Although only 6 percent of Americans nationwide have asthma, roughly one in four children in Harlem suffer from the condition—and a recent Columbia study has shown that identifying the exact cause of this disparity is not an easy task.
New Mailman School of Public Health research—which has particular resonance in Harlem—has identified more closely what actually triggers asthma’s onset and symptoms, and how this might explain neighborhood discrepancies.
Matthew Perzanowski—an assistant professor of environmental health sciences, who co-authored the recent “NYC Neighborhood Asthma and Allergy Study” with several other doctors and researchers, said that children growing up in East and West Harlem are at two or three times the risk of having asthma, as compared to bordering neighborhoods like the Upper East Side and Upper West Side.
Asthma, characterized by chronic lung inflammation and episodes of airway constriction, is an environmental disease, Perzanowski said. His study of seven-year-old subjects—recruited through their parents’ health insurance, most middle-class, and all are receiving health care—investigated environmental exposures believed to have ties to asthma rates.
Half of the children come from low-asthma neighborhoods and half from high-asthma neighborhoods, such as Harlem and Washington Heights. After measuring environmental conditions in the homes of all subjects, the study found correlations between mouse and cockroach allergen exposure and the onset or exacerbation of asthma symptoms. Children who had four or more episodes of wheezing correlated with higher rates of pest allergens. The study also identified possible correlations between local sources of diesel particulates and rates of asthma symptoms.
“We still don’t have a definitive answer on what leads to asthma,” Perzanowski said. “But we are trying to tease apart many factors, from genetic susceptibility to community and individual level differences and exposure to allergens.”
According to New York City Department of Health and Mental Hygiene statistics, asthma hospitalizations are disparate both among and within boroughs. As of 2000, asthma was the number-one cause of hospitalizations in the city among children age 14 and younger. Perzanowski though said, “Hospitalizations, particularly in high asthma prevalence neighborhoods, have gone down pretty dramatically in the last 15 years through the efforts of the medical community and the Department of Health in educating parents and physicians.” He added though that the rates of asthma still seen today “have much to do with socioeconomic health care and how health care is accessed.”
Cockroach and mouse allergens, he said of the recent study, are more common in lower-income homes and neighborhoods, often due to structural degradation of the home. Cracks or holes in walls, for instance, are conducive to the entry of the pests whose allergens affect asthma. Diesel exhaust, another likely trigger, is prevalent in areas where bus depots are located or where truck routes are common—often in lower-income areas, and more commonly above 96th Street.
“We need to educate people to get appropriate therapy for their children, control versus emergency rescue medication, and to have an asthma action plan for how to monitor the disease and increase medications in order to avoid hospitalizations,” Perzanowski said.
Although individual efforts to reduce home allergens, such as pest removal in a home, can be effective, “From a public health standpoint, we can do more community involvement in understanding what asthma triggers are and how to reduce them, as well as how to get the appropriate therapy,” he said.
Local initiatives, such as the Harlem Hospital Center Asthma Prevention Project and collaborations with the Harlem Children’s Zone, have sought to address asthma disparities through neighborhood studies, child screenings, medical action plans, and programs for better management and reduction. And some say scientific research, like Perzanowski’s study, can help confront the ongoing challenges of a condition so common that it becomes a basic part of daily life in neighborhoods like Harlem.
Vivian Williams-Kurutz, director of the nonprofit New Song Community Corporation’s Harlem Center for Healthy Living, said that many people tend to just accept asthma because it has become so common, and because there has not been a deep understanding of the causes of glaring neighborhood differences. “There are people who have been active in Harlem for years who have been passionate about this topic,” she said, adding, “but there just hasn’t been an incredible traction in creating something that has been able to get the monster.”