ANNAPOLIS, Md. (AP) — A report on the Chesapeake Bay released Tuesday found strong disparities between communities in different parts of the bay’s watershed in terms of health, economics and social justice concerns.

The findings show a larger context for the challenges of improving the health of the nation’s largest estuary, since this was the first time an integrated environmental justice index was included in the University of Maryland Center for Environmental Science’s evaluation. The index considers social factors such as poverty, race, ethnicity, and preexisting health conditions.

While UMCES has considered elements in recent years like walkability and income disparities in communities, this year the U.S. Centers for Disease Control and Prevention added a new integrated environmental justice index that adds a health component that UMCES had not considered before. That includes data at census levels from more than 4,000 reporting regions in the watershed.

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The health of the bay is a reflection of what’s happening across its six-state watershed, which includes Delaware, Maryland, New York, Pennsylvania, Virginia and West Virginia and the District of Columbia.

Tuesday’s report indicates that urban and rural areas face greater challenges than suburban areas under the environmental justice index, which includes social vulnerability, environmental burdens — such as air and water quality — and health vulnerability, such as underlying conditions like asthma or diabetes.

Rural parts of the bay’s watershed like the Eastern Shore of Maryland and Virginia face greater challenges, said Bill Dennison, vice president for science application at UMCES.

“What’s really apparent here is that to have a healthy ecosystem you have to have a healthy community. If you don’t have a healthy community, the net result is the bay is going to feel the effect,” Dennison said. “The inequities we’re seeing at the economic, social, level are being manifested as well into the health of the bay.”

Similar to last year, UMCES gave the overall health of the bay a “C” grade in its report card. However, the center noted the bay has been showing significantly improving trends overall.

Still, the center’s president, Peter Goodwin, said there’s work to be done in order to reduce nutrient pollution. Although having more “nutrients” in the water might sound like a good thing, in this case, it’s actually pollution like nitrogen and phosphorus from agricultural and urban runoff. The pollution acts like fertilizer and causes excessive growth of algae, which produces toxins that can sicken swimmers and harm fish.

“We need to pick up the pace of restoration so that we can hit our nutrient reduction targets in the future and ensure our resilience to climate change,” said Peter Goodwin, president of the UMCES.

It’s widely believed that states in the watershed won’t make a 2025 deadline to significantly cut nutrients that flow into the bay.

The overall bay health score has increased by six points in the past two years, according to the report.

Of seven indicators, there were improvements in water clarity, nitrogen, phosphorus, and aquatic grasses.

At a news conference announcing the report card, Maryland Sen. Chris Van Hollen described bay restoration efforts as like “trying to run up an escalator that’s going down.”

“We have to establish new, ambitious targets, and we need to hold ourselves accountable to get there,” Van Hollen, a Democrat, said.