Air Pollution, Heat, Cold, and Health: Disparities in the Rural South

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Many populations in rural settings, especially racial and ethnic minority groups, may suffer disproportionate environmental health burdens, such as from air pollution or extreme temperatures. Yet the vast majority of research on environmental health disparities (i.e., “environmental justice”) for air pollution, as well as research on air pollution and health more generally, is conducted for cities. The people, communities, and air pollution sources and mixtures are quite distinct in rural versus urban settings, such that national strategies (i.e., federal regulations) may not be sufficiently protective of health for rural populations. Similarly, research on the health consequences of high and low temperatures, especially for prolonged periods of heat (i.e., “heat waves”), has almost exclusively focused on urban areas. Therefore, current research has major scientific gaps on how the health of rural populations, including rural racial and ethnic minority groups, is impacted by air pollution and extreme temperature. The rural south, particularly the Appalachian region, has higher rates of adverse health outcomes in both older populations (>65y) and infants, compared to national averages. Within the south, rural populations suffer higher rates of multiple morbidities than urban populations, including health outcomes that are linked to air pollution and extreme heat and cold in urban environments. Rural residents also have lower overall income, lower educational attainment, less access to health care, and three years lower life expectancy than their urban counterparts. Evidence suggest that health disparities by race are larger for rural minorities than their urban counterparts. Given the differences in populations, behaviors, environmental hazards, and socioeconomic status (SES), the associations between air pollution, extreme temperature, and health could differ substantially for rural and urban settings. These relationships may also differ across types of rural areas, given the heterogeneity of rural environments. Scientific evidence is urgently needed on the disproportionate impacts of air pollution and extreme temperature in rural environments, with an understanding of the range of rural settings. Our long-term goal is to generate the methods, databases, and scientific estimates that enable knowledge to protect health in rural populations. We propose to: 1) generate a data architecture for air pollution, heat, cold, health, SES, rural form, and other factors in Virginia and West Virginia; 2) estimate disparities in exposure to air pollution and weather (cold, heat, and heat waves) by race/ethnicity, SES, and rurality, accounting for variations in rural form; and 3) estimate disparities in the associations between exposure to air pollution or weather and health for the very young (adverse birth outcomes) and older populations (hospital admissions for those <65 years) for rural populations, considering differences by various vulnerability factors (low SES, race/ethnicity) and rural form. These aims will provide some of the first comprehensive evidence of how air pollution, heat, and cold impact health in rural communities, including differences by rural form and intersectionality of vulnerability factors, such as race, ethnicity, and SES.