary. Environmental Health Perspectives 110, 1163–1168.
Berkman, L., Kawachi, I., 2000. A historical framework for
social epidemiology. In: Berkman, L., Kawachi, I. (Eds.),
Social Epidemiology. Oxford University Press, New York.
BMJ (British Medical Journal), 1996. The big idea. British
Medical Journal 312, 985.
Bolin, B., Nelson, A., Hackett, E., Pijawka, D., Smith, C.,
Sicotte, D., Sadalla, E., Matranga, E., O’Donnell, M., 2002.
The ecology of technological risk in a Sunbelt City.
Environment and Planning A 34, 317–339.
Bourdieu, P., 1985. The social space and the genesis of groups.
Theory and Society 14, 723–744.
Bourdieu, P., 1986. Distinction: A Social Critique of the
Judgement of Taste. Routledge, London (R. Nice, Trans.).
Bowen, W., 2001. An analytical review of environmental justice
research: what do we really know? Environmental Management 29 (1), 3–15.
Brainard, J., Jones, A., Bateman, I., et al., 2002. Modelling
environmental equity: access to air quality in Birmingham,
England. Environment and Planning A 34, 695–716.
Brauer, M., Hoek, G., van Vliet., P., et al., 2003. Estimating longterm average particulate air pollution concentrations: application of traffic indicators and geographic information
systems. Epidemiology 14 (2), 228–239.
Briggs, D., Collins, S., Elliott, P., Fischer, P., Kingham, S.,
Lebert, E., Pryl, K., van Reeuwijk, H., Smallbone, K., van der
Veen, A., 1997. Mapping urban air pollution using GIS: a
regression-based approach. International Journal of Geographical Information Science 11 (7), 699–718.
Brunekreef, B., Holgate, S., 2002. Air pollution and health.
Lancet 360, 1233–1242.
Brunekreef, B., Janssen, N., de Hartog, J., Harssema, H., Knape,
M., van Vliet, P., 1997. Air pollution from truck traffic and
lung function in children living near motorways. Epidemiology 8, 298–303.
11
Brunner, E., 2000. Toward a new social biology. In: Berkman, L.,
Kawachi, I. (Eds.), Social Epidemiology. Oxford University
Press, New York, pp. 306–331.
Bullard, R., 1990. Dumping in Dixie: Race, Class and Environmental Quality. Westview Press, San Francisco.
Burnett, R., Cakmak, S., Brook, J.R., 1998. The effect of the
urban ambient air pollution mix on daily mortality rates in 11
Canadian cities. Canadian Journal of Public Health 89 (3),
152–156.
Burnett, R., Ma, R., Jerrett, M., Goldberg, M., Cakmak, S.,
Pope III, C., Krewski, D., 2001. The spatial association
between community air pollution and mortality: a new
method of analyzing correlated geographic cohort data.
Environmental Health Perspectives Supplements 109 (3),
375–380.
Buzzelli, M., Jerrett, M., 2004. Comparing proximity measures of
exposure to geostatistical estimates in environmental justice
research. Environmental Hazards 5 (1–2), 13–21.
Buzzelli, M., Jerrett, M., Burnett, R., Finkelstein, N., 2003.
Spatiotemporal perspectives on air pollution and environmental justice in Hamilton, Canada, 1985–1996. Annals of the
Association of American Geographers 93 (3), 557–573.
Chakraborty, J., Armstrong, M., 1997. Exploring the use of
buffer analysis for the identification of impacted areas in
environmental equity assessment. Cartography and Geographic Information Systems 24 (3), 145–157.
Chakraborty, J., Armstrong, M., 2001. Assessing the impact of
airborne toxic releases on populations with special needs.
Professional Geographer 53 (1), 119–131.
Coughlin, S., 1996. Environmental justice: the role of epidemiology
in protecting unempowered communities from environmental
hazards. The Science of the Total Environment 148, 67–76.
Cutter, S., 1995. Race, class and environmental justice. Progress
in Human Geography 19, 107–118.
Cutter, S., HM, DK, 2001. Subsidized inequities: the spatial
patterning of environmental risks and federally assisted
housing. Urban Geography 22 (1), 29–53.
Daniels, M.J., Dominici, F., Samet, J.M., Seger, S.L., 2000.
Estimating particulate matter–mortality dose–response curves
and threshold levels: an analysis of daily time-series for the 20
largest US cities. American Journal of Epidemiology 152,
397–406.
Davey Smith, G., Hart, C.W.G., 1997. Individual social class,
area-based deprivation, cardiovascular disease risk factors,
and mortality: the Renfrew and Paisley study. Journal of
Epidemiology and Community Health 52, 399–405.
Dominici, F., Daniels, M., Zeger, S.L., Samet, J.M., 2002. Air
pollution and mortality: estimating regional and national
dose–response relationships. Journal of the American Statistical Association 97, 100–111.
Duncan, G., Daly, M., McDonough, P., Williams, D., 2002.
Optimal indicators of socioeconomic status for health.
American Journal of Public Health 92 (7), 1151–1157.
Evans, G., Kantrowitz, E., 2002. Socioeconomic status and
health: the potential role of environmental risk exposure.
Annual Review of Public Health 23, 303–331.
Evans, J., Tosteson, T., Kinney, P., 1984. Cross sectional
mortality studies and air pollution risk assessment. Environment International 10, 55–83.
Eyles, J., 1997. Environmental health research: setting an agenda
on spinning our wheels or climbing the mountain? Health and
Place 3, 1–13.
ARTICLE IN PRESS
12
M. Buzzelli / Health & Place 13 (2007) 3–13
Eyles, J., 1999. Health, environmental assessments and population health: tools for a complex process. Canadian Journal of
Public Health 90 (Suppl. 1), s31–s34.
Feinstein, P., 1993. The relationship between socioeconomic
status and health: a review of the literature. The Milbank
Quarterly 71, 279–322.
Finklestein, M., 2002. Pollution-related mortality and educational level. Journal of the American Medical Association
288, 830.
Frohlich, K., Corin, E., Potvin, L., 2001. A theoretical proposal
for the relationship between context and disease. Sociology of
Health and Illness 23, 776–797.
Gamble, J., 1998. PM2.5 and mortality in long-term prospective
cohort studies: cause–effect or statistical associations? Environmental Health Perspectives 106, 535–549.
Gatrell, A., 1997. Structures of geographical and social space and
their consequences for human health. Geografiska Annaler
79B, 141–154.
Gatrell, A., Popay, J., Thomas, C., 2004. Mapping the
determinants of health inequalities in social space: can
Bourdieu help us? Health and Place 10, 245–257.
Glickman, T., 1994. Measuring environmental equity with
geographical information systems. Renewable Resources
Journal 116, 17–20.
Hamilton, J., 1993. Testing for environmental racism: prejudice,
profits, political power? Journal of Policy Analysis and
Management 14 (1), 107–132.
Harner, J., Warner, K., Pierce, J., Huber, T., 2002. Urban
environmental justice indices. Professional Geographer 54 (3),
318–331.
Hayes, M., 1994. Evidence, determinants of health and population epidemiology: humming the tune, learning the lyrics. In:
Hayes, M., Foster, L., Foster, H. (Eds.), The Determinants of
Population Health: A Critical Assessment. Department of
Geography, University of Victoria, Victoria, Canada, pp.
121–134.
Hoek, G., Fischer, P., van der Brandt, P., Goldbohm, S.,
Brunekreef, B., 2001. Estimation of long-term average
exposure to outdoor air pollution for a cohort study on
mortality. Journal of Exposure Analysis and Environmental
Epidemiology 11, 459–469.
Hofrichter, R., 2003. The politics of health inequities: contested
terrain. In: Hofrichter, R. (Ed.), Health and social justice:
Politics, Ideology, and Inequity in the Distribution of Disease.
Jossey-Bass, San Francisco, pp. 1–56.
Holifield, R., 2001. Defining environmental justice and environmental racism. Urban Geography 22 (1), 78–90.
House, J., Lepkowski, J., Kinney, A., Mero, R., Kessler, R.,
Herzog, A., 1994. The social stratification of aging and health.
Journal of Health and Social Behaviour 35, 213–234.
IOM (Institute of Medicine), 2002. The Future of the Public’s
Health. National Academy Press, Washington DC.
Jerrett, M., Burnett, R., Kanaroglou, P., Eyles, J., Finkelstein,
N., Giovis, C., Brook, J., 2001. A GIS-environmental justice
analysis of particulate air pollution in Hamilton, Canada.
Environment and Planning A 33, 955–973.
Kaplan, G., Lynch, J., 1997. Whither studies on the socioeconomic foundations of population health? American
Journal of Public Health 87, 1409–1411.
Kawachi, I., 2000. Income inequality and health. In: Berkman,
L., Kawachi, I. (Eds.), Social Epidemiology. Oxford University Press, New York.
Knight, J., 2002. Statistical error leaves pollution data up in the
air. Nature 417, 667.
Krewski, D., RT, B., Goldberg, D., Hoover, K., Siemiatycki, J.,
Jerrett, M., Abrahamowicz, M., White, W., 2000. Reanalysis
of the Harvard Six Cities Study and the American Cancer
Society Study of Particulate Air Pollution and Mortality.
Health Effects Institute, Cambridge, MA.
Krieger, N., 2003. Theories for social epidemiology in the twentyfirst century: an ecosocial perspective. In: Hofrichter, R.
(Ed.), Health and Social Justice: Politics, Ideology, and
Inequity in the Distribution of Disease. Jossey-Bass, San
Francisco.
Krieger, N., Williams, D., Moss, N., 1997. Measuring social class
in public health research: concepts, methodologies, and
guidelines. Annual Review of Public Health 18, 341–378.
Link, B., Phelan, J., 1995. Social conditions as fundamental
causes of disease. Journal of Health and Social Behaviour
(Special Issue), 80–94.
Lipfert, F., Morris, S., 2002. Temporal and spatial relations
between age specific mortality and ambient air quality in the
United States: regression results for counties, 1960–97.
Occupational and Environmental Medicine 59, 156–174.
Lloyd-Smith, M., Bell, L., 2003. Toxic disputes and the rise of
environmental justice in Australia. International Journal of
Occupational and Environmental Health 9 (1), 14–23.
Lovell, A., 2002. Risking risk: the influence of types of capital
and social networks on the injection practices of drug users.
Social Science and Medicine 55, 803–821.
Lynch, J., Kaplan, G., 2000. Socioeconomic position. In:
Berkman, L., Kawachi, I. (Eds.), Social Epidemiology.
Oxford University Press, New York.
Lynch, J., Davey Smith, G., Kaplan, G., House, J., 2003. Income
inequality and health. In: Hofrichter, R. (Ed.), Health and
Social Justice: Politics, Ideology and Inequity in the
Distribution of Disease. Jossey-Bass, San Francisco, pp.
217–227.
Maantay, J., 2002. Mapping environmental injustices: pitfalls and
potential of geographic information systems in assessing
environmental health and equity. Environmental Health
Perspectives Supplements 110 (2), 161–171.
Maantay, J., 2003. Zoning, equity and public health. In:
Hofrichter, R. (Ed.), Health and Social Justice: Politics,
Ideology, and Inequity in the Distribution of Disease. JosseyBass, San Francisco, pp. 228–250.
Macinko, J., Starfield, B., 2004. Annotated bibliography on
equity and health. International Journal for Equity in Health
1, 1–50.
McCleod, L., Jones, L., Stedman, A., Day, R., Lorenzi, I.,
Bateman, I., 2000. The relationship between socio-economic
indicators and air pollution in England and Wales: implications for environmental justice. Regional Environmental
Change 1 (2), 78–85.
McMaster, R., Leitner, H., Sheppard, E., 1997. GIS-based
environmental equity and risk assessment: methodological
problems and prospects. Cartography and Geographic
Information Systems 24, 172–189.
Mitchell, G., Dorling, D., 2003. An environmental justice
analysis of British air quality. Environment and Planning A
35, 909–929.
Morgenstern, H., 1995. Ecologic studies in epidemiology:
concepts, principles and methods. Annual Review of Public
Health 16, 61–81.
ARTICLE IN PRESS
M. Buzzelli / Health & Place 13 (2007) 3–13
Mustard, J., Frank, J., 1991. The Determinants of Health.
Canadian Institute for Advanced Research, Population
Health Program, Toronto.
Oakes, JM., Rossi, P., 2003. The measurement of SES in health
research: current practice and steps toward a new approach.
Social Science and Medicine 56, 769–784.
O’Neill, M., Jerrett, M., Kawachi, I., Levy, J., Cohen, A.,
Gouveia, N., Wilkinson, P., Fletcher, T., Cifuentes, L.,
Schwartz, J., 2003. Health, wealth, and air pollution:
advancing theory and methods. Environmental Health
Perspectives 111 (16), 1861–1870.
Ott, R., 1995. Human exposure assessment: the birth of a new
science. Journal of Exposure Analysis and Environmental
Epidemiology 5 (4), 449–472.
Poland, B., 2000. The ‘considerate’ smoker in public space: the
micro-politics and political economy of ‘doing the right
thing’. Health and Place 6, 1–14.
Poland, B., Coburn, D., Robertson, A., Eakin, J., 1998. Wealth,
equity and health care: a critique of a ‘‘population health’’
perspective on the determinants of health. Social Science and
Medicine 46 (7), 785–798.
Pope III, C., Burnett, R., Thun, M., Calle, E., Krewski, D., Ito,
K., Thurston, G., 2002. Lung cancer, cardiopulmonary
mortality, and long-term exposure to fine particulate air
pollution. Journal of the American Medical Association 287
(9), 1132–1141.
Pulido, L., 1996. A critical review of the methodology of
environmental racism research. Antipode 28 (2), 142–159.
Pulido, L., 2000. Rethinking environmental racism: white
privilege and urban development in southern California.
Annals of the Association of American Geographers 90 (1),
12–40.
Raphael, D., Bryant, T., 2003. The limitations of population
health as a model for a new public health. In: Hockman, E.
13
(Ed.), Health and Social Justice: Politics, Ideology, and
Inequity in the Distribution of Disease. Jossey-Bass, San
Francisco, pp. 410–427.
Schwartz, J., Zanobetti, A., 2000. Using meta-smoothing to
estimate dose–response trends across multiple studies, with
application to air pollution and daily death. Epidemiology 11,
666–672.
Sheppard, E., Leitner, H., McMaster, R., Tian, H., 1999. GISbased measures of environmental equity: exploring their
sensitivity and significance. Journal of Exposure Analysis
and Environmental Epidemiology 9 (1), 18–28.
United Church of Christ, Commission for Racial Justice, 1987.
Toxic Wastes and Race in the United States. United Church
of Christ, Commission for Racial Justice, New York.
Vedal, S., 1997. Ambient particles and health: lines that divide.
Journal of the Air and Waste Management Association 47 (5),
551–581.
Wagstaff, A., van Doorslaer, E., 2004. Income inequality and
health: what does the literature tell us? Annual Review of
Public Health 21, 543–567.
Wakefield, J., 2001. A critique of ecological studies. Biostatistics
1, 1–18.
Weed, D., McKeown, R., 2003. Science and social responsibility
in public health. Environmental Health Perspectives 111 (14),
1804–1808.
Wilkinson, R., 1996. Unhealthy Societies: The Afflictions of
Inequality. Routledge, London.
Williams, S., 1995. Theorizing class, health and lifestyles: can
Bourdieu help us? Sociology of Health and Illness 17,
577–604.
Zidek, J., Bates, D., 2002. Statistical issues and causality. In:
Bates, D., Caton, R. (Eds.), A Citizen’s Guide to Air
Pollution, second ed. David Suzuki Foundation, Vancouver,
pp. 153–176.