AAP Voices Blog

Sacrifice Zones—a Personal and Cultural Perspective

As a rural pediatrician, I made a house call several weeks ago to assess a child with serious health issues. The accompanying photograph shows the proximity of the child’s front porch to an industrial refinery. The child’s mother told me that the smell is so bad some nights that she gets a headache and cannot go outside.  Her specialist medical provider is 4 hours from their home and may be unaware of the polluted ZIP code or sacrifice zone in which this child and others are being raised.   

Sacrifice zones are defined by the Climate Reality Project, “areas where residents are subjected to heightened levels of pollution and hazardous materials, despite the adverse impacts on their health.”

Because of pollution and environmental hazards in sacrifice zones, infants living there have an increased incidence of being born preterm or at a low weight on top of a disproportionate increase in incidences of cancer, organ damage, and asthma and respiratory illness.   

The Mississippi River Chemical Corridor, between Baton Rouge and New Orleans, accounts for 25% of the petrochemical production in the United States. It is a well-known sacrifice zone, but southwest Indiana and the Houston Ship Channel are less publicized examples. Typically, residents who live in sacrifice zones have fewer resources and are people of color.  Environmental racism is the term used to describe the disproportional impact of polluting facilities, hazards, and environmental degradation on marginalized communities.   

While considerable attention has focused on the fact that communities of color predominately populate sacrifice zones, little meaningful action has been achieved in mitigating ongoing toxic exposures.  The Environmental Protection Agency (EPA) has utilized Title VI of the Civil Rights Act in order to bring action against polluters located near communities of color, however, a recent ruling by the United States District Court, Western District of Louisiana, Lake Charles Division, significantly hamstrings efforts going forward to curtail harmful environmental drivers of health.  The District Court’s Aug. 22, 2024, permanent injunction prevents the EPA from imposing or enforcing any disparate impact-based requirements against the State of Louisiana or any State agency under Title VI. The ruling largely blocks the agency’s initiative to address disproportionate industrial pollutants in Louisiana’s historically over-polluted Mississippi River Chemical Corridor, which has been called, “Cancer Alley” by environmental groups.  Although this decision is limited to the State of Louisiana, other state attorneys general have filed suits against the EPA challenging limits on particulate emissions as well as carbon emissions, which could be nationwide in scope. 

The legal initiatives by industrially motivated state attorneys general also illustrate the need to address pollution as a separate entity from climate change. While inevitably connected, they each add to the significant consequences on children and targeted communities.  To address environmental injustice as a driver of health will require continued advocacy and effort. Like environmental activist Erin Brockovich, pediatricians need to be persistent and tenacious.  

How you can channel your inner Erin Brockovich and take action: 

1. Know the environmental risk factors in ZIP codes where your patients live and document exposure to pollution and environmental hazards when taking a social history.
2. Work with your chapter to understand the existing and proposed legislation in your state and its effects on the health of children and families.   
3. Educate decision makers on the effects of commercial and environmental drivers of health on pregnant women and children.
4. Partner with youth and advocacy groups in your community to address environmental racism and injustice by speaking up and out about children’s rights to a clean and healthful environment.  

Together, pediatricians can leverage their voices and elevate the rights of children to create a clean and healthful environment.  

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.