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“Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481

“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485

 The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).

“This mapping capacity not only enables examination of information based on objective (based on empirical evidence), comparable (quantitative), and visualizable (mapped) terms, it also puts this information in front of the analysts and decisionmakers in a form they cannot ignore.” 7; HOFFMAN, community science model: “In his mind, this model consists of (1) serving as a focal point for bringing together community residents, scientists, and policymakers; (2) serving to generate knowledge that can be a catalyst for change; and (3) developing methodologies and products that can be scalable—particularly for neighborhood use. The visualization of the problem through redlining maps is critical. … EJ at its core is about the spatial distribution of environmental benefits and burdens. Winling described redlining as the Rosetta Stone that unlocks an understanding of the spatial organization of most American cities. It “most definitely created a template” that would be built out over generations.” 15

Lee argues that EJ practice has long stagnated over an inability to properly define the concept of disproportionate (environmental and public health) impacts, but that national conversations on system racism and the development of EJ mapping tools have improved his outlook on the potential for better application of the concept of disproportionate impact. Lee identifies mapping tools (e.g. CalEnviroScreen) as a pathway for empirically based and analytically rigorous articulation and analysis of disproportionate impacts that are linked to systemic racism.

In describing the scope and nature of application of mapping tools, Baker highlights the concept of cumulative impacts (the concentration of multiple environmental, public health, and social stressors), the importance of public participation (e.g. Hoffman’s community science model), the role of redlining in creating disproportionate vulnerabilities, and the importance of integrating research into decision making processes.

Baker ultimately argues that mapping tools offer a promising opportunity for integrating research into policy decision making as part of a second generation of EJ practice. Key areas that Lee identifies as important to the continued development of more effective EJ practice include: identifying good models for quantitative studies and analysis, assembling a spectrum of different integrative approaches (to fit different contexts), connecting EJ research to policy implications, and being attentive to historical contexts and processes that produce/reproduce structural inequities.