Combating Harlem's Asthma Epidemic

Kimberly Ballesteros is among the lucky three-quarters.

Out on a shopping trip on 125th Street, Ballesteros, 11, can dash from Lenox to Adam Clayton Powell without worrying that she will run out of breath and end up in the emergency room.

But Ballesteros is acutely conscious that many of her peers are not so fortunate. She can cite the statistic: One-fourth of Harlem children have asthma.

"So many of my friends, they can't hardly breathe," Ballesteros said. "My cousin, he says he feels like a fish put out of water."

The 26-percent asthma rate was more than double the rate that a research group -- which included Harlem Hospital, the Harlem Children's Zone, and Columbia University's Mailman School of Public Health --e expected to find. The national asthma rate for children of the same age group is between 5 and 7 percent. Some experts say the Harlem rate is higher than any other asthma rate ever documented in the United States.

"We've discovered the underbelly of the iceberg and it's twice as large as we thought it was," Dr. Stephen Nicholas, who ran the study, told the Associated Press. Nicholas is the Harlem Hospital Director of Pediatrics and a Columbia associate professor of clinical pediatrics.

Bronchial asthma is a respiratory system condition in which the air tubes to the lungs become especially vulnerable to constriction. Asthma attacks are controllable when properly treated, but they kill 5,000 people in the United States each year. Asthma develops only in people with a genetic predisposition toward it, but that predisposition is made manifest when triggered by environmental conditions such as smoke, animal dander, and air pollution. For this reason, asthma cases are more frequent in poor urban communities that are disproportionately exposed to hazardous pollutants.

Now, researchers, public health workers and elementary school teachers are working to address a problem that urban children have been shouldering for years. Teachers are adding asthma awareness instructions to their curricula. And doctors and volunteers are intervening in the homes of those children who tested positive in the study, attempting to help parents and children learn to manage the disease.

Most of this intervention is being spearheaded by the Harlem Children's Zone, a nonprofit group that provides a wide range of social services in areas from housing to public health. The School of Public Health and Harlem Hospital continue to play additional roles.

Combatting Harlem's asthma epidemic has also become a popular topic among area politicians, including U.S. Senators Charles E. Schumer and Hillary Rodham Clinton and City Councilmember Bill Perkins.

The two New York senators, known for choosing to rally separately around the same topics, have both made public commitments to fighting the epidemic. In April, Schumer called on the Senate to appropriate $200 million in additional funding to place 2,000 new asthma counselors in New York City. In May, Clinton spoke to an East Harlem asthma symposium, promising that she too would work for a solution.

Perkins, the councilmember for District Nine -- which includes much of Harlem -- is focusing not on helping asthma victims learn to manage their condition but on improving the environmental conditions that cause or exacerbate the disease.

"Those of us in public policy have a major task at hand to correct the environment that is aggravating this critical health problem," Perkins said. He cited poor housing maintenance, lead paint, and air pollution from bus depots as particularly grievous environmental problems contributing to the epidemic.

Perkins noted that public health funding is still a problem for Harlem, but he stressed that asthma should be a priority.

"There are some budgetary implications that require us to make sure funding is made available," he said. "If we did not do that we would be allowing the crisis in the budget to be balanced at the price of the breath of the asthmatic children, effectively condemning them to death."

Both senators, the councilmember, Manhattan Borough President C. Virginia Fields, and other area politicians will all walk tomorrow in the CAMINAR (or Community Actively Marching to Inspire Awareness and Responsibility) for Asthma, a march designed by the East Harlem Asthma Working Group to raise awareness about the epidemic. Additionally, Perkins and a group of colleagues say they are currently pushing legislation through the council to force the health department to intervene in some asthma cases. Despite these public efforts, some Harlem citizens say their political representatives are not paying enough attention to the problem.

"I haven't heard of any politicians working on asthma, and I think that is very concerning," Tanya Baldwin, a Harlem resident, said. "Children really need to have healthy air to function, to be able to work at school, to go through their lives."

And even the most effective intervention efforts for children with asthma may be a surface solution to a deeper problem: poverty, poor housing conditions, and pollution in the area.

The issue of pollution has become especially vital since March, when the Bloomberg administration announced plans to re-open a pier in West Harlem that has acted as a garbage shunt for one-third of Manhattan's trash. The pier, known as a "marine transfer station," closed two years ago with the Fresh Kills landfill. But as part of Bloomberg's plan to ship garbage off the island via barges, the pier will again become a trash waystation.

West Harlem Environmental Action (WEACT), an environmental advocacy group dedicated to reducing pollution in the area, says that Bloomberg's plan stinks of environmental racism: If the marine transfer station were not in Harlem, the mayor would not consider reopening it.

WEACT says its members are concerned that the marine transfer station's reopening, in combination with increasing diesel fuel exhaust, will keep asthma rates on the increase.

"Given the large number of Harlem children with asthma who are vulnerable to pollution-related asthma attacks, it is more important than ever for our leaders to step up to reduce the disproportionate burden of diesel exhaust and other sources of air pollution in our communities," said Swati Prakash, environmental health director for WEACT, in a statement.

Whether the best solution is environmental change, personal intervention, or public advocacy, asthma victims in Harlem are stuck with a problem that will take a lot of education and maintenance to combat.

"At school sometimes they teach us about what asthma is and what we have to do in case of an asthma attack," Ballesteros said. "It's easy steps, but for people who have asthma I think it's really hard, because they get really impatient and they get nervous."

Despite some public education efforts, most Harlem adults still seem to know relatively little about asthma and treatment.

Even Marie Iang, a 125th Street shopowner whose 7-year-old daughter suffers from severe asthma, said that when the asthma attacks happen her family is not sure how to react.

"I am scared for her," Iang said. "So I just try to get to the hospital and I hope that things are okay."

Margaret Hunt Gram is an undergraduate at Columbia University in New York, where she is majoring in English and comparative literature. She is city editor of the Columbia Daily Spectator.

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