Black children are more likely to have asthma than kids of any other race in America. About four million children in the US have the lung condition. More than 12 per cent of Black children suffer from the disease, compared with 5.5 per cent of white children. They also die at a much higher rate. The rippling effects of racism have led to high poverty rates, poor health outcomes and shortened life expectancies in Black communities. Increased asthma rates is just one outcome of America’s unequal living conditions and healthcare system. Across America, nearly four in 10 Black children live in areas with poor environmental and health conditions compared to one in 10 white children. Black children are more likely to live near polluting plants or busy roads, and in rental housing with mould and other triggers. This is because of racist housing laws in the nation’s past. The disparities are built into a housing system shaped by the longstanding effects of slavery and Jim Crow-era laws. Many of the communities that have substandard housing today or are located near toxic sites are the same as those that were segregated and redlined decades ago.
“The majority of what drives disparities in asthma, it’s actually social and structural,” says Sanaz Eftekhari, vice president of corporate affairs and research of the Asthma and Allergy Foundation of America. “You can tie a lot of the asthma disparities back to things that have happened, years and years and decades ago.” America’s discriminatory housing policies make Black Americans more likely to live in rental housing. Rental units are much more likely to have deficiencies or inadequacies and fewer means to address problems that increase exposure to asthma triggers. Throughout the 20th century, federal housing policies promoted homeownership and wealth generation – but those benefits were largely inaccessible to Black families.
In Connecticut, for example, more than half of Black households rent, compared with a quarter of white households. An Asthma Allergy Foundation of America report examining asthma disparities found that Black renters were more likely to report the presence of mice, cockroaches or mould in their homes. Black people also live in older housing at higher rates, exposing them to triggers like dust and mould. “So many of our children are living in these just utterly disrepair homes with mould, open cracks, leaking, and vermin,” says Dr. Jessica Hollenbach, co-director of the Asthma Center of Connecticut Children’s hospital. Nitrogen oxide emissions have been linked to high asthma rates.
These gases are typically emitted from vehicle exhaust, coal, oil, diesel and natural gas burning and can cause health issues such as eye irritation and asthma aggravation. Dr Mark Mitchell, a former director of Hartford Connecticut’s health department and a founder of the Connecticut Coalition for Environmental Justice, has tried to sound the alarm on Hartford’s asthma rates. The coalition began investigating and advocating for environmental justice after concerns arose about a regional landfill expansion and possible links to high rates of asthma, cancer and other diseases in communities neighbouring them. Mark recalled how, in the mid ’90s, he examined about 30 kids and found that a third of them had asthma. He urged the state to look into what he believed was a clear pattern of disparities. “They told me… we don’t really know who has asthma and doesn’t have asthma, and besides, it’s not unusual for a third of inner-city kids to have asthma,” says Mark, who is now associate professor of climate change at George Mason University. The state’s health department did not respond to multiple requests for comment on its efforts to combat its asthma rates.
“We know that our emergency rooms in the middle of the night during the summer are filled with children who can’t breathe,” Herrington says. The prime cause, she said, is just as apparent. “People need to demand change… and people need to not be reasonable. At what point do you say, this is bullshit? White supremacy and racism have everything to do with it.” Abimbola Ortade, an activist and board member of Hartford Connecticut’s Black Lives Matter 860 chapter, recently lost his sister to COVID. Like many Hartford residents, she had asthma for most of her life, and diabetes, a combination that proved deadly. Abimbola also has asthma, along with two of his children. He worries frequently about their future – and his. Asthma, Abimbola says, is merely one example of how structural racism fuels health disparities that are likely to worsen as Black children go through life – including the toll of toxic stress on their mental health. “In my neighbourhood, you’ve got to worry about the police killing you, stress killing you, heart failure or asthma killing you,” he says. The situation could be eased by improving diagnosis rates and creating a standardised approach to help keep asthma under control. At Connecticut Children’s hospital, more than 150,000 children have been screened and more than 41,000 have been diagnosed with asthma through the Easy Breathing programme. “I think the biggest issue is that asthma is a chronic disease that requires care every single day,” says Dr Melanie Sue Collins, director of the Pediatric Pulmonary Fellowship and Cardiopulmonary Lab at Connecticut Children’s. “And what I see many of my patients and families struggling with is the basic needs of life.”
HUSKY Health, which includes the state’s Medicaid and the Children’s Health Insurance Program, covers about 22 per cent of the state population. On a federal level, resources have been put toward various housing and health grant programs. An Asthma Disparities Subcommittee was formed by the National Institutes of Health in 2010 and published a federal action plan in 2012. And the Affordable Care Act broadened coverage access for millions. But advocates say more asthma-specific legislation and funding is needed. Overall asthma rates have trended downward in recent years but rates among Black children remain outsized and disparate. In Connecticut, the prevalence of asthma in the state’s public school system has slightly decreased over time but about one in eight students have asthma. The incidence among Black students is about 50 per cent higher. That often means absenteeism – and in the near and long term, failure. “If you miss school, you can’t succeed in school,” Collins says of a fraught cycle many kids encounter. “And if you don’t succeed in school, you have a really difficult time having a life where you can do things comfortably, whether it’s eating, having shelter or a successful job.”