New River Bridge in Summer

How Our Environment Impacts Our Health

Matt Cox, PhD
Greenlink Analytics

Guest Blog By: Dr. Matt Cox

Two facts to start with:

  1. At the end of July, the CDC forecasted that the rate of COVID deaths is going to accelerate over the next month (at least).
  2. 2020 marks the 50th anniversary of the Clean Air Act.

We’re in the middle of a global pandemic, with a respiratory virus wreaking havoc on the American population and its economy. The human toll continues to grow in many communities, cities, and states; deaths and hospitalizations are up, to say nothing of the impacts of social isolation, quarantines, and the recession.

How is that connected to the passage of one of America’s most important environmental laws? Simply put, if the Clean Air Act had never been passed, these COVID outcomes would almost certainly be much worse.

In 2011, the EPA projected that the Clean Air Act would help the country dodge 200,000 heart attacks and 230,000 premature deaths this year, although I’m pretty sure they didn’t factor “global pandemic” into their model.

Economists, engineers, and policy analysts have estimated the human damage wrought by air pollution, coming in with a price tag over $750 billion a year, or about 5% of US GDP.

These costs are almost entirely the result of the impact on public health – lost workdays, heart attacks, strokes, and premature deaths. How many COVID deaths would not have occurred if we had better air quality? Unfortunately, our air quality has recently been getting worse, impacting about half of the US population.

One focus of my organization is trying to improve outcomes across the country, community by community, city by city, state by state, by working on energy and environmental policy. Energy consumption is a major cause of air pollution across this country, and the impacts are not randomly distributed. Where you live and what you live in are major drivers of energy costs, and systemic racism in the American context has led to frontline communities bearing the brunt of these costs.

This is not new in American life – the environmental justice movement started in a rural county of North Carolina in the early 80s. These concerns are increasingly studied through energy burdens – the percent of household income spent on energy bills.

Structural and systemic causes drive low-income and communities of color to face higher barriers to accessing opportunities to alleviate high utility burdens [1] [2] [3], including low wages, the wealth gap, and other financial barriers [4], historical governmental policies such as redlining [5], housing quality [6], and even higher costs for energy-efficient equipment from neighborhood retailers [7]. Utility bills are also the most commonly-cited reason that people turn to short-term loan products, contributing to chronic poverty in the United States [8]. And ultimately, this circles back to health again – in addition to the toll on mental health such levels of stress can have, a fifth of American households report skipping a meal or not filling a prescription in order to keep the lights on.

So that’s a lot of doom and gloom. What do we do about it? Clean energy has a lot to offer this conversation and demonstrates how so much of this is tied together. From 2016 through 2019, we were asked to assess the public health impact of one of the most impactful energy efficiency programs of the past decade – the Atlanta Better Buildings Challenge. We utilized our AI-enabled modeling of the US energy system to assess the impacts, and the results were eye-opening.

This voluntary program in Atlanta, Georgia, had public health benefits as far away as Maine and Minnesota, and in 2017, the biggest beneficiary of the whole effort wasn’t even Atlanta – it was Birmingham, Alabama! The effort had also added jobs to the city and grown the economy.

We’ve also done recent studies of full-on clean energy transitions in states with significant Appalachian footprints – North Carolina (cool video summary) and Virginia. In North Carolina, a big push would save folks $100 a year, create over 100,000 jobs, reduce every major pollutant, and in the process reduce missed work days by 255 YEARS while saving 1200 lives. In Virginia, we showed that a transition to a fully-decarbonized power sector would save Virginians over $3.5 billion in health costs, while also saving households thousands of dollars on energy bills and being an overall cost-effective strategy. This message was ultimately compelling enough that it became state law in early 2020, when Governor Northam signed the Virginia Clean Economy Act.

There’s plenty to be optimistic about because we have the tools and the knowledge to make things better. There’s also plenty to be aware of, because there’s so much work to do to capture those opportunities to make a better world. Making the world more just in terms of health outcomes, clean energy, and many other areas can be a massive win-win…if we muster the political and economic will to bring it into being.

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[1] Ross, L., A. Drehobl, and B. Stickles. 2018. The High Cost of Energy in Rural America: Household Energy Burdens and Opportunities for Energy Efficiency. Washington, DC: ACEEE.

[2] Jessel, S., S. Sawyer, and D. Hernández. 2019. “Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature.” Frontiers Public Health 7: 356.

[3] Berry, C., C. Hronis, and M. Woodward. 2018. “Who’s Energy Insecure? You Might be Surprised.” In Proceedings of the ACEEE 2018 Summary Study on Energy Efficiency in Buildings, 13: 1–14.

[4] Jargowsky, P. 2015. Architecture of Segregation: Civil Unrest, the Concentration of Poverty, and Public Policy. New York and Rutgers-Camden: Century Foundation, and Center for Urban Research and Education.

[5] Rothstein, R. 2017. The Color of Law: A Forgotten History of How Our Government Segregated America. Liveright Publishing.

[6] Bednar, D., T. Reames, and G. Keoleian. 2017. “The Intersection of Energy Justice: Modeling the Spatial, Racial/Ethnic and Socioeconomic Patterns of Urban Residential Heating Consumption and Efficiency in Detroit, Michigan.” Energy and Buildings 143: 25–34.

[7] Reames, T., M. Reiner, M. Stacey. 2018. “An incandescent truth: Disparities in energy-efficient lighting availability and prices in an urban U.S. county.” Applied Energy Vol 218.

[8] Levy, R. and J. Sledge. 2012. A Complex Portrait: An Examination of Small-Dollar Credit Consumers. Chicago. Center for Financial Services Innovation.

Disclaimer: Blog posts on CEG’s Community Perspectives blog do not necessarily reflect the views of the Community Education Group, its grantors, its corporate sponsors, or its organizational partners, but rather they provide a neutral platform whereby each author serves to promote open, honest discussion about issues specific to their personal expertise, lived experience, and perspective. Please note that some of the content on Community Perspectives may be graphic due to the nature of the issues being addressed by the author.

Wooden Grist Mill in the Fall

Communicating Public Health Messages Through Community Engagement

Any time there’s a public health crisis, healthcare officials are faced with the challenge of how best to communicate messages to the public. With that in mind, CEG has sourced two articles focusing on how to communicate public health messages both on social media and in rural settings—areas where CEG is working tirelessly to communicate with folks in West Virginia.  Check out the links, below:

Social Media in Public Health: A Vital Component of Community Engagement
By: Mark R. Miller, William D. Snook, and Elizabeth Walsh

Community Engagement Toolkit for Rural Hospitals
From: Washington State Hospital Association

Photo of an outline of the state of West Virginia made out of white powder, presumably heroin or cocaine, and a rolled up straw for snorting it

Community Education Group RESPONDS: Misreading the Tea Leaves on West Virginia’s HIV Outbreak

At his recent abstract presentation delivered at the Conference on Retroviruses and Opportunistic Infections (CROI), Dr. R. Paul McClung presented a portrait of a successful HIV intervention in Cabell County, West Virginia. By his estimation, the response to what was then the third HIV outbreak in that state, beginning in January 2018, was a fine example of a successful infectious disease responseMedPage Today described it as “A Blueprint for Public Health Response,” and McClung cited a strong public health infrastructure in the county, including “…a large academic medical center, a large network of community health centers, and a ‘growing capacity to treat substance use disorder,’ such as a syringe service program in place since 2015” (Walker, 2020). Given the consistently negative press both the state and the county receive, this glowing review of Cabell County’s response is a welcome change—but it is also, unfortunately, a largely incomplete portrayal of events as they occurred, and of circumstances on the ground as they still stand.

While the staff of the Cabell-Huntington Health Department, their Harm Reduction Program, and the local community-based organizations and healthcare providers did an excellent job of working together to identify new cases of HIV among People Who Inject Drugs (PWIDs) and others in the county, what Dr. McClung fails to mention is that many—a significant percentage—of those cases identified in Cabell County between January 2018 and December 2019 were patients who were not/are not residents of Cabell County.

Huntington sits on the border of both Kentucky and Ohio and is also surrounded by several rural counties. It serves as one of the primary hubs of drug trafficking in the region, a place where people drive hours and hundreds of miles to get their drugs and, unfortunately, often contract infectious diseases in conjunction with the injection of those drugs. As Dr. McClung’s reporting correctly identified, a majority of the new HIV diagnoses were directly related to Injection Drug Use (IDU). According to the West Virginia Office of Epidemiology and Prevention Services (OEPS), of the 69 new cases identified in 2019, 63 (91.3%) reported IDU as a risk factor (OEPS, 2020). It was not, however, until January of this year (2020) that the state redefined how they count reported cases of HIV, allowing for counties to correctly attribute newly identified cases back to the patients’ counties or states of origin.

Dr. McClung’s reporting leaves out the important fact that little to no investigation has been done on the ground in the rural counties that surround Cabell and Kanawha Counties, the site of the fourth HIV outbreak, identified in 2019. This is not because nobody wants to conduct these investigations, but because the resources simply do not exist for them to be done. Even in Cabell County, the Harm Reduction Program operates with only a handful of staff members for a job that requires ten. In these rural counties, entire county health departments operate with similarly small staffs, yet their responsibilities extend beyond just Harm Reduction and HIV testing. They are also tasked with protecting communities from environmental health risks, and with inspecting houses, institutions, recreational facilities, sewage and wastewater facilities, and drinking water facilities.

When we discuss West Virginia’s response to the inaccurately defined “cluster,” we cannot do so without acknowledging that we do not know whether or not the HIV outbreak was

contained to Cabell (nor if the outbreak in Kanawha Count was contained) simply because neither adequate testing, nor case investigation, has been conducted outside of Cabell and Kanawha Counties. To paint a portrait of a successful public health intervention without addressing the existing gaps in public health infrastructure and surveillance outside of urban areas of rural states is misleading.

When it comes to both drug use and infectious disease, two things are certain: (1) neither are contained solely within urban areas, and (2) both have been growing in rural America for more than a decade. We have yet to effectively grasp or contend with these rural health crises, despite the best efforts of county and state health departments.

Despite Dr. McClung’s accurate observation of Cabell County, there is a greater story to be told and greater needs to be met. We need more resources. We need enough funds dedicated to hiring appropriate staff. We need enough funds to adequately provide infectious disease testing and epidemiological reporting. We need enough funds to provide treatment. Right now, West Virginia’s rural counties lack those resources, putting a strain on Cabell to pick up where they cannot.


Driesbach, E. (2020, March 16). Treating patients ‘rapidly and effectively’ helped contain HIV outbreak in West Virginia. Thorofare, NJ: SLACK Incorporated: Healio: Infectious Disease: HIV/AIDS: Meeting News. Retrieved from:…

Office of Epidemiology and Prevention Services. (2020, March 01). HIV Diagnoses by County, West Virginia, 2018-2020. Charleston, WV: West Virginia Department of Health and Human Resources: Bureau for Public Health: Office of Epidemiology and Prevention Services. Retrieved from:

Walker, M. (2020, March 11). West Virginia HIV Outbreak: A Blueprint for Public Health Response – Used four pillars of federal initiative to manage local HIV epidemic. New York, NY: MedPage Today, LLC: Meeting Coverage: CROI. Retrieved from: