EnvironmentalHealth, as stated by Friis (2012), “comprises those aspects of human health,including quality of life, that are determined by physical, chemical,biological, social, and psychological factors in the environment”. Additionallyhe points out that “it also refers to the theory and practice of assessing, correcting,controlling, and preventing those factors in the environment that potentiallycan affect adversely the health of present and future generations” (Friis,2012). Large proportions of current diseases are associated with environmentalsources. It is estimated by the World Health Organization (WHO) in the report Preventing Disease Through HealthyEnvironments – towards an estimate of the environmental burden of disease that”24% of the global disease burden and 23% of all deaths can be attributed toenvironmental factors” (Pruss-Ustun, 2006). Diseases with large environmentalcontribution include diarrhea, lower respiratory infections, malaria, chronicobstructive pulmonary disease, malnutrition, cerebrovascular disease, asthma, andtuberculosis and lung cancer. Worldwide “children suffer a disproportionateshare of the environmental health burden” (Pruss-Ustun, 2006). Accordingto WHO, air pollution is defined as “a major environment-related health threatto children and a risk factor for both acute and chronic respiratory disease”.Air quality is degrading worldwide.
Friis (2012) states that “many Europeancities do not meet WHO air quality standards for at least one pollutant” and “inthe United States (U.S.), about 25% of the population lives in areas that donot meet the U.S.
air quality standards”. TheAmerican Heritage Science Dictionary defines air pollution as “contaminationof air by smoke and harmful gasses, mainly oxides of carbon, sulfur andnitrogen” and The New Dictionary ofCultural Literacy states that “the most serious air pollution results fromthe burning of fossil fuel, especially in internal-combustion engines”. Combustionof fossil fuels is the major source of air pollution in the U.S. Acute effectsof air pollution include the following: irritation of eyes, nose and throat,asthma, bronchitis, pneumonia, coughing, nausea, and headaches. Chronic effectsof air pollution include heart disease, chronic obstructive pulmonary diseaseand lung cancer.
Accordingto Center for Disease Control and Prevention (CDC), the prevalence of asthmaand mortality due to air pollution increased in the United States by 58% since 1980.It is stated by the United States Environmental Protection Agency (EPA) that “asthmais a serious, sometimes life-threatening chronic respiratory disease thataffects the quality of life for more than 23 million Americans, including anestimated 6 million children”. Mayo Clinic defines asthma as “a condition in whichairways narrow and swell and produce extra mucus” that “makes breathingdifficult and triggers coughing, wheezing and shortness of breath”. Irena Buka(2006) reports that “the Committee on Environmental Health of the AmericanAcademy of Pediatrics issued a policy statement in 2004 emphasizing the linkbetween ambient air pollution” (defined by WHO as pollution emitted fromindustries, households, cars, and trucks) “and children’s health”. “Childrenare known to be more vulnerable to the adverse health effects of air pollutiondue to their higher minute ventilation, immature immune system, involvement invigorous activities, the longer periods of time they spend outdoors and thecontinuing development of their lungs during the early postneonatal period”(Buka, 2006). According to CoordinatedFederal Action Plan to Reduce Racial and Ethnic Asthma Disparities announcedby EPA, “approximately 7 million children age 0 to 17 in the U. S. have asthma,with poor and minority children suffering a greater burden of the disease”.
JamesGauderman (2004) reports that “in 1993, the Children’s Health Study recruited1759 fourth-grade children (average age, 10 years) from elementary schools in12 southern California communities as part of an investigation of the long-termeffects of air pollution on children’s respiratory health”. The children werefollowed for up to 8 years and the results of the study provided robustevidence that “lung development… from the ages of 10 to 18 years, is reduced inchildren exposed to higher levels of ambient air pollution” (Gaudermna, 2004). TheGALA II and SAGE II studies of early-life air pollution and asthma risks inminority children led by UCSF (University of California, San Francisco) observedof 5,000 participant from Chicago, Bronx, Houston, San Francisco and PuertoRico from 2006 to 2011. The results of these studies showed that AfricanAmerican and Latino infants living in communities with poor air quality due totraffic-related pollutant are more likely to develop childhood asthma (Thakur, 2013).
BostonChildren’s Hospital Community Asthma Initiative (CAI) was developed owing tothe fact that “asthma hospitalization and Emergency Department visits aredisproportionately high for African American and Hispanic children”, accordingto the hospital’s website. CAI is meant to help improve the health and qualityof life of children with asthma and their families (Community AsthmaInitiative). 2 to 18 years old children who live in Boston and have been eitherseen in Boston Children’s Emergency Department or hospitalized for asthma can benefitfrom the initiative (Community Asthma Initiative). The program “works with eachfamily to understand their child’s asthma and the medications used to treat it,and to identify and reduce asthma triggers in the home and other places wherethe child spends time” (Community Asthma Initiative). CAI has proved to be aneffective program and has been adopted in other cities and states.InMay 2012 EPA released Coordinated FederalAction Plan to Reduce Racial and Ethnic Asthma Disparities (the Plan).
Itproposed “to build on the strength and lessons learned from past and existingfederal asthma problems and combined efforts among federal programs at thecommunity level” (Coordinated Federal Action Plan, 2012). The Planoutlines the following four strategies to reduce the disproportionally highburden of asthma for minority children: (1) “reduce barriers to theimplementation of guidelines-based asthma management”; (2) “enhance capacity todevelop integrated, comprehensive asthma care to children in communities withracial and ethnic asthma disparities”; (3) “improve capacity to identify thechildren most impacted by asthma disparities”; (4) “accelerate effort toidentify and test interventions that may prevent the onset of asthma amongethnic and racial minority children” (Coordinated Federal Action Plan, 2012).WEACT for Environmental Justice (WE ACT) is a community organization described ontheir website as “a Northern Manhattan membership-based organization whosemission is to build healthy communities by ensuring that people of color and/orlow income residents participate meaningfully in the creation of sound and fairenvironmental health and protection policies and practices”, noted in theAugust 10th, 2017 press release that “more federal support is neededto reduce asthma disparities nationwide” (Report, 2017).
The report Unequal Air and Care: Federal Impacts onPediatric Asthma Disparities in 4 U.S. cities states that “the federalgovernment’s Coordinated Federal ActionPlan to Reduce Racial and Ethnic Asthma Disparities needs more support tohave an impact on asthma disparities in communities of color and low-income” (Report,2017). The report “highlights work done to assess and discuss the strategiesoutlined in the Federal Action Plan,and to assess their effectiveness at reducing the disparate burden of asthma indisadvantaged children aged 0-8 in four U.
S. cities: Jackson, MS, New Orleans, LA,Detroit, MI and New York City, NY” (Unequal Air and Care, 2017). Key finding ofthe project stress that “federal approaches to asthma disparities are toobroadly focused” and do not adequately take into consideration the “social andpolitical factors that children of color and low-income face”, such as stress,poverty, poor housing, and access to quality health care (Unequal Air and Care,2017).
The report provides recommendations which include: (1) “addressing thesocial and environmental determinants of health that contribute to pediatricasthma disparities in America”; (2) “establishing a Health-in-all-Policiesagenda across federal sectors by adopting an inter-sectoral approach to buildinga culture of health for disadvantaged children”; (3) “expanding the capacity todeliver integrated comprehensive asthma care to children in communities withracial and ethnic asthma disparities”; (4) “building the capacity of state andlocal governments, as well as clinical and non-clinical community-basedorganizations / institutions, to provide community-level care for asthmatic andat-risk children” (Unequal Air and Care, 2017). Itis stated by WE ACT that, “nationally, about 1 in 11 children have asthma, butin some low-income areas of New York City, the childhood asthma rate can beupwards of 1 in 4” and that high indoor levels of pollutants (mold, pests, etc.),which can be 2 to 5 times higher than outdoor pollutant levels, directlycontribute to the high prevalence of asthma in the city (Coalition for AsthmaFree Homes). With the goal for asthma free homes, “WE ACT and members of theCoalition for Asthma Free Homes created a prescription to address asthma andasthma disparities: the Asthma-FreeHousing Act” (Coalition for Asthma Free Homes). If passed, the act would “prioritizeprevention measures in homes of susceptible persons”, “require landlords toinspect for Indoor Allergen Hazards and correct them and their causes usingapproved methods”, and “create a system for physician referrals for housinginspections by the City for patients with asthma” (Coalition for Asthma FreeHomes).WHOprovides leadership worldwide in minimizing adverse environmental healthoutcomes associated with air pollution.
In the United States, EPA wasestablished in July of 1970 due to the growing public demand for clear water,air and land. The agency monitors environmental quality. The Clean Air Act(CAA) of 1970, “a comprehensive federal law that regulates air emissions fromstationary and mobile sources, authorizes the EPA to establish National AmbientAir Quality Standards (NAAQS) to protect public health and public welfare andto regulate emissions of hazardous air pollutants” (Summary of the Clean AirAct). The Clean Air Act Amendments of 1990 strengthened regulations for autoemissions, toxic air pollutants, acidic deposition, and stratospheric ozonedepletion. Steps to reduce emissions of harmful air pollution include:technological controls (mechanical devices used to reduce industrial emissionsof particular matter), energy conservation and strengthening of national andinternational air quality laws.