Environmental stressors, such as air and noise pollution or lack of green space, disproportionately affect marginalized communities and worsen mental and physical health outcomes. These stressors do not exist in isolation. They are products of systemic inequalities embedded in capitalist social relations. Drawing on research in Berlin’s inner-city neighborhoods, Debora Darabi’s contribution to the “Kin City” series discusses how poverty, environmental injustice, and public health crises intersect, challenging us to rethink the social structures that shape these phenomena.
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People who are more exposed to local environmental stressors, such as air pollution, noise pollution, or lack of available green space, ultimately develop worse mental health outcomes. The result of this analysis, which formed the basis of my medical dissertation and focused on several key indicators of environmental stress in Berlins inner-city neighborhoods, showed that it is not primarily environmental stress that is independent of social relations in society, namely social relations constituted by and giving rise to capital, that is a risk factor for mental health, but rather the interaction of environmental stress that exacerbates the everyday stress that poor people and people with a migration background already experience.
In neighborhoods with a higher proportion of poor people – even if you were not poor as an individual – you were also exposed to higher levels of local environmental stressors, such as air pollution, mainly from industry and traffic. ‘Local poverty,’ meaning the average level of poverty in the neighborhood, was the strongest predictor of elevated mental health stress. The bottom line of all this was that it is poverty that shapes and constitutes what everyday life looks like for people who live in a neighborhood with a lot of poor people. You can expect the infrastructure to be worse. You can expect environmental pollution to be higher. And you can expect that witnessing everyday poverty and everyday injustice, even if it does not happen to you personally, will lead to worse mental health outcomes.
Life expectancy and the class question
This is consistent with the scientific consensus that there is a higher severity of somatic symptoms (physical, cardiovascular, respiratory, etc.) in urban environments, particularly in neighborhoods where there are a lot of poor people or a lot of people with immigrant backgrounds, which tend to be overlapping populations, especially in countries of the Global North. These people are exposed to significantly higher levels of all kinds of environmental stressors, as well as chronic stress from living in precarious social conditions and having to worry about food security and paying their rent. These people end up developing significantly higher rates of all kinds of environmental stress-related diseases, including mental stress, which was the focus of my dissertation.
The way this is treated in medicine is that we look at poverty, immigrant background, environmental stress, and lack of education as something like risk factors that may predispose you to developing a disease. We do not really ask why. We do not really ask, why is it that poor people have a significantly shorter life expectancy and are much more likely to develop all kinds of illnesses – from mental health to physical health? Is it not a phenomenon of the society in which they live? Is it not the case that poverty exists alongside disease, but that poverty actually causes disease? Poverty is not an individual characteristic of someone because – and this is a very specific term in German science – he is far from education or he is socially disadvantaged. But is social deprivation not a particular phenomenon that appears in society, conditioned by capital?
The point I am trying to make is that in order to be able to answer questions about environmentalism as it relates to public health, it is really important to ask which society these phenomena are observable in, what social relations produce environmental stress, as well as inequality, injustice, and mental or physical health problems, and what the causal mechanism is in order to be able to respond to it. You cannot respond to a problem you do not understand. Part of the environmental discourse that revolves around terms like the ‘Anthropocene,’ which refers to the time in Earth’s history when human activity began to intervene in planetary ecology, to some extent obscures the reality that it is not just human activity in general that is intervening in planetary systems and ecology, but it is specifically human activity as conditioned by capital. It is industrialization under capital that reconstitutes and fundamentally reshapes the way in which humans intervene in nature, or what Karl Marx calls the metabolism – the total social metabolism of humans and nature, which is labor in its capitalist form. This then produces all kinds of phenomena that we can now observe as local pollution or global climate change, which are not the same.
Living in a world of class society
While in a country like Germany you may not feel much of climate change, in certain inner-city neighborhoods in Berlin – as my research shows – industrial pollution and pollution from traffic, which can be noise, air, or just a general lack of green space, can be significantly higher. So it is also important to distinguish at this level what we are talking about, especially because in many discourses on global climate change we contrast the Global South and the Global North as if they were one homogeneous mass, which they are definitely not. We live in a world of capital, which means we live in a world of class society. And in this class society, even in the Global North, there are huge differences in the causal mechanisms of local pollution and who actually gets to experience or bear the burden of that kind of pollution.
To bring it back to capitalist social relations, it is important to understand that environmental stress is the result and the form in which social metabolism – the production and reproduction of everyday life under capital – takes shape. The reproduction and production of everyday life under capital, as such, functions on an ever-expanding scale. It is a necessity of capital, which is value that valorizes itself. Value is abstract socially necessary labor time and capital is value that valorizes itself, to produce on an ever-expanding scale. This ever-expanding production is then what causes environmental stress at the local and global levels, and produces all the other phenomena that we see as the negative results of that same stress – namely, all kinds of diseases, but also all kinds of decimation of the natural environment, for example, the death of animal species. These are not the causes; these are the results of a process that has its own inherent logic and an inherently expansive logic. Degrowth discourses that do not question growth as such and thus do not go beyond the capitalist system, or discourses about making capitalism greener, are not adequately able to respond to this problem because they are fundamentally contradictory to what is the inherent dynamic of the system, and therefore something like degrowthing is something that the system will never do. If there is degrowth in a particular sector, it will be offset by growth in another sector.
For this kind of discourse, it is important to understand what we are talking about: the inherent law of motion of the society in which we live. If we do not understand that law, then we are not able to respond adequately to the society that is the result of that law. When it comes to health, much of the discourse revolves around minimizing the effects that we can observe, which is not unimportant. This is not a plea to stop caring about the reality we face; it is a plea to understand the underlying laws that govern that reality, and that responding to the public health crisis caused by global climate change is more complicated than just offsetting the effects of global climate change and local pollution.
Environmentalism? Let’s talk about social relations under capital
We have to accept the idea that there are mechanisms at play that produce these phenomena. We need to understand the mechanisms that are at the material heart of this, and when it comes to public health, to end this very brief whitewashing of what is the problem of climate change, local pollution, environmental injustice, and then the adverse health outcomes that we can observe, especially for disenfranchised urban populations.
In the context of medicine, I would say that for the global working class, wherever they may live, including in the global North, we have to talk about social relations. We have to talk about bourgeois society under capital. We have to talk about the fact that it is not an accident, and it is not something that can be solved by mere state reform or any kind of state intervention. But we have to understand that the social mechanism that produces this is the valorization of capital, especially in a period of the production of relative surplus value and the different forms that this takes – whether it is poverty, whether it is poor people who are exposed to more environmental stress, or immigrants, who are predominantly poor people, who are also exposed to more environmental stress. These are all particular moments within the totality of capital, that is bourgeois society in which all social relations are mediated by value, including the relation of labor to capital. If we are able to understand this, then it makes much more sense why poor people everywhere – whether they are poor Germans, poor Turks or poor Nepalese – have a significantly shorter life. In that life, they are significantly more sick from all kinds of diseases, whether it is respiratory, cardiovascular, or all kinds of environmentally related cancers. I was in Silesia in October, and in all the towns near coal mines or industrial production sites, the incidence of respiratory diseases is 50 times higher than in the rest of Poland, and this is not a coincidence. Poor people have to live where they work, and housing is cheaper in areas that are less desirable to live in, for example, near coal plants, where the air is worse, the noise is louder, and so on.
We have to understand all these mechanisms not as a moral injustice, but as the result of a social relationship that has its own logic. If we want to address the injustice that we observe and that hopefully makes us feel something, we have to understand the social mechanism, we have to understand the laws of capital, and we have to bring them to the level of consciousness, of mass consciousness, to be able to fundamentally set in motion what Karl Marx once called the social revolution.