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The U.S. Department of Health and Human Services has for decades ignored its responsibility to enforce civil rights laws, as I argued last year in a First Opinion essay. Doing nothing to protect minority populations from inequitable health harms resulting from the health care industry’s greenhouse gas emissions constitutes environmental and institutional racism.

HHS has now chosen to make matters worse by creating an Environmental Justice Index (EJI) that will do many things — except provide environmental justice.

In announcing the index, HHS Secretary Xavier Becerra stated that “Too many communities . . . particularly low-income . . . and communities of color continue to bear the brunt of pollution.” HHS describes the EJI as “the first national, placed-based tool” to measure and map areas of the United States that are most at risk for the health effects of environmental issues.


The index is designed to collect and publish data on 36 factors across three modules — social vulnerability, environmental burden, and health vulnerability. The measures of environmental burden include air and water pollution but, oddly, not flooding, the deadliest, costliest, and most widely experienced environmental hazard in the U.S. Equally if not more disappointing, data regarding climate warming or extreme heat episodes will not be reported, despite the fact these disproportionately harm minority communities. The social vulnerability module includes poverty, health insurance coverage, and unemployment measures, while the health vulnerability module includes data on the prevalence of asthma, cancer, diabetes, and hypertension.

For each U.S. census tract, HHS will publish unweighted scores for each module along with an overall environmental justice score or rank. The higher the score, the more severe the census tract’s cumulative environmental burden. A score of 0.80, for example, means that 80% of census tracts experience less burden.


In theory, EJI scores will enable the federal government and others, as the fact sheet states, to “identify and prioritize areas that may require special attention or additional action to improve health and health equity” and to “educate and inform the public about their community.”

In practice, where real-world effects come into play, the EJI will constitute another form of discriminatory action: climate redlining.

It is impossible to believe that EJI scores will not be increasingly used by, for example, insurance carriers of all stripes. It would provide primary data for health insurers, including Medicare Advantage plans, to code their beneficiaries. (As a related aside, with census tract populations as small as 1,000, how does the Environmental Justice Index not violate, at least in spirit, the Health Insurance Portability and Accountability Act of 1996 which protects the disclosure of health information without an individual’s consent?)

It is also impossible to believe that banks and other financial institutions will not use the EJI to evaluate assets and collateral, credit worthiness, and liquidity; that federal entities such as Fannie Mae and Freddie Mac will not use this index in making decisions about securitized mortgage loans; and that numerous other industries will not use it to divest.

At some point, the Environmental Justice Index introduces moral hazard: High scores will invite moral hazard by leaving those with low scores, including health care providers, less inclined to decarbonize.

The index also exacerbates several existing realities. Historical redlining has pushed various racial and ethnic communities into higher- and high-risk climate areas, and systematic under-investment in infrastructure has aggravated the problem. Black and Hispanic Americans are also overexposed to climate-related harms because they disproportionately live in warmer or lower-latitude states that have less ability to adapt to increasing temperatures. They generally also have fewer economic and political resources to respond to innumerable and unrelenting climate crisis-related health harms including unhealthy or substandard air quality that is largely the result of burning fossil fuels.

An example of how the Environmental Justice Index may play out is a 2021 Oregon law that required the state’s Department of Forestry to classify the fire risk of tax lots and properties. One week before HHS announced its index, the Oregon Department of Forestry deleted from its website its Oregon Wildfire Risk Explorer, a statewide map that, like the EJI, scored wildfire burden. Not surprisingly, Oregonians were upset that high risk scores would lower property values, reduce property insurance offerings, and raise premiums. Six months later, Oregon’s risk explorer website remains down.

HHS must also be aware that the federal Securities and Exchange Commission, the Federal Reserve, the Federal Deposit Insurance Corporation, and the Office of the Comptroller of the Currency have been struggling over the past two years to develop regulations to address the inherent tension between providing equal access to financial services and managing climate-related risks.

In a video broadcast in February 2022, Michael Hsu, the acting director of the Office of the Comptroller of the Currency, which regulates $15 trillion in bank assets, bluntly stated addressing the climate crisis cannot create, as he stated, a “climate redline map that impacts LMI [low-and moderate income] communities inversely.” In November 2022 testimony before the House Committee on Financial Services, Hsu argued that climate-related risks must be managed in a way that does not force Americans to conclude the government is working against them.

HHS would be wise to work with these and other agencies.

In sum, HHS’s index will advertise the already well-known fact that certain racial and ethnic communities suffer significantly greater environmental burdens. Quantifying the comparative difference will just compound their health and economic hardships. One is forced to conclude the perversely-titled Environmental Justice Index is subterfuge. It is, or will become, an Orwellian surveillance tool that institutionalizes climate apartheid. It will define structural racism and potentially serve as a platform to help identify increasingly inevitable sacrifice zones.

What is even more remarkable about the Environmental Justice Index is that it furthers the fact that HHS continues to refuse, per its Office of Environmental Justice’s stated mission, to address the “root causes” of climate change. Two-plus years into a supposed all-of-government approach to address the climate crisis, HHS has still not adopted a single related regulatory rule. The department charged with enhancing the health and well-being of all Americans has apparently declared defeat. Instead of working to address the untold misery and death caused by the health care industry’s annual footprint of 500 million metric tons of carbon dioxide equivalents — that’s like burning 553.2 billion pounds of coal — HHS is increasingly satisfied to take a nihilistic approach and simply describe the results. Instead of working to eliminate the health care industry’s greenhouse gas pollution, which has long been considered a preventable adverse effect of medical care, HHS is in practice merely counting as medical errors the myriad resulting health harms.

Worse, failing to eliminate or cure the health care industry of its greenhouse gas addition — which would leave the industry financially and environmentally sustainable — HHS is contributing to what researchers have recently term a doom loop by drawing resources and attention away from addressing root causes, again eliminating carbon dioxide emissions.

Morally speaking, as Hannah Arendt argued six decades ago, “it is hardly less wrong to feel guilty without having done something specific than it is to feel free of all guilt if one is actually guilty of something.”

During a webinar in December 2022, the Environmental Protection Agency’s deputy assistant administrator for environmental justice admitted, “we’ve never really followed the civil rights laws.” HHS should admit the same failure and go from there.

David Introcaso is a Washington, D.C.-based health care research and policy consultant whose work increasingly focuses on the climate crisis.

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