Communities exposed to high levels of toxic waste are at risk for serious health problems. But, at the same time, those who live in these communities are less likely to visit a doctor. A recent study from researchers at the University of Alabama at Birmingham explains why.
In several neighborhoods of North Birmingham, Alabama the soil is laced with dangerous contaminants. North Birmingham is home to two coke oven plants, asphalt batch plants, a steel producing factory, and various other industrial plants that spew harmful chemicals that find their way into the soil. The Environmental Protection Agency classified this area as the 35th Avenue Superfund site in 2011. Superfund sites are areas established by the U.S. government as having dangerous levels of environmental contamination. As of 2022, there are nearly 2,000 different Superfund sites nationwide. The 7% of the U.S. population living within a mile of one face a wide range of increased health risks. This is the case in North Birmingham.
Historic Image of North Birmingham
[Source: Library of Congress]
Researchers compared three neighborhoods in North Birmingham. Two were close and one was far away from the 35th Avenue Superfund site. They examined residents’ usage of hospitals and the types of doctor appointments they attended. What they found was counterintuitive. Those living near the Superfund site were less likely to go to outpatient doctor appointments, appointments that do not require hospitalization, than those living farther away from the site. At the same time, those living near the site were more likely to wind up in emergency rooms or be admitted into hospitals for long-term care.
These findings are important as those who live near Superfund sites have higher rates of a wide variety of illnesses due to their proximity to Superfund sites. For example, those who live in the neighborhoods near the 35th Avenue Superfund site have higher rates of chronic lung disease—2.2% more of the population than in neighboring towns—because of their exposure to harmful chemicals. Overall, those living near the 35th Avenue Superfund site were twice as likely to report they were in poor health compared to their counterparts.
Regular outpatient care—physicals and routine check-ups—are important to patient health. When individuals don’t attend outpatient care, the chances that warning signs will be missed and illness overlooked increase, explain the researchers. Outpatient care can also result in illnesses being caught at late stages leading to worse health. Due to this, the low numbers of outpatient doctor appointments relate to higher rates of hospitalization.
Sign Outside a Home in North Birmingham
[Source: Steven Depolom]
Researchers also found that those living near Superfund sites report higher levels of financial concern. This might explain the lower rates of outpatient doctor appointments. For the uninsured, the average cost of an outpatient visit in Alabama is around 100 dollars, which is a lot in a state where minimum wage is $7.25 an hour.
Fear and distrust of doctors is another potential reason for the low rates of outpatient visits. Women, ethnic and racial minorities, individuals with disabilities, and those with lower socioeconomic status are much more likely to mistrust doctors. This is especially seen in individuals who fit into more than one of the above categories. This is due in part to a long history of abuse and poor treatment from doctors towards those who identify as one, or more, of these groups. In communities such as North Birmingham where the population is more than 70% Black and where individuals may already have disabilities due to chronic exposure to toxic waste, it wouldn’t be surprising to find that people are hesitant to trust medical professionals.
The health issues in communities neighboring Superfund sites are an urgent problem. While the U.S. government is taking action to remedy the harm of Superfund sites, this study makes it clear that an important step is lessening health burdens for individuals by making outpatient doctor appointments more accessible. How can the underlying reasons for this disparity in outpatient and inpatient care be addressed? Potential strategies include offering free or reduced-price clinics so the financial burden can be alleviated. To address the mistrust in doctors which is due to a long history of harm is a challenge but, by doctors engaging with the communities they treat beyond just in the exam room and by diversifying the medical industry, trust may be able to be rebuilt. Overall, to address the health burdens in communities near Superfund sites, the gap in healthcare must be bridged.