I can remember when it first happened; my 18 month old daughter had a typical cold. I treated it as usual; a little Tylenol Cold and she would be fine in a few days. After two weeks, she was still sneezing and one night, she started coughing and she wouldn’t stop.
After several nights of coughing and realizing that my over the counter medicines were not working, I made up my mind to take her to the doctor. The next morning while eating breakfast, I can remember hearing her breathe, while hearing her breathe wasn’t a strange thing, I realized I was far enough away that I shouldn’t have been able to hear her breathe. She was wheezing, she was struggling to breathe and looked as if she was going to pass out and, at that point, I panicked and rushed her to the emergency room. When we arrived at the hospital, they took us right in. I told the doctors what her symptoms were and they responded automatically as if they could see through her tiny body and immediately knew what was wrong with her. They put a mask over her face, put some fluid in the cup attached to the mask, hooked up the hose to a spigot in the wall and turned it on. There was a loud hissing sound and billows of smoke poured out from the sides of the mask. It resembled a reverse gas mask, instead of blocking the dangerous chemicals out of your body, it was pushing them in.
Finally, after what seemed to be hours, a doctor, who looked no older than myself, sat next to me and asked, “Has your child been diagnosed with asthma?” After I replied no, he went on to tell me that my child was suffering from an asthma attack. Everything that was said to me after that was a blur, I just remember nodding at everything he said and thinking about just how badly I wanted to go home with my child, put her to bed and make her feel better. But for the next three hours, my daughter was put on several rounds of some form of medicinal vapor, through this reverse gas mask, and still, the coughing and wheezing did not cease. I held on to her tightly and smelled her hair. I can remember crying. Neither of us had eaten anything for the day and we were both severely sleep deprived from the endless nights of coughing. My usually overly talkative child said not a word.
The attending doctor on duty came over to assess my daughter after we were in the emergency room for more than 4 hours. He put his hand on her head, stumbled over a few uncomfortable statements, and then blurted out, “Do you have roaches?” I thought to myself, are you kidding? I was insulted and before I was able to reply and in an effort to end the uncomfortable silence and my deadly stare, he went on to say, “In most cases, if you have a pest infestation, it can bring on asthma attacks in children and sometimes the cold weather has something to do with it as well.” He didn’t wait for me to reply before he handed me a packet of printouts, two prescriptions and told me to follow up with my pediatrician and sent me on my way. I knew in my heart that a “pest infestation” was nowhere near the cause of my child’s asthma just as the War in Iraq was not caused by WMD’s.
The next few months were filled with doctors appointments, emergency room visits, calls from my daughter’s school, nights waking up to put my child on her medicine regimen, late night phone calls to our pediatricians on-call line, purchases of allergen resistant pillows, mattress covers and blankets, purchasing air filters, humidifiers, sealing windows in the winter, monitoring the humidity in the summer, checking the pollen count in the fall and spring and monitoring what food she ate and didn’t eat, second guessing myself about whether she had a cold, allergies or if she was having an asthma attack and reading all of the materials that were given to me relating to asthma and its treatment and causes. Every piece of material that was given to me was in regards to how to manage her treatment regimen and her indoor environment. I didn’t have any pets, I made sure that the house was always dust and mold free, we had no cockroaches and even when the pollen counts were low, she still suffered from attacks. I couldn’t understand what the problem was. I was managing her environment and managing her treatments, noting all the symptoms and treating them as directed but she was still suffering from violent attacks for months at a time.
Singular in the Fall and the Spring for her allergic asthma. My pediatrician disagrees with my pediatric allergist as to just how long I should keep her on the Singular, the pediatrician says just when she needs it, i.e. wait till she has an asthma episode. My allergist says to use it as a preventative measure so that she doesn’t have an asthma attack at all. In the winter when it is extremely cold or rainy when she has an attack, twice a day until two days after she stops coughing, I have to give her Xopenex which is a form of albuterol which helps with the coughing and wheezing. If the coughing doesn’t stop after a while or gets worse, well then it’s a doctor’s visit and hopefully she is prescribed Pulmucort which is an inhaled steroid which she also has to take twice a day for a week and then once a day for a week because you cannot just suddenly stop giving someone a steroid due to the side effects. If it is REALLY bad, well then she gets Prednisone which is a liquid steroid which makes her very hyper and very aggravating because she bounces off the wall like a Tasmanian devil on crack. Now, I am a smart, college educated (half-way at least, still working on it), woman of the world and at times I find myself scratching my head as to what exactly it is I am supposed to be doing with my child and her asthma.
Not only did this take a toll on my child’s physical health, asthma took its toll on me as well. Endless nights of less than 2 hours sleep, multiple absences at work, the inability to attend classes due to the fear of having to miss class for an asthma emergency. Being known as the woman who had to leave work early and come in late due to a sick child doesn’t do much for a woman’s career when she works with a collection of men who have stay at home wives and wouldn’t know what it was like to stay up with a sick child. My work suffered, my career suffered, my life suffered. I was placed into that stereotype of a poor woman of color who had a sick child because she lived in substandard living conditions and had poor health care. However, I was far from that.
I can remember during one of my many late night emergency room visits, staring at a poster with happy kids jumping in the air with the saying, “I Have Asthma But It Doesn’t Have Me.” It was an advertising campaign done by the New York City Board of Health. I was insulted and pissed off; the picture of the boys jumping in the air looking happy and healthy was not the image of my child. She was not happy, there was no jumping in the air and yes, asthma did have her and it had me as well.
The images presented in the advertisement in the emergency room was much different than the imagery that was being projected on a mailer sent out to Manhattan residents looking for support for Mayor Bloomberg’s congestion pricing plan for Manhattan. “She cannot hold her breath waiting for Albany to act.” This was the tag line used in this advertisement. Why the different messages? Why did asthma not “have” those in the Bronx but for those with asthma in Manhattan, they “can’t hold their breath”? And prior to seeing the congestion pricing ad, I was not aware of the effect that diesel exhaust had in people and children with asthma.
The link between asthma attacks and diesel exhaust is down played and at times not even mentioned in some of the asthma related materials, pamphlets and print outs in from doctor’s offices and emergency rooms and pamphlets distributed by government and city agencies. Roaches, dust mites, mold and pet dander are named as the prime suspects that are attacking children and while these items all are indeed a significant factor in New York City’s asthma novella, the nefarious “air pollution” is either last on the list or not listed at all as a culprit. So, while I am running around my house cleaning, washing, and dusting, I was doing more harm to my daughter by taking her on strolls throughout my neighborhood and taking her to the park since I lived one block away from the Cross Bronx Expressway, a half block away from the Bronx River Parkway, less than a mile away from the Bruckner Expressway, 10 blocks from the Sheridan Expressway, less than five miles away from the Hunts Point Market and a waste production plant and my daughters daycare was behind a parking garage and the daycare’s backyard was located directly behind a parking garage/mechanic station. I lived in what I now know to be called an “Asthma Alley”. An asthma alley is any place that has an unusually high instance of asthma cases, and out of the 10 known asthma alleys in New York City, five are in the Bronx. (Popik)
The materials and advice given to me by pediatricians, emergency room doctors, medical pamphlets, and the New York City Department of Health are given to thousands of people in the South Bronx, and they all have one direction, manage indoor pollutants and put your child on a good medicine regimen. Clean and medicate; the advice is clear. However, there is no campaign that says we must do something about the air or the environmental pollutants in these neighborhoods that are riddled with the youngest of asthma suffers.
Is this a purposeful omission on the part of New York City and the medical profession? Are the marketing materials and advertising campaigns aimed towards the parents of children with asthma distributed throughout the South Bronx purposely leading African American and Latino parents of children with asthma towards asthma management through medication and managing asthma triggers throughout the home, instead of informing parents of the industrial and vehicular pollution that effects asthmatic children because they are trying to hide environmental injustices taking place in the South Bronx; or are parents of children with asthma in the South Bronx fully aware of the links between industrial pollution, diesel exhaust and asthma triggers and do not care enough to fight the environmental injustices in their neighborhoods; or is air pollution and diesel exhaust not really a factor?
“You are the salt of the earth. But if the salt loses its saltiness, how can it be made salty again? It is no longer good for anything, except to be thrown out and trampled by men.” (New International Version Bible, Matthew. 5:13)
The Bronx has long been considered the scourge of the city, a place to pass through on your way to beautiful Connecticut, posh Westchester or wonderful Upstate New York. In the 50’s and 60’s the Bronx was torn apart by the building of the Cross Bronx Expressway which destroyed neighborhoods and obliterated communities, in the 70’s the Bronx was burning and it was caught live on television during the 1977 World Series, to the French, "c'est le Bronx" means “what a mess” and I have met a few French tourists that were surprised that the Bronx was not a cesspool minus indoor toilets and running water, and in the 90’s, thanks to a very raw documentary, we learned about the Hunts Point Hookers and learned about an entirely different market. These negative images of this supposed barren land have taken away from the fact that there is a community of people living, breathing and being in those areas, desensitizing the country, dare I say the world to this area. This is why it became easier over the years to put all of the unwanted industries in the Bronx. Destroy the community, destroy the opposition, now, it’s has been left to be trampled by the men of industry.
Too many, the Bronx, specifically the South Bronx, is absent of family and people and is just a wasteland. However, as of 2000, the South Bronx is a population of approximately 522,412 people with 39 percent African American and 60 percent Latino residents. There is a high poverty rate in the South Bronx and the community carries the highest concentration of Blacks and Hispanics living in one area than the rest of New York City. (Zimmerman)
But it is important to know and not take away from the fact that there are indoor living conditions that exacerbate the asthma problem in the South Bronx as well. Cockroaches are a factor, rats are a factor, families crowed into apartments are a factor, smoking in the home is a factor, poor health insurance and no health insurance is a factor, language barriers between physicians and doctors are a factor, cultural fear of doctors and hospitals are a factor, pets are a factor, peeling paint in poorly kept apartment and tenement houses are a factor. But you can fix most if not all of these factors with the proper education, home maintenance and community outreach.
What is it?
Just what is this disease, this condition, this menace, this thing that is terrorizing children all throughout the South Bronx? According to the Asthma and Allergy Foundation of America, asthma is:
Characterized by inflammation of the air passages resulting in the temporary narrowing of the airways that transport air from the nose and mouth to the lungs. Asthma symptoms can be caused by allergens or irritants that are inhaled into the lungs, resulting in inflamed, clogged and constricted airways. Symptoms include difficulty breathing, wheezing, coughing tightness in the chest. In severe cases, asthma can be deadly. (Asthma Facts and Figures)
And Asthma is not your run of the mill, single minded diseases. I guess you can say that asthma has a multiple personality disorder. The American Academy of Allergy Asthma and Immunology has definitions for the many different types of asthma as identified in their chart below:
Type of Asthma |
Definition |
Triggers |
Prevalence |
Allergic Asthma |
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Non-Allergic Asthma |
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Exercise-Induced Asthma (EIA) |
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Occupational Asthma |
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Nocturnal Asthma |
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(AAAAI: Patients and Consumer Center Allergic Asthma Information)
This chart, however thorough, leaves out another kind of asthma, and while the triggers and symptoms do not differ from other types of asthma, it is the effectiveness of the regular treatments that define asthma strain; Steroid Resistant Asthma. Steroid Resistant Asthma is, “defined by the failure to improve baseline AM pre-bronchodilator FEV1 by greater than 15% predicted following 7-14 days of 20 mg twice daily oral prednisone.” (Leung) Basically, the medicine aforementioned, that turns my child into a hyper-active menace has little effect on some asthma suffers.
WHAT IS THE CAUSE OF ASTHMA?
There is no clear identifiable cause of asthma, however many studies have been done that show several factors that can be attributed to the development of asthma; genetics, development of the lungs and a weakened immune system, infections and exposure to chemicals, air pollution and second hand smoke, premature babies born with lungs that are not fully developed are also at risk for developing asthma. (Tinkleman) The list below gives more of an in-depth explanation about the possible causes of asthma.
Genetics
Premature Birth
Immune System
Environmental Exposures
New York City and Asthma
New York City has is said to have one of the worst asthma rates in the country. Over 500,000 New Yorkers have asthma that is six percent of the population. A disproportionate number of them are poor minority children. In the Hunts Point neighborhood of the Bronx, over thirty percent of the students have asthma. (Strouse)
In response to these staggering figures, New York City health officials, medical professionals and HMO’s formed a number of organizations to get hold of the problem. The Childhood Asthma Initiative, The New York City Asthma Initiative, The Children’s Health Fund’s Childhood Asthma Initiative (CAI) and The Bronx Improving Asthma Care for Children Project just to name a few. The list can go on and on. But these organizations did little but push medicines and home visits. The City has responded in such a two-faced way that it is really hard to decide which side they are on, the people of the South Bronx or industry.
The South Bronx Factor
So what makes the South Bronx so different than all of the other asthma alleys in New York City?
Advertising is one of the most powerful tools of communication today; it can convey feelings of want, need, urgency and inadequacy. It can implore people to vote, purchase cars, visit websites, buy jewelry, consider anorexia, drink milk or join the military. Advertising is used to push smoking cessation initiatives; who would forget the Hispanic man who had a tracheotomy and had to now speak with a voice box showing how he showers and listening to how he used to swim in Puerto Rico; he cannot swim now, he’ll drown. “Knowledge is Beautiful” urges a person to get tested for HIV. Advertising produces some of the most powerful images in the world; so why this same vehicle of persuasive communication wouldn’t be used to warn and inform parents about the effects of exhaust fumes on children with asthma in the South Bronx?
The current system of communication and education of parents of children with asthma in the South Bronx, on one fundamental front, is a failure or at the least, selling a half truth. Government agencies and advertising agencies alike have missed the mark when it comes to informing parents within this “asthma alley” that where they live is just as important a factor to their children’s asthma and asthma triggers as how they live. Asthma “management” in the form of medicine regimens and indoor pollutant control is pushed where as fixing the pollutants in your outdoor environmental is rarely, if ever mentioned. And while a detailed medicinal plan and indoor pollutants are significant factors to asthmatics, so are the 15,000 trucks that pass through the South Bronx on a daily basis spewing diesel exhaust throughout the neighborhood.
What good would the advertising campaign on HIV awareness have been if it left out the fact that you could contract HIV through sharing needles and focused only on sexual transmission? No matter how many millions of condoms you handed out, how many times you teach people to practice abstinence or how big of a push you have for people to get tested for HIV, you cannot ignore the fact that HIV can also be transmitted by intravenous drug use. And because of that, thousands of people would still become infected. If people share needles and become infected and then engage in unprotected sex, the disease would be transmitted by sex, yes, but was also transmitted by the sharing of needles; just like cleaning my apartment and spending hundreds of dollars on medications and natural cleaning products and allergen free products didn’t prevent my daughter from having attacks due to the outdoor environmental pollutants. Denying or misdirecting information to families in the South Bronx is just as bad as ignoring the childhood asthma epidemic all together.
And why you ask are public health officials and medical professionals not sounding the alarms in regards to the outdoor environmental factors that are potentially causing these asthma attacks or the disease on the whole, because the population of the South Bronx are African American and Latino, poor, immigrant, and they are the underserved population of New York City, basically the unwanted. Some do not vote others are not citizens; these are to the politicians in New York, the faces of people who do not effect change or fight for their rights. They can be swept under the rug. They can be ignored and forced to live in these unjust conditions.
For a mother of a child with asthma, you note all of the new treatments and drug regimens that are out there that would help your child, from doctors, parenting magazines and even lifestyle magazines such as Essence. I can recall reading Essence one evening, receiving my monthly dose of hair do’s and don’ts, problems that face black single women and what to do when your man is hard to handle, when I was met by an advertisement for an asthma medication. Even throughout my silly womanly reading, I was able to clear through the written chatter and take note of what was in front of me. This is the way in which I have come upon medicines such as Pulmucort and Singular, it is how I became aware of high priced humidifiers, window sealants, etc. But it was a specific ad, which was only given out to about 350,000 Manhattanites during Mayor Bloomberg’s push for congestion pricing that not only caught my attention, it made me furious.
The Bloomberg Congestion Pricing ad and television spots specifically linked car congestion and its pollution to childhood asthma and urged people to react. It is the most direct piece of advertising I have seen regarding asthma and diesel exhaust in New York City to this date. It doesn’t merely suggest that diesel exhaust is an asthma trigger, but it loosely suggests that it is the cause. In one television spot, a woman describes how she lives under the 59th street bridge and that all four of her children have asthma. What does that mean to you? What do you assume from that ad? Well if living underneath the 59th Street bridge has or had that effect on this woman and her four children, what effect do you think living near the or under or around the Bruckner Expressway has on people living in the Bronx? It tells me, it screams to me that this is a major factor.
At that point, I had never linked car exhaust pollution to my child’s asthma condition, yes, diesel exhaust is on the list, however when it comes to pushing a solution to that problem, well there is no solution listed. The solutions were, manage, clean, treat, manage, clean, treat. I thought I was doing something wrong, I am sure others thought and continue to think and are led to believe due to conversations with doctors and by reading the asthma checklists and management materials given, I was mismanaging my child’s condition. But if it was exhaust fumes that were the real culprit of my child’s asthma attacks, well then, this became an entirely new ball game.
Looking at the “I Have Asthma But It Doesn’t Have Me.” advertisement, I can recall that I have seen “playgrounds” like this. I use the word playground very loosely. An area where there are no trees that is made up of mostly concrete and no grass or shade does not constitute a playground. It’s more or less, an open-air prison. Looking at this image, I instantly notice two things, the image is in black and white and there are no trees for the exception of some pathetic saplings located in the back right corner of the image. This image is not inspiring, it is depressing and deceptive. Was it designed to fail? Was it designed to manage?
In the Childhood Asthma Initiative ad, it states that you can have asthma without asthma having you. So you can live with having asthma, it is OK. That message is put forth with the image of the strong happy boys jumping in the air playing, looking healthy, set in what one will only guess to be an inner city neighborhood. It makes the viewer have the feeling that having asthma is ok and manageable. This ad causes no great reaction for me to want to do anything environmentally to change my child’s condition because everything will be ok.
Since all of the images and words being used tells me that everything is ok, why would I then believe that I live in an area that is not healthy for my child, this would not be a factor to me. If you keep yelling out that the sky is falling, make television spots and advertisements that support the sky falling, people will not notice the giant tidal wave that is heading right for them. And after being bombarded with these images of happy children over and over and over again, the people in these communities are not going to question why their children are still sick. It is hard to change the mind of a community once it has already been told that they themselves are the reasons why their children are sick and that they can be happy and live with the sickness if they properly manage it. These ads are the modern “medicine men” of the millennium. Worse than that is when community organizations are not fully aware and informed of the full effects of the dangers in their community.
The Ad Council and the Environmental Protection Agency in 2003 introduced a campaign that told parents to “Attack Asthma”, but again, it only spoke of indoor air pollutants and used an ad with a fish slowly losing its water and said, “Even One Attack Is To Many”. The corresponding website gave three tips to “Attack Asthma, Learn More”. Step one; talk to your doctor. Step two; come up with an asthma management plan. Step three; asthma proof your home. Am I the only one that sees something missing here?
The ad for congestion pricing in Manhattan suggests that the root, cause and trigger of people with asthma is diesel exhaust, they skip all of the other triggers. It also states that it is something that a person is unable to live with; “She cannot hold her breath waiting…” is a declaratory statement. She cannot, she is unable to wait. Here is this very adorable little girl with an asthma inhaler and all you can do is feel sad and want to help her. She cannot live with asthma. The ad is generic, she could live on the Upper East Side or Upper West Side, and her ethnic background is clearly not defined. The ad screams, HELP HER! It is very pitiful to see a child using an inhaler. I would want to react if I saw this advertisement; I would want to react if I saw a mother with four children living in Manhattan suffering with all of her children having asthma. I would want to prevent whatever is causing these children to suffer.
I am at a loss of understanding, it seems most illogical. We can blame fossil fuels for putting holes in the ozone layer, changing weather patterns, melting polar icecaps, and poisoning the environment, so why is it not that we do not see it is destroying the lungs of our children.
The Multifaceted Solution
There are many ways in which to reduce and/or eradicate the volatile asthma conditions for children in the South Bronx; it involves public awareness and efficient policy making. By only addressing the indoor home pollutants and triggers, focusing heavily on maintenance though medication and ignoring and not addressing the outdoor pollutants within the community, emergency room visits, missed school and work days and the mortality rates surrounding childhood asthma will increase once industry continues to increase in the South Bronx and industry is expanded throughout the community.
Acknowledgement
The first step towards eliminating any issue is stating that the issue is in fact an issue; in this case, it would be to identify diesel exhaust and fumes from the waste production plants in the South Bronx as an asthma trigger. Throughout all of the interviews taken and materials read for this report, although there are solid links to outdoor environmental pollution and asthma it has yet to have been clearly made apparent to those living in the area. Emphasis still remains on indoor pollution in the homes and poor asthma management in regards to medicine regimens. There is a big mental block within the community when it comes to the reality of diesel fuel and the fumes from the waste production plants in the South Bronx being an asthma trigger and that block must be removed. Once this is done, the next step would be awareness.
Awareness
Awareness would be achieved on two levels; the first would be through television and print advertising and the second would be that of redirecting the educational materials on childhood asthma that are currently circulating throughout hospitals and schools. Just like the attention grabbing Truth™ campaigns that shock people into the harsh realities behind tobacco, the same type of pointed advertising campaign needs to be created linking diesel exhaust to asthma attacks. From bus shelters, to prime time television commercial spots to local newspapers, people need to be shocked and appalled by what they are being exposed to in their community.
The educational materials that are distributed in hospitals, doctor’s offices and schools within the South Bronx need to be revised to reflect the additional asthma trigger. Currently, the emphasis in most of these materials is placed on dust mite and vermin dander with a slight mention of air pollution being a trigger. Air pollution needs to be more clearly defined and not listed last on the list of triggers. Given that the South Bronx is an “asthma alley”, these materials should identify just how many pollutants, on average, that their children are exposed to on a daily basis.
Deal with the Diesel
For those with Non-Allergic Asthma, the next step would be to curtail the diesel emissions and while we may not be able to tear down the highways and thruways in the South Bronx or shut down the Hunts Point Market, there can we ways that we can reduce the levels of pollution that are being emitted. Several adjustments can be made to Mayor Bloomberg’s congestion pricing plan to fit the needs of the people living in the South Bronx. Just like the plan for Manhattan, the idea is to have trucks that come through that area pay a high toll or limit altogether the times of day in which trucks can pass through the area. By limiting the times that that type of traffic can pass through the area to school hours or night hours, it would allow for less pollution during the times of day that children in the neighborhood would be commuting to and from school. We can also demand that on a corporate level, companies that do business in the South Bronx that contribute to the pollution in the area that are within 5 miles of a school or a residential neighborhood provide grants to local schools and families in order for them to properly protect their homes from neighborhood pollution.
Send them to Camp
For those children with Allergic asthma, those that have issues with pollen, I would like to see New York City in conjunction with New York State and business which have buildings in the South Bronx sponsor children to go to asthma camps in the Midwest, specifically Arizona, which touts that the dry air is better for people with asthma.
Many may say that advertising and re-education is not the way to go and that emphasis still needs to be placed on asthma management and thinking about the long term. By taking away the emphasis on asthma management, people are not learning the right way to take care of their children and the mortality rate and hospitalization rate could and would increase again. However, while we are not taking away from the strides that have been made in the recent past, if the asthma hospitalization rate has gone down due to medicinal management and controlling indoor pollutants, imagine how much further the asthma epidemic could be put under control if we tackle the last frontier of asthma triggers such as congestion and waste production plant pollution.
In the end….
In poor communities, the people in the community are trampled by their surroundings. Because they are the unwanted and unseen, it is easier for big business to take advantage of them. By making it seem as if social conditions contribute or dominate the triggers of childhood asthma, it is blaming the families and not the real culprits for their children’s condition and the environmental injustices that they face. By eliminating diesel fuels and waste product pollution as a trigger from asthma management materials, they are leading people within these communities to believe that it is they, not big business, that contribute to asthma triggers by unclean living environments and poor medicinal management. It is easier to blame the poor then it is to reform industry in order to create better living conditions. By blaming cockroaches, smoking and dust solely for asthma, it hides the need for reform and lets the city officials and big business off the hook for creating poor living conditions.
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