Reflecting on Who Bears the Cost — Environmental Justice and the Health of North Denver Communities

As physicians and healthcare professionals, we are trained to recognize the many factors that shape health outcomes, such as genetics and socioeconomic status. Yet one determinant of health often goes overlooked in the clinical setting: environment. Where patients live, work, and breathe can significantly influence disease risk and long-term health outcomes. In North Denver communities such as Globeville, Elyria-Swansea (GES), and nearby Commerce City, environmental conditions are primary drivers of health inequities. 

Who truly pays the price for industrial growth and economic development? GreenLatinos’ recent report, Who Bears the Cost?North Denver Environmental Justice and Data Audit, authored by Katherine L. Dickinson, Carla Nyquist, and Stephanie Pease of Colorado School of Public Health and Ean Thomas Tafoya of GreenLatinos, highlights this pressing question. While society broadly benefits from industrial operations and energy production, the health burden of these systems is disproportionately concentrated in historically marginalized communities. For North Denver residents, the costs are often measured not only in dollars, but in chronic illness and diminished quality of life. 

The Burden of Cumulative Exposure

For decades, North Denver communities have suffered the burdens of living alongside highways, industrial facilities, waste operations, food processing plants, and petroleum refining activity. More recently, concerns surrounding expanding infrastructure—including the proposed expansion of the CoreSite data center in the GES community—have reignited conversations about environmental justice and cumulative exposure. 

Environmental exposure is rarely limited to a single pollutant. Rather, many residents experience layered or cumulative exposure to air and soil pollutants from multiple sources simultaneously. These exposures may include particulate matter (PM2.5 and PM10), nitrogen oxides (NOx), sulfur dioxide (SO₂), volatile organic compounds (VOCs), diesel exhaust from heavy truck traffic, and other industrial emissions. In some areas, concerns regarding water quality and industrial waste further compound the risks. When multiple environmental hazards coexist, their effects can amplify one another and create a greater cumulative health burden. 

For physicians, this concept of cumulative exposure is critical to understand. Patients are not exposed to pollutants in isolation. A child living near a highway, attending school close to industrial activity, and breathing poor air quality daily may face far greater health risks than what one isolated exposure might suggest. 

The Health Consequences We Cannot Ignore

The health impacts of environmental pollution are well documented, and physicians practicing in affected communities may already be seeing these patterns firsthand. 

Respiratory illness is among the most immediate concerns. Children living in highly polluted areas experience higher rates of asthma, and poor air quality may contribute to more frequent exacerbations requiring emergency care or hospitalization. Adults with chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD) may experience worsened symptoms and increased disease burden. 

Cardiovascular health is also affected. Exposure to fine particulate matter, particularly PM2.5, has been associated with increased risks of hypertension, myocardial infarction, and stroke. Long-term exposure to industrial toxins and VOCs may contribute to elevated cancer risk, while emerging research links air pollution to developmental and cognitive impairments in children. 

Equally important but often underrecognized are the mental health implications of environmental burden. Living in areas with persistent pollution and uncertainty regarding community health can contribute to chronic stress and psychological distress. Environmental injustice affects not only physical health, but also a community’s sense of safety and well-being. 

Who Benefits—and Who Pays?

The question raised in Who Bears the Cost? forces us to examine a difficult reality. Society as a whole benefits from industrial infrastructure. Communities depend on transportation systems, food distribution networks, manufacturing, energy production, and technological growth. Yet the health costs associated with these benefits are not evenly distributed. 

In North Denver, many of the communities most affected by pollution are lower-income neighborhoods and communities with large Latino populations. Historically marginalized groups often face greater exposure to environmental hazards while simultaneously having fewer resources to mitigate those risks. This pattern represents a classic example of environmental injustice. Vulnerable populations experience disproportionate harm while others benefit from economic gains. 

The hidden cost of pollution often manifests as increased healthcare expenditures and worsened health disparities. These are costs borne not only by individual families, but by the healthcare system as a whole. 

The Role of Physicians: Beyond the Exam Room

As healthcare providers, we cannot separate environmental conditions from patient health. Environmental history should be viewed as part of medical history. 

When caring for patients with respiratory symptoms, cardiovascular disease, or unexplained exacerbations of chronic illness, clinicians should consider asking questions about environmental exposures. Does the patient live near highways or industrial facilities? Are symptoms worse during poor air quality days? Are there known environmental concerns in their neighborhood? 

Patient education also matters. Physicians can empower patients by discussing air quality monitoring tools, indoor air filtration strategies, reducing outdoor exposure during poor Air Quality Index days, and recognizing environmental triggers that may worsen symptoms. 

Equally important is validation. Patients living in heavily polluted areas may feel dismissed or powerless when discussing environmental concerns. Acknowledging that environmental exposure may contribute to symptoms can build trust and improve patient-centered care. 

However, physician responsibility does not end in the clinic. Healthcare professionals are uniquely positioned to advocate for healthier communities by sharing clinical observations and engaging in conversations about public policy. Environmental justice is fundamentally a health issue, not simply a political debate. 

A Call to Action

Should certain neighborhoods bear disproportionate health burdens, so others may benefit from economic growth? 

As physicians, we have a responsibility to recognize the social and environmental determinants of health and to advocate for prevention. Stronger environmental protections, thoughtful zoning policies, and meaningful community engagement are just the tip of the iceberg. 

The communities of Globeville, Elyria-Swansea, and Commerce City deserve more than recognition of harm after the fact. They deserve a healthcare community willing to speak up. 

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