Air pollution and environmental health disparities: how disadvantaged communities may be particularly susceptible to poor reproductive outcomes

Abstract

BACKGROUND AND AIM: Disadvantage communities face differential exposure to high levels of air pollution and other environmental hazards. In addition to having fewer resources and several co-occurring risk factors such as increased psychosocial stress, fewer opportunities for health promoting behaviors and less access to high quality health care, they also have less access to protective factors. These factors drive differential susceptibility across population subgroups and can explain why disadvantaged populations suffer disproportionately from the negative health effects of air pollution. The aim of this presentation is to describe different models that frame differential exposure and susceptibility and provide evidence to support these phenomenon specifically among pregnant people and those who may become pregnant. METHODS: I will present three frameworks/conceptual models that are rooted in theory and capture the way social and environmental factors interact to produce environmental health disparities. RESULTS:The social production of disease model, the integrated social-environmental model of health and well-being, and the stress-exposure-disease model will be discussed. I will highlight the important contributions of each. Shared mechanistic pathways such as those involved with the stress response system (i.e., allostatic load), the inflammatory and sympathathic nervous systems will be emphasized. Lastly, I will present empirical evidence to support the theorized mechanisms and upstream social and contextual factors that contribute to environmental health disparities, with a specific emphasis on race and socioeconomic status, in reproductive health. CONCLUSIONS:The use of conceptual frameworks rooted in theory can strengthen environmental health disparities research. KEYWORDS: air pollution, environmental health disparities, conceptual models, reproductive health