Environmental Health Inequalities Research Articles

8.E. Skills building seminar: Methods for measuring the true health cost of pollution

Abstract Healthy environments are essential for physical and mental wellbeing. Air pollution is considered to be one of the most significant environmental risk factors for ill health and premature death within the European Union. Poor air and noise quality have been linked to the exacerbation of symptoms, hospital admissions, and even premature deaths, especially for those with cardiorespiratory diseases. The associated medical costs and productivity losses therefore also impose a large economic cost. Exposure to environmental stressors disproportionately affects socially disadvantaged groups, and therefore contributes to the large socioeconomic inequities in health observed persistently in Europe. The EU has prioritised action on causes of pollution. For example, its Green Deal outlines ambitious plans to address climate challenges such as pollution and align air quality ambitions closer to the World Health Organization guidelines. Likewise, the European Environmental Agency routinely monitors the mortality burden associated with air pollution, while the impact of environmental noise on European citizens is examined through the Environmental Noise Directive. While in the political scene there is interest to advance the reduction of pollution, efforts are hindered by the lack of an harmonized methodology to quantify the socioeconomic cost of environmental stressors. Currently, researchers working with the burden of disease framework face many challenges in its application in the context of environmental stressors. Among others, these challenges include unmet data needs and major lack of transparency in methodological developments. In this skills-building seminar, we will outline an integrated approach for measuring the true health cost of pollution. This approach is currently being trialled in the EU-funded BEST-COST project, which sets out to improve methodologies for understanding the socioeconomic cost of environmental stressors, focusing on air and noise pollution. The project brings together a consortium of 17 partners from Europe and the USA, and is led by Sciensano, the Belgian institute for health. Through a synergy of theoretical outlines and real-life examples, seminar participants will gain methodological insights in the three key components of this integrated approach - i.e., the quantification of the health burden of environmental stressors via comparative risk assessment, the monetization of Disability-Adjusted Life Years to assess economic impact, and the quantification of environmental health inequalities via a novel area-level based framework. Key messages • There are significant unmet needs with respect to both data and methodologies for quantifying the socioeconomic cost of environmental stressors. • We outline an integrated approach for measuring the true health cost of pollution, combining health burden, economic burden, and environmental health inequalities.

Integrating social inequalities in the burden of environmental stressors

Abstract In the process of designing equitable policies to reduce the burden of environmental stressors, it needs to be taken into consideration that socially disadvantaged communities are disproportionately exposed to environmental pollutants. These environmental health inequalities are currently however not routinely taken into account when designing mitigation measures, amongst others because of the absence of a coherent methodological framework. Within the BEST-COST project, an innovative framework for assessing social inequalities in the socioeconomic impact of environmental stressors will be developed and implemented. In particular, a novel index of multiple deprivation was developed. This includes indicators that are considered to be temporally and culturally valid for assessing social and material deprivation in Europe. In particular the new index was developed to make comparison across different European countries and to be used at a small geographical level. Within the workshop we will discuss the stepwise framework developed, starting from the results of a scoping review conducted to gather information methodological approaches used in the currently existing MDIs developed in Europe. The results of the scoping review were used to make informative decisions about the selection of indicators and other relevant methods (e.g. weighting). The construction of the composite score for the use within BEST-COST was evaluated also considering the data availability of the selected indicators at a small geographical level (i.e. LAU2) for the case-study countries: Belgium, Estonia, France, Norway and Portugal. Initial results of the quantification of social inequalities in the burden of environmental will be presented. Participants to the workshop will be able to understand the advantages and challenges of this kind of exercises with specific examples.

Promoting environmental justice in industrially contaminated areas: from national assessments of environmental health inequalities to approaches focused on single communities

Promoting environmental justice in industrially contaminated areas: from national assessments of environmental health inequalities to approaches focused on single communities

Environmental Exposure Inequities Among Sexual and Gender Minority Populations in the United States: A Scoping Review

Despite growing attention and guiding frameworks, we still know very little about how environmental exposures may be contributing to the health inequities experienced by sexual and gender minority (SGM) people, especially exposures beyond psycho-behavioral mechanisms that have traditionally been viewed as the pathways between minority stress and negative health outcomes. To address this gap in knowledge, we conducted a scoping review to determine the extent to which disparities in environmental exposures between SGM and non-SGM (ie, heterosexual and cisgender) populations have been measured in the United States. We searched PubMed for studies that were (1) peer-reviewed; (2) written in English; (3) quantitatively measured environmental exposures; (4) included 1 or more groups identifying as a sexual minority, gender minority, or both; (5) compared to the general population; (6) in the United States; and (7) published on or after January 1, 2011. Our scoping review identified very few studies that examined and documented environmental exposure disparities between SGM and non-SGM populations in the United States. These studies focused mostly on cigarette smoke exposures. None examined environmental exposure disparities between gender minority and cisgender populations. To address this critical gap in environmental health research for SGM populations in the short term, researchers can merge existing environmental data (eg, data from the Environmental Protection Agency) with SGM population data. Longer-term solutions require systematically including validated sexual orientation and gender identity measures across federal, state, and local datasets, as well as increased funding for original research that explores diverse environmental exposures. Taken together, these efforts can significantly advance our ability to identify and address environmental health inequities experienced by SGM people.

Sociodemographic inequalities in long-term exposure to air pollution, road traffic noise, and greenness: A population-based cohort study of women.

Recent evidence suggests environmental health inequalities both within and between European countries and socially deprived groups may be more susceptible to pollution. However, evidence is still inconclusive and additional studies are warranted. This study aims to investigate sociodemographic inequalities in long-term residential exposure to air pollution, road traffic noise, and greenness, taking lifestyle and degree of urbanization into account. In total 20,407 women, born 1914-48 residing in Uppsala County, Sweden, were followed between 1997 and 2017. Time-varying sociodemographic variables were obtained from registers, and questionnaires provided lifestyle information. Generalized estimating equations were used to compute beta-coefficients (β) and 95% confidence intervals (95% CI) for associations between sociodemographic and lifestyle variables and spatial-temporal modeled particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), road traffic noise and greenness. All models were additionally stratified by urbanization type. Urban area residency was the most important predictor of high exposure to air pollution and noise, and to low greenness. For instance, β for NO2 was -2.92 (95% CI = -3.00, -2.83) and -3.10 (95% CI = -3.18, -3.01) µg/m3 in suburban and rural areas, respectively, compared with urban areas. For greenness, the opposite held true with corresponding β of 0.059 (95% CI = 0.056, 0.062) and 0.095 (95% CI = 0.092, 0.098). Within urban areas, elderly, unmarried and well-educated women had the highest environmental burden. However, less pronounced, and even reversed associations were found in suburban and rural areas. This study provides evidence of a mixed pattern of environmental health inequalities across sociodemographic groups in urban areas.

Health impacts under different ozone mitigation pathways in Beijing-Tianjin-Hebei and its surroundings

To evaluate the effects of the various ozone (O3) control approaches on environmental health and health inequalities, 121 reduction scenarios for nitrogen oxides (NOx) and volatile organic compounds (VOCs) were developed, and their environmental health impacts were calculated. With the target of achieving the 90th percentile of the daily maximum 8 h mean O3 concentration (MDA8-90th) of 160 μg/m3 in Beijing-Tianjin-Hebei and its surroundings (“2 + 26” cities), three typical scenarios namely, High-NOx reduction ratio (HN, NOx/VOCs = 6:1), High-VOCs reduction ratio (HV, NOx/VOCs = 3:7), and Balanced reduction ratio (Balanced, NOx/VOCs = 1:1) were investigated. The results show that O3 formation is currently NOx-limited at the regional scale, while some developed cities are VOC-limited, indicating that NOx mitigation should be the core for achieving the targeted concentration (160 μg/m3) at the regional scale, whereas cities such as Beijing in the short term should focus on VOCs mitigation. The population-weighted O3 concentrations in the HN, Balanced, and HV scenarios were 159.19, 159.19, and 158.44 μg/m3, respectively. In addition, the O3-related premature mortality was 41,320 in “2 + 26” cities; control measures under HN, Balanced, and HV could potentially decrease O3-related premature deaths by 59.94 %, 60.25 %, and 71.48 %, respectively. The HV scenario has been found to be more advantageous in lowering the O3-related environmental health impacts than the HN and Balanced scenarios. It was further found that premature deaths avoided by the HN scenario were mainly concentrated in economically unadvanced regions, whereas those prevented by the HV scenario were mainly concentrated in developed cities. This may lead to geographical inequities in environmental health. As ozone pollution in large cities with high population density is primarily VOC-limited, decrease in VOCs should be focused on in the short term to avoid more O3-related premature deaths, whereas NOx control may be more important in decreasing ozone concentrations and ozone-related mortality in the future.

Spatial scale and spatial effects: Shedding light on how a change of scale can affect the characterization of environmental health inequalities

Resolving health inequalities continues to be a priority in improving quality of life around the world. Their impact is of increasing concern to public health governance, which considers the issue of environmental health inequalities to be paramount. To meet this challenge, we have developed a methodology based on the development of spatial composite index in order to assess these inequalities while also providing an alternative to classic approaches that are solely based on territory weaknesses. The aggregation of the widest possible range of factors involved in environmental health provide a clear picture of a territory. This study uses different cases to understand how the change of scale influences the analysis of environmental health inequalities. Our analysis is based on a densely populated area located in a region in the north of France where the standardized mortality ratio is higher than the national average. Multidimensional composite indices were developed simultaneously from datasets collected for different administrative units, and were used to compare levels of resilience and vulnerability within the geographical area. Joint analysis of composite indices led to the identification of territorial blackspots. Indices could therefore enable stakeholders to prioritize certain administrative units, implementing specific measures according to the specificities of each administrative unit. The study discusses the consequences of the choice of a spatial unit and a geographical area in the assessment of territorial inequalities in health, particularly in terms of accessibility, availability and exhaustivity of data. The selection criteria also depend on the jurisdictional fields of action stakeholders.

Inequalities of PM2.5-related health impacts in the complicated regional trade networks

Unplanned regional socioeconomic development contributes to PM2.5 pollution, which severely infringes on human well-being and even lives. Facing the spillover and migration of pollution, the cross-regional issue of environmental health inequalities implied in trade networks requires accurate recognition and research. In this research, a city-level PM2.5-related health impact complex network model (PHCNM) is developed. The Community Detection Algorithm (CDA) and the Stochastic Approach for Weighted Link-Structure Algorithm (SAWLSA) are optimized and applied to deconstruct the structures, hierarchies, and characteristics of PHCNM to assess the interactions of environmental health inequalities across regions and cities. At the urban layer, the empirical results suggest that the top 5 cities (i.e., Chongqing, Shanghai, Chengdu, Beijing, and Tianjin) have premature mortality of more than 25000 people each year, which is about 27% of the total. The demographic surge and PM2.5 pollution deterioration are responsible for the worsening health burden of cities. Chengdu, Suzhou, Shanghai, and Hangzhou are identified as development-driven critical cities; Shijiazhuang, Tangshan, Cangzhou, and Handan are recognized as pollution-driven critical cities. Thus, city-specific management and treatment of PM2.5 are possible depending on the characteristics of their environmental health inequalities. While at the regional layer, the urban agglomerations of Yangtze River Delta (YRD-UA) and Pearl River Delta (PRD-UA) transfer pollution and health threats through commercial interaction among cities, leaving the urban agglomerations of Beijing-Tianjin-Hebei (BTH-UA) and Chengdu-Chongqing (CC-UA) as victims of their environmental and health development. And the regional inequalities index elevates from 0.770 to 0.780, reflecting the easing of regional health inequalities. The research reveals that health inequalities significantly reside in communal or regional boundaries; therefore, the internalities and externalities of communal structures can offer insights into the regionalized and communalized development patterns of urban agglomerations.

Associations Between Built Environment Factors and SARS-CoV-2 Infections at the Neighbourhood Level in a Metropolitan Area in Germany

COVID-19-related health outcomes displayed distinct geographical patterns within countries. The transmission of SARS-CoV-2 requires close spatial proximity of people, which can be influenced by the built environment. Only few studies have analysed SARS-CoV-2 infections related to the built environment within urban areas at a high spatial resolution. This study examined the association between built environment factors and SARS-CoV-2 infections in a metropolitan area in Germany. Polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infections of 7866 citizens of Essen between March 2020 and May 2021 were analysed, aggregated at the neighbourhood level. We performed spatial regression analyses to investigate associations between the cumulative number of SARS-CoV-2 infections per 1000 inhabitants (cum. SARS-CoV-2 infections) up to 31.05.2021 and built environment factors. The cum. SARS-CoV-2 infections in neighbourhoods (median: 11.5, IQR: 8.1–16.9) followed a marked socially determined north–south gradient. The effect estimates of the adjusted spatial regression models showed negative associations with urban greenness, i.e. normalized difference vegetation index (NDVI) (adjusted β = − 35.36, 95% CI: − 57.68; − 13.04), rooms per person (− 10.40, − 13.79; − 7.01), living space per person (− 0.51, − 0.66; − 0.36), and residential (− 0.07, 0.16; 0.01) and commercial areas (− 0.15, − 0.25; − 0.05). Residential areas with multi-storey buildings (− 0.03, − 0.12; 0.06) and green space (0.03, − 0.05; 0.11) did not show a substantial association. Our results suggest that the built environment matters for the spread of SARS-CoV-2 infections, such as more spacious apartments or higher levels of urban greenness are associated with lower infection rates at the neighbourhood level. The unequal intra-urban distribution of these factors emphasizes prevailing environmental health inequalities regarding the COVID-19 pandemic.

Changes in PM2.5-related health burden in China's poverty and non-poverty areas during 2000–2020: A health inequality perspective

China suffers from severe PM2.5 pollution that has resulted in a huge health burden. Such PM2.5-related health burden has long been suspected to differ between China's poverty-stricken areas (PAs) and non-poverty-stricken areas (NPAs). Yet, evidence-based examination of this long-held belief, which is critical as a barrier of environmental injustice to advancing China's sustainability, is still missing. Here our study shows that the PM2.5 pollution is more serious in China's NPAs than PAs—with their annual averages being respectively 54.83 μg/m3 and 43.63 μg/m3—causing higher premature mortality in the NPAs. Compared to economic inequality, China's total PM2.5-related premature mortality was relatively evenly distributed during 2000–2015 across regions of varying levels of gross domestic product (GDP) per capita but increased slightly in 2015–2020 owing to the dramatic change in age structure. The elderly population increased by 31 %. PM2.5-related premature deaths were more severe for populations of low socioeconomic status, and such environmental health inequalities could be amplified by population aging. Additionally, population migration from China's PAs to developed cities contributed to 638, 779, 303, 954, and 896 premature deaths in 2000, 2005, 2010, 2015, and 2020, respectively. Changes in the age structure (53 %) and PM2.5 concentration (28 %) had the greatest impact on premature deaths, followed by changes in population (12 %) and baseline mortality (8 %). The contribution rate of changes in the age structure and PM2.5 concentration was higher in PAs than in NPAs. Our findings provide insight into PM2.5-related premature death and environmental inequality, and may inform more equitable clean air policies to achieve China's sustainable development goals.

Environmental Microsegregation: Urban Renewal and the Political Ecology of Health

In recent years, multiple-burden maps were developed as a tool for assessing environmental health inequities in cities. Maps of this kind are particularly useful in identifying disadvantaged neighbourhoods. In the case of Erlangen (Germany), the historical development of poorer neighbourhoods may mean that their situation as regards environmental assets is relatively favourable. However, urban renewal often precipitates the redistribution of environmental “goods” and “bads” in such a way as to place a disproportionate burden on socio-economically deprived people and privilege the better-off. This type of environmental microsegregation occurs on a scale below that of neighbourhoods, which means that newly developed approaches in urban geography may fail to identify it. This article details the roots of these processes in changes in the structure of ownership and the respective administration of housing and considers possible methods for monitoring these tendencies.

Epigenomic Stories: Evidence of Harm and the Social Justice Promises and Perils of Environmental Epigenetics

This article develops the concept of epigenomic stories to analyze how scientists describe and study the relationships between environmental epigenetics, health inequities, and social justice. Based on a multisited ethnography of epigenetic knowledge production and its circulation across laboratories, clinics, and communities in the United States and Canada between 2016 and 2021, we build on Black feminist and science studies scholarship to convey the racial, gender, and epistemic consequences of epigenomic stories. We argue that these stories reflect how scientists position epigenetics as a way of providing biological evidence of social harms and shifting responsibilities from individuals to broader structures. Yet these stories also reflect the limits of epigenetic methods and models in effectively capturing and addressing lived experiences of oppression. Thus, while scientists envision epigenetics as a resource for social change, they do so in ways that privilege biological ways of knowing. In analyzing the values and power relations embedded in these practices, we argue that epigenomic stories reflect what is at stake socially, politically, and materially when we tell stories with science. We contend that efforts to mobilize epigenetic knowledge for social justice must therefore center marginalized peoples’ knowledge and experiences and address how racism and sexism shape science and its social consequences.

The Michigan Farmworker Project: Development and Implementation of a Collaborative Community-Based Research Project Assessing Precarious Employment and Labor Exploitation

Farmworkers are among the most underserved and marginalized populations of workers despite their essential role in the U.S. food supply chain. The Michigan Farmworker Project (MFP) evolved as a collaborative, community-based participatory project among state and regional service entities, legal service organizations, and the university. The overarching goal of the project was to study the relationship of precarious working conditions and labor exploitation with occupational and environmental health inequities and social justice for farmworkers in Michigan. We employed critical race theory and community-based participatory research approaches to guide the development and implementation of the MFP. We describe the development of the participatory process with community partners and discuss implementation challenges and lessons learned from the field. Throughout the research, we reflect on how farmworkers’ social and working environment goes beyond precarity, revealing labor exploitation as an important deterrent of farmworker health and well-being. Despite entrenched systems of structural oppression, farmworkers contribute to and improve our society with their rich cultural backgrounds, their work, and their resilience. The diverse composition of this community-university partnership amplified collaboration, enriched our understanding of the role of precarity and labor exploitation among farmworkers, and contributed to the study’s success. The MFP will continue strengthening the community-university partnership with the goal of continuing to address health inequities in the farmworker population.

Environmental health impacts and inequalities in green space and air pollution exposures in six European cities

BACKGROUND The GoGreenRoutes project (Horizon 2020/869764) aims to introduce co-created nature-based solutions (NBS) as interventions to enhance access to green space in six medium-sized European cities (Burgas, Lahti, Limerick, Tallinn, Umea, and Versailles). We analyzed the spatial distribution and health impacts associated with unequal exposure to air pollution and green space prior to the implementation of these NBS interventions in each city. METHODS We retrieved air pollution (NO₂ and PM₂.₅) and green space (NDVI and % Green Area proxies) data at a 250m x 250m grid-cell level for each city, in addition to population and mortality data for 2015. We compared baseline exposures to WHO guidelines and calculated the exposure differences at the grid-cell level. We applied a comparative risk assessment methodology to estimate the mortality burden attributable to not achieving the WHO guidelines. We evaluated exposures and attributable mortality distributions and their associations to understand current urban environmental inequalities. RESULTS We found high variability in air pollution and green spaces levels between and within all six cities. Around 60% of the population lacked green space and 90% of the population were exposed to air pollution above WHO guidelines. Overall, we estimated a city range between 3-37 and 2-71 deaths/100,000 persons were attributable to exceedances in WHO NO₂ and PM₂.₅ limit values, respectively; 4-13 deaths/100,000 persons were associated with lack of Green Area; and 18-35 deaths/100,000 persons were linked to NDVI levels below the city target. Green space and air pollution were highly spatially correlated, likewise their attributable burdens. CONCLUSIONS Our results suggest that urban populations in the analyzed cities are affected simultaneously by lack of green space and increased air pollution. We expect NBS interventions will contribute to reducing the environmental health burden and inequalities in the GoGreenRoutes cities. KEYWORDS Health impact assessment; urban health; health equity; nature-based solutions.

Air pollution and public health vulnerabilities, susceptibilities and inequalities in Wales, UK.

Outdoor air pollution is the largest environmental risk to health. Air pollution, deprivation and poor health status are inextricably linked; highlighting issues of environmental injustice, social and health inequalities. Air pollution (nitrogen dioxide, NO2 and fine particulate matter, PM2.5), population and deprivation data were identified at Lower Super Output Area level in Wales, UK, for 2012-18. Air pollution data were categorized according to different air pollution concentrations. Population and deprivation data were considered simultaneously to describe population vulnerabilities, susceptibilities and inequalities. Simple statistical analyses were performed using a difference in proportions method with 95% confidence intervals. Over time, the majority of Welsh people transitioned to living in areas of lower NO2 and PM2.5 pollution. Areas of worse air pollution comprised more young people than people aged 65+; both populations are known to be susceptible to air pollution exposure. By 2018, significant socioeconomic inequality gaps were found where 'most deprived' population groups for both pollutants experienced greater disadvantage. Air quality in Wales is improving. However, local-level variations in exposure risk still exist. System-wide action must ensure that air quality improvement-related benefits are equitable and acknowledge current evidence about the harms that even low levels of air pollution can have on health.

Exploring Environmental Health Inequalities: A Scientometric Analysis of Global Research Trends (1970-2020).

Environmental health inequalities (EHI), understood as differences in environmental health factors and in health outcomes caused by environmental conditions, are studied by a wide range of disciplines. This results in challenges to both synthesizing key knowledge domains of the field. This study aims to uncover the global research status and trends in EHI research, and to derive a conceptual framework for the underlying mechanisms of EHI. In total, 12,320 EHI publications were compiled from the Web of Science core collection from 1970 to 2020. Scientometric analysis was adopted to characterize the research activity, distribution, focus, and trends. Content analysis was conducted for the highlight work identified from network analysis. Keyword co-occurrence and cluster analysis were applied to identify the knowledge domain and develop the EHI framework. The results show that there has been a steady increase in numbers of EHI publications, active journals, and involved disciplines, countries, and institutions since the 2000s, with marked differences between countries in the number of published articles and active institutions. In the recent decade, environment-related disciplines have gained importance in addition to social and health sciences. This study proposes a framework to conceptualize the multi-facetted issues in EHI research referring to existing key concepts.

Using agent-based modelling to test hypotheses on the role of neighbourhood social mechanisms in the development of small-area health inequalities

BackgroundSmall-area health inequalities may originate from differentials in the spatial distribution of environmental stressors on health. The role played by neighbourhood social mechanisms on small-area health inequalities is difficult to...

Environmental health inequities at COVID-19 pandemic times: challenges and perspectives

Negative impacts of the COVID-19 pandemic appear to disproportionately affect different population groups by outweighing the risks in socially and environmentally marginalized segments of society. The aim of the current study is to review on how environmental health inequities have negatively impacted the fight against the COVID-19 pandemic, as well as on challenges and perspectives in the post-pandemic transition context. The saturation of health services at tertiary level, difficulties in getting access to treatment for chronic morbidities, as well as the centuries-old unequal supply of essential environmental sanitation services are determining factors for inequity and pandemic severity levels. Strategies used to minimize disparities in the access to healthcare services have been directed towards integrating primary healthcare services to the health surveillance sector, as well as further developing digital health actions. It is possible concluding that the multidimensionality of the pandemic crisis must be understood based on the socio-environmental systemic perspective, with emphasis on its potential to worsen pre-existing environmental health inequities and to produce new inequities in the future in regions and populations affected by health and environmental vulnerability.

Carcinogenic air pollution along the United States’ southern border: Neighborhood inequities in risk

Air pollution poses serious and socially inequitable risks to public health. Social disparities are marked along the US-Mexico border, yet prior research has not assessed inequities in air pollution exposure across the entire US-side of the border region. We apply an intersectional approach to examine contextually relevant sociodemographic variables, including (1) Hispanic/Latinx ethnicity by race and (2) nativity (US vs. Foreign) by citizenship, and cancer risks attributable to air pollution exposures. We pair data from the 2012–2016 American Community Survey with 2014 National Air Toxics Assessment estimates of carcinogenic risks from all sources of hazardous air pollutants at the census tract level (n = 1448) and use a series of generalized estimating equations to assess inequities in risk. Increased concentrations of renter-occupants, Hispanics, mid-to-high socioeconomic status households, and foreign-born citizens were associated with elevated risks. Hispanic ethnicity intersected with non-White racial identification to amplify risks. In contrast, increased concentrations of non-Hispanic Black people and foreign-born non-citizens were not associated with disparate risks. To ameliorate environmental health inequities in this context, research and policy actions must be tailored to the US-Mexico border and consider intersectional positions within the Hispanic population.

Environmental Inequalities in Kathmandu, Nepal—Household Perceptions of Changes Between 2013 and 2021

Environmental health inequalities in cities of the Global South are hardly studied up to now, though they are expected to increase due to rapid urbanization and motorization taking place in many of these cities. In this study, environmental inequalities in the city of Kathmandu, Nepal for the years 2013 and 2021 are analyzed. The goal of the study is to determine the degree of environmental inequalities and their changes over time. The study examines horizontal and vertical inequalities in access to drinking water sources, air and noise pollution exposure, and health effects based on self-reported household data. Results show statistically significant environmental inequalities between neighborhoods in Kathmandu regarding access to basic water infrastructure, air and noise pollution exposure, and resulting health effects. Inequalities between socio-economic groups are not significant. Over time, the perceived exposure to air pollution has increased, mainly due to increased motorized traffic, whereas vertical inequalities persisted. While inequalities between socio-economic groups have not increased, the high socioeconomic group reveals more concerns and awareness about environmental burdens than the low socioeconomic group. In conclusion, given the intertwined horizontal and vertical inequalities, any planning response action needs to consider the population's vulnerability to target interventions to the most affected areas.