The Social Determinants of Death from COVID-19
“Who Knew How Bad Things Were, and Who Was Looking Elsewhere?”
An interview with Dr. Adonia Lugo
On January 14, Angelenos got the startling news that jet fuel had fallen over part of the region, raining down on school children at recess and neighborhood backyards in Southeast Los Angeles County. “This could have sounded like something out of a Hollywood sci-fi blockbuster,” says Dr. Adonia Lugo, but she says that it’s better to understand this event as “an especially harmful but otherwise mundane incident in an area regularly burdened with toxic air. [Residents] live under flight paths leading to and from one of the world’s busiest airports, meaning they have more exposure to particulate pollution on a daily basis than wealthier residents in the region.” Lugo’s work centers around the field of environmental justice, and it has led her to understand events like this not as unforeseeable tragedies but as the result of choices made by politicians, planners, and developers.
Today, Lugo is warning that the fallout of the latest crisis—the COVID-19 pandemic—is once again disproportionately impacting vulnerable communities across the United States. As scientists scramble to build their collective knowledge across all aspects of the novel coronavirus, they are finding that previous, long-term exposure to air pollution makes individuals more vulnerable to death in the pandemic.
Unfortunately, in the U.S. “there is a long history of polluting facilities being sited in neighborhoods where people don’t have as much political power: immigrant neighborhoods, black neighborhoods, low-income neighborhoods.”
This can be seen in Los Angeles, where, to look at one example, the 10 Freeway was built in such a route that it bisected a thriving black neighborhood called Sugar Hill. Not only did the bulldozers destroy many homes, says Lugo, but the project has left a legacy of respiratory issues.
“The problem with those decisions that were made about freeways decades and decades ago is that, once the freeways started getting used, they created these pollution corridors, where we know that people who live within a certain distance of freeways are more exposed to particulate pollution…That has big impacts on public health, in terms of having high rates of asthma or other respiratory illnesses.”
When combined with a respiratory pandemic, the result of these decisions about where to locate freeways and factories can have deadly consequences. As Lugo explains, “It’s very sad that COVID-19, which has been touted as something that doesn’t care about what class you are in terms of infection, actually is going to be hitting these communities that have had long-term exposure to air pollution harder.”
One thing getting in the way of protecting these communities is a failure of visibility. Lugo asks, “Who knew how bad things were for struggling communities before COVID-19, and who was looking elsewhere?” It can be easy for those with power—politicians, urban planners, and developers—to overlook health impacts on minority and poor communities because the residents of those communities often lack the resources to fight proposed development.
“If somebody’s working two jobs and taking care of their kids, when are they going to have time to go to a city council meeting? When are they going to have the opportunity to go and share their views with that elected official?” This influences decisions in ways small and large, says Lugo. “It’s the reality that when cities are making decisions about where things are going, if they know that there’s not going to be as much complaining from a certain population, then maybe it’s easier to put that thing that people with wealth don’t want to have in their backyard. It’s easier to site it in a place where people don’t have the time and the infrastructure to be participating in our democratic system as much.”
So what can be done now to address these social determinants of health? While we can’t rapidly undo the legacy of decades of environmental harm, we can try to make sure that governmental responses to COVID-19 and, on a broader time scale, to climate change, are undertaken with a strong concern for society’s most vulnerable. This starts with paying attention to and understanding this history.
The students in the program Lugo chairs, the Master of Arts in Urban Sustainability at Antioch University Los Angeles, are currently discussing how “the kind of strain that the economic shutdown puts on vulnerable communities is part and parcel of environmental inequities that will continue to be exacerbated by climate change.”
One of her former students, Shayla Davis, says that her studies in the program have led her to work to make it “common knowledge that any time a crisis occurs, the most vulnerable populations will be impacted the most.” Davis points out that “nursing homes, jails, and prisons are hotbeds for the virus,” and she is taking action to try to raise awareness about vulnerable populations. “I interviewed someone last week who is currently incarcerated and the issues he’s facing in the penal system are atrocious.”
This kind of informed activism is exactly what Lugo is trying to foster. She says that “these inequities and the harm they represent are precisely why more and more social movements are calling for a ‘just transition,’ shutting down the extractive economy as we build a regenerative one.” As Lugo explains, “When we say ‘sustainable,’ we don’t mean keeping today’s system going; we mean converting those systems and building new ones that actually meet society’s needs, in particular the needs of those who have been most burdened with environmental harms.”
For people looking to understand these issues more deeply, Lugo recommends they watch the PBS series RACE: The Power of an Illusion, which is “a particularly good series for articulating the origins of race as a now-debunked scientific concept and the lingering effects that that’s had, and then specifically looking at different areas such as housing, and how the fallacy of race created what we call the racialized wealth gap… It helps to make the connection between race and the built environment and land use.”
She also recommends the series Unnatural Causes: Is Inequality Making Us Sick?, which is “all about the social determinants of health and public health approaches trying both to document how social inequality produces different outcomes in term of life expectancy and what sorts of chronic illness people are suffering from, and also what to do about that.”
And for people looking to funnel their energy on a political level, there is “volunteering people can do in their neighborhoods, joining mutual aid networks, helping neighbors, donating blood.” But there are also ways of making change at a policy level. Lugo recommends “supporting the policy recommendations that are coming from places like the Movement for Black Lives,” which has a deeply considered response to COVID-19. She also says that “finding a local coalition that is pushing for certain kinds of policy action is a really good way to be useful.” In Los Angeles, the group Healthy LA is doing this kind of work, making “the connection between what’s happening and what was already happening in terms of our urban inequality and how it’s shaped the particular landscape that COVID-19 is coming into.”
Cultural anthropologist Adonia E. Lugo, PhD, is the chair of the MA in Urban Sustainability Program at Antioch University Los Angeles. Her research looks for ways to bring her racial justice expertise from the field of bicycle advocacy into equitable and sustainable mobility at large. She is currently collaborating with partners around the country to define “mobility justice,” a concept that highlights the complex difficulties that people of color and other marginalized groups face both when traveling through public spaces and in urban planning and development processes. She is an advisory board co-chair with People for Mobility Justice, a core organizer of The Untokening, and the manager of the Bike Equity Network email list. Her book, Bicycle/Race: Transportation, Culture, & Resistance, was published in 2018.