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Introduction to Environmental Justice & Health Equity


The purpose of this fact sheet is to: (1) define concepts related to environmental justice and its connection with health equity; (2) provide two case studies outlining the Department of Health and Human Services (HHS) and Health Resources and Services Administration (HRSA) response to significant environmental justice issues; and (3) offer a comprehensive list of resources for HRSA award recipients to learn more about the intersection of environmental justice, climate change, and health equity and how it may impact the communities they serve.

Background & civil rights protections

HHS/HRSA continues to ensure that its award recipients are informed of federal efforts to advance environmental justice and conservation, and to protect the health of impacted communities on the frontlines of environmental hazards that affect health.

Climate change presents a significant risk to the health of communities that already bear a disproportionate impact of discrimination and inequity. The impact of environmental hazards that drive health inequities are felt most by underserved populations, such as racial and ethnic minorities. There has been significant research on the unequal burden of toxic pollution and environmental hazards on racial and ethnic minority and low-income communities, due to a history of practices and policies that permit the release of hazardous pollutants, which cause environmental health risks in these communities.1

Under Title VI of the Civil Rights Act, entities that receive funding from HHS/HRSA are prohibited from discriminating against beneficiaries based on race, color, and national origin (including limited English proficiency).2 Environmental justice and Title VI are rooted in the same principle that no person should bear an unfair share of harm based on protected characteristics, such as race, color, and national origin.3 Executive Order 14008 aligns with Title VI and outlines a whole-of-government approach to advancing environmental justice for communities that have been “historically marginalized and overburdened by pollution and underinvestment in housing, transportation, water and wastewater infrastructure, and health care.”

Key terms

  • Environmental justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.4
  • Equity means the consistent and systematic fair, just, and impartial treatment of all individuals.5
  • Fair treatment means no group of people should bear a disproportionate share of the negative environmental consequences resulting from industrial, governmental and commercial operations or policies.6
  • Underserved communities refers to populations sharing a particular characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life.3

Case study 1: Flint, Michigan & HRSA’s response

On April 25, 2014, Flint, Michigan, a city with a predominantly Black population (69.4%) switched its water supply from Detroit-supplied Lake Huron water to the Flint River. The Flint River water was corrosive to lead, and no corrosion control was used to prevent contamination from the aging infrastructure and lead pipes that ran throughout the city. This created a severe public health emergency where the Flint River water was leaking lead and other contaminants from the pipes running to homes throughout the Flint community, severely impacting the drinking water quality for residents of Flint.

Residents began voicing concerns about their water taste, color, and odor, as well as various health concerns they began noticing, such as skin rashes. By the time the water source was switched back to Lake Huron in October 2015, almost 100,000 Flint residents had been impacted by drinking water quality changes. A State of Emergency was declared on January 16, 2016, almost two years after the water source had been switched and residents had been voicing their serious concerns.

In May 2016, HHS Centers for Disease Control and Prevention conducted a community assessment to evaluate the behavioral and physical health concerns. Elevated lead exposure levels caused by drinking the contaminated water were highest among single-parent families and areas with lower socioeconomic advantage (i.e., poverty and low educational attainment).7 It also disproportionately affected developmentally vulnerable children and pregnant mothers.

Prior to the water crisis, Flint was already experiencing a multitude of environmental and health issues, including poor nutrition, concentrated poverty, and older housing, all of which further exacerbated the crisis and its impact (see report from the Michigan Civil Rights Commission, The Flint Water Crisis: Systemic Racism Through the Lens of Flint for more information (PDF - 2 MB)).

HRSA-funded community health centers supported the immediate healthcare needs of the residents of Flint by providing community outreach, lead testing, and referral to treatment and behavioral health counseling. Community outreach activities included lead screenings and referrals, distribution of water filtering kits, and prevention education. Additionally, Genesee County’s Healthy Start program expanded access to services to minimize the health effects of lead exposure among pregnant women, infants and young children in Flint by working in partnership with community organizations across the area.

Case study 2: Alabama Department of Public Health & first HHS/DOJ Environmental Justice Agreement under Title VI of the Civil Rights Act

On May 4, 2023, the Department of Justice (DOJ) and HHS announced an interim resolution agreement in their environmental justice investigation into the Alabama Department of Public Health and the Lowndes County Health Department (collectively ADPH) in Lowndes County, Alabama. The 18-month investigation began in November 2021 regarding concerns in ADPH’s operations and compliance with Title VI of the Civil Rights Act.

Specifically, the investigation revealed that ADPH’s enforcement of sanitation laws threatened residents of Lowndes County with criminal penalties and even potential property loss for sanitation conditions that they did not have the capacity to alleviate. The investigation also revealed that ADPH engaged in a consistent pattern of inaction and neglect concerning the health risks associated with raw sewage. Despite ADPH’s awareness of the issues as well as the disproportionate burden and impact placed on Black residents in Lowndes County, it failed to take meaningful actions to remedy these conditions.

ADPH agreed to take measures to improve public health and the environment for the residents of Lowndes County, including:

  • Suspending enforcement of sanitation laws that could result in criminal charges and potential property loss for residents in Lowndes County who lack the means to purchase functioning septic systems.
  • Coordinating with CDC to measure the level of health risks different populations experience from raw sewage exposure and adopt CDC’s recommendations.
  • Launching a public health awareness campaign to ensure residents receive critical health and safety information related to raw sewage exposure.
  • Providing public health educational materials for Lowndes County healthcare providers to provide more information on symptoms and illness related to raw sewage exposure.
  • Creating a plan to improve access to adequate sanitation systems and address public health risks associated with raw sewage exposure.

The agreement marked the first environmental justice settlement jointly secured by HHS and DOJ under federal civil rights laws—specifically Title VI—and affirmed that environmental justice is a public health issue and an HHS priority (see Interim Resolution Agreement (PDF - 527 KB)). Title VI applies generally to all HHS (including HRSA) award recipients, prohibiting discrimination based on race, color, and national origin. This agreement serves as a notification to HRSA award recipients that Title VI may be applied in cases of environmental justice; and outlines concrete steps that may demonstrate proactive compliance on this front, such as providing educational materials and creating a comprehensive plan to address certain public health concerns, as applicable.


1 Brulle RJ, Pellow DN. Environmental justice: human health and environmental inequalities. Annu Rev Public Health. 2006;27:103-124. doi:10.1146/annurev.publhealth.27.021405.102124


3 a,b Department of Justice.,operate%20in%20a%20nondiscriminatory%20manner.

4 HHS Office for Civil Rights.


6 Environmental Protection Agency.

7 Centers for Disease Control and Prevention. (2020, May 28). Community Assessment for Public Health Emergency Response: Flint Water Crisis.

8 a,b,c Liévanos RS, Evans CR, Light R. An Intercategorical Ecology of Lead Exposure: Complex Environmental Health Vulnerabilities in the Flint Water Crisis. Int J Environ Res Public Health. 2021;18(5):2217. Published 2021 Feb 24. doi:10.3390/ijerph18052217

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