“Take a deep breath and hold it. Now without exhaling, try to breathe in again.”

We were in the cardiac room, discussing a young man that had died a few hours before we came onto our shift. He had been brought in after he was found in the subway with albuterol inhalers all around him. And Dr. Cherkas, in his infinite wisdom, was helping me understand what it’d be like to have an asthma exacerbation.

We see a lot of asthma in both Sinai and Elmhurst. Really, in most of NYC. It’s no surprise when you understand the history. 

In the 1930s, the government “graded” neighborhoods in major cities by desirability for real estate investment. Areas with largely Black and immigrant communities, “shifting population of questionable character and occupation,” were marked in red on maps as areas that were risky to lend. Similarly, black and immigrant residents were barred from more “desirable” neighborhoods with fear that they would lower the area’s grade. These racist policies led to less investments, less businesses, more highways (because the land is cheaper), and less green spaces in neighborhoods with people of color. Of the devastating effects still persisting today, asthma is only one of them.

I spent my early years not too far from a place in the Bronx often called the “Asthma Alley.” Its location – by nearby warehouses with MANY truck routes, four highways, a printing press, power plants, and sewage works – means this area has some of the worst air pollution levels in the US. Unsurprisingly, the rates of asthma in this area are the highest in not only NYC, but the country.

So what do we do with this information as ED providers?

  • Empathize with your patients.
  • Consider the environment as a very large trigger, one that cannot be easily changed.
  • Share this information with the patient. It may be used to support their attempts to get housing elsewhere.
  • Get involved in advocacy. Support bills requiring environmental efforts.

https://www.researchgate.net/figure/Borough-statistics-2000-a-percent-minority-population-b-percent-persons-below_fig1_7458043

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892895/

https://www.healthline.com/health/asthma/barriers-to-breath-health-disparities

https://patientengagementhit.com/news/redlining-linked-to-asthma-racial-health-disparities-inequities

https://a816-dohbesp.nyc.gov/IndicatorPublic/beta/data-stories/redlining/

https://gothamist.com/news/for-nyc-the-legacy-of-redlining-is-in-the-air-we-breathe

https://www.theguardian.com/us-news/2019/apr/04/new-york-south-bronx-minorities-pollution-inequity

https://www.nature.com/articles/s41586-021-04190-y

https://www.newswise.com/articles/living-in-redlined-neighborhoods-associated-with-lower-lung-function-in-individuals-with-asthma

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