At a birthday party on a farm, 5-year-old Carter Manson experienced his first public asthma attack. While playing games and enjoying the festivities with his best friend, Carter suddenly clutched his chest and repeatedly said “I can’t breathe.”
His mother, Catherine, was alarmed and quickly comforted him, urging him to breathe. However, the inhaler that could have relieved his symptoms was left in the car.
Catherine ran to retrieve the inhaler and only then was Carter able to catch his breath.
This scary incident highlights the importance of having an asthma action plan and ensuring that necessary medication is always on hand.
Catherine, who is now 39, expressed her determination to be better prepared for future asthma attacks her son may have. Unfortunately, it is difficult to predict triggers and prevent attacks because even small things can set them off. The prevalence of asthma is higher among Black children compared to children of other races in the United States.
This is largely due to systemic racism and past housing policies that resulted in Black families living in disproportionately polluted areas near industrial plants. Additionally, many Black children receive suboptimal medical care and harbor a mistrust of doctors, resulting in their asthma being more severe and less well-controlled.
Asthma affects approximately 4 million children in the United States. However, the percentage of Black children who suffer from asthma is significantly higher than that of white children. Over 12% of Black children nationwide have asthma, compared to only 5.5% of white children. Furthermore, the mortality rate for asthma is much higher among Black children than any other race. These statistics underscore the urgent need to address the root causes of asthma among Black children and work towards providing equitable access to high-quality medical care for all.
The disproportionately high prevalence of poor environmental and health conditions in communities where Black children live is a significant concern. Almost 4 in 10 Black children in the United States are exposed to subpar environmental conditions, which is significantly higher than the 1 in 10 white children who face similar conditions. Toxic pollutants, such as nitrogen oxides and particulate matter, are released by factories, while idling trucks and traffic also contribute to air pollution.
These disparities reflect a housing system that has been shaped by the lasting impacts of slavery and segregation. Many of the same communities experiencing substandard housing and toxic exposure today were previously redlined and racially or economically segregated decades ago.
According to Sanaz Eftekhari, the Vice President of corporate affairs and research of the Asthma and Allergy Foundation of America, the root cause of asthma disparities is largely social and structural. Many of the historical racial and economic injustices faced by Black communities have created the conditions for disparities in asthma. Although asthma can be treated with medication and regular appointments with medical professionals, Black children are often unable to access these treatments, leading to a higher rate of emergency room visits for asthma symptoms, compared to white children.
Community organizer Kamora Herrington of Hartford, Connecticut, is well aware of how asthma affects children in her city. She believes that it is time for people to demand real change and not simply settle for what is considered reasonable, and that addressing systems of white supremacy and racism is crucial to reducing asthma disparities.
Catherine Manson, a Connecticut resident, struggled with repeated mold infestations in her apartment outside of Hartford. Despite her best efforts to scrub the walls and floors, the spores persisted, and the mold eventually spread throughout the home, causing increased coughing and breathing difficulties for Catherine and her kids. The family relied more heavily on their nebulizer treatments during their four years in the mold-infested home, and Catherine was diagnosed with asthma.
The property had two different landlords during this period, neither of whom effectively addressed the mold problem. Catherine believes that a leaky roof may have been the root cause of the mold, which worsened whenever it snowed or rained. Like many Black families, the Manson family found themselves stuck in a substandard home that posed a significant threat to their health and wellbeing.
Although they desired to leave the apartment, the family was unable to do so for a long time due to financial difficulties, particularly during the height of the COVID-19 pandemic.
They finally moved in 2021.
Discriminatory housing policies in the United States have contributed to the prevalence of rental housing among Black Americans. Historically, federal housing policies have supported homeownership and wealth generation, but access to these benefits was often inaccessible to Black families due to systemic racism and discrimination. Therefore, Black families were more likely to live in rental housing, which frequently lacks adequate maintenance and can expose them to a range of health hazards, including exposure to mold and other pollutants. These housing policies are a significant factor that has perpetuated and intensified the disparities in health outcomes, such as asthma, experienced by Black communities in the United States.
Rental housing is more prone to problems that could exacerbate asthma symptoms, leading to greater exposure to asthma triggers. Black households are more likely to rent than White households in Connecticut, with more than half of Black households renting versus a quarter of White households. In Hartford, nearly 70% of Black households rent.
According to a report by the Asthma and Allergy Foundation of America, Black renters are more likely to experience vermin infestations and the presence of mold or cockroaches in their homes, affecting their respiratory health.
Black people also tend to live in older housing, exposing them to triggers such as dust and mold. In Hartford, 63% of Black households live in houses built before 1960, which could lead to poor indoor air quality and generate asthma triggers. Dr. Jessica Hollenbach, co-director of the Asthma Center of Connecticut Children’s, emphasized that too many children are living in unsafe homes with open cracks, mold, and leaking, potentially worsening their asthma symptoms and overall health.
Pollution is a significant contributor to the high rates of asthma among children in Connecticut.
The state’s five largest cities, including Bridgeport, Hartford, New Haven, Stamford, and Waterbury, have high concentrations of children with asthma, as well as a higher incidence of environmental and chemical exposures known to trigger asthma. Data from the Environmental Protection Agency’s National Emissions Inventory shows that Fairfield, Hartford, New Haven, and New London counties together emit over 10% of the state’s total nitrogen oxide emissions. Census tracts with the highest combined asthma rates are located in all four counties. Nitrogen oxide gases are often produced by vehicle exhaust, coal, oil, diesel, and natural gas burning and can cause eye irritation and aggravate asthma symptoms.
Dr. Mark Mitchell, a former director of the Hartford Health Department and a founder of the Connecticut Coalition for Environmental Justice, has been drawing attention to the high asthma rates in Hartford. The coalition began investigating and advocating for environmental justice after raising concerns about a regional landfill expansion that could be linked to high rates of asthma, cancer, and other diseases in nearby communities. Mitchell recalled examining about 30 kids in the mid-1990s and discovering that one-third of them had asthma, prompting him to urge the state to investigate the apparent pattern of disparities.
However, Mitchell’s alarm was dismissed by state officials who argued that they did not know who had asthma and who didn’t, and that a one-third asthma rate for inner-city kids was not uncommon. The state department of health has yet to respond to inquiries regarding their efforts to address asthma rates in Connecticut.
Dr. Mark Mitchell’s research and work have led him to believe that high asthma rates in Connecticut are closely associated with traffic-related air pollution and other air pollutants. Black and Hispanic populations are disproportionately exposed to pollutants, especially fine particulate matter, while white populations are responsible for the majority of emissions. Black communities bear a significant burden of the asthma epidemic in Connecticut. According to DataHaven, more than 21% of children in East Hartford experienced asthma between 2018 and 2021, compared to the statewide average of 13%. These disparities highlight the urgent need to address environmental and structural inequalities and work towards equitable access to clean air and safe housing for all communities.
Kamora Herrington, who has lived in Hartford, Connecticut, for much of her life, launched Kamora’s Cultural Corner as a gathering space for residents in a mostly Black north-end neighborhood of the city. The area faces numerous socioeconomic challenges stemming from systemic racism, which leads to high poverty rates, poor health outcomes, and short life expectancies compared to other parts of the city. Herrington recalls that a garden in the area was once a site where rows of milk delivery trucks idled daily, emitting black smoke and clouds of dust. The lot was also where trucks were repaired, allowing toxins to seep into the ground. Across the street, low-income apartments and multifamily houses were home to many children who would play nearby.
Today, the ground is too toxic to plant in, and residents use raised flower beds. Herrington worries about the long-term health impacts on generations of Black children who have grown up in the area. She emphasizes that Blame should not be put on Black parents for their choices, as years of structural inequalities have led many Black people to live in areas where they have limited alternatives.
As a Black mother, I have experienced an excessive amount of blame and abuse from a larger system that acknowledges their responsibility in the issues facing the Black community but find it easier to shift the blame onto us, said a Black woman. The majority of rental housing in Hartford lacks proper ventilation or air conditioning, which is particularly detrimental to children with asthma during hot summers.
An activist who recently lost his sister to COVID notes that structural racism fuels health disparities, leading to shorter lifespans for Black adults and negatively impacting the mental health of Black children. The root causes of these issues are ignored by elected officials and must be addressed before it is too late, he added. Asthma among Black children is like a ticking time bomb, he concluded.
Black children are particularly vulnerable to asthma due to multiple risk factors, such as high rates of low birth weight. The toxic combination of stress, racism, and discrimination that many Black people face raises the risk of preterm birth and low birth weight, which can lead to asthma and other disorders. These factors disproportionately affect Black communities regardless of their socioeconomic status. Additionally, segregated and low-income communities often lack access to adequate healthcare facilities and expertise, which are often located in wealthier, white communities.
To address these issues, advocates recommend increasing representation of Black doctors, particularly pulmonologists, allergists, immunologists, and researchers. They believe this will improve the quality of care, eliminate biases, and increase trust among Black patients.
Catherine Manson, a Black mother, expressed her difficulty in finding the appropriate health care professionals to manage her children’s asthma. She believes pediatricians are not knowledgeable enough, leaving her to advocate for her children’s health on her own.
Asthma is especially disruptive for Black children and their families beyond its medical implications, creating a trickle-down effect on other aspects of their lives. Due to asthma, Carter and his 9-year-old sister Caydence have missed weeks of school, which caused them to fall behind in their studies. This, in turn, has forced their parents to miss work to care for them, leading to financial difficulties for the family.
Efforts have been made to manage and control asthma in Connecticut. The Easy Breathing program at Connecticut Children’s Hospital, which involves over 330 pediatricians in more than 90 practices in Connecticut, has been adapted for use in schools. Through the program, over 150,000 children have been screened and more than 41,000 have been diagnosed with asthma. Its aim is to improve diagnosis rates and standardize approaches to assist in keeping asthma under control.
The biggest challenge facing asthma patients and their families is the fact that the disease requires ongoing care every day, said Dr. Melanie Sue Collins, Director of the Pediatric Pulmonary Fellowship and Cardiopulmonary Lab at Connecticut Children’s. HUSKY Health, which covers about 22% of the state’s population, include the state’s Medicaid and the Children’s Health Insurance Program.
While some federal resources have been put towards housing and health grant programs, asthma advocates argue that more asthma-specific legislation and funding is necessary to address the issue of disproportionate asthma rates among Black children in the US. Although overall asthma rates have decreased in recent years, Black children continue to have higher rates of the condition compared to other groups.
In Connecticut’s public school system, the prevalence of asthma slightly decreased over time, but about 1 in 8 students still have asthma, and the incidence is about 50% higher among Black students. As asthma can lead to absenteeism, it can hinder academic success in the short and long term. This ultimately impacts one’s ability to enjoy a comfortable life, as success in school can lead to better opportunities in jobs, housing, and food security.
After years of managing her children’s asthma, Catherine Manson is pleased with the improvements she’s seen in her children’s health. She’s been successful in adhering to their asthma control plan, and it’s been paying off – Carter is now playing flag football, and Caydence is running track. Carter hasn’t used his inhaler since November 2020, and the children haven’t missed a single day of school this year.
Despite the progress, Catherine still worries about potential triggers as the seasons change. She’s had to miss work, along with her children’s dad, to attend to their health needs. Catherine now works in the medical field as a patient service representative, having left her previous career to focus on her family’s health needs. Although she’s pleased with their progress, the financial cost of managing her children’s asthma still weighs heavily on her family.