Good News About Asthma by Rich Kassel, Oct 22, 2007 Twitter A mural in Greenpoint, Brooklyn If you are like me, you missed an amazing bit of data buried in a New York Times article about the widening gap between the city’s rich and poor on a range of chronic illness. A couple of weeks ago, the Times reported that asthma hospitalization rates “plummeted” in the last decade. That news would have been easy to miss. The article was headlined, "Gap in Illness Rates Between Rich and Poor New Yorkers Is Widening, Study Shows" and reported on a study by the New York City comptroller, William Thompson, Jr., which showed that children went to the hospital for asthma emergencies far less frequently in 2005 than in 1995. (Special thanks here go to Carbon Tax Center co-founder and master number cruncher Charlie Komanoff for bringing the story to my attention, with kudos to community activist Ed Ravin and some of my Natural Resources Defense Council colleagues for many helpful insights that also inform this article.) Here are the key data points: Children in the poorest sixth of the city, in terms of neighborhood median household income, saw their asthma hospitalization rate plummet by 47.4 percent. In the next half of neighborhoods, the rate dropped by 55.3 percent. To put it another way: In the poorest third of the city, half as many kids went to the hospital because of an asthma attack in 2005 than in 1995. This is amazing news. As somebody who has spent most of the past 15 years working to reduce diesel pollution, I’m stunned. And, as somebody who watches how the media covers health and the environment very closely, I’m equally stunned at the lack of media coverage about this kernel of the story. (Let’s face it: A gap in diabetes rates between East 63rd Street and East 103rd Street is no longer, regrettably, “Man bites dog.” But cutting the number of kids going to the emergency room for asthma — in the city’s poorest neighborhoods — surely is.) Behind the Story How has this drop in child asthma hospitalization rates happened? Of course, parents, children, doctors and nurses deserve the lion’s share of credit for their response, across the board, to the asthma epidemic that hit New York City and other cities in the past two decades. Kids got sick, parents got involved, and doctors and nurses figured out better ways to treat asthmatic children. But smarter policy choices are contributing too, by reducing the known triggers of asthma emergencies. We don’t know what “causes” asthma, but we do know that many commonly found substances can trigger an asthma episode. For example, we know that ultra fine particles in diesel exhaust can trigger an asthma attack. Cleaner Buses, Cleaner Air Over the past decade, New York City Transit invested hundreds of millions of dollars in new, cleaner diesel, natural gas and hybrid-electric buses that are equipped with the most advanced, state-of-the-art pollution controls. The transportation authority sped up the retirement of hundreds of old, two-stroke diesel buses that lacked any meaningful pollution controls, putting them out of service in some cases, up to six years ahead of the normal schedule. As a result, the fleet’s buses are 97 percent cleaner than they were in 1995. So, while our region still fails to meet federal Environmental Protection Agency health standards for ground-level ozone and particulate soot pollution, diesel soot levels have been dramatically reduced where it counts most — on the sidewalks of many New York City neighborhoods, including the low-income areas and communities of color that have housed NYC Transit bus depots for decades. The Great Unknowns Asthma hospitalization rates, though, are clearly dropping faster than our pollution levels. Why? I don’t know. But a few questions, if answered, may help us understand what’s going on. First, what has been the role of community-based health facilities and mobile medical units, both of which are far more prevalent than they were a decade ago? Are there fewer asthmatic kids—or are they just being treated close to home and not in hospital emergency rooms? Second, what has changed in the drugs being prescribed and in the frequency of those prescriptions? Are children taking more effective drugs for asthma conditions? If so, that would suggest asthma rates remain the same but that asthma treatment is working. If fewer children are taking drugs, that could mean that asthma itself has actually dropped. Third, has anything changed in the diagnoses being handed out? A personal example: A couple of years ago, my infant son had a breathing emergency that led him to the hospital. During the epic that followed, I asked several of the healthcare professionals I met whether he had asthma. Across the board, their response could be paraphrased as, “it depends how you define asthma.” In other words, some doctors would have looked at my son and checked the box marked “asthma.” Others would have diagnosed an allergic reaction and taken a more wait-and-see approach. Fourth, has there been a similar drop in asthma-related school absences? According to the city health department, asthma is a leading cause of school absences. So, if child asthma hospitalization rates have been cut in half in many neighborhoods, school attendance should have increased somewhat to account for all of the now-healthy children. The Fruits of Knowledge Clearly, there is a level of awareness of, and service for, asthma that did not exist in 1995. In my son’s case, he was ultimately diagnosed with, and treated for, a soy allergy, and we put the inhaler away for good. Throughout the system, children, parents, teachers, nurses, doctors and other healthcare providers all are doing a better job at diagnosing, treating and managing the asthma (and non-asthmatic allergies) of our city’s children. Since 1999, the health department’s Asthma Initiative has coordinated the NYC Asthma Partnership, a citywide coalition of more than 300 organizations and individuals. It manages an impressive array of educational and training programs for schools, daycare facilities, healthcare institutions and other key links in the asthma services chain. (Check out their Web site, which includes neighborhood-by-neighborhood data, summaries of available education and training programs and much more). But I’m still wondering about the four questions posed above. Mostly, I’m trying to figure out whether asthma itself has been reduced, or whether it’s being moved out of the city’s emergency rooms. If you have thoughts on this, post a comment. Maybe we can all get to the bottom of this story. ( I am so stunned by the data—and the lack of coverage—that I decided to write about this asthma story, rather than the article about PlaNYC that I promised you last month. Look for that story in November.) Rich Kassel is a senior attorney at the Natural Resources Defense Council (NRDC), where he focuses on urban air pollution and transportation issues. He also chairs the Tri-State Transportation Campaign, a regional transportation advocacy organization, and is on the boards of the New York League of Conservation Voters and Transportation Alternatives. In addition to his Gotham Gazette pieces, he blogs on a variety of environmental issues on the NRDC Switchboard at http://switchboard.nrdc.org/blogs/rkassel. 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