ADVANCEMENT OF THE PRACTICE
On the other hand, Health Vulnerability Module scores are calculated by first determin- ing if the indicator estimate for a tract ranks in the top one third nationwide (>66.66%). If so, the tract is assigned a flag score of 1, oth- erwise, it receives a flag score of 0. The Health Vulnerability Module score is then calculated by summing the number of flags and multi- plying this sum by 0.2 to produce a module score between 0 and 1, which ensures that all modules are weighted equally in the overall EJI. The overall EJI score is then calculated by summing the ranked scores of these three modules to determine an overall percentile ranking for each census tract (Figure 2). The EJI model is based on the Environmen- tal Justice Screening Method (EJSM; Sadd et al., 2011). The EJI diers, however, from other EJSM-derived tools—such as CalEnvi- roScreen (California Oce of Environmental Health Hazard Assessment, 2021)—as the EJI uses an additive rather than multiplica- tive model. The EJI also diers from CalEnvi- roScreen and similar tools in that it does not give a heavier weight to pollution exposures than to other environmental justice factors. These decisions were intended to facilitate easy adaptation and interpretation of the EJI by a wide range of users with varying techni- cal expertise and health literacy. The overall EJI rank is a useful tool for identi- fying and prioritizing communities experienc- ing high cumulative impacts of environmental burdens on health and health equity. Once highly burdened census tracts are identified, the module, domain, and indicator scores that drive high EJI ranks can be used to inform actions that are targeted to their specific social, environmental, and health burdens. For example, during an environmental assessment for a new program in Manhat- tan, New York, census tracts along the Cross Bronx Expressway were identified as already experiencing high cumulative impacts from environmental burdens and thus were pri- oritized for mitigative actions based on their overall EJI rank. By taking a closer look into the module, domain, and indicator ranks pro- vided in the EJI, it was clear that air pollution indicators (specifically diesel particulate mat- ter and air toxics cancer risk) in the Environ- mental Burden Module and the high preva- Using the Environmental Justice Index
FIGURE 2
Model Calculations for the Environmental Justice Index (EJI)
Environmental Burden Module
Social Vulnerability Module
Health Vulnerability Module
Ranking Calculated From Health Vulnerability Flags (Range = 0–1)
Overall EJI Score (Range = 0–3)
Percentile Ranked Sum of Environmental Burden Indicators (Range = 0–1)
Percentile Ranked Sum of Social Vulnerability Indicators (Range = 0–1)
Final EJI Ranking (Range = 0–1)
Note. The overall EJI score is calculated by summing the Environmental Burden, Social Vulnerability, and Health Vulnerability Module scores. The overall EJI score is then percentile ranked to produce the final EJI ranking from 0 to 1. The Health Vulnerability Module rank is calculated by summing the flags indicating the high prevalence of a specific condition (e.g., high prevalence of asthma) and multiplying the sum by 0.2 to produce a rank between 0 and 1.
lence of chronic health conditions (including asthma and diabetes) in the Health Vulner- ability Module were driving cumulative impacts in this area. As a result, recommen- dations for focused health protective mitiga- tion measures, including the installation of air filtration systems and funding low- and zero-emission public transportation, were made to sponsoring agencies (Oce of the Assistant Secretary for Health, 2022). Limitations of the Environmental Justice Index The EJI is intended as a high-level mapping and screening tool that characterizes cumu- lative impacts and patterns of environmental injustice across the U.S. and is a useful start- ing point for investigating issues of distribu- tive and procedural justice and their eects on health and well-being. The EJI is not, however, intended for labeling highly impacted commu- nities as “environmental justice communities,” nor is it intended to characterize all environ- mental justice issues that a community might experience. Additionally, as environmental injustice occurs locally, high-level tools, such as the EJI, cannot fully represent all the social, environmental, or health issues that a commu- nity might face, as the data representing these issues (e.g., pesticide use, low birthweight) might be limited or too coarse to be applied at a neighborhood scale. Given that the environ- mental indicators included in the EJI do not represent detailed measures of risk or expo- sure assessment, the EJI is not intended as a
representation of risk or exposure for a given community or as a tool to discern whether individuals are at risk of exposure. While the full EJI ranking is useful for the identification, prioritization, and characteriza- tion of cumulative impacts in an area, it is not designed for use in secondary analysis where disease is the outcome of interest. To make the EJI more useful in this context, the EJI Social– Environmental Ranking was created using only the Environmental Burden and Social Vulnerability Modules of the EJI. Health out- come prevalence estimations from the Health Vulnerability Module were not included in its construction, making it appropriate for study- ing associations with health outcomes. The EJI Social–Environmental Ranking can be found in the EJI database at https://eji.cdc.gov. Conclusion The EJI adds to a growing body of literature and tools as the first national, place-based tool that looks at the cumulative impacts of environmental burdens on health. By using a cumulative impacts framework and relative rank methodology, the EJI allows users to iden- tify communities experiencing high cumula- tive impacts from environmental burdens, so that those communities can be prioritized for mitigative action. This framework also allows users to further investigate indicators that could be driving high cumulative impacts in a community so that mitigative action can be tailored to meet the needs of individual com- munities. Lastly, this framework allows users
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Volume 86 • Number 2
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