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

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.

Grant Number: 5R01MD016054-04
NIH Institute/Center: NIH
Principal Investigator: Michelle Bell