National Nurses United

Asthma 6/11/06 11:31 AM Page 15 The number of Americans without health coverage—46 million at last count—is growing, and more and more employers are either refusing to offer healthcare or forcing employees to contribute more to their plans. A study by the Financial Times found that between 1998 and 2003, the number of employers with fully paid health plans dropped from 35 percent to 28 percent. A good health plan is no armor against the triggers that induce asthma, however. Com- and Long Beach over the next four years. Between them, the two ports emit 1,760 tons of diesel particulates each year. West Coast ports handle 49 percent of all U.S. cargo. "The thousands of men and women I represent and work for raise their families under a cloud of port pollution," says ILWU International President James Spinosa. "They have made a simple demand of their union: while they want a good living, they do not want to pay with their lives for a stronger economy." cutbacks annually. Our public health nursing staff has been cut repeatedly over the years." While money may be short, the dedication to do something about asthma is strong. "This is a condition we can influence, if not the incidence, at least the amount of hospitalization," argues Brunner, ticking off his department's program for beating back the beast: insuring access to primary health care; helping families reduce asthma triggers in their homes and apartments; and improving 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." —dr. wendel brunner "HOSPITALIZATION IS A REFLECTION OF POVERTY. munities aiming to reduce those triggers are increasingly trying to pressure the federal government to enforce EPA guidelines on "environmental justice." The guidelines state that "no group of people, including racial, ethnic, or socioeconomic group, should bear a disproportionate share of the negative environmental consequences resulting from industrial, municipal, or commercial operations or the execution of federal, state, local, and tribal environmental programs." But both the EPA General Inspector and U.S. Civil Rights Commission found that the government has done virtually nothing to implement the guidelines. From 1993 to 2005, the EPA received 164 complaints alleging civil rights violations in environmental decisions. It rejected 117 of them, accepted 47, but dismissed 28 of the 47. A decision is still pending on the other 19. In spite of indifference on the federal level, local communities, public health agencies and politicians have cobbled together coalitions, which have made significant progress in reducing asthma triggers. Such a coalition in Contra Costa County won the first agreement in the nation on reducing oil refinery "flare offs," a procedure where volatile gases are burned off in controlled fireballs, releasing many potential asthma triggers. Similar coalitions have formed around the issue of diesel pollution at West Coast ports. Under the slogan "Saving Lives," the longshore workers union has joined with local communities and Los Angeles Mayor Antonio Villaraigosa to reduce diesel pollution by 20 percent at the ports of Los Angeles JUNE 2006 The union is making reducing diesel pollution part of its bargaining strategy for the next West Coast contract, and plans to try and spread the issue to other places. "The ILWU is going to enforce this coastwide, and we're taking it to the East Coast through the [International Longshoremen's Association]. We are also raising this internationally so that pollution will not have a homeport anywhere," says Stallone. Stallone says the union is also working with communities in west Oakland, Calif. that are concerned about diesel emissions from freeways. "We are concerned because our people come out of those communities. We work in it and we live in it." According to the EPA, a $100 million retrofit of pollution-generating diesel engines could save $2 billion in health costs. None of this work in fighting asthma will be easy, and part of the problem is how public health is constructed and financed in the U.S. "It is very difficult for local health programs to address these problems," says Brunner, the public health director. He points out that the average size of a health department in the U.S. is 16 employees, "which includes everyone from the director to the janitor." The system, he says, "is just too fragmented." It is also under funded. Brunner is in the process of cutting $3.5 million out of his $16 million budget, and trying to rustle up foundation grants, while juggling county, state, and federal money. In the end, something gets cut. Lewis, the asthma nurse practitioner, sees the impact of such cuts everyday. "Primary care in San Francisco, like other counties throughout California, has suffered gradual W W W. C A L N U R S E S . O R G the quality of medical care, including educating doctors. The Contra Costa County Public Health Division also holds classes to educate community members on how to interpret local and state air quality regulations, as well as EPA rules, including their rights under environmental justice guidelines. It also brings together community members and the staffs of regulating bodies in town hall meetings. The Division is working closely with schools and Kaiser Permanente to try and figure out a formula for on-site treatment of asthma attacks. Kaiser RN Calvert is optimistic about making progress against the disease. "Asthma does not have to be debilitating. It doesn't have to mean lost time at school and work. The means to control it are available." One of those means is education, although as Lewis, who works with teens and young adults, points out, "It is a very labor-intensive process involving patient teaching." Ultimately it is a problem bigger than a city or county or even a state, and goes to the heart of the present crisis in healthcare. "I think these deaths and hospitalizations reflect a public health and primary care system in decline throughout our nation," says Lewis. "The sad truth is that these deaths are preventable. How advanced is our healthcare system if our patients are dying from treatable and preventable diseases?" ■ Conn Hallinan is a foreign policy analyst for Foreign Policy in Focus and a columnist for the Berkeley Daily Planet. Carl Bloice is a freelance writer based in San Francisco. REGISTERED NURSE 15

• Cover