Black children are more likely to have asthma. A lot comes down to where they live.
Black children are more likely to have asthma than kids of any other race in America.
About four million children in the US have the lung condition. More than 12 per cent of Black children suffer from the disease, compared with 5.5 per cent of white children. They also die at a much higher rate.
The rippling effects of racism have led to high poverty rates, poor health outcomes and shortened life expectancies in Black communities.
Increased asthma rates is just one outcome of America's unequal living conditions and healthcare system.
Why does asthma disproportionately affect Black children in the US?
Across America, nearly four in 10 Black children live in areas with poor environmental and health conditions compared to one in 10 white children.
Black children are more likely to live near polluting plants or busy roads, and in rental housing with mould and other triggers. This is because of racist housing laws in the nation's past.
The disparities are built into a housing system shaped by the longstanding effects of slavery and Jim Crow-era laws. Many of the communities that have substandard housing today or are located near toxic sites are the same as those that were segregated and redlined decades ago.
“The majority of what drives disparities in asthma, it’s actually social and structural,” says Sanaz Eftekhari, vice president of corporate affairs and research of the Asthma and Allergy Foundation of America. “You can tie a lot of the asthma disparities back to things that have happened, years and years and decades ago.”
Rental housing creates risks for asthma
America’s discriminatory housing policies make Black Americans more likely to live in rental housing.
Rental units are much more likely to have deficiencies or inadequacies and fewer means to address problems that increase exposure to asthma triggers.
Throughout the 20th century, federal housing policies promoted homeownership and wealth generation - but those benefits were largely inaccessible to Black families.
In Connecticut, for example, more than half of Black households rent, compared with a quarter of white households.
An Asthma Allergy Foundation of America report examining asthma disparities found that Black renters were more likely to report the presence of mice, cockroaches or mould in their homes.
Black people also live in older housing at higher rates, exposing them to triggers like dust and mould.
“So many of our children are living in these just utterly disrepair homes with mould, open cracks, leaking, and vermin,” says Dr. Jessica Hollenbach, co-director of the Asthma Center of Connecticut Children’s hospital.
Years of inequities have forced families into substandard rental properties
While people may prefer to blame Black parents, saying they should make better choices for their families, Catherine Manson - whose five-year-old son has asthma - points to the years of inequities that have led people to live where they can.
“As a Black woman who is also a Black mother, I have experienced ridiculous amounts of blame and abuse from a larger system that understands they’re culpable but understands that the issues are so big, that it’s a whole lot easier to say, ‘Black mommy, you’re the problem,’” she says.
Her family's rental apartment in Connecticut was plagued by stubborn mould spores, which worsened her children's health and saw Catherineherself diagnosed with asthma.
The mould began to form because the owners failed to address a leaky roof.
Pollution is also a major factor in asthma rates
Nitrogen oxide emissions have been linked to high asthma rates.
These gases are typically emitted from vehicle exhaust, coal, oil, diesel and natural gas burning and can cause health issues such as eye irritation and asthma aggravation.
Dr Mark Mitchell, a former director of Hartford Connecticut’s health department and a founder of the Connecticut Coalition for Environmental Justice, has tried to sound the alarm on Hartford’s asthma rates.
The coalition began investigating and advocating for environmental justice after concerns arose about a regional landfill expansion and possible links to high rates of asthma, cancer and other diseases in communities neighbouring them.
Mark recalled how, in the mid ’90s, he examined about 30 kids and found that a third of them had asthma. He urged the state to look into what he believed was a clear pattern of disparities.
“They told me… we don’t really know who has asthma and doesn’t have asthma, and besides, it’s not unusual for a third of inner-city kids to have asthma,” says Mark, who is now associate professor of climate change at George Mason University.
The state’s health department did not respond to multiple requests for comment on its efforts to combat its asthma rates.
Mark says his research and work have led him to believe that the state’s asthma rates are heavily tied to traffic-related air pollution, as well as other air pollutants.
Black people suffer the brunt of it. Exposure to pollutants - specifically, fine particulate matter - is often disproportionately experienced by Black and Hispanic populations, while the emissions are disproportionately caused by white populations.
Why is asthma more deadly for Black children in the US?
Asthma in Black American children is often more severe and less likely to be controlled. This comes down to a combination of poor medical care and mistrust of doctors.
Asthma is treatable. It can be managed with medicine, routine appointments and inhalers. But Black children often struggle to get treatment, and are more likely than white kids to end up in the emergency room with asthma symptoms.
Kamora Herrington, a community organiser in Hartford, Connecticut, doesn't need to study the statistics to know that the children of her city are suffering.
“We know that our emergency rooms in the middle of the night during the summer are filled with children who can’t breathe,” Herrington says.
The prime cause, she said, is just as apparent.
“People need to demand change... and people need to not be reasonable. At what point do you say, this is bullshit? White supremacy and racism have everything to do with it.”
Structural racism fuels health inequalities
Abimbola Ortade, an activist and board member of Hartford Connecticut’s Black Lives Matter 860 chapter, recently lost his sister to COVID. Like many Hartford residents, she had asthma for most of her life, and diabetes, a combination that proved deadly.
Abimbola also has asthma, along with two of his children. He worries frequently about their future - and his.
Asthma, Abimbola says, is merely one example of how structural racism fuels health disparities that are likely to worsen as Black children go through life - including the toll of toxic stress on their mental health.
“In my neighbourhood, you’ve got to worry about the police killing you, stress killing you, heart failure or asthma killing you,” he says.
Abimbola is critical of elected officials and what he believes is a reluctance to truly address the disparities and root causes.
Asthma, he said, “is like a ticking time bomb.” Black kids have other things working against them when it comes to asthma risks.
Low birth weight, which is highest among Black babies, is one risk factor.
The confluence of toxic stress, racism and discrimination that many Black people endure, heightens the risk of preterm births and low birth weights - and the disorders, like asthma, that may follow. These factors are present regardless of socioeconomic level.
Segregated or low-income communities are less likely to have easy access to health care facilities or specialty medical clinics, which are predominantly in or next to white or higher-income communities.
Advocates say increasing representation of Black doctors - including pulmonologists, allergists, immunologists and researchers - is key to better care, eliminating bias and disrupting valid mistrust in doctors.
Asthma is disruptive beyond its health consequences
Asthma can be particularly disruptive for Black children and their families beyond its health implications, creating a trickle down effect in other facets of their lives.
Catherine's son Carter, and his nine-year-old sister Caydence who also has asthma, have missed weeks of school, leaving them behind in schoolwork. And in turn, their parents were forced to miss work to care for them - putting a strain on the family’s finances.
“I’ve missed work, their dad has missed work,” says Catherine, who now works in the medical field as a patient service representative, after leaving a beloved career in part to focus on her family’s health.
“But you have to pay the bills. Then you miss work and you miss money and that comes out of your budget. It affects everything.”
How can the US bring asthma under control?
The situation could be eased by improving diagnosis rates and creating a standardised approach to help keep asthma under control.
At Connecticut Children's hospital, more than 150,000 children have been screened and more than 41,000 have been diagnosed with asthma through the Easy Breathing programme.
“I think the biggest issue is that asthma is a chronic disease that requires care every single day,” says Dr Melanie Sue Collins, director of the Pediatric Pulmonary Fellowship and Cardiopulmonary Lab at Connecticut Children's. “And what I see many of my patients and families struggling with is the basic needs of life.”
HUSKY Health, which includes the state’s Medicaid and the Children’s Health Insurance Program, covers about 22 per cent of the state population.
On a federal level, resources have been put toward various housing and health grant programs. An Asthma Disparities Subcommittee was formed by the National Institutes of Health in 2010 and published a federal action plan in 2012. And the Affordable Care Act broadened coverage access for millions.
But advocates say more asthma-specific legislation and funding is needed. Overall asthma rates have trended downward in recent years but rates among Black children remain outsized and disparate.
In Connecticut, the prevalence of asthma in the state’s public school system has slightly decreased over time but about one in eight students have asthma. The incidence among Black students is about 50 per cent higher.
That often means absenteeism - and in the near and long term, failure.
“If you miss school, you can’t succeed in school,” Collins says of a fraught cycle many kids encounter. “And if you don’t succeed in school, you have a really difficult time having a life where you can do things comfortably, whether it’s eating, having shelter or a successful job.”