Ashia, Albina and Asthma- an individual story and a neighborhood history

Asthma is a disease in which the breathing tubes become very inflamed and can become obstructed by mucus and spasm down, narrowing the airways and making it almost impossible to breathe. Asthmatic patients are often some of the sickest in our ICU, and a previously young healthy person can become severely ill and die rapidly. The high pressures in their lungs can make ventilating them challenging, and patients have had cardiac arrest from asthma despite or because of ventilation, needed chest tubes for popped lungs, and more. Black children have nearly two times the rate of asthma as white children, are twice as likely to be hospitalized for asthma and four times as likely to die from asthma. On the podcast today, I interview a person who suffers from asthma and has come through multiple ICU stays, medication changes, sick days and clinic visits. You will hear how asthma impacts her life, and I hope it provides an understanding of the cost to a child and family when someone develops asthma.

Ashia Allen grew up in Albina, a formerly red-lined district and the heart of the historic Black community of Portland, OR. She attended Boise-Eliot elementary school which is located very close to I-5 as well as Benson Polytechnic High School, which sits right above I-84. She has suffered from asthma since childhood, but definitely does her best to not let it stop her despite multiple set-backs. She attended college at Grambling State University, where she learned about the interaction of air pollution and asthma in a science class, and is passionate about working to decrease asthma risk for future children, including her own. She is also an amazing dancer, and danced with Orchesis Dance Company.

Ashia's elementary school by the I-5 freeway
Ashia's highschool by I-84 freeway

Ben Duncan joins me to give a history of air pollution and diesel mitigation work in North Portland, where diesel emissions are particularly high and impact communities of color disproportionately. He is the Chief Diversity and Equity Officer for Multnomah County. He has been with the county since 2004 when he began his career in Environmental Health as a community health worker. He has since worked as a health educator, policy analyst and manager of the Health Equity Initiative. He is also a founding board member of OPAL Environmental Justice Oregon, an organization that organizes low income and people of color to build power for environmental justice and civil rights in the community. He also serves as Chair of the Oregon Governor’s Environmental Justice Taskforce, and recently became Chair of Oregon Public Health Institute’s Board. He recounts over 20 years of work on projects related to clean air and diesel reduction, and those years correspond to Ashia’s entire lifespan living with and suffering from asthma.

Ben Duncan joins me to give a history of air pollution and diesel mitigation work in North Portland, where diesel emissions are particularly high and impact communities of color disproportionately. He is the Chief Diversity and Equity Officer for Multnomah County. He has been with the county since 2004 when he began his career in Environmental Health as a community health worker. He has since worked as a health educator, policy analyst and manager of the Health Equity Initiative. He is also a founding board member of OPAL Environmental Justice Oregon, an organization that organizes low income and people of color to build power for environmental justice and civil rights in the community. He serves as Chair of the Oregon Governor’s Environmental Justice Taskforce, and recently became Chair of Oregon Public Health Institute’s Board. He recounts over 20 years of work on projects related to clean air and diesel reduction, and those years correspond to Ashia’s entire lifespan living with and suffering from asthma.

Diesel exhaust contains a variety of chemicals that can make people sick. For example, black carbon is a component of a particularly deadly form of particulate matter called PM 2.5, often forming its backbone, carrying deadly combustion particles deep into the lung, where they cross into the bloodstream and circulate throughout the body causing disease in nearly every organ and from womb to tomb. Pregnant women exposed to it have premature deliveries and give birth to children who are smaller for age. Multiple studies have shown that exposure to black carbon stunts the growth of a child’s lungs and increases the risk of that kid developing asthma. One study looked at healthy children from non-smoking homes and measured the black carbon in the cells they coughed up, and found that as the black carbon in their lungs increased, their lung function decreased. The black carbon in their lungs was directly related to the air pollution where they lived.  The damage does not stop in childhood, because we are all vulnerable to the air we breathe. This tiny particulate matter can circulate all around the body and it causes damage everywhere in the body- including heart attacks, strokes, and lung disease, as well as decreased brain function, including studies showing MRI changes in children’s brains, worsened vocabulary and cognitive performance, as well as associations with dementia in the elderly. Previously on this site and podcast, we have talked about the case of Tubman elementary school, also in Albina and located by a freeway with black carbon levels far in excess of the ambient benchmark. 

Gall and George Study at Tubman Middle School

We reflect on what it truly means to work for a world in which Black Lives Matter. Ben shares about how, across the country, black communities suffered not only the economic effects of being red-lined into areas of lower land prices, but also the health effects of having those be the areas where freeways were planned, urban industry developed, etc. We discuss the tension of balancing economic development and job growth with understanding the health toll, and the severe cost of ignoring the health impact of our policy decisions.

EPA report on Children's Environmental Health Disparities

Please listen to the podcast and leave your comments below or share them on Instagram or Facebook. See some of Ashia’s amazing dance performances here and here! Learn more about the history of Albina here, and about the history of Emanuel hospital where I work, which displaced the heart of the Albina black community including one of its most iconic buildings to build, including an expansion that never happened. You can see reporting from OPB and Legacy as well.

To Do

1- Learn more about the impact of air pollution on health-  listen to podcast Episode 2 with Dr. Matt Drake and Episode 17 with Dr. Ritz. Learn about how red-lining can affect those asthma risk in Episode 27 with Prof. Shandas.

2- Learn more about how policy can work- listen to Episode 12 about cleaning up diesel school buses with Dr. Adar and Episode 16 with the American Lung Association’s analysis of the economic stimulus and decrease in asthma we might see with a transition to electric vehicles

3- For more about air pollution and air toxics in the Portland Metro area, listen to Episode 5 with Mary Peveto and Episode 7 with Prof. Linda George

4- Find out what you can do in your community to decrease air pollution. Reach out to your local county commissioner, city council, and state and national legislators to tell them that cleaning up the air not only saves lives it saves money. For more on that, learn about the ROI on the Clean Air Act here.

5- Consider a donation to organizations like Neighbors for Clean Air or OPAL Environmental Justice or a group in your community working to clean up the air. Consider it an investment with high returns in terms of lower future healthcare expenditures and higher productivity!

Twitchy Airways Club Members

1- Pay attention to air quality indices, and learn more about how the air you breathe can affect your health. 

2- Learn more about asthma or COPD and talk to your doctor about your health. If you have asthma, consider taking the ALA Online Asthma Basics Course

3- Complete a trigger diary if you still don’t know what worsens your breathing, and consider using this ALA checklist to address indoor air quality concerns like cockroaches and mold.

References-

Asthma and Allergy Foundation of America. “Cost of Asthma on Society.” Accessed March 2 2021. 

Barnett S and Numagambetov T. Costs of asthma in the United States: 2002-2007. JACI. 2011. Jan:127(1):145-152. DOI: http://dx.doi.org/10.1016/j.jaci.2010.10.020.  

DEQ Diesel Emissions inventory, Portland OR

EPA.gov- Children’s Environmental Health Disparities: Black and African American Children and Asthma.

Brown, Amanda. “Health Effects of Particulates and Black Carbon.” Presentation- US EPA Transport and Clean Air Seminar December 2013.  

Gall and George et al. Indoor and outdoor air quality at Harriet Tubman Middle School and the design of mitigation measures: Phase I report. 2018.

Gauderman et al. “The effect of air pollution on lung development from 10 to 18 years of age.” NEJM 2004; 351: 1057 -1067 

Janssen et al. “Health Effects of Black Carbon.” World Health Organization. 2012. 

Keet et al. Long-Term Coarse Particulate Matter Exposure Is Associated with Asthma among Children in Medicaid.” AJRCCM. Volume 197, Issue 6. Nov 2017.  

Khreis et al. Exposure to traffic-related air pollution and risk of development of childhood asthma: A systemic review and meta-analysis. Environment International. Sep 2017. 100. Pp 1-31.

Kulkarni et al. “Carbon in Airway Macrophages and Lung Function in Children.” N Engl J Med 2006; 355:21-30 

Lamichhane, Dirga Kumar et al. “A meta-analysis of exposure to particulate matter and adverse birth outcomes.” Environmental Health and Toxicology 2015

Lemke LD, Lamerato LE, Xu X, et al. Geospatial relationships of air pollution and acute asthma events across the Detroit-Windsor international border: study design and preliminary results. J Expo Sci Environ Epidemiol. 2014;24(4):346-357. doi:10.1038/jes.2013.78

Orellano P, Quaranta N, Reynoso J, Balbi B, Vasquez J. Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis. PLoS One. 2017;12(3):e0174050. Published 2017 Mar 20

Wang LY, Zhong Y, Wheeler L. Direct and indirect costs of asthma in school-age children. Prev Chronic Disease. Jan 2005. 2(1).