The human health consequences of air and water pollution, along with climate impacts like rising heat, disproportionately affect low-income populations and people of color. That’s led to a renewed call for justice on environmental health issues from the American College of Physicians (ACP).

In a new position paper, published Tuesday in the Annals of Internal Medicine, ACP calls on medical professionals to take leadership on climate change impacts that affect the health of vulnerable communities, leading to higher risks of asthma, cancer, stroke and other conditions.

Among them are exposure to unhealthy levels of air pollution, which affects 40% of the American population. But it’s racial and ethnic minorities that are exposed to higher levels of certain pollutants, like particulate matter and ground-level ozone, when compared with White people.

“Discriminatory housing and urban planning policies have segregated people of color and those with low socioeconomic status in areas with elevated environmental risk factors,” the ACP paper explains.

As another example, people who live in communities historically subjected to redlining—policies that limited people of color to certain geographic neighborhoods—experience greater risk from urban heat island effects. That’s the case in cities including Richmond, Virginia, where these communities have fewer trees, more paved surfaces, and therefore higher afternoon temperatures.

Unsafe drinking water, as well as lead contamination from water and paint in older homes, also disproportionately affects these marginalized communities. In Chicago, the third-largest city in the United States, there are still nearly 400,000 lead water pipes in use.

“Environmental risks affect different populations in different ways,” the ACP paper notes. “Older adults, pregnant people, and children may be particularly vulnerable to environmental pollution. Outdoor workers are at higher risk for heat-related illness.”

While the ACP paper articulates a number of policy recommendations, some of them amplified or reiterated from a similar 2016 position paper, it calls on the medical profession to change its own practices, too, in order to protect the vulnerable and keep global warming within the 1.5°C level of the Paris Agreement.

“Climate change and health content should be integrated into internal medicine continuing medical education and medical school and residency curricula,” said the professional organization. “Physicians are encouraged to inform their community and policymakers about the health effects of climate change.”

The effort also should include working with public health agencies and communities to monitor environmental health threats, and promote both prevention and adaptation in the face of climate impacts.

In the U.S., the healthcare sector is responsible for 8.6% of total greenhouse gas emissions. In the United Kingdom, a study of the National Health Service found that most emissions were related to the supply chain (62% of the overall footprint) while direct delivery of care amounted to 24%.

“Hospitals and other settings should take action to cut emissions and supply chain waste and promote preventive care,” ACP said.

As an overarching value, though, ACP insists that all measures to limit the health impacts of climate change must keep environmental justice in focus. The same principle holds true beyond U.S. borders.

“Countries with historically high greenhouse gas emissions, including the United States, should provide financial assistance to developing, climate change–vulnerable countries for adaptation and mitigation activities,” ACP said.

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