title: What causes environmental inequalities and related health effects? An analysis of evolving concepts.
abstract: Early environmental justice studies were exposure-oriented, lacked an integrated approach, and did not address the health impact of environmental inequalities. A coherent conceptual framework, needed to understand and tackle environmental inequalities and the related health effects, was lacking. We analyzed the more recent environmental justice literature to find out how conceptual insights have evolved. The conceptual framework of the WHO Commission on Social Determinants of Health (CSDH) was analyzed for additional explanations for environmental inequalities and the related health effects. This paper points out that recent environmental justice studies have broadened their scope by incorporating a broader set of physical and social environmental indicators, and by focusing on different geographic levels and on health impacts of environmental inequalities. The CSDH framework provided additional elements such as the role of structural determinants, the role of health-related behavior in relation to the physical and social environment, access to health care, as well as the life course perspective. Incorporating elements of the CSDH framework into existing environmental justice concepts, and performing more empirical research on the interactions between the different determinants at different geographical levels would further improve our understanding of environmental inequalities and their health effects and offer new opportunities for policy action.
authors.affiliation: Centre for Sustainability, Environment and Health (DMG), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands. hanneke.kruize@rivm.nl.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Kruize
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands. m.droomers@amc.uva.nl.
authors.forename: Mariël
authors.initials: M
authors.lastname: Droomers
authors.affiliation: Centre for Sustainability, Environment and Health (DMG), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands. Irene.van.Kamp@rivm.nl.
authors.forename: Irene
authors.initials: I
authors.lastname: van Kamp
authors.affiliation: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands. Annemarie.Ruijsbroek@rivm.nl.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Ruijsbroek
mesh_terms: D003210:Concept Formation; D004782:Environmental Health; D054624:Health Status Disparities; D006801:Humans; D038622:Internationality; D008962:Models, Theoretical