The paper puts forth the concept that racism, and its manifestation in racial discrimination, is a possible cause of disparities in health outcomes.

The paper puts forth the concept that racism, and its manifestation in racial discrimination, is a possible cause of disparities in health outcomes. Give an example of how this can be so. 

2. Explain how racial residential segregation may be linked to environmental exposures and poor outcomes. 

3. Explain how techniques of risk assessment fail to incorporate factors relevant to environmental justice and structural racism. 

4. Can the impacts of structural racism be adequately studied by environmental scientists alone, or are other inputs necessary? 

Commentary A Section 508-conformant HTML version of this article is available at https://doi.org/10.1289/EHP8186 Confronting Racism in Environmental Health Sciences: Moving the Science Forward for Eliminating Racial Inequities Devon C. Payne-Sturges,’ Gilbert C. Gee, and Deborah A. Cory-Slechta’ nd Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA 2Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA University of Rochester School of Medicine, Rochester, New York, USA BACKGROUND: The twin pandemics of COVID-19 and systemic racism during 2020 have forced a conversation across many segments of our society, including the environmental health sciences (EHS) research community. We have seen the proliferation of statements of solidarity with the Black Lives Matter movement and commitments to fight racism and health inequities from academia, nonprofit organizations, governmental agencies, and private corporations. Actions must now arise from these promises. As public health and EHS scientists, we must examine the systems that produce and perpetuate inequities in exposure to environmental pollutants and associated h OBJECTIVES: We outline five recommendations the EHS research community can implement to confront racism and move our science forward for eliminating racial inequities in environmental health. DISCUSSION: Race is best considered a political label that promotes inequality. Thus, we should be wary of equating race with biology. Further, EHS researchers should seriously consider racism as a plausible explanation of racial disparities in health and consider structural racism as a factor in envi- ronmental health risk/impact assessments, as well as multiple explanations for racial differences in environmental exposures and health outcomes. Last, the EHS research community should develop metrics to measure racism and a set of guidelines on the use and interpretation of race and ethnic- ity within the environmental sciences. Numerous guidelines exist in other disciplines that can serve as models. By taking action on each of these rec- ommendations, we can make significant progress toward eliminating racial disparities. https://doi.org/10.1289/EHP8186 Introduction institutions and scholarship have not avoided racism’s influence. Statements of solidarity with the Black Lives Matter movement Further, EHS research has often ignored or excluded indigenous or and against anti-Asian hate and commitments to fight racism and traditional ecological knowledge that emphasizes interconnectiv- health inequities have proliferated since the summer of 2020. ity between physical cultural and spiritual roles and responsibilities These statements and commitments have included calls from aca- within a system (Arquette et al. 2002; Daniel 2019; Kelly 2020). demia, nonprofit organizations, governmental agencies, and pri- What, then, is required of EHS so that this moment is not wasted vate corporations. We have been forced to reckon with the twin and supports the social justice movement? As an initial step, we pandemics of COVID-19 and systemic racism. The environmental offer five recommendations for strengthening the science of racism health sciences (EHS) community has joined this movement by and developing guidelines on the meaning and use of race and eth- pledging to enhance diversity within its ranks (Mccarthy 2020). nicity in environmental health research. launching new initiatives on environmental health equity, and atoning for its own racist history and past relationship with the Recommendation #1. Recognize That Race is a Sociall eugenics movement (Brune 2020). Significantly, these changes are Political Construct, Not a Fixed Biological Trait. Investigate voiced not only by individuals, but also by professional societies All Potential Causes of Racial Disparities in Environmental Casey et al. 2020) and governmental agencies (Lenox 2020). Health instead of Assuming They Are Due to Intrinsic Of course, actions must arise from these promises. As public health and environmental health scientists, we must contribute by Biological Differences taking a longer, harder look at environmental r m -the systems Race is often conceptualized as a fixed biological characteristic in that produce and perpetuate inequities in exposure to environment research, but changes in racial classifications over time clearly tal pollutants and associated health effects. The disciplines that demonstrate that race is a social construct that reflects political exi- contribute to EHS-including epidemiology, biostatistics, expo- gencies, not biological differences. For example, Asians and sure science, and toxicology-were developed in the context of Pacific Islanders were historically construed as one race. However, racist laws, practices, and policies. Indeed, Francis Galton, the after 1997, Pacific Islanders lobbied to become classified as a dis- ounder of the concepts of statistical correlation, also coined the tinct race, a practice that was codified in Directive 15 (Office of phrase eugenics and advocated for avoiding racial admixture Management and Budget 1997), which mandates how federal Markel 2018). Let us at least accept this fundamental truth: EHS agencies collect data on race and ethnicity. These categories con- tinue to evolve. For example, ongoing debates (Robbin 2000; Khoshneviss 2019) consider whether people from the Middle East Address correspondence to Devon C. Payne-Sturges, Maryland Institute for should be considered a separate race (they are currently classified Applied Environmental Health, University of Maryland School of Public as White). Moreover, Directive 15 considers people from Spanish- Health, 2234 L SPH, 255 Valley Dr., College Park, MD 20742 USA. Telephone: (301) 405-2025. Email: dps [email protected] speaking countries to be an ethnic group rather than a racial group. The authors declare they have no actual or potential competing financial Yet, this practice confounds many who consider LatinX peoples to interests. be a race and fail to see the distinction between race and ethnicity. Received 28 August 2020; Revised 2 April 2021; Accepted 16 April 2021; For this reason, many have also argued that LatinX persons should ublished 4 May 2021. be a racial group (Allen et al. 2011; Telles 2018). Note to readers with disabilities: EHP strives to ensure that all journal These racial labels are not merely about identity, but reflect and content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to reinforce structural inequalities (Roberts 2012). For example, in the complexity of the information being presented. If you need assistance United States v. Bhagat Singh Thind (1923), the Supreme Court in rnal content, please contact [email protected]. Our staff 1923 intervened to classify people from the country of India as will work with you to assess and meet your accessibility needs within 3 Asian even though they were considered to be Caucasian by many working days. anthropologists at that time. The reason for this reclassification Environmental Health Perspectives 055002-1 129(5) May 2021

was discriminatory because federal policies during that period Meanwhile, as well documented in records made public from is differential treatment based on race. This is how people often In order to address these questions, we will also need to con- allowed Caucasians, but not Asians, to seek naturalized citizenship numerous lawsuits, tobacco companies have targeted Black com- think of discrimination, that is, that racial minorities are treated sider how best to build interdisciplinary research teams and to (NRC 2001). As another example, in 1970, Louisiana passed a stat- munities with mint-flavored menthol cigarettes for decades poorly due to explicit racial animus. However, the second way of integrate methods and theories from systems and social sciences ute defining someone who is Black as having 1/32 Black ancestry, (Kaplan 2021). Mentholated cigarettes have been shown to have thinking of discrimination is based on the concept of disparate with EHS and corresponding training programs. The point is not which means that someone who is 97% White should be classified greater addictive potential than their nonmentholated counter- impact, which is treatment on the basis of inadequately justified to throw away the conventional research questions (e.g., what is as Black (Marcus 1983). Assuming that any differences between parts, possibly influencing the metabolism of nicotine (Wickham actors other than race that harms a racial group. In other words, a the exposure-disease response relationship on average?), but to Black and White individuals are genetic in this context is clearly 2020). The banning of menthol cigarettes has long been an elu- practice can be discriminatory if it creates a racial disparity and if investigate new ones too, especially if we are concerned about absurd. The law was originally passed in the 1700s to "keep the sive goal for public health regulators (Kaplan 2021). The tobacco the practice does not have any compelling reason to exist. No disproportionate impacts and environmental health inequities. [White] landowner from having to share his land with his illegitim industry has successfully delayed FDA action on menthol prod- explicit racial animus is necessary in the second definition. This mate children" who were conceived from rape or extramarital ucts (Delnevo et al. 2020). Thus, the difference between Black idea was the basis for Griggs v. Duke Power Co. (1971), a suit lev- Recommendation #3. Develop New Measures of Racism affairs with his Black slaves (Marcus 1983). The 1970 Louisiana and White smokers appears to be due to the types of cigarettes ied against an employer who required employees to take aptitude law establishing the race formula was repealed in 1983 (Marcus marketed to Black communities rather than an intrinsic difference tests. On the surface, such tests appeared race neutral because they Within EHS research, discrimination has been operationalized in 1983). These examples illustrate how race is a social construct that in metabolism. were required of both Black and White employees. However, these two main ways. First, discrimination has been inferred when undamentally reflects wealth, power, and privilege. For these rea- Accordingly, the most dangerous interpretation of race is that tests had two qualities that made them discriminatory under the racial disparity remains after accounting for compelling covari- sons, commentators in other disciplines have argued against con- of biological differences because such interpretations have been idea of disparate impact. The tests a) disadvantaged Black employ- ates (e.g., socioeconomic conditions, land use ordinances, zoning ceptualizing race as a biological construct, for example: the basis for eugenics and harmful research (Braun 2006; Phelan ees owing to their lower educational levels and, just as importantly, policies). The assumption that the residual disparity represents . "The use of biological concepts of race in human genetic et al. 2013; Byrd and Ray 2015). Investigators should consider b) had no bearing on the job duties. Thus, the Supreme Court ruled the effects of racism relies on the assumption that key confound- research … is problematic at best and harmful at worst" multiple explanations simultaneously and do their best to rule out that the tests were discriminatory against Black workers. ers have been accounted for and that racism is the true driver of (Yudell et al. 2016). competing explanations. Importantly, we are not arguing that Rigorous science requires that we seriously consider racism the disparity (Bullard 1993). Second, racial residential segrega- "Attributing differences in biologic endpoints to race is not researchers should stop evaluating differences in exposures and and discrimination as plausible explanations for racial/ethnic tion, which represents the cumulative impact of historic and con only imprecise, but also of no proven value in treating an outcomes according to race. Rather, we should first document inequities in environmental exposures and racial/ethnic differences temporary racist practices that spatially separate races, is used as individual patient" (Schwartz 2001). whether racial differences exist and then investigate specific fac- in the impacts of such exposures (Mohai and Bryant 1992; a measure of discrimination. Practices that contribute to residen We would not expect other social labels, such as political party tors that might cause such differences. In short, researchers Morello-Frosch et al. 2002; Morello-Frosch 2002; Gee and Payne- tial segregation range from outright racial hostility (e.g., lynch- affiliation, to represent an underlying biological trait. For example, should define, measure, and investigate race as rigorously as they Sturges 2004). Such consideration includes studying how racism ings) to more subtle practices, such as redlining by banks of if we found that Republicans and Democrats differed in risk for would any other exposure or outcome and acknowledge its limi- . Accounts for the disproportionately higher rates of exposure steering by real estate agents. Segregation has been linked to a hypertension, we would not assume that these disparities resulted tations as a proxy measure of the underlying construct or mecha- among racial/ethnic minorities (Clark et al. 2017; Ash and variety of environmental exposures and poor outcomes (Morello- from differences in some cluster of alleles. Rather, we would inves- nism(s) it is meant to represent (Nelson et al. 2018). Boyce 2018; Mikati et al. 2018; Tessum et al. 2019) Frosch and Jesdale 2006; Mehra et al. 2017). tigate environmental and social mechanisms, such as environment Leads to preexisting health conditions (e.g., asthma) that However, we need to think beyond these metrics. Research in tal exposures, social class, culture, stress, health care access, and so Recommendation #2. Seriously Consider Racism as a render people more susceptible to environmental exposures other disciplines has documented racial inequities in police shoot forth. Yet, health differences across races are often assumed to be Plausible Explanation of Racial Disparities in Health (e.g., air pollution) (Guarnieri and Balmes 2014) ings, mass incarceration, educational tracking, media portrayals due to underlying biological differences. The U.S. Food and Drug Amplifies the effects of environmental exposures [e.g., effect citation practices, hospital case-management algorithms, emer- Advances in EHS have revolved around the deployment of obser Administration (FDA) approved the antihypertensive drug Bidil modification between stress and lead poisoning on high gency department waiting times, National Institutes of Health fund- for Black patients, and no other races, based on an underlying vational, experimental, computational, and clinical approaches to blood pressure, effect modification by socioeconomic status ing, and innumerable other segments of life (Krieger 1999; Gee and assumption that biological differences exist between Blacks and more fully uncover the biological mechanisms hypothesized by the environmental public health paradigm (Sexton et al. 1992; U.S. (SES) of lead effects on intelligence quotient] (Bellinger et al. Ford 201 1; Ginther et al. 201 1; Bailey et al. 2017). In addition, some Whites (Temple and Stockbridge 2007; Johnson 2019). It was EPA 2021). But as EHS researchers aim to discover and explain 1988; Hicken et al. 2013) measures have been developed to focus on personal experiences of believed that Blacks did not benefit as much as Whites from angio- how factors-including chemical, physical, synthetic, and infec- Impairs one’s ability to obtain effective medical care discrimination (Williams et al. 1997; Krieger et al. 2005; Landrine tensin converting enzyme (ACE) inhibitors and that alternative tious agents, as well as social stressors-affect biological systems, (Gonzales et al. 2014; Kugelmass 2016) et al. 2006). This suggests that many aspects of environmental rac- drugs were needed to provide better care. The role of genetics in it is not enough to just describe social disparities in exposures and Creates spillover effects that impair the well-being not sim- ism are yet to be documented, conceptualized, and measured. explaining the difference remains an untested hypothesis. health outcomes. We need to also investigate social mechanisms ply of an individual but of their families and communities As the example of the lead poisoning crisis in Flint, Michigan, Hypertension, one of the major risk factors for congestive heart (Pellow 2000; Powell 2008) as plausible explanations of environ- (e.g., when racism puts Black fathers in prison) (Priest et al. showed us, there are numerous points along the continuum where failure, is more common within the Black community (CDC mental exposures and illnesses. A social mechanism that is particu- 2013; Lee et al. 2015; Williams et al. 2019) inequality occurs, ranging from governmental policies, to the 2010), and chronic social stress has been implicated as a possible manipulation of data, to remediation and restoration (Michigan larly relevant for the study of race disparities is racism and racial Impedes the ability to conduct rigorous scientific research contributor to the development of hypertension (Brody and Hunt discrimination (Gee and Payne-Sturges 2004). e.g., when researchers stereotype participants, when mistrust Civil Rights Commission 2017). Racism occurs partly due to 2006). Diet, exercise, and other environmental variables are also In the United States, racism is the social system that provides the rooted in the Tuskegee Study diminishes participation in explicit racial animus, but it also manifests as willful neglect and possible mediators (Brody and Hunt 2006). Later research sug- basis of allocating power and privilege to Whites and disadvantages research) (Corbie-Smith et al. 2002; Ford and Airhihenbuwa purposeful prioritization of advantaged communities. Although it gested that the differential effect of ACE inhibitors by race was 2010) has been recognized that the Flint crisis was due to structural rac to racial/ethnic minorities (Jones 2000; Williams et al. 2019). mostly due to higher sodium intake (Flack et al. 2000). Racism fundamentally alters one’s circumstances across the life Affects the reporting, interpretation, publication, and funding ism (Michigan Civil Rights Commission 2017; Hammer 2019), Assumptions about biological differences in drug effectiveness course, such as where one lives and their educational and occupa- of racial disparities research (Tyer 2005; Ginther et al. 2011; there are yet no good metrics for detecting such discrimination. and metabolism are embedded, sometimes insidiously, within tional opportunities (Gee and Ford 2011; Gee et al. 2019). Racism Kubota 2020). Therefore, we call upon researchers to develop new measures of medical practice (Vyas et al. 2020) and have also appeared in toxi- can confer stress, restrict opportunities, and contribute to adverse Thus, as EHS researchers, we need to start asking different ques- racism and racial inequities that may be particularly relevant to cological research relevant to EHS. For example, higher levels of exposures (Morello-Frosch 2002; Lewis et al. 2015). Racism has tions (Payne-Sturges 201 1) that can address the complex interactions EHS. This may necessitate working in transdisciplinary teams that cotinine have previously been reported for Black smokers even occurred throughout history but, importantly, persists today (Ford between conditions, policies, and social, natural, and built environ- include scholars from fields such as sociology, history, and ethnic though they report smoking fewer cigarettes compared with White and Airhihenbu Dyke 2018). Because rac- mental systems that result in unequal environmental health conditions studies. This requires working with members of racial minority smokers (Caraballo et al. 1998). Further, although Blacks usually ism is such a powerful driver of social circumstances, it has been or disproportionate impacts among (diverse) disadvantaged popula- communities, who often are able to see the manifestations of racial smoke fewer cigarettes and start smoking cigarettes at an older age, considered a fundamental cause of illness by numerous scientific tion groups, communities, neighborhoods, and individuals. For bias long before the ideas diffuse into the academic literature (Israel they are more likely to die from smoking-related diseases than bodies including the Institute of Medicine (Institute of Medicine example, how does environmental in equality arise and why does it et al. 2005, 2010). These measures then need to be incorporated into Whites (CDC 2020). Many investigators hypothesize that racial Committee on Understanding and Eliminating Racial and Ethnic persist? What is the role of institutionalized racism and the economics surveys such as the National Health and Nutrition Examination differences in the metabolism of tobacco toxins may explain differ- Disparities in Health Care 2003), the American Medical Association of industrial development and production (i.e., industrial location, Survey or must permit linkages with such surveys and other data ences in tobacco-related morbidity and mortality (Benowitz et al. (AMA 2020), and the American Public Health Association racialized division of labor, suburbanization, and economic restruc sets so that race and racism can be rigorously studied. 1999; Hukkanen et al. 2005). However, in a recent study aimed at (Benjamin 2020). As several meta-analyses have shown, when indi- turing)? Given the important role of toxicology in EHS, how can ani- evaluating the hypothesis that melanin (skin pigment) affects nico- viduals experience racial discrimination, they are more likely to mal models be reformulated to be more directly relevant to the Recommendation #4. Consider Structural Racism as a ine disposition kinetics in humans, researchers concluded there have a variety of health problems (Pascoe and Smart Richman 2009; environmental context of human chemical exposures? Ultimately, Factor in Environmental Health Risk/Impact Assessment was no evidence of correlations between melanin and the pharma- Paradies et al. 2015). what new strategies can be developed for alleviating systemic drivers Risk assessment plays an important role in EHS because it shapes cokinetic parameters of nicotine or cotinine or tobacco dependence Racial discrimination, the behavioral manifestation of racism, of racial and socioeconomic disparities in environmentally mediated environmental health policy decisions at local and national levels. measures among a group of Black smokers (Liakoni et al. 2019). has been defined as having two components (NRC 2004). The first health outcomes and access to healthy environments? Although the majority of EHS researchers are not directly Environmental Health Perspectives 055002-2 129(5) May 2021 Environmental Health Perspectives 055002-3 129(5) May 2021

involved in risk assessment, their work (including basic research exposures, it is imperative to develop animal models of social . Race, Ethnicity, and Language Data: Standardization for releases/new-ama-policy-recognizes-racism-public-health-threat [accessed on chemical properties; estimating fate, transport models, and disparity and acknowledge the potential for cumulative effects. Health Care Quality Improvement (Institute of Medicine 14 April 2021]. pollutant exposure models; toxicity testing on animal models; Further, the risk assessment framework, which is predicated Subcommittee on Standardized Collection of Race/Ethnicity APA Task Force on Race and Ethnicity Guidelines in Psychology. 2019. APA and epidemiologic studies of human populations) feeds directly on the environmental public health paradigm, does not examine Data for Healthcare Quality Improvement 2009) Guidelines on Race and Ethnicity in Psychology: Promoting Responsiveness ity. Washington, DC: American Psychological Association. https:/ into risk assessment. However, unfortunately, evidence shows the upstream economic and social forces that create disparities in "The impact of racism on child and adolescent health" www.apa.org/about/policy/guidelines-race-ethnicity.pdf [accessed 24 April that the system of environmental health protection based on risk exposure to environmental chemicals in the first place and con- (Trent et al. 2019) 2021]. assessment does not work well for the people who need it the tribute to enhanced toxicity. Because of this, environmental poli- "On racism: a new standard for publishing on racial health Arquette M, Cole M, Cook K, LaFrance B, Peters M, Ransom J, et al. 2002. Holistic most (Israel 1994). cies are likely based on underestimations of true health risks. inequities" (Boyd et al. 2020) risk-based environmental decision making: a Native perspective. Environ Since the mid-1970s, quantitative risk asses a method Moreover, the interpretation of risk varies considerably by de- Environmental health scientists should follow suit and de- Health Perspectivetps://doi.org/10.1289 to identify and measure the risk that a particular environmental mographic group. Many studies have documented a "White male elop our own set of guidelines in collaboration with community ehp.02110s2259. Ash M, Boyce JK. 2018. Racial disparities in pollution exposure and employment at contaminant presents at a given exposure level-has been critical effect" whereby White men are more likely to downplay risks members, policy makers, social scientists, and representatives US industrial facilities. Proc Nati Acad Sci U S A 115(42):10636-10641, PMID: to many federal environmental regulatory and policy decisions. associated with a variety of hazards (e.g., air pollution, climate from all of the other disciplines that contribute to EHS research. 30275295, https://doi.org/10.1073/pnas.1721640115. Risk assessment consisting of a four-step process (hazard identifi- change, cigarette smoking) compared with women and people of Professional societies, including the Society of Toxicology, the Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, Bassett MT. 2017. Structural cation, dose-response assessment, exposure assessment, and risk color (Finucane et al. 2000; Marshall et al. 2006; Sansani 2018). International Society for Environmental Epidemiology (ISEE), racism and health inequities in the USA: evidence and interventions. Lancet characterization) is a reductionist approach used mainly to assess Therefore, if White men dominate decision making about risks and the International Society of Exposure Science could also fur- 389(10077):1453-1463, PMID: 28402827, https://doi.org/10.1016/S0140-6736(17) and regulate individual chemicals. Risk assessment has guided that disproportionately affect people of color (Marshall 2006), ther this effort. For example, ISEE recently established an anti- 30569-X. Bellinger D, Leviton A, Waternaux C, Needleman H, Rabinowitz M. 1988. Low-level the development of ostensibly race-neutral environmental poli- risk assessment can help reinforce structural racism, exacerbate racism task force whose goals include promoting consideration lead exposure, social class, and infant development. Neurotoxicol Teratol cies. The limitations of chemical-by-chemical risk assessment to racial inequalities, and perpetuate race-related differences in envi- of structural racism as a mechanism for inequities in environment 10(6):497-503, PMID: 3244341, https://doi.org/10.1016/0892-0362(88)90084-0. address real-world exposures have been acknowledged but sel- ronmental exposures and their effects. In this way, risk assess- tal health and encouraging more rigorous use and interpretation Benjamin G. 2020. Racism is an ongoing public health crisis that needs our at dom taken seriously (Israel 1994). Risk assessment typically ment can serve as a tool of White supremacy, which is, at its of race in environmental health research (D. Payne-Sturges and now. Statement from APHA Executive Director. 29 May 2020. ctor. 29 May 2020. https://www.apha. omits multiple chemical exposures, cumulative and synergistic most fundamental level, about the exercise of power to privilege M. Hicken, personal communication). Such guidelines would call org/News-and-Media/News-Releases/APHA-News-Releases/2020/Racism-is-a effects, and consequences of co-occurring nonchemical stressors Whites and disenfranchise racial minorities (Jones 2000; Bailey upon the researchers to public-health-crisis [accessed 14 April 2021]. and their potential downstream convergence that can lead to the et al. 2017; Gee et al. 2019; Walsdorf et al. 2020). With these . Provide the scientific rationale for examining race as an ex- Benowitz NL, Perez-Stable EJ, Fong I, Modin G, Herrera B, Jacob P III. 1999. Ethnic differences in N-glucuronidation of nicotine and cotinine. J Pharmacol Exp enhancement of biological effects. limitations taken together, it comes as no surprise that we con- posure, confounder, or modifier Ther 291(3):1196-1203, PMID: 10565842. Yet the human environment includes multiple risk factors in tinue to have race-based differences in environmental exposures . Describe how race was measured and operationalized okor-Billmann T, Langan EA, Billmann F. 2020. The reporting of race and/or ethnic- addition to a multiplicity of chemicals acting concurrently or and health effects. . Integrate the role of racism and its various components (e.g., ity in the medical literature: a retrospective bibliometric analysis confirmed sequentially. This fact has direct relevance to both epidemiologic The EHS field needs to devise new ways to assess the cumu- discrimination, prejudice) into research, and in doing so, to room for improvement. J Clin Epidemiol 11 J Clin Epidemiol 119:1-6, PMID: 31715264, https://doi.org/ cal and basic science studies, where the focus is predominantly lative health toll/burden of pollution by focusing on structural consider how racism operates at multiple levels (Bailey et al. 10.1016/j.jclinepi.2019.1 1.005. 2017; Williams et al. 2019) and across the life course (Gee Boyd RW, Lindo EG, Weeks LD, Mclemore MR. 2020. On racism: a new standard on single chemical exposures and usually at the mean or median causes (racialized policies, practices, and decisions) of dispar- for publishing on racial health inequities. Health Affairs Blog. 2 July 2020. level. Given that chemical exposures and other environmental ities, incorporating concerns of impacted communities, and pro- et al. 2012, 2019). https://doi.org/10.1377/hblog20200630.939347/full/ [accessed 24 April 2021]. risk factors can operate on the same biological substrates, they moting policies that not only address these structural causes but Braun L. 2006. Reifying human difference: the debate on genetics, race, and health. open the door for multiple interactive effects with the potential to also move society toward a more regenerative environment, espe- Summary Int J Health Serv 36(3):557-573, PMID: 16981631, https://doi.org/10.2190/8JAF- modify the toxicity of chemicals. cially among communities that are already overburdened D8ED-8WPD-J9WH. As environmental health researchers, we are accustomed to mak- Brody H, Hunt LM. 2006. BiDil: assessing a race-based pharmaceutical. Ann Fam Currently, risk assessments conducted by the U.S. Environmental (O’Brien 2000; Cousins et al. 2019; Sengupta 2020). Health Protection Agency generally limit consideration of susceptible Impact Assessment (Yuen and Payne-Sturges 2013) and system ing the invisible visible, be it the health impacts of tiny particles or Med 4(6):556-560, PMID: 17148635, https://doi.org/10.1370/afm.582. epigenetic changes from exposures to chemicals. If we are serious Brune M. 2020. Pulling do ments. Executive Director’s Blog. 22 July D. Pulling down our monuments. Execu populations to the elderly, children, pregnant women, and perhaps dynamics (Homer and Hirsch 2006; Hovmand 2014) are promis- 2020. https://www.sierraclub.org/michael-brune/2020/07/john-muir-early people with comorbidities, without considering the broader social- ing approaches for overcoming key limitations of risk assessment about ending environmental racism, we must also direct our atten- tion to making more visible the social mechanisms and systems sierra-club?utm_source=sierraclub&utm_medium=email&utm_content=history environmental context. Epidemiologic studies ignore interactions in this regard. These approaches facilitate the explicit considera- between chemical and nonchemical exposures 1994) or suffer tion of systems and their structures that create health inequities that create racialized disparities in environmental health and how [accessed 11 August 2020]. Bullard RD, ed. 1993. Confronting Environmental Racism: Voices from the Grassroots. Boston, MA: South End Press. rom an absence of methods allowing such assessments when sample and the integration of quantitative and qualitative evidence from they influence the toxicity of chemical exposures. This means sizes are modest. Animal models th across multiple disciplines and sources of knowledge to inform looking farther upstream and asking different research questions Byrd WC, Ray VE. 2015. Ultimate attribution in the genetic era: White support for nificantly removed from human relevance in their assessment of the development of more equitable public health policies. related to disproportionate environmental health impacts of prac- genetic explanations of racial difference and policies. Ann Am Acad Polit Soc Sci 661(1):212-235, https://doi.org/10.1177/0002716215587887. impacts of single chemical exposure effects in of any tices such as redlining, predatory lending, and the siting of pollut- such human relevant contexts; although stress is sometimes exam- ing industries, as well as so-called race-neutral policies and lax Caraballo RS, Giovino GA, Pechacek TF, Mowery PD, Richter PA, Strauss WJ, et al. 1998. Racial and ethnic differences in serum cotinine levels of cigarette smok ined, the relevance of stress paradigms typically u Recommendation #5. Develop Guidelines on the Use of Race environmental enforcement. We should also work to increase col- ers: Third National Health and Nutrition Examination Survey, 1988-1991. JAMA els (e.g., restraint stress, forced swim, social isolation) needs serious and Ethnicity within EHS laboration with social scientists, be explicit about our reasons for 280(2):135-139, PMID: 9669785, https://doi.org/10.1001/jama.280.2.135. reconfiguration so as to relate to the types and magnitude of stressors using race in research, measure and classify race in a precise and asey JA, Kioumourtzoglou MA, Nieuwenhuijsen MJ. 2020. ISEE statement on The previous recommendations were about furthering the devel- rigorous way, and increase community-based participatory anti-black violence and racism. https://www.iseepi.org/common/Uploaded associated with poverty, including lower income, SES, neighborhood opment of the science of racism within the EHS context; this rec- 20files/2020%20Website %20Edits/ISEE%20Statement.pdf [accessed 3 August poverty, and social and neighborhood resource deprivation, factors ommendation focuses on the use of race and ethnicity within research. Our recommendations are not meant to be exhaustive EHS research. Unfortunately, race is notoriously poorly meas- but, rather, a starting point for future discussion and research. 20. that are above and beyond those experienced in higher economic CDC (Centers for Disease Control and Prevention). 2010. A Closer Look at African ured. One study of 995 medical articles found that race was American Men and High Blood Pressure Control: a Review of Psychosocial strata (Evans and Kim 2013; Perry et al. 2019). Similarly, epidemio- logic studies need to query stress exposures relevant to the context of defined in only 4.5% of the studies and the method for racial clas- Acknowledgments Factors and Systems-Level Interventions. https://www.cdc.gov/bloodpressure the populations being studied. sification mentioned in only 10.3% (Bokor-Billmann et al. 2020). All authors read and approved the final manuscript. D.C.P.-S. docs/African_American_Sourcebook.pdf [accessed 24 April 2021]. CDC. 2020. African Americans and tobacco use. https://www.cdc.gov/tobacco/ More relevant paradigms might be considered for both animal We would not accept such lax reporting for any environmental was supported by the National Institutes of Health/National disparities/african-americans/index.htm [accessed 29 March 2021]. models and human epidemiologic studies. One possible avenue exposure, nor should we accept it when researching disparities. Institute of Environmental Health Sciences (award no. Clark LP, Millet DB, Marshall JD. 2017. Changes in transportation-related air pollu- would be through stress paradigms contextually related to We should demand rigor in the study of race and ethnicity. Many KOIES028266). The content of this article is solely the tion exposures by race-ethnicity and socioeconomic status: outdoor nitrogen inequity aversion, that is, receipt of unequal reward for the same disciplines have thus developed guidelines to clarify the meaning responsibility of the authors and does not necessarily represent dioxide in the United States in 20 States in 2000 and 2010. Environ Health Perspect task, a phenomenon seen even in children as well as in other and use of race and ethnicity in research and publications, include he official views of the funding agencies. 125(9):097012, PMID: 28 1289/EHP959. Corbie-Smith G, Thomas SB, St George DMM. 2002. Distrust, race, and research. mammalian species. In human studies, such stress has also been ing the following: Arch Intern Med 162(21):2458-2463, PMID: 12437405, https:/doi.org/10.1001/ shown to modify decision making, including enhancing the tend- . APA Guidelines on Race and Ethnicity in Psychology (APA archinte.162.21.2458. ency to choose smaller and earlier rewards over larger delayed Task Force on Race and Ethnicity Guidelines in Psychology References Cousins IT, Goldenman G, Herzke D, Lohmann R, Miller M, Ng CA, et al. 2019. The con- ones (a phenomenon known as delay discounting) (Haushofer 2019) Allen VC Jr, Lachance C, Rios-Ellis B, Kaphingst KA. 2011. Issues in the assessment cept of essential use for determining when uses of PFASs can be phased out. and Fehr 2014). Because animal models are the basis for much of American Anthropological Association statement on race of "race" among Latinos: implications for research and policy. Hisp J Behav Environ Sci Process Impacts 21(11):1803-1815, PMID: 31204421, https://doi.org/10 Sci 33(4):411-424, PMID: 23239903, https://doi.org/10.1177/0739986311422880. 1039/C9EMO0163H. the research used for risk assessment and because disadvantaged (Executive Board of the American Anthropological Association AMA (American Medical Association). 2020. New AMA policy recognizes racism Daniel R. 2019. Understanding our environment requires an indigenous worldview. human populations often experience the highest chemical 1998) as a public health threat. Eos 100, https:/doi.org/10.1029/20190137482." Environmental Health Perspectives 055002-4 129(5) May 2021 Environmental Health Perspectives 055002-5 129(5) May 2021

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