DESCRIPTION OF ISSUES
WHERE/WHEN APPLICABLE
RESPONSES
TESTIMONIES

DESCRIPTION OF ISSUE:
Asthma is a chronic lung disease that periodically obstructs airflow. The symptoms can range from mild to life threatening. The causes of asthma are unknown, but the environmental factors that trigger or worsen the disease are better understood. House dust mites, roaches, mold, and animal dander are all allergens that can trigger asthma symptoms. Secondhand smoke, viral infections, and certain air pollutants can also trigger or worsen an attack.

Asthma in the United States is on the rise and disproportionately affects people of color. Between 1980 and 1994, the asthma rate rose by more than 75% (The Centers for Disease Control and Prevention (CDC), Surveillance for Asthma Prevalence - United States, 1960-1995, Morbidity and Mortality Weekly Report, 47 (no. SS-1): 1-28). Asthma hospitalization rates for black and Latino children were substantially higher than for white and Asian children in 2001. This is a patten that has existed since 1997 (Boston Public Health Commission, "The Health of Boston 2003").

Asthma is also the leading cause of childhood emergency hospitalization in Boston and the number one cause of school illness and absenteeism in the Boston public school system. Boston children under the age of five experienced 273 hospitalizations for asthma in 2001 (Boston Public Health Commission, "The Health of Boston 2003").

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WHERE/ WHEN APPLICABLE:
In 1997, the Heart of the City had the highest incidence of asthma attacks leading to the dispatch of Boston Medical Emergency Services. Dorchester had 30.5% of the incidences, Roxbury had 21%, Jamaica Plain 9.4% and Mattapan 9% (Boston Public Health Commission, Report to the Mayor, 1999).

From 1997 to 2000, Roxbury, North Dorchester, Jamaica Plain, South Dorchester, the Fenway, and Mattapan had the highest asthma hospitalization average annual rates in the city among children under the age of five.

Asthma hospitalization average annual rates (per 1,000 population): 

                            Ages 0-5       Ages 5-14
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Roxbury                  14.7                 5.8
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N. Dorchester          12.3                 4.7
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Jamaica Plain           11.2                5.4
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Mattapan                  10.3                6.2
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S. Dorchester           10.1                 6.5
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Boston Avg.               8.4                 4.4

The discrepancy between the asthma rates in the Heart of the City and the state as a whole is even more striking. The asthma rates in Dorchester and Roxbury are 178% higher than the state average. (Urban Environmental Initiative, EPA) Roxbury has 9.8 hospitalizations per 1,000 people versus the state average of 2.1 per 1,000 people (Weinhold, "When Good Buses Go Bad: Diesel Exhaust Linked to Neighborhood Air Pollution," 2001). Roxbury, Dorchester, and Jamaica Plain have three of the top five hospitalization rates for asthma in the State of Massachusetts, with Roxbury the highest of all.

Some of the blame for the high rates of asthma in Roxbury has been focused on the high number of diesel buses and bus storage facilities in the neighborhood, particularly north of the Heart of the City in Dudley Square. Public health organizations have joined with grass-roots non-profit groups to investigate the accuracy of this perceived connection.

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RESPONSES:
--  In 2002, the Harvard School of Public Health initiated a community-based study on indoor allergens that trigger asthma in Boston Public Housing -- specifically in the Franklin Hill public housing development in Dorchester/ Mattapan, where 40% of adults and 56% of children have self-reported as being diagnosed with the disease. These numbers are far higher than the 5.6% national average in the United States, including 6.9% in children under the age of 18 (National Health Statistics Survey). The study found that causal indoor factors included dryness when apartments are overheated in the wintertime; mold growth; high nitrogen dioxide levels from gas stoves and smokers; high levels of VOCs and particulate matter; and a high level of antigens from cockroaches, mice, and pets.

-- The Boston Urban Asthma Coalition facilitates a network of organizations and communities working to combat asthma in Boston, with a focus on public housing facilities.

-- The U.S. Environmental Protection Agency (EPA) has targeted asthma in Boston, particularly among low-income children of color in the Heart of the City, through its Urban Environmental Initiative.

-- Alternatives for Community and Environment (ACE) has worked to decrease the asthma rate in Roxbury by investigating the impacts of diesel buses and bus storage facilities on air quality and advocating for environmental justice based on its findings.

-- In 1999, through the Healthy Homes Initiative, the Boston Public Health Commission received a $1.9 million grant from the Federal Department of Housing and Urban Development (HUD) for remediation of the homes of asthmatic children, as well as for asthma education.

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TESTIMONIES:
"There is a growing acknowledgment that housing has a lot to do with increasing asthma rates because this is where you find many of the triggers and the sensitizers to the condition" (Jack Spengler, Akira Yamaguchi Professor of Environmental Health and Human Habitation in the Department of Environmental Health at the Harvard School of Public Health, talking about a study at Franklin Hill public housing relating to indoor air quality).

"Diesel exhaust is not healthy stuff. We know that. But we don't know how specifically damaging it is-whether it's actually causing health effects such as the elevated asthma rates. Nobody really knows that yet" (George Allen, engineering supervisor in the Department of Environmental Health at the Harvard School of Public Health, "Allen Contributes to Website that Offers Air Pollution Information in Real Time," Harvard School of Public Health, 2001).

"My son's asthma got worse; he has had pneumonia a couple of times. Finally, I went to the Asthma Clinic to find out what might be causing all his attacks. If they hadn't sat down and educated me about asthma triggers that can be found in my home, his asthma would have kept on getting worse" (Natasha Perry, Dorchester resident).

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