The Drum Major Institute and AM New York have come out with an article outlining class discrepancies in asthma rates. Asthma is an under-recognized, national problem which had been increasing in prevalence. Since 2002 there may be evidence of a plateauing of this increase, but it remains a problem for many Americans. Some facts from the American Lung Assn for context:

In 2003 it was estimated that 20 million Americans currently have asthma. Of these, 11million Americans (4 million children under 18) had an asthma attack.

Current asthma prevalence in adults ranged from 5.6% in Georgia to 9.9% in Maine and Massachusetts.

After a long period of steady increase, evidence suggests that asthma mortality and morbidity rates continue to plateau and/or decrease. In 2002, there were 4,261 deaths attributed to asthma -- an age-adjusted rate of 1.5 per 100,000.

Close to 1.9 million emergency room visits were attributed to asthma in 2002.

In 2003, asthma accounted for an estimated 24.5 million lost work days in adults.

The annual direct health care cost of asthma is approximately $11.5 billion; indirect costs (e.g. lost productivity) add another $4.6 billion, for a total of $16.1 billion dollars. Prescription drugs represented the largest single indirect cost, at $5 billion. The value of lost productivity due to death represented the largest single indirect cost at $1.7 billion.

Lung function declines faster than average in people with asthma, particularly in people who smoke and in those with excessive mucus production (an indicator of poor treatment control).

The Drum Major institute and AM New York's article shows that children in poor, minority areas of NYC are FAR more affected by asthma than children in richer, whiter areas of the city. Here are some excerpts:

Sadly, tens of thousands of children in New York City with asthma choke for air every day, in all five boroughs, and our elected officials are doing far too little to help them.

While asthma affects New Yorkers in every neighborhood, it affects many more people in low-income communities of color. The New York City Department of Health and Mental Health has found that asthma rates in Bushwick and Williamsburg are 400% what they are in the city as a whole...

Among the primary findings of the report is that most New Yorkers who suffer from asthma live in unhealthy housing. Of the 300 asthmatics who were interviewed, an astounding 69% reported living in cockroach-infested apartments. Sixty-seven percent said they had excessive dust in their apartments, and 47% had rat or mouse infestation problems. One out of three asthmatics reported mold in their apartments.

Asthma rates in these two neighborhoods are four times the city average!! That is a BIG hint that there is a major health problem in those neighborhoods. SOMETHING has to be causing those hot spots of asthma. To me it sounds like an environmental health problem in addition to a class problem. If it was ONLY a class issue, one could correlate asthma rates with income levels. Are other equally poor neighborhoods also afflicted by higher than average asthma rates or is this unique to those two neighborhoods. That is an issue that needs to be clarified. There is no question that poverty is a major issue in terms of availability of health care, and that includes asthma. But to me such a geograpgical spike of asthma rates suggests an environmental effect as well. What is it about the air in those neighborhoods that triggers asthma?

The article gives some hints, indicating a correlation with sub-standard housing, but again, it needs to be clarified whether the asthma hot spots correspond to such sub-standard housing citywide or primarily in those two neighborhoods. Regardless, the article continues, showing that neglect by the city of housing codes is a part of the problem:

All of these housing conditions are clear violations of New York City's housing code. Nonetheless, the City's Department of Housing Preservation and Development (HPD) is renowned for failing to get slumlords to fix housing code violations, even the most serious ones.

A study by the Association for Neighborhood and Housing Development showed that tenants have to wait an average of one year before landlords fix housing code violations that the law requires be fixed within 24 hours. Similarly, a recent study by the tenant advocacy coalition, Housing Here and Now, showed that of the 1,533 buildings that were on HPD's Major Problem Building List in 2003, almost a third had even more "immediately hazardous" violations in 2005 than in 2003.

Unfortunately, HPD's failure to enforce the housing code means that tens of thousands of New Yorkers who suffer from asthma, and other respiratory ailments, live in apartments that are riddled with asthma triggers. According to Bushwick resident Veronica Acosta, "We are forced to live in unhealthy homes because irresponsible landlords refuse to fumigate and make necessary repairs to our old buildings. Even after taking our landlord to court four times, he still refuses to repair our apartment."

The inability or unwillingness of the city to enforce housing codes is something that people I know have encountered. It is not restricted only to poor neighborhoods. But it clearly will affect poor neighborhoods the most. Landlord neglect is treated overly leniently and complaints often ignored. One wonders why the city is so unwilling or unable to enforce its own laws. Perhaps better leadership might help?

The article continues, indicating that lack of health information and available preventative care is also an issue for these neighborhoods:

The report also shows that a great majority of asthmatics in Bushwick improperly treat their asthma. An alarming 59% of Bushwick residents do not use any preventative medicine to control their asthma.

In addition, the study shows that 48% of asthmatics treat their asthma attacks in the emergency room, and that one out of four asthmatics does not understand how to use their asthma medications correctly. This confusion can have dreadful consequences.

Treating asthma in the emergency room is the least cost-effective and least reasonable way to do it. Yet our health care systems do not recognize preventative care as desirable. So for the poorest, preventative care is unavailable and hence they are forced to deal with their condition through the emergency room, the least efficient way of treating a chronic condition. The inefficient way our health care system deals with chronic illnesses creates a greater cost to all of us.

This DMI/AM New York article illustrates three things: the effect that poor enforcement of housing codes have on the health of poor New Yorkers, the inefficiency of our health care system, and the fact that hot spots of illness--regions where an unusually high incidence of a disease--are alarms that are frequently ignored in our society. The questions need to be asked: What is causing those hot spots? Why isn't the city enforcing its own laws? And, why do we tolerate a health care system that is neither cost-effective nor effective in maintaining our health?

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