National Nurses United

Asthma 6/11/06 11:31 AM Page 13 inadequate healthcare, substandard housing, the interrelationship between industry, transportation, and communities, and some serious educational deficiencies about how to control the disease. C onsider the enormous differential in ER visits and hospitalization. "Hospitalization is a reflection of poverty," says Brunner. "If a community has a higher hospitalization rate, it doesn't mean that community has a higher incidence of asthma, but it does mean they are poor." Studies have found that asthma sufferers who have access to primary care physicians, as well as adequate resources for medicine, have fewer ER visits and fewer hospitalizations. "Asthma is a socio-economic disease," says Kay McVay, RN and former president of the California Nurses Association, that is getting worse because "we are moving backwards in terms of eliminating poverty and the JUNE 2006 unhealthy circumstances in which people live." Asthma can strike down the affluent as well as those on the economic margins, but where you live, and what you do at work, has a lot to do with whether you develop asthma. According to the U.S. Environmental Protection Agency (EPA), 133 million Americans live in areas where pollution reaches unhealthy levels. African-Americans are more than twice as likely to live in those polluted neighborhoods as whites, and the average income in these neighborhoods is about 15 percent lower than for the rest of the nation, reported The Associated Press in December 2005. African-Americans had five times the number of asthma-related ER visits than whites and over three times the hospitalization rate. African Americans also had a death rate 200 percent higher than whites, and 160 percent higher than Hispanics, according to U.S. Health and Human Services data. "Poor communities, frequently communiW W W. C A L N U R S E S . O R G ties of color but not exclusively, suffer disproportionately" Carol Browner, EPA head during the Clinton Administration, told the AP. "If you look at where our industrial facilities are located, they are not in middle-class neighborhoods." Dr. John Brofman, director of respiratory intensive care at MacNeal Hospital in Berwyn, a suburb of Chicago, says air pollution makes asthma worse. "Not only do people get hospitalized, but they die at higher rates with significant air pollution," Brofman also told the AP. One reason why asthma rates are rising may be the policies of the Bush Administration. According to a recent AP story, "The Government Accountability Office concluded that the EPA devoted little attention to environmental quality when developing rules for the Clean Air Act between 2000 and 2004." EPA scientists recently charged that the White House proposes weakening sections of the Clean Air Act that regulate the release of diesel particulates, sulfur dioxide, and nitrogen dioxide, all asthma triggers. In the name of "streamlining" environmental regulations, the Bush Administration will permit some 4,000 companies in 922 communities—most of them poor, many of them predominantly minority—to increase toxic admissions from 500 pounds a year to 5,000 pounds, according to a December 2005 Los Angeles Times article. The United States' refusal to sign the 1997 Kyoto Protocol or to reduce U.S. production of greenhouse gases that are warming the planet plays a role in rising asthma rates as well. "During the past two decades, the prevalence of asthma in the United States has quadrupled, in part become of climate-related factors," concluded Dr. Paul Epstein in a New England Journal of Medicine study on the impact of global warming on health. Environmental triggers, or allergens, are not restricted to what comes out of smokestacks and tailpipes, however. Some of the most insidious are the ones people live among: dust mites, rodent and cockroach droppings, mold, animal dander, and nitrogen dioxide from poorly vented stoves and heaters. While these triggers can be found anywhere, they tend to be more prevalent in substandard housing. There is even a psychological dimension to asthma. An Ohio State University study of 338 Chicago neighborhoods found that asthma rates went up or down depending on how secure people felt in their neighborhoods. REGISTERED NURSE 13

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