Linking health, justice, and the environment for responsive nursing practice
By Alysha T. Jones
October 3, 2023
- Environmental racism is a human rights and health issue of relevance for nurses in Canada committed to advancing racial and social justice.
- Mounting ecological crises are impacting human health, but these impacts are not felt equally. Polluting industries and environmental hazards disproportionately harm Indigenous, Black and other racialized communities.
- Because social justice and health equity are explicit mandates of nursing, there is a clear impetus for nurses in Canada to develop practices that address environmental justice. In this article, I offer three approaches to accomplish this goal.
The Canadian government may pass first-of-its-kind legislation to address environmental racism and promote environmental justice in this country. Environmental racism “is the disproportionate proximity and greater exposure of Indigenous (including First Nations, Métis, and Inuit), Black and other racialized communities to polluting industries and environmentally hazardous activities” (Waldron, 2021, para. 1).
In February 2022, Green Party MP Elizabeth May reintroduced Bill C-226, the National Strategy Respecting Environmental Racism and Environmental Justice Act, to the House of Commons. If passed, Bill C-226 would require the federal government to study the relationship(s) between racialization and socio-economic status and environmental hazards and harm. Following this study, governmental agencies will then develop a strategic plan to redress and prevent environmental racism.
Yet many within the nursing community may wonder why or how Bill C-226 and environmental racism are relevant to the nursing profession.
In this brief analysis, I will examine environmental racism as both a determinant of health and a pressing health justice issue that calls for attention from the nursing profession in Canada. Nurses in Canada, particularly those with more power and privilege within the dominant social order (i.e., White, settler, middle class, cis-gendered, heterosexual, able-bodied), have a responsibility to listen to and learn from those unjustly affected by environmental health harms such as pollution and hazardous waste. Because health equity and social justice are central to the Canadian nursing paradigm, environmental racism is worthy of sustained attention from nurses in research, education, advocacy and policy.
Settler colonialism, systemic racism and health
There has been an increasingly concerted effort within Canadian nursing to challenge settler colonial and White supremacist structures that facilitate discrimination against groups of people based on race, such as Indigenous, Black and other racialized populations (Danda, Pitcher, & Key, 2022; Symenuk et al., 2021). There are urgent and compelling reasons why this is so: racism in Canadian society and our health-care system is pervasive and systemic. Systemic racism is woven into policies and institutional practices that normalize and perpetuate the preferential treatment of White people and the inequitable treatment of Indigenous, Black and other racialized peoples in terms of health, education, justice, employment and social participation (Bravemen et al., 2022). It has excluded and continues to exclude, oppress and harm vast portions of those living in Canada through intergenerational trauma and new forms of cultural genocide, such as the overrepresentation of Black and Indigenous people in the Canadian criminal justice system (Walker, 2022). Indigenous and Black people comprise 4.5 per cent and 3 per cent of the Canadian population, respectively, but nearly one-third and one-tenth of the federal prison population, respectively (Malakieh, 2020; Morgan, 2018).
Because of its pervasiveness and systemic power, racism is a powerful determinant of physical, mental and social health (Paradies et al., 2015). Racism drives inequities in the socio-structural determinants of health, such as income and education, resulting in higher rates of poverty, unemployment and housing insecurity for racialized communities (National Collaborating Centre for Determinants of Health, 2018). Systemic racism normalizes White, Eurocentric views on health and creates barriers to health-care access, such as culturally unsafe care, resulting in lower rates of breast, cervical and colorectal cancer screenings for Black, racialized and newcomer populations (Ezeife, Padmore, Vaska, & Truong, 2022).
Furthermore, as Canadian society continues to confront the cruelty of the residential school system, the missing and murdered Indigenous women, girls, and two-spirit (MMIWG2S) crisis, and persistent health and social inequities for Indigenous Peoples, systemic racism embedded in the health-care system is continually exposed (e.g., Turpel-Lafond, 2020). The death of Joyce Echaquan, a 37-year-old Atikamekw woman, is one heartbreaking example of racism’s dangerous impact on the lives and health of Indigenous Peoples in Canada. Given this ominous situation and the problematic overrepresentation of whiteness in nursing (De Sousa & Varcoe, 2022; Oudshoorn, 2020), there is no question that nurses must enact anti-racist and anti-colonial practices, such as applying the Truth and Reconciliation Commission of Canada’s Calls to Action 18 to 24, which specifically address Indigenous health in their workplaces, as part of their professional competence. This work is being undertaken across the country by national, provincial and territorial associations and regulatory bodies and, importantly, in schools of nursing.
However, the environmental dimensions of systemic racism have largely remained unexamined by Canadian nursing. Systemic racism has shaped the Canadian government’s environmental decision-making and policies, consequently exposing Indigenous, Black and other racialized communities to additional environmental harm and injustice (Waldron, 2018).
Environmental racism undermines health
Mounting ecological crises such as air, water and soil pollution and climate change (a profound crisis outside the scope of this short piece) impact human health, but those impacts are not felt equally across demographics. Hazardous industrial waste sites, landfills and incinerators are more prevalent in Indigenous, Black and other racialized communities than in affluent, White-dominated ones, resulting in disproportionate rates of respiratory illness, cancer and developmental disability (Alvarez & Rosenfeld Evans, 2021 Waldron, 2018).
Environmental writer Steve Lerner (2010) uses the term “sacrifice zones” for communities on the front lines of pollution and contamination, such as the Aamjiwnaang First Nation in “Chemical Valley,” Sarnia. For decades, the Aamjiwnaang community has been surrounded by one of Canada’s most intense concentrations of petrochemical plants and oil refineries (Wiebe, 2016). As such, community members experience high levels of air pollution, multiple “everyday” harmful chemical exposures, and elevated rates of skin, digestive, cardiorespiratory, reproductive, nervous system and autoimmune diseases (Wiebe, 2016).
Sociologist Ingrid Waldron (2018) writes that Black, Indigenous and other racialized communities are particularly vulnerable to environmental pollution and hazards because systemic racism simultaneously undermines health in all domains (physical, mental, social, economic and more), resulting, for example, in the well-documented health and income gaps for racialized peoples. In her groundbreaking book, There’s Something in the Water, Waldron describes the double burden of systemic and environmental racism in Black and Mi’kmaw communities in Nova Scotia. In the Black Nova Scotian community of Lincolnville, residents have lived within one kilometre of landfills for the past 50 years. According to a Lincolnville resident,
- If you look at the health of the community prior to 1974 before the landfill was located in our community, our community seemed to be healthier. From 1974 on until the present day, we noticed our people’s health seemed to be going downhill. Our people seem to be passing on at a younger age. They are contracting different types of cancer that we never heard of prior to 1974 (Waldron, 2016, p. 17).
For communities such as Lincolnville, environmental racism directly impacts physical and mental health and operates in a feedback loop with economic and other socio-structural determinants of health. The Lincolnville landfill undermines economic health for residents through a lack of business investment and jobs, devalued property and loss of a younger workforce leaving the community given these factors (Waldron, 2018). At the same time, low income and poverty, connection to family and friends and attachment to home and place make it difficult for residents to leave environmentally hazardous communities such as Lincolnville (Waldron, 2020).
Within the context of systemic racism and settler colonialism, Black Nova Scotian communities — and many Indigenous communities in Canada, such as Aamjiwaang — have been exposed to disproportionate environmental harm because they have been viewed as expendable and inferior to White people, who disproportionately wield decision-making power (Waldron, 2018).
The experiences of people from Lincolnville and Aamjiwnaang First Nation provide important anecdotal evidence and context for the problem of environmental racism in Canada, but formal data is lacking. There is a dearth of published and funded research demonstrating the links between government policy, industry practices and environmental harms against Indigenous, Black and other racialized communities in Canada (Waldron, 2022). As Indigenous environmental justice leader Deborah McGregor (2018) notes,
- Despite well-documented cases of environmental injustice [EJ] in Canada, particularly involving Indigenous peoples …, the country lags significantly behind in scholarship and policy innovations on this issue compared with the United States…. In the United States, an EJ policy framework, including a unique Indigenous and tribal component, has existed for two decades (p. 7).
Implications for the Canadian nursing profession
Because social justice and health equity are explicit mandates within nursing, there is a clear impetus for the profession to study and integrate research on environmental racism, ideally in collaboration with affected communities. American nurses are gaining success and strength in environmental justice as a practice area (e.g., Amiri & Zhao, 2019; Cantu et al., 2016; Kerr, Cook, Chaney, Sotor, & Huffling, 2022; LeClaire, Luebke, & Oakley, 2021) and can serve as excellent guides for Canadian nurses with less experience in researching and writing about environmental justice concerns.
According to sociologist Robert Bullard (2021), environmental justice means that everyone, regardless of race, class or gender, has the right to a healthy environment and equal protection from environmental harm. In addition to individual nurses, Canadian nursing schools and provincial, territorial and national nursing organizations need to learn, teach, research and advocate for environmental justice as integral to health equity and public health in Canada. Including efforts to address environmental racism within the social justice mandate of nursing could diversify the range of perspectives that hold power in health care and health policy-making. Although this may seem a formidable task given the pressures of short-staffing, nursing shortages and overwork for nurses, there are three general ways in which Canadian nurses can develop and incorporate an understanding of environmental racism and justice in their practice.
What follows is a collection of self-reflection and self-awareness exercises when considering health, justice and the environment together.
3 exercises to understand and address environmental racism in nursing practice
1. Listen and Learn
Listen to the experiences of Black, Indigenous and other racialized peoples and find ways to join in with their historical and ongoing efforts to combat environmental violence and racism. See the collaborate and advocate sections below for specific examples.
Learn about whiteness, White privilege, White supremacy, colonialism, racial capitalism, systemic racism and their intersections with environmental health in Canada and elsewhere from resources such as the following:
Partner directly with affected communities and organizations, including community-based environmental, climate and social justice organizations and organizations such as the ENRICH Project. The Environmental Noxiousness, Racial Inequities, & Community Health Project is a multimethod, collaborative, community-based project examining the impacts of hazardous industries near Mi’kmaq and African Nova Scotian communities. See also the Canadian Coalition for Environmental and Climate Justice and Ecojustice.
Connect with or join organizations such as the Canadian Association of Nurses for the Environment and the Canadian Association of Physicians for the Environment. Nurses are immersed in institutionalized power relationships in which they may grapple with their own discrimination and inequity in health-care contexts. Therefore, they need their own allies and supporters to collaborate with.
Co-create interdisciplinary research and teaching programs with racialized stakeholders, such as Indigenous and Black community members and scholars in environmental studies and science, geography, sociology and political science.
Develop undergraduate and graduate nursing curricula to address environmental health concerns from a racial equity and anti-colonial lens and feature communities most affected in these discourses.
Ask your member of Parliament to support Bill C-226 and successive measures to implement environmental justice. The Prevent Cancer Now advocacy group released a public statement and social media image with details about Bill C-226.
Advocate to all levels of government, from the municipal to the federal level, for healthy public policy that includes equitable and just environmental policy in Canada. The National Collaborating Centre for Healthy Public Policy has resources that can be helpful.
Environmental racism is a human rights and health issue of concern to nurses in Canada committed to racial and social justice for all people. Although Bill C-226 is on the way to becoming actualized, a long history of resistance to environmental racism in Black, Indigenous and other racialized communities in Canada continues. It is time for nurses in Canada, as numerous and diversely situated as we are, to join in resisting environmental violence and injustice alongside affected communities with our hearts (caring and commitment), heads (critical thinking and analysis) and hands (action and solidarity).
I acknowledge my social position as a White settler, middle-class, cis-gendered, heterosexual Canadian woman. My social location, with its intersecting privileges, limits my views and findings on this topic. I have not experienced environmental or systemic racism and other forms of injustice experienced by Black, Indigenous and other racialized peoples in Canada. This short essay aims to bring attention to environmental racism, but I encourage the reader to listen to the voices and read the work of those most affected first and foremost.
A sincere thanks to the anonymous nurse reviewer and Brianna Hammond (Nascent Knowledge Consulting) for reviewing this manuscript and providing constructive feedback to improve it.
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Alysha T. Jones, RNc, MSc, MScN(c), is a community health nurse and clinical nurse educator in Victoria, B.C., and is an active participant in the Canadian Association of Nurses for the Environment.