If the pandemic shutdown were now, those with obesity and others who suffer from the adverse effects of ground-level ozone might have caught a break. Officials know that other forms of pollution dropped significantly during the early spring.

Particulate pollution was greatly reduced briefly, according to a state Department of Energy and Environmental Protection (DEEP) report, because so many cars and trucks remained off the roads for weeks. DEEP reported that nitrogen dioxide levels (NOx) decreased 30% from normal along Interstate 95 from Washington, D.C., to Boston.

As summer’s heat sets in, tailpipe emissions are also rising as the state’s economy opens, creating conditions that are ideal for dangerously high levels of ground-level ozone.

Those trends likely will match those of previous years.

“The heat certainly makes the work of breathing harder just because your body temperature goes up and your metabolism goes up.”

— Dr. John Morton

The American Lung Association’s “State of the Air” report issued on April 21 rated all Connecticut counties “F” for ground-level ozone for 2016-2018. That F rating refers to the number of “orange” days, when at-risk groups—including people with obesity and those with chronic respiratory illnesses—are warned to limit outdoor activity, and “red” days, which indicate unhealthy ozone for all. The three counties with the worst ratings were Fairfield, New Haven and Middlesex.

Obesity rates, especially among Blacks and Latinos, have increased as the climate has warmed, and scientists find the two are connected in two different ways: First, hotter summer extreme temperatures worsen chronic health problems for people carrying extra weight.

On the other hand, researchers have found, the American way of life—frequent car travel, sedentary routines, and industrial farming–all contribute to climate change. Large-scale, energy-intensive food production feeds high greenhouse gas emissions while contributing to social conditions that promote processed food with poor nutritional value over access to fresh food.

Obesity And The Risks

Obesity is defined as a body mass index (BMI) over 30. Severe obesity is defined as a BMI over 40. Examples of obesity are a 5-foot 6-inch tall person who weighs 186 pounds or more, or a 6-foot tall person weighing more than 221. Examples of severe obesity are a 5-foot 6-inch person weighing more than 247 and a 6-foot-tall person over 294.

The Centers for Disease Control and Prevention (CDC) said in its most recent national report that obesity affects 42% of adults, 40% of young adults (age 20-39), 45% of middle-aged adults (age 40-59) and 43% of people age 60 and older.

When combining data from 2016-2018, non-Hispanic Blacks had the highest prevalence of obesity at 39.1%, followed by Hispanics, 33% and non-Hispanic whites, 29.3%, according to the CDC.

In Connecticut, 27% of all adults, almost 12% of children and 14% of toddlers (2-4) have obesity. In 1990, the rate was 10% of all adults, reports Connecticut Data Haven in its 2019 Community Health Well-Being Survey.

Scroll through this gallery to view combined obesity prevalence from 2016-2018 among non-Hispanic Blacks, Hispanics and non-Hispanic whites.

Across all groups, roughly a third of Connecticut’s population, about 1.2 million people, suffer on high-ozone days. In 2019, there were officially 21 high-ozone days. In 2020, two days have exceeded the threshold as of July 7.

Obesity is a disease of inflammation—meaning the body perceives an invader, and hormones that drive metabolism react. Ozone increases inflammation in the human body, said Dr. John Morton.  He is a surgeon, obesity researcher, and division chief for bariatric and minimally invasive surgery for the Yale New Haven Health System and vice chair of surgical quality for Yale School of Medicine.

“Higher ozone is going to create a double hit,” he said. “You have the inflammatory response of obesity along with ozone, which will make it worse.

“We saw that in COVID obesity was a big risk factor in China and Europe and the United States because of the enhanced inflammatory response,” he said. “Certainly, ozone and obesity don’t mix.” Obesity also has been proven to be a response to environmental factors like chemicals and BPA plastics, and climate change itself is linked to rising obesity rates because of greenhouse-gas-intensive practices like raising red meat, Morton said.

Obesity decreases lung function and makes chronic problems like sleep apnea worse, he said. “The heat certainly makes the work of breathing harder just because your body temperature goes up and your metabolism goes up.” Over his 20 years of practice, he said, he has noticed “more issues with heat and sun.”

“The biggest thing if you are carrying extra weight is to do something about your weight. We have many different therapies. We believe obesity is a disease,” Morton said. Those therapies include six federally approved medications; a modified bariatric surgery known as a sleeve gastrectomy, which makes the stomach smaller; cognitive therapy; and other procedures that help with hormone production.

Morton said he used to advise that patients visit air-conditioned stores to walk around on very hot days, although during the pandemic “it’s become harder” to do that and stay away from crowds. But staying active is still important, he said. “It helps their heart. It helps their mood. Social isolation becomes a big risk factor for mortality. People who carry extra weight become socially isolated.”

He acknowledged that it can be hard to move around in heat, high ozone, and during a worldwide pandemic. He advises taking a walk during cooler times of the day. “If it is time to slow down, slow down. Hydration is really important.”

Scientists say not enough studies have been done on obesity and climate change in light of the 2.3 billion adults who the World Health Organization estimates have obesity. In the United States, funding for climate-related health effects occupies just .004% of the National Institutes of Health budget, said Dr. Kristie L. Ebi, an epidemiologist at the University of Washington who studies the health risks of climate variability.

“Ozone affects anybody who has any kind of lung issue,” she said in response to a question during the Metcalf Institute for Marine and Environmental Reporting workshop in June. “We don’t differentiate vulnerable groups very well. We tell everyone to do the same thing” when ozone levels are high. That is to stay inside.”

A University of Michigan review of 170 studies linked ozone to breathing problems in people with body mass indexes over 30. The study noted that those with obesity experience lower lung function in general. It also noted that “few epidemiologic studies have examined the interaction between excess weight and ozone exposure among adults.” The authors suggested that as obesity rates rise, more particular studies of people with obesity are needed to figure out risks they live with. They added that “recognition of this susceptibility could help regulators to designate obese populations as at-risk populations under the Clean Air Act for consideration in standard setting and public health warnings for air pollution.”

A 2019 study by California and Colorado scientists found a connection between ozone exposure and higher triglycerides (fat found in the blood) and lower “good” or HDL cholesterol. And a 2007 Harvard School of Public Health study of older veterans concluded that those with obesity and lung sensitivities suffer more when exposed to ozone.

Dr. Kai Chen

The Institute for Health Metrics and Evaluation’s Global Burden of Disease study estimated ozone exposure causes 254,000 additional premature deaths globally each year. For Connecticut, that study estimated that 231 deaths in 2017 from chronic obstructive pulmonary diseases (COPD) were due to long-term ozone exposure. “This is a very conservative estimate,” said Kai Chen, an assistant professor of epidemiology at Yale School of Medicine who studies the intersection of climate, pollution and human health, “because cardiovascular mortality is also related to ozone exposure.”

Ozone is connected to other health conditions, too. For example, a 2017 study by a group of scientists across the United States connected long-term exposure to ozone in Black women, and a study of New York asthma sufferers linked ozone to increased hospitalizations.

Warning Standard May Be Too Lax

Current science suggests that the state’s danger threshold for ground-level ozone should be stricter, scientists say. It is based on the Environmental Protection Agency’s unhealthy ozone standard of 70 parts per billion over eight hours using data from the previous three years. The federal standard was last lowered from 75 ppb in 2015.

“This standard is likely not enough to protect the public health,” said Chen, who has studied ozone and health in the United States and China.

Setting a stricter danger threshold would immediately result in many more “orange” and “red” days, issuing warnings to people with chronic health conditions like obesity, heart disease and asthma to limit their movement outside. As the climate warms, ozone levels will get worse not only in the summer but also in the winter, scientists predict.

About 170,000 people—roughly 5 percent of the state’s population—live within a mile of these facilities, risking exposure to a leak, explosion or adverse health effects.

Low-income people and children of color under the age of 12 are more likely than their white counterparts to live in these “fenceline” communities, according to a report by the Center for Effective Government.

Derek Torrellas Photo.

On Welton Street, New Haven, residents live near the Chlor-Alkali plant.

In its report “Living in the Shadow of Danger: Poverty, Race and Unequal Chemical Facility Hazards,” the center examined more than 12,500 facilities in 50 states, grading states based on the “disparities faced” by people living adjacent to or near these facilities. The center reported that children of color under age 12 living in the state were 2.2 times more likely than white children to live within a mile of one of these facilities. In many instances, residents are unaware of the dangers just blocks from their homes, the report said.

Connecticut, and 25 other states, earned a “D” grade for its inequities. But, like in many states, there’s little that can be done because many of the facilities were built under old zoning laws and are protected.

“I’ve been doing this for 25 years, and I don’t see things changing. It’s frustrating,” said Edith Pestana, administrator of the state Department of Energy and Environmental Protection’s (DEEP) Environmental Justice Program, which was formed to assist neighborhoods unfairly burdened by environmental hazards.

“I have to say I was traumatized that we got a ‘D,’ but … people are living where they were always living, and it hasn’t improved.”

“A lot of it has to do with terrible zoning. A lot of facilities are grandfathered in,” Pestana said. “Until cities start looking at public health again, when they are rewriting their planning and zoning rules, things are not going to change.”

But the dangers are real, especially for people of color, experts and advocates said. Between 2010 and 2014, incidents occurred more frequently at facilities in neighborhoods predominantly populated by people of color—one incident per six facilities compared with one per 11 in predominantly white neighborhoods.

In 2015 the EPA estimated that 150 “catastrophic” accidents occur nationwide at regulated facilities each year.

“These incidents keep happening and happening. It feels like we get a new report once or twice a week,” said Anna Fendley of United Steelworkers, which represents 30,000 workers in chemical facilities across the country, including Connecticut.

The most recent incident in Connecticut took place in December 2016, when an explosion occurred inside a warehouse at New Haven Chlor-Alkali bleach manufacturing plant. The incident did not cause any injuries, but it was a wakeup call to some nearby residents.

“You have families that live on this street,” said 28-year-old John Smith, pointing to his son arriving home from school. He lives on Welton Street across from railroad tracks that bring 90-ton railcars of chlorine to and from the plant. “I like this street, it’s quiet except for the trains, but if I could I wouldn’t live near here.”

Federal, State And Local Oversight

An amendment to the Clean Air Act of 1990 mandated that facilities holding large quantities of certain potentially toxic chemicals submit a “risk management plan” to the EPA detailing the procedures to be followed if an explosion sends those chemicals airborne.

Peter Hvizdak - New Haven Register Photo.

The Chlor-Alkali facility was damaged following an explosion last December.

Connecticut’s 27 regulated facilities range from chemical manufacturers to food and beverage facilities and aerospace companies. The chemicals stored or processed include ammonia, chlorine, pentane, butane, propane and others.

The facilities employ more than 7,000 workers and are scattered statewide. In addition to New Haven, facilities are in Bridgeport, Norwalk, North Haven, New Britain, Wallingford, Bristol, Suffield and Windsor Locks, among other communities, according to reports compiled by the Houston Chronicle’s Right-To-Know Network. The newspaper created the listing because the EPA does not have a public database of “risk management plan” facilities online.

In 1993, DEEP created an Environmental Justice Program to help communities exposed to higher levels of environmental pollution.

No “segment of the population should, because of its racial or economic makeup, bear a disproportionate share of the risks and consequences of environmental pollution or be denied equal access to environmental benefits,” according to the state agency’s policy.

In 2009, the state enacted a landmark environmental justice law, which helps neighborhoods express community health concerns and negotiate with companies.

But that has done little to lessen the dangers because the law covers only new and expanding companies. Most facilities storing and processing chemicals existed prior to 2008.

The worst-case disaster scenario for the Chlor-Alkali plant would be a broken hose on one of those railcars, which would allow the chlorine to vaporize into the air, according to the company’s plan submitted to the EPA. An entire railcar of chlorine escaping could be toxic as far as 25 miles, impacting 1.6 million people, the documents report. The plant calls this “extremely unlikely,” but acknowledges the more immediate risk to those living nearby.

“However, even a chlorine release that is stopped within 30 minutes could be toxic to our nearby neighbors,” the documents read.

“There’s a really good chance you’re in danger if you’re that close,” said Sean Moulton, one of the contributors to the report who now works for the Project on Government Oversight. That organization took over much of the Center for Effective Government’s work in March 2016.

“Certain societal forces got us to this point,” he said. “We need to do something about future facilities and figure out a way to reach out to communities that are there now, ensuring that they have the proper tools and knowledge to deal with short-term emergencies and address long-term consequences of living near these facilities.”

 To view graphic details, click map’s upper left corner.                           Graphic by Marie Shanahan.

Changes In New Haven

What can change is how municipalities handle incidents. Sometimes it takes an incident—or an explosion—to bring about change.

In New Haven, residents have long complained about the Chlor-Alkali bleach manufacturing plant, formerly H. Krevit & Co., which shook their Cedar Hill neighborhood last December. A container explosion released sodium hypochlorite, a chemical dangerous to inhale and ripped a hole through the rear of the building. Residents heard and felt the morning blast but weren’t notified it was a chemical explosion for six hours.

After the explosion, the city’s Office of Emergency Management updated its notification system so if that were to happen again, phone calls and text messages would go to residents within 2 miles of the incident. The city also plans to distribute a chemical preparedness pamphlet citywide.

Chlor-Alkali’s business development manager, Arjun Murthy, now regularly attends meetings with neighbors to address concerns and said the plant has “made a number of process changes inside our plant and added new equipment to ensure that something similar never happens again.”

“Unfortunately, we had to have an incident to get to this point,” said Marie Gallo, a member of the Cedar Hill Merchants Association and owner of Gallo’s Appliance, which is a few blocks south of the plant. At a recent merchant meeting during which the city announced its plan, she said, “If we were taken a little more seriously three or four years ago, maybe we wouldn’t be at this point now.”

“These communities suffer disproportionately,” said Dr. Mark Mitchell, a public health physician who founded the Connecticut Coalition for Environmental Justice and currently serves as principal of Mitchell Environmental Health Associates.

“There’s a direct correlation between the percentage of people of color in a community and the number of environmental hazards in those communities—and the relationship is even stronger between poverty and environmental hazards.”

“People don’t know that it’s dangerous. They don’t know what they are living next to,” he said. “And particularly in low-income neighborhoods, people move very frequently and so even if you tell people today, then next year there could be a whole new set of people who won’t know.”