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In November 2018, M\u00f3nica Huertas\u2019 daughter, a pre-school student, was discharged from Hasbro Children\u2019s Hospital in Providence after spending two days in the pediatric intensive care unit for asthma exacerbations.<\/p>\n
The girl\u2019s chronic asthma has sent her to the hospital seven times in her short life, although only two of those visits brought her upstairs to the \u201cpopsicle doctors\u201d \u2014 the nickname her mother uses for the PICU, because of its staff\u2019s practice of giving popsicles to sick children.<\/p>\n
Huertas, who is a community organizer and climate justice activist, has three other children, including two sons and another daughter. Her other daughter also has chronic asthma and has been to the hospital four times because of it, although she\u2019s never been to the \u201cpopsicle doctors.\u201d But she has been to the \u201cflower doctors\u201d \u2014 the urgent care, walk-in clinic, named after its wallpaper, where Huertas takes the kids \u201cif it\u2019s not a big thing.\u201d<\/p>\n
Huertas\u2019 youngest child, still an infant, has started coughing at night for days in a row. \u201cI know that cough,\u201d his mother said. Only one of her children is asthma-free.<\/p>\n
The issue of pediatric asthma in Providence spreads well beyond Huertas\u2019 family.<\/p>\n
A statewide concern that disproportionately burdens low-income, urban communities of color, childhood asthma is caused by multiple factors \u2014 with air pollution and hazardous indoor housing conditions being the main triggers for asthma exacerbations.<\/p>\n
While some Rhode Island state agencies are taking steps to address the problem, experts say it is unlikely that the state will raise its current standards for ambient air quality to reduce asthma.<\/p>\n
A statewide health concern<\/b><\/p>\n
Data from a 2019 presentation by the Rhode Island Department of Health show that asthma is a widespread condition affecting Rhode Island\u2019s children, particularly low-income children of color living in cities.<\/p>\n
Within the Ocean State, asthma is the most common chronic condition in children. Just under 11 percent of the state\u2019s children have it, compared to 8.4 percent nationally, giving Rhode Island the ninth highest childhood asthma rate in the country.<\/p>\n
Urban children in the state are the most burdened by the illness. Asthma accounts for 12.2 out of every 1,000 children\u2019s emergency room visits in the state\u2019s four core cities \u2014 almost triple the 4.5 out of 1,000 visits in the rest of the state.<\/p>\n
In addition, more than 70 percent of pediatric asthma emergency department visits in the state involve children enrolled in Medicaid. The RIDOH presentation also noted that \u201cBlack children and Hispanic children are more likely to visit the emergency room or be hospitalized due to asthma.\u201d<\/p>\n
Huertas, who lives in Providence\u2019s Washington Park neighborhood, is Puerto Rican, and her children are of Puerto Rican and Guatemalan descent. According to the City of Providence\u2019s Climate Justice Plan, individuals residing in Washington Park, South Providence, Wanskuck and the West End \u2014 all low-income communities of color \u2014 represent \u201cthe majority of asthma-related emergency room visits\u201d in Providence.<\/p>\n
\u201cAll the kids have asthma around here,\u201d Huertas said, referring to her neighborhood. \u201cYou could knock on any door and you could find someone with asthma.\u201d<\/p>\n
Indoor and outdoor factors can worsen asthma<\/b><\/p>\n
A combination of factors can contribute to chronic asthma and trigger asthma exacerbations, including indoor housing conditions such as mold, dust, pets or smoke, and outdoor factors such as harmful emissions.<\/p>\n
According to the Providence Climate Justice Plan, areas that are closer to highways, ports, freight transportation corridors and industrial areas have greater \u201cexposure to air pollution and the risk of health effects.\u201d<\/p>\n
Pollutants such as ozone and particulate matter can cause asthma, according to Dr. Nicholas Nassikas MD \u201915, a University Pulmonary, Critical Care and Sleep Medicine fellow specializing in asthma and its relationship with pollution and climate change. \u201cThe studies that have been done so far support a clear link between air pollution and asthma exacerbations,\u201d he said.<\/p>\n
Particulate matter is a kind of pollutant produced by emissions from cars, industries and power plants, according to the Environmental Protection Agency\u2019s website. Particulate matter contains \u201cvery small particles that can be breathed into the deepest part of the lungs,\u201d which causes asthma exacerbations, said Nassikas. Ozone can also contribute to asthma, he added.<\/p>\n
The Providence Climate Justice Plan uses the EPA\u2019s Environmental Justice Screening and Mapping Tool to identify frontline communities that suffer \u201cthe greatest environmental health consequences of air pollution.\u201d<\/p>\n
Providence\u2019s frontline communities include parts of South Providence, Washington Park, Olneyville, Manton, Silver Lake, Wanskuck and the West End \u2014 all low-income communities of color.<\/p>\n
The report was developed in partnership with Providence\u2019s Racial and Environmental Justice Committee, which Huertas helped lead. Learning about environmental racism and health inequities motivated her to get involved in the REJC. \u201cWe are affected the most by (pollution),\u201d she said. \u201cThat\u2019s not right.\u201d<\/p>\n
Huertas\u2019 neighborhood, Washington Park, is the closest residential area to Providence\u2019s port \u2014 a major fossil fuel transport hub causing \u201csignificant local health impacts,\u201d according to the Climate Justice Plan.<\/p>\n
\u201cThe emissions from oceangoing vessels burn some of the dirtiest fuel,\u201d according to the report. \u201cHeavy duty diesel engines in trucks and trains, and off-gassing from valves and storage tanks also contribute to local air pollution.\u201d<\/p>\n
Washington Park is also near the I-95 highway, Allens Avenue and Narragansett Boulevard. According to Linda Perri, co-chair of the Washington Park Neighborhood Association, traffic from these roads is a noticeable source of contamination.<\/p>\n
For example, cars avoiding I-95 traffic jams often opt for Allens Avenue, where \u201cin the summertime, there\u2019s a cloud of orange-brown dust on the road,\u201d Perri said. \u201cWe cringe every time we drive down that stretch of land.\u201d<\/p>\n
A 2019 study by the Rhode Island Department of Environmental Management shows that areas near I-95 experienced higher levels of pollution than other areas in the state.<\/p>\n
Julian Drix, asthma control program lead at the RIDOH, takes multiple causes into account when screening factors that might worsen asthma. \u201cWe look at environmental conditions, but also quality of housing,\u201d he said.<\/p>\n
Drix leads the Home Asthma Response Program, a harm reduction strategy that focuses on reducing indoor asthma triggers. HARP sends professionals into the homes of asthma patients who sign up for the program, helping them identify triggers and ways to mitigate them, such as using mattress covers or keeping dust to a minimum.<\/p>\n
So far, the program has produced positive results, bringing \u201ca real change in conditions inside people\u2019s homes,\u201d said Drix. He added that \u201cthe most successful public health interventions \u2026 address the underlying environmental and socioeconomic determinants of health.\u201d<\/p>\n
According to Drix, community organizations are best positioned to introduce legislation to improve air quality. RIDOH can collaborate with these organizations by providing data from evidence-based research.<\/p>\n
While Drix doesn\u2019t know that any legislators are working on specific bills aimed at reducing the asthma crisis, he is \u201choping there will be growing interest in this.\u201d<\/p>\n
Air quality standards are unlikely to change<\/b><\/p>\n
If Providence air pollution continues at current levels, \u201cwe\u2019re going to continue to see \u2026 asthma exacerbations due to these different pollutants,\u201d Nassikas said. \u201cIf we start to install policies that try to reduce pollution emissions, then we should see a reduction in asthma exacerbations.\u201d<\/p>\n
An example of such policies might be increasing bike lanes, which would reduce the number of polluting cars on the road and promote exercise, Nassikas said.<\/p>\n
Policy changes aimed at lowering the current standards for ambient air pollutants would also have a positive impact on health, but would be much harder to pass due to the interests of multiple stakeholders, Nassikas said. \u201cThere are people who would say that it would be too harmful to the economy,\u201d he said, adding that changing the standard \u201cwould definitely be better for health.\u201d<\/p>\n
According to Karen Slattery, supervising air quality specialist at RIDEM, Rhode Island abides by the National Ambient Air Quality Standards set by the EPA, and is not considering establishing its own, more stringent pollution standards. \u201cThat\u2019s a very difficult task,\u201d she said. \u201cWe\u2019d have to have the science behind that, and the science \u2026 doesn\u2019t show that we need a lower standard.\u201d<\/p>\n
Slattery added that \u201cWe don\u2019t have reason to set a lower standard in Rhode Island because we\u2019re not even close to the federal standard at this point.\u201d<\/p>\n
The EPA has the authority to make the NAAQS more stringent, but lowering the standards at the federal level has historically been a complicated process. Even the current NAAQS were established after decades of political battles involving multiple lawsuits.<\/p>\n
Instead of focusing on the standards, RIDEM is increasing its air monitoring in areas with higher rates of pollution, as shown by the I-95 contamination study, said Slattery. This includes communities around Providence\u2019s port.<\/p>\n
\u201cWe can do our part: We\u2019re going to look at what\u2019s out there, making sure (pollution) sources are compliant,\u201d said Slattery, adding that RIDEM has received grant money to plant trees along I-95 to filter particulate emissions, which would reduce harm to frontline communities.<\/p>\n
For Huertas, any initiative taken to combat pollution and its adverse health effects on frontline communities must include neighborhood voices: \u201cWe can\u2019t move forward unless the most marginalized and most affected are at the forefront.\u201d<\/p>\n
Pick up a copy of next week\u2019s paper to read the second part of \u201cA look into asthma in Providence.\u201d<\/p>\n<\/p><\/div>\n