Ep 2: Casting Shade
Shade Inequity, Health, and Spatial Justice
Thermal camera capture of shaded and unshaded areas during a hot July day in Richmond, VA. Photo credit: Jeremy Hoffman
Summer is the best season in Rhode Island. People are outside all the time and cooling off under the shade of big, lush trees. What happens when you don’t have shade to cool off in? Some neighborhoods have little to no shade, and usually have higher concentrations of Black folx. Why do urban heat maps and redlining maps align? How can we consider shade a resource like food & housing? How do COVID & the climate crisis widen these inequities?
About This Episode
Summer is the best season in Rhode Island. It makes us forget all the slushy, slippery days of the dark winter. People are outside all the time at the beach, running on trails, at outdoor events, and cooling off under the shade of big, lush trees. But what happens when you don’t have shade to cool off in? Some neighborhoods have less shade than others - and it’s no coincidence that these are usually neighborhoods with higher concentrations of Black folx. It’s also no coincidence that urban heat maps overlay with redlining maps almost perfectly.
How can we start thinking of shade as a resource just like food, housing, and transportation? And how does the current pandemic and the looming climate crisis widen these disparities?
Max Jordan Nguemeni Tiako - MS4 at the Yale School of Medicine
I mean, among many things I think environmental health should be part of what we learn about. If it's not in med school, it ought to be in residency training. Just to think about the context in which people live in, right? People don't live in a vacuum, you know. Someone shows up in your clinic; there is a context in which they are coming from and it's important to think about things like temperature, safety, shade, all those kind of like built environment factors that truly have an impact on sometimes whether someone is going to recover more quickly versus not. And then, you know, in this age, climate change is really, you know, wreaking havoc just about everywhere.
Eugenia C. South - Assistant Professor of Emergency Medicine at the Hospital of the University of Pennsylvania and the Presbyterian Medical Center of Philadelphia
Jennifer Vanos - Senior Sustainability Scientist, Julie Ann Wrigley Global Institute of Sustainability & Assistant Professor, School of Sustainability at Arizona State University
Greg Wellenius - Professor of Environmental Health at Boston University School of Public Health
Chelsea Graham - Dr. Graham is a recent graduate of the Brown Family Medicine Residency. She completed a Global Health Fellowship in 2019 and practices family medicine with a focus on gender and sexual health at Thundermist Health Center. She is also a clinical instructor for family medicine residents at Brown and Kent/Thundermist. In addition, she has done teaching surrounding family planning in Mexico where she collaborates with Compañeros En Salud/Partners In Health. She is a bilingual provider and volunteers at Clinica Esperanza. She is also involved in anti-racism work with Alpert Medical School and completed their BASCE fellowship in 2019: Brown Advocates For Social Change and Equity.
Jeremy Hoffman - Chief Scientist at the Science Museum of Virginia and an Affiliate Faculty in the L. Douglas Wilder School of Government and Public Affairs and the Center for Environmental Studies at Virginia Commonwealth University.
Kufa Castro - Program Coordinator for Groundwork RI, focusing on incorporating creative practices to spread environmental awareness, specifically about climate change resiliency in urban communities. Kufa is also a Project Assistant at Rhode Island Latino Arts working on a cultural history tour of the South Side and West End of Providence. Originally from the Dominican Republic and raised in Pawtucket, Kufa is an artist, actor, and media producer currently working on a new adaptation of “Comedy of Errors/Comedia de Equivocaciones” for Trinity Rep’s touring production for the summer of 2019. The play will tour public libraries and parks across Providence County. Kufa also worked as an Agricultural Apprentice with the Southside Community Land Trust from April to September 2018.
Frank Jolifer, a student at Shea High School and a youth in the Pawtucket area looking to bring change and inform the people
Everett Pope - community activist, organizer with Sunrise RI
Jay Hazen - South Providence resident
Sam Bloch - Writer at The New Food Economy. Also written for the New York Times, L.A. Weekly, Places Journal, CityLab, Art in America, Artnet, Commercial Observer, blogged for Artsy, Art Los Angeles Contemporary, and MOCA.
Sam Coren - Currently pursuing a PhD in American Studies, whose research interests include the U.S. built environment, urban ecology and infrastructure; and feminist science and technology studies. They have exhibited as a research-based artist at sites in Providence and upstate New York, exploring humans’ relationships to urban rivers and other distressed landscapes (some of these projects are documented at samuelcoren.com). Sam’s dissertation research focuses on human and multi-species societies along the margins of interstate highways, and highlights the role of community participation in infrastructure planning.
Chinyere Agbai ("CHEEN-yeh-reh Ah-bye") - Doctoral candidate in the Department of Sociology at Brown University. She researches how the market for housing produces and reproduces inequalities in wealth, race, and health. More broadly, her work is concerned with the linkages between urban inequality, the racial wealth gap, structural racism in social policy, the welfare state, and the social determinants of health. Her recent work explores the historical roots of the contemporary racial wealth gap. Chinyere earned a Bachelor of Arts in Political Science from the University of Pennsylvania
David Eisenman - Professor at the David Geffen School of Medicine at UCLA and has a joint appointment at the UCLA Fielding School of Public Health where he directs the Center for Public Health and Disasters. Dr. Eisenman is also an Associate Natural Scientist at RAND. Dr. Eisenman lives and surfs in Marina del Rey, California.
“I teamed up with researchers from Arizona state university and we looked at social vulnerability and protections to extreme heat in Phoenix and in Los Angeles counties....The first paper we wrote was about Maricopa County. The analysis was very interesting because we looked at data around deaths, mortality and hospitalizations and ER visits for extreme heat related causes. And we looked at census data and then we looked at different databases around air conditioning access and which parts of the community had cooled spaces. One of the members of the team built a database on what we call publicly available cooled spaces. So that would be malls and museums and libraries are places where you can go to get cool. And so we did an analysis of people who died from heat events and which neighborhoods they come from, and looked at the social vulnerability of those neighborhoods. So the percent of folks who are impoverished and the percent uninsured in those neighborhoods. We also looked at their access to publicly available cooled spaces. One of the things we found is that the longer the walking distance to the first available publicly cooled space, the higher the risk of death. There's more finessed analysis than that, but the idea is that we were thinking people sometimes don't have air conditioning or if they have it, it doesn't work. We know from anecdotes, people go to the mall, people go to the library, places like that to stay cool. In fact, the CDC recommends that if you don't have air conditioning, you go somewhere cool. So you want to see if there's any evidence that communities that had more access to those kinds of resources had lower mortality from heat. And we found some relationship, which was really interesting.”
Further Resources & Articles Cited
Kingsley, S. L., Eliot, M. N., Gold, J., Vanderslice, R. R., & Wellenius, G. A. (2016). Current and Projected Heat-Related Morbidity and Mortality in Rhode Island. Environmental health perspectives, 124(4), 460–467. https://doi.org/10.1289/ehp.1408826
South EC, Hohl BC, Kondo MC, MacDonald JM, Branas CC. Effect of Greening Vacant Land on Mental Health of Community-Dwelling Adults: A Cluster Randomized Trial. JAMA Netw Open. 2018;1(3):e180298. doi:10.1001/jamanetworkopen.2018.0298
Summer is the best season in Rhode Island - it’s not the Ocean State for nothing. It’s a twenty-five minute drive to the beach, even after stopping for ice cream and donuts. People are outside all the time. They’re playing basketball, running with their dogs, sitting in parks, and eating at outdoor festivals. When it gets too hot, people cool off with air conditioning or in the breezy shade.
This summer is going to be a little different. It’ll still be hot, but rules for curbing the spread of COVID19 will still be in place. People can’t cool off in places with air conditioning, like the mall or the Y or the movie theater. People are going to have to spend most of their time in their homes, or outside. And that’s going to be a problem because for many, that’s not an option.
AZ: So what is it like a really hot summer day look like then? What do you do?
Everett: Oh my gosh, man, it's, it's hell. Like literally hell. Like it's so hot. It's so, so, so, so hot. And then there's probably like one or two trees.
Frank: Like you can open up your window and you just feel the blazing heat inside and you can just feel how hot it is. And it's, and it is a problem cause when you look outside there's no trees for like miles on end or you can go down a whole street. So those summers did hit heavy...I'd be outside, I'd be playing, I'd be running around...trying to like stand under cover like on some random person's property cause it's so hot outside, you know?
Kufa: She can't bring her dog out to go walk because the dogs' paws literally burn
EP: the fact that like in my neighborhood, it's like five to eight degrees harder than like the Blackstone Valley neighborhood. And it's like, that's like less than like a three mile, you know what I'm saying?...That's a problem.
I’m Angela Zhang, and you’re listening to Not Built For Us. This is a podcast about structures that keep health inequitable, and how doctors can work with other fields to dismantle them and build better ones.
If you know me, you know I’m really into the environment. I bring reusable utensils with me, I compost religiously, and pre-COVID I used to bring trays of leftover food home from events and get crafty, like the curry I made with some leftover veggies and decorative kale from the platter. In medical school, I became interested in climate, environmental, and spatial justice. Those are academic words for some simple concepts: how does nature benefit us, how can we design urban spaces so everyone can have that benefit, and how is climate change affecting that?
Before we answer those questions, I need to give a nod to environmental justice and indigenous rights activists who have been doing this work for years. I’m recording this episode in what is known as Providence, Rhode Island, but was considered, for millennia, land shared by the Narragansett, the Wamapnoag, the Nipmuc, the Pequot, and the Niantic nations.
Today we’ll focus on heat and shade. Why is shade so important? How are trees and shade good for you? Why aren’t they distributed equally? While reporting this, I saw these big questions play out on the ground, especially for communities of color. People were building makeshift shade tents that skirted government regulations, all so they could stay cool while waiting for the b us. Especially now, as the weather warms and people will need to find AC and shade to regulate their temperature, this feels like a big issue. However, it’s not one many doctors think about when advocating for patient health. The pattern of heat and shade we see in our cities is the result of an event cascade from racist redlining policies.
I’m going to use the term shade equity a lot. Often you can find shade in the canopy cover of a tree, or the overhang of a manmade structure. Shade equity frames shade as a resource, one that is distributed inequitably like food, housing, or transportation access. It acknowledges that the wealthy have disproportionate access to this resource, and that it’s a structural issue, that it often affects already vulnerable and minoritized communities. It acknowledges that shade itself has health impacts.
I first heard this term while talking to Sam Bloch. He’s a journalist who used to live in Los Angeles, a city known for being soaked in sunshine. And he started writing about shade equity when he began to notice a huge difference between neighborhoods in the city. Specifically, the iconic Hollywood Hills --
SB: you have these lush edenic basically enclaves that are sort of hidden from the rest of the city.
And the Valley, which is a series of neighborhoods with very little shade where Sam would wait for the bus.
Sam Bloch: I would feel my skin heat up and I would start to get sweaty and I would try to find somewhere just to hide out from the heat. And just observing the way that people begin to contort themselves and try to find slivers of protection from the sun was interesting, is one way to put it. Also sort of farcical and comical because people would seek just the tiniest slivers of shade wherever they could behind a telephone pole, maybe a Palm tree.
Sam became really interested in this idea of shade equity, that someone could have more shade than another person just based on where they lived. Oftentimes, places with the least shade are also the most under-resourced in other ways, and are often where the most people of color live.
In LA, this inequity is not happenstance. In the 1930s, the zoning code mandated that newly constructed single family homes should have front and side yards. These homes in high-value neighborhoods were meant to be bought by white families - more on that later. You could plant a street tree outside your home, but that was on you to pay for the maintenance. In poor neighborhoods,
Sam: that don't have wide yards and big trees in the front, you have this sort of kind of bombed out automobile moonscape….people kind of just know that trees mean money.
Some neighborhoods used to be built for industry and transport. So, you might find a lot of power lines, narrow sidewalks, and intersections.
Sam Bloch: city regulations are that you can't really plant a shade tree under an overhead power line. You don't have big enough tree wells to plant a thick tree...So you can't plant a tree within 60 feet of an intersection or 15 feet of a driveway. So you see that the built environment has basically precluded any possibility for trees.
These regulations aren’t meant to be racist. That’s important. Because even if the intent isn’t racist, the impact continues inequity by literally outlawing shade.
Other times, outlawing shade felt more purposeful. In South LA, the local government trimmed and removed street trees close to where sex workers congregated. In housing projects, police would forbid trees that obstructed sight lines of the surveillance cameras mounted on street poles, even though the cameras don’t deter crime anyways.
As Sam talked about LA, I saw Providence, Rhode Island. That’s where I live now, and that’s where I’ll be unpacking this. How did shade inequity become such a big issue and why does it look so similar from LA to Providence?
I’m walking in South Providence with Jerome Hazen, a resident who lives here. South and West Providence sit across the river from the East Side, where Brown University is located. Though they are only a mile apart, the two sides of the river couldn’t look more different. The East Side, with its lush trees and manicured lawns, houses a lot of Brown’s academic faculty and students. West and South Providence are home to more of the working class and folks of color.
Jay: It's bleak, you know, it's concrete and oil stains everywhere. I mean I granted it as city, I realize that, but I just think a better job could be done to create more beauty in this area. There's more trees in the cemetery that are beautiful and provide more shade for who? Dead people.
Jay and I walk down Elmwood, one of the main streets in this area. It’s pretty warm for a winter day, and lots of people are outside. I’m constantly adjusting the angle of my mic because of the wind, which you can hear as background.
Jay Hazen:The wind just, you know, barrels down on that street.Like where I live, there's no trees around the building. So you know, the walls are cold. It's drafty.
Even on this crisp winter day, I’m feeling the direct sunlight. I wore layers but I’m peeling them off one by one. We walk into the shade of a big tree, the first we’ve seen in almost a mile. But the other half of the sidewalk is almost totally taken up by a city trash can. Between that and the tree well, it’s a narrow space. A person with a walker comes towards us. We have to step into the road to let them pass.
Jay Hazen:Like this view right here. Yeah. You see trees in the background, but like this like corner, it's like waking up to this all day every time. For kids it's like, it's just so bleak and the energy, it just feels, you just feel more alone…[Angela]: And this is what, this is a childcare center?
Kids run around the playground, swinging and sliding and shouting. The only shade from the winter sun is underneath the monkey bars. I can’t imagine this playground in the hot, muggy New England summers.
Jennifer Vanos: on a warm summer day that's clear in most cities, maybe above 80, you're going to get to temperatures that can be dangerous to kids.
This is Dr. Jennifer Vanos, an assistant professor at Arizona State University. She studies playgrounds and how their construction can affect the health of kids. Heat, she says, is one of the biggest issues.
Jennifer Vanos: because of playground safety guidelines, we have to use things like rubber or other artificial materials, plastic...they can heat up to temperatures, um, upwards of 160 to 170 Fahrenheit. If you don't shade a plastic or a rubber surface, then kids can easily burn themselves on those surfaces.
These burns sometimes hurt kids enough to send them to the emergency room. These burns are also under-reported since they aren’t all serious enough to seek medical attention. The heat that reflects off surfaces can lead to hyperthermia and heat exertion. It doesn’t even have to be that hot for all this to happen.
Jennifer Vanos: And what you find when you go into the shade and measure the surface temperatures in the shade is that they will generally almost reach as low as air temperature. If it's on grass, then it can be even cooler.
So, take a typical summer day: It’s 80 degrees out and sunny. A shaded, grassy playground will be fine, but on an unshaded playground on that same day it can be dangerous for kids and parents, who won’t want to hang around in the beaming sun while their kids play. Outside of the playground, adults face similar issues when they want to go outside for some exercise.
Kufa Castro: Whenever I went to go work out, I went to like the greens part of the city, which wasn't where I lived or like Blackstone Boulevard and the East side. Like I was going to work out there instead of like finding a path, like a walking trail like in another place of where I felt that kind of spoke to, you know, to the community that I'm more from
This is Kufa Castro. He’s a community organizer who teaches high schoolers about environmental advocacy in Central Falls, Rhode Island, a densely-populated, deeply Latinx, former mill city just north of Providence. He describes what it’s like to lead a group of teenagers on a walk through the town.
Kufa Castro: and just feeling that low tree canopy...and not having places to stop for shade for miles. and how rough that was….it felt like bootcamp, you know, for the first day.
There’s a reason that just walking in the heat feels like a workout. Heat stresses your body, and sometimes, that stress can be extreme enough to land you in the hospital. You might go for dehydration, heatstroke, or worsening of existing kidney or heart disease. Maybe you got so dehydrated that you got kidney stones or a UTI. A ten degree Fahrenheit increase in temperature can lead to twenty four percent more admissions to the emergency department. Ten degrees seems like a big jump, like the difference you might see over months as days progress towards summer. But on the same summer day in Providence, if the ground temperature under the leafy trees of Brown University measures 82 degrees, it can be as hot as 95 degrees in Pawtucket and Central Falls. That’s the difference, right there, that could land someone in the ED.
And that’s a problem. Because so much of what health professionals recommend for patients is about physical activity. The most up-to-date clinical guidelines suggest a range of 150 to 300 minutes per week of moderate to intense aerobic activity. That breaks down to just a little under an hour a day. For residents of Central Falls or Pawtucket, the lack of shade and green spaces in their neighborhoods makes it harder to exercise and stay healthy.
Dr. Chelsea Graham sees patients in Pawtucket with Brown’s family medicine residency. The clinic sees a lot of patients with chronic conditions, like diabetes, lung disease, high blood pressure, heart disease, asthma, eczema, and obesity.
She describes one patient in particular.
Chelsea: He's an older gentleman from the South who has spent a lot of time outside and loves. He's a very social guy. Before he moved to the central falls area, he loved to be outdoors and would walk all the time.But then when he moved to Pawtucket, it's either really cold in the winter and so he doesn't feel comfortable going outside and then the summer it's just almost too hot. And so he isolates and that affects his mood, affects his depression, staying inside, and then it affects his diabetes.
Being stuck inside is causing problems for many of Dr. Graham’s patients. Those who have recently immigrated often talk about adjusting to extra hot summers and extra cold winters. They don’t feel like they have outdoor spaces to socialize, which are really important community-oriented ways to improve mental well-being.
So that’s all the bad stuff if you don’t have trees. But what if you do? What’s so great about trees besides protecting you from heat? Trees are miracle workers. They are everywhere, but often blend right in. They help squirrel away carbon, protect ecosystems, mitigate flooding, and even may help our bodies calm down without us realizing it.
Beyond the physical medical concerns of overly hot environments, there is a ton of research about the ways that just the presence of trees can change the ways our bodies react and run. Dr. Eugenia South practices medicine in Philadelphia. She researches the effect of the presence and lack of what she calls “urban vegetation” on her city’s residents.
ES: People talked about vacant land as fracturing ties between neighbors...people talked about physical health, particularly as it related to kids and the risk of injury and then trash buildup. ...They said the abandoned homes just messes up like the beauty of the neighborhood....This person said, it makes me feel not important.... seeing vacant lots and abandoned buildings. To me, that's a sign of neglect. So I feel neglected.
Dr. South created a study to understand how Philadelphians experienced this neglect. She had residents walk around wearing heart monitors and measure their heart rate as a marker of acute stress.
ES: if you're in a stressful situation like...you are walking down the street, it's dark. You see someone across the street, you feel your heart rate going up and that's a physiologic response to stress. That's your fight or flight mechanism kicking in. When you think about randomized control trials, normally you're randomizing people to get, you know, drug a or drug B or intervention or intervention B. What we did in this trial was we randomized places to get an intervention….we took 541 vacant lots and randomly assigned them to get either the greening treatment, a trash cleanup only treatment or no intervention.
Dr. South found some pretty incredible results. The heart rate of people who walked by the greened lots went down almost sixteen beats a minute compared to those who walked by the control, unchanged site.
Eugenia South: So this was sort of a signal to us that these newly green spaces became sort of helped people to almost distress. So before perhaps they were sort of stressful spaces and after the greening they became less stressful based on heart rate.
In research interviews, residents felt safer where there were more green lots, and they went outside more. In general, those people exhibited fewer depressive symptoms, even if they lived in impoverished neighborhoods with histories of extreme violence.
ES: gun assaults went down by up to 29% in neighborhoods below the poverty line. So you can see that this is a pretty powerful intervention...the city of Philadelphia has actually incorporated vacant lot greening into their violence prevention plan. For the first time, the violence prevention plan, which is still heavily focused on individuals...also now involves place-based intervention...I keep coming back to this, but again, this idea that changing the environment can actually change how people relate to each other.
Many of the communities we’ve talked about that lack trees are also some of the ones most marginalized and under-resourced. Clearly this didn’t happen overnight. So, how did it get this way?
I had lived in Providence for three years, and wanted to know more about how the city was designed. How did the spaces that had the fewest trees also have the most people of color, the most health disparities, and the most waste byways? To answer that, we need to rewind several decades and talk about something called “redlining.”
In 1933, there was this entity called the home owner’s loan corporation. It was founded as part of the New Deal. The corporation was supposed to refinance defaulted home mortgages to prevent foreclosures. There were a lot of these because remember, this was during the Great Depression. They created what they called “residential security maps” in most major US cities. The maps advised which neighborhoods were at high risk for mortgage lending. They drew red lines around these neighborhoods, and lending institutions could deny those areas access to different types of investments. This would have been fine, except that the red lines the corporations drew around these high risk neighborhoods were mostly neighborhoods with communities of color. In Rhode Island, those were Black, Portuguese, and Italian communities.
When the Federal Housing Administration sent out a manual that directed people in real estate on how to use these maps, they instructed them to keep white neighborhoods white for the property values. That sounds racist, but the 1938 manual literally talks about “incompatible” groups in white neighborhoods. In this way, they codified the link between whiteness and high property values.
Redlining still exists today. You can see it in how neighborhoods are resourced, which is not by accident. But you can also feel it on a hot day.
Jeremy Hoffman: My name is Jeremy Hoffman. I'm the chief scientist at the science museum of Virginia and a faculty member at Virginia Commonwealth university.
Jeremy and his team were looking at the urban heat island effect in Richmond. They found that the warmest and coolest place during a heatwave in Richmond were sixteen degrees apart. If you’ve listened this far, you’ll know we’ve already talked about this. But here’s where it relates back to redlining.
Jeremy Hoffman: when we looked at the spatial expression of those temperatures...this map looked a lot like our redlining map whereby the hotter areas which we were actually representing, redder tones were in the same places as the red lined districts drawn by the homeowners loan corporation in the 30s. So we asked a really simple followup question, are there statistically significant differences between the temperatures experienced in the formerly red line neighborhoods versus the non red line neighborhoods?
The researchers looked at 108 areas that had been redlined, and had land surface temperature data.
Our results are quite stark in that 94% of the cities that were red lines show the exact same tendency whereby the formerly redlined areas are physically warmer during the summer than their non red line neighbors. We've for a long time recognized that these equity economic disparities are related to health disparities and differential climate vulnerabilities in cities. But very rarely have we ever asked like, how did we get here?... linking this red lining map to the heat Island map was a way of connecting the present to the past in a new and in a really visceral way. It's like, you know, a decision that was made almost a hundred years ago is playing out today as a climate vulnerability is just amazing. But really incredibly troubling.
This same connection exists in Providence.
Sam Coren: my name is Sam Coren. I'm a third year PhD student in American studies at Brown.
Sam spent most of their life in South Providence and Cranston. Back then, Allens Avenue was...
Sam Coren: farmland and forested...kids were free to sort of run around. They used to hop in the back of freight cars and steal potato chips and stuff like that.
Now, it’s lined with industrial plants fenced in behind narrow sidewalks and blowing trash. How did this happen?
Sam Coren:The building of I 95 sealed the fate, so to speak of Allens Ave and the waterfront. The petroleum storage facilities that are there now and the scrap metal yards and all the different heavy industrial uses are locked in place by zoning.
Zoning is the official governmental designation of land for different uses. Allens Avenue is zoned as heavy industrial, which creates red tape for any other suggested use.
Zoning is inherently racial and political too. Providence is built on a river that cuts the city into smaller chunks. The river waterfronts used to be highway corridors, industrial sites, and warehouse districts. The waterfronts on the East side of Providence have transformed into green, walkable, inviting spaces. India Point Park bustles every summer with festivals, families, dogs, water sports, and a bike trail. The water by Brown University is the site of a weekly festival called Waterfire that draws tourists from all over.
But for the waterfronts by Allens Avenue, the only officially allowed uses are industry and adult entertainment venues.
Sam Coren: I think what Allens Ave is today, the fact that the waterfront is heavy industrial and heavily contaminated has to do with the fact that the South side historically has been less politically powerful than other parts of the city.
So then after an area is redlined and has cheap land prices, that starts leading to a cascade of events. In Providence, a lot of neighborhoods that were redlined were also divided by newly built highway on and off ramps, fracturing communities even further. This is a lot of the land. In fact, in the 1930s maps, the only “green” or “best” neighborhood was the East Side of Providence. Yup, you guessed it, the green spaces near Brown. The rest of the neighborhoods were colored yellow or red and were deemed more risky. And I’ll just remind you again that these neighborhoods were deemed risky because Black and Brown folks lived there. They were designed for passage for things like carriages and cargo, and so had big wide streets that were made for driving, not for walking.
Sam Coren: The neighborhoods that were built for the working class tended to be designed more hastily and without provisions for greenery and landscape that might go into the building of more affluent districts.
Shade inequity isn’t a new problem. In Rhode Island, Groundworks, where Kufa works, has done some incredible community outreach in Pawtucket and Central Falls, which are historically low-income and redlined areas. They assess which yards would be good to plant shady trees in and plant trees at local elementary schools. But, Kufa says, this kind of advocacy work is difficult to do when you are working with a predominately white local government. Kufa recalled sitting in on a government meeting where local officials discussed heat maps and tree canopies in Providence.
Kufa Castro: Just seeing like urban heat Island maps and seeing that the, you know, where the hottest blisters are on a map is where I live, where everybody I know lives, and seeing that discrepancy and just the fact of our concentration in these were real hotspots...I've never felt so much like tension in a room. And I feel like this work has to come with a lot of like counseling and therapy for, for the people that you share this information with and that you work in this field. Cause it's some heavy stuff.
OK, so I’ve talked about the disparity in shade equity within a few square miles in Providence, the history behind that, and why it harms the health of our patients. It shouldn’t surprise you that this is all getting worse with climate change.
Climate change is already affecting our most vulnerable communities. These communities are worldwide, but also right here. Already, our cities are seeing 1, 5, 10 more dangerously hot days each summer. If we don’t take action on the climate crisis, cities like Baltimore, Boston, Chicago, Philadelphia, and New York could see 70 more days of extreme heat, which would result in extras of thousands of deaths per year. And remember from the top of this episode, that the communities without trees are hotter, so they might have more extreme heat days than we actually measure from our weather stations.
Climate change doesn’t always look like hurricanes, floods, or heatwaves. The climate crisis is sneaky. For a while, it will continue to look like balmy sundress days in December, or mixed hail and sleet in April. It will look like the just barely increased salt in freshwater reservoirs in Bangladesh, so small of an increase that you can’t taste it, but has been correlated with preterm births. It will look like us compensating for the differences in food supply until one day, the vulnerable won’t be able to compensate anymore. It already looks like Pawtucket streets burning dog paws and the basketball courts feeling like skillets in the summer. These will seem like isolated incidences, because our minds are not wired to piece all the warning signs together.
Let’s pause and do an emotional check in. You may be feeling overwhelmed right now. So what can we do as doctors? First, our voices matter. Everett Pope, from Sunrise Rhode Island:
Angela: Do you feel like doctors should care about this stuff, and -
Everett Pope: Hell yeah. Hell yeah. Y'all got like, come on because y'all got juice. Like the random doctor I ain't never heard of for my whole life could write a random paper and that's going to be headline news for the next week and a half.
So advocacy for this can look like a lot of different things. Underlying it all, I want to come back to shade equity. Like, shade is a resource we can choose to allocate equally, but usually do not. Just like food, water, clean air, and housing.
First, you can talk with your patients. Talk to them about exercising while being conscious of their built environment. When I interviewed Dr. Graham, she talked through how she counseled patients on their diets.
Chelsea: What's working for you? What's not working for you?...And then also asking about like access to food, you know, what groceries can you buy and that kind of stuff. Cause again, I'm not going to tell people what to eat if they can't afford it or if they can't get to the grocery store.
As you can tell, Dr. Graham is practiced at this. What if doctors could do this about shade? When we give activity recommendations to patients, we might ask them how they feel about being outside in their neighborhood. Do they feel safe, where are the sidewalks and the parks, are there trees and shade? A breeze? Can they be outside without overheating? Do they have AC units indoors?
Eugenia South: There is this movement called park RX that...which sort of involves prescribing nature. So a physician actually giving a patient a prescription to go out in nature. This is still very early...I think nature right now is where exercise was, you know, 15 or 20 years ago. We need to talk to patients about getting outside. We should really be thinking about incorporating nature into existing social determined interventions such as community health worker initiatives...where are the nature locations that would be good to go to. What are the safe places to go, et cetera. And we of course have to remember that one size is not a one size fits all type of intervention.
The second thing we can do is advocate on a larger scale . Greg Wellenius and his team, for instance, successfully advocated for the weather service to lower the temperature at which heat advisories were sent out. Dr. Wellenius also says that action on climate change is really, really important.
GW: Climate change is likely the number one threat to public health gains that we'll see in our lifetimes. But it's also the number one opportunity to create a better, healthier, more equitable society. This is not a problem about a far off distance or other people. This is going to impact you and your family and your community today and tomorrow.
You can also get involved in research. Dr. Vanos said it means a lot to researchers like her to access data sets that doctors have, like pediatric asthma rates. Researchers know more about air temperature or air quality, but don’t have the evidence to drive policy. If you combine the two, you can start showing policymakers the intersection between health inequity and environmental justice.
JV: People will listen more when you make it about health than just about an air temperature. The first question people ask, well what does that mean for people's health in the city or people's health in the neighborhood?
We should work with policy makers, architects, urban planners, arborists, historians, and most importantly, the folks in the community itself. That way, the solutions are ones the communities actually need. Maybe it’s planting trees, or creating shade with other materials. Maybe it’s scoring communities based on their climate justice initiatives. By collaborating, we can also do our best to avoid pitfalls down the road, like greening neighborhoods without considering that it’s often the first step to gentrification.
While doing all of this, we have to remember to center the communities that this advocacy really benefits.
Kufa Castro:I remember getting into this field and not seeing that many professionals of color. It was a hard thing like going into city hall meetings and being like the only one. I go in there and everybody's white, Pawtucket doesn't look like that.
Right now, I’m recording this while sitting on a comforter in my closet. We’re in the middle of COVID-19, an unprecedented pandemic that has changed our world, but not as much as climate change will. We have to stay inside as much as possible and stay six feet away from others. What will this look like in Pawtucket, Central Falls, and West and South Providence this summer when these rules are still in place? What will it look like when the inside of a home is just as hot as the outside, and all the parks are full? With higher rates of infection and unemployment, COVID is already disproportionately affecting Black and Brown communities the most. This summer, we’ll still be in a pandemic, and the lack of greened spaces and shade equity will be even more apparent in our neighborhoods.
Part of my goal with these audio essays is to amplify the voices outside of medicine, the ones I didn’t know about until I made an effort to branch out. I’ve felt frustrated listening to the struggles of community advocates, the makeshift solutions that skirt regulations to help other people. But I’ve also felt hopeful. I’ve interviewed people all around the country who think and work and live this.
Close your eyes for a moment. Think about the neighborhoods we’ve just walked through together, either in Providence or the ones similar in your city. Think about the racist ways redlining echoes through history into today. And now, think about how we start to change that. How would it look different with trees everywhere, leaves rustling in the wind and shade over you? Think about what your patients would do if the built space were changed. I think we can imagine a better future.
KC: Kids are touching, naming the trees, feeling connected to them, names like Fred Spots
EP: We’d probably walk around more, i could convince my friends to walk around more. My friends think I'm weird to walk and take the bus. Enjoy the city a little bit more. Make things so much more beautiful.
This episode was written, edited, hosted, and produced by me, Angela Zhang. I use she/her pronouns and I’m a 4th year medical student at The Warren Alpert Medical School of Brown University. I’ll be applying to residencies this year. This episode would not have been possible without the Office of Diversity and Multicultural Affairs at my medical school, who employed me as a Fellow for this last year and helped fund some of this work. Being able to dive full-time into these complex topics was invaluable. I met so many people passionate about this work, not all of whom made it into the audio for this episode, but I’ll link their work in the show notes. If you want to learn more, these are the experts.
Thanks to Max Jordan Nguemeni Tiako, Eugenia South, Jennifer Vanos, Greg Wellenius, Chelsea Graham, Jeremy Hoffman, Kufa Castro, Frank from Shea High School, Everett Pope, Jay Hazen, Sam Bloch, Sam Coren, Chinyere Agbai, and David Eisenman for their time and energy.
For their help with ideation, patient editing, and listen-throughs, a huge thanks to Allison Behringer, Ana Gonzalez, Laura Garbes, Maggie Goddard, Sarah Hsu, Anders Lindgren, Fatima Husain, and Judee Burr.
Music credits to Kevin MacLeod, Lee Rosevere, Podington Bear, and the Let’s Move! campaign.