In November 2018, Mónica Huertas’ daughter, a pre-school student, was discharged from Hasbro Children’s Hospital in Providence after spending two days in the pediatric intensive care unit for asthma exacerbations.
The girl’s chronic asthma has sent her to the hospital seven times in her short life, although only two of those visits brought her upstairs to the “popsicle doctors” — the nickname her mother uses for the PICU, because of its staff’s practice of giving popsicles to sick children.
Huertas, who is a community organizer and climate justice activist, has three other children, including two sons and another daughter. Her other daughter also has chronic asthma and has been to the hospital four times because of it, although she’s never been to the “popsicle doctors.” But she has been to the “flower doctors” — the urgent care, walk-in clinic, named after its wallpaper, where Huertas takes the kids “if it’s not a big thing.”
Huertas’ youngest child, still an infant, has started coughing at night for days in a row. “I know that cough,” his mother said. Only one of her children is asthma-free.
The issue of pediatric asthma in Providence spreads well beyond Huertas’ family.
A statewide concern that disproportionately burdens low-income, urban communities of color, childhood asthma is caused by multiple factors — with air pollution and hazardous indoor housing conditions being the main triggers for asthma exacerbations.
While some Rhode Island state agencies are taking steps to address the problem, experts say it is unlikely that the state will raise its current standards for ambient air quality to reduce asthma.
A statewide health concern
Data from a 2019 presentation by the Rhode Island Department of Health show that asthma is a widespread condition affecting Rhode Island’s children, particularly low-income children of color living in cities.
Within the Ocean State, asthma is the most common chronic condition in children. Just under 11 percent of the state’s children have it, compared to 8.4 percent nationally, giving Rhode Island the ninth highest childhood asthma rate in the country.
Urban children in the state are the most burdened by the illness. Asthma accounts for 12.2 out of every 1,000 children’s emergency room visits in the state’s four core cities — almost triple the 4.5 out of 1,000 visits in the rest of the state.
In addition, more than 70 percent of pediatric asthma emergency department visits in the state involve children enrolled in Medicaid. The RIDOH presentation also noted that “Black children and Hispanic children are more likely to visit the emergency room or be hospitalized due to asthma.”
Huertas, who lives in Providence’s Washington Park neighborhood, is Puerto Rican, and her children are of Puerto Rican and Guatemalan descent. According to the City of Providence’s Climate Justice Plan, individuals residing in Washington Park, South Providence, Wanskuck and the West End — all low-income communities of color — represent “the majority of asthma-related emergency room visits” in Providence.
“All the kids have asthma around here,” Huertas said, referring to her neighborhood. “You could knock on any door and you could find someone with asthma.”
Indoor and outdoor factors can worsen asthma
A combination of factors can contribute to chronic asthma and trigger asthma exacerbations, including indoor housing conditions such as mold, dust, pets or smoke, and outdoor factors such as harmful emissions.
According to the Providence Climate Justice Plan, areas that are closer to highways, ports, freight transportation corridors and industrial areas have greater “exposure to air pollution and the risk of health effects.”
Pollutants such as ozone and particulate matter can cause asthma, according to Dr. Nicholas Nassikas MD ’15, a University Pulmonary, Critical Care and Sleep Medicine fellow specializing in asthma and its relationship with pollution and climate change. “The studies that have been done so far support a clear link between air pollution and asthma exacerbations,” he said.
Particulate matter is a kind of pollutant produced by emissions from cars, industries and power plants, according to the Environmental Protection Agency’s website. Particulate matter contains “very small particles that can be breathed into the deepest part of the lungs,” which causes asthma exacerbations, said Nassikas. Ozone can also contribute to asthma, he added.
The Providence Climate Justice Plan uses the EPA’s Environmental Justice Screening and Mapping Tool to identify frontline communities that suffer “the greatest environmental health consequences of air pollution.”
Providence’s frontline communities include parts of South Providence, Washington Park, Olneyville, Manton, Silver Lake, Wanskuck and the West End — all low-income communities of color.
The report was developed in partnership with Providence’s Racial and Environmental Justice Committee, which Huertas helped lead. Learning about environmental racism and health inequities motivated her to get involved in the REJC. “We are affected the most by (pollution),” she said. “That’s not right.”
Huertas’ neighborhood, Washington Park, is the closest residential area to Providence’s port — a major fossil fuel transport hub causing “significant local health impacts,” according to the Climate Justice Plan.
“The emissions from oceangoing vessels burn some of the dirtiest fuel,” according to the report. “Heavy duty diesel engines in trucks and trains, and off-gassing from valves and storage tanks also contribute to local air pollution.”
Washington Park is also near the I-95 highway, Allens Avenue and Narragansett Boulevard. According to Linda Perri, co-chair of the Washington Park Neighborhood Association, traffic from these roads is a noticeable source of contamination.
For example, cars avoiding I-95 traffic jams often opt for Allens Avenue, where “in the summertime, there’s a cloud of orange-brown dust on the road,” Perri said. “We cringe every time we drive down that stretch of land.”
A 2019 study by the Rhode Island Department of Environmental Management shows that areas near I-95 experienced higher levels of pollution than other areas in the state.
Julian Drix, asthma control program lead at the RIDOH, takes multiple causes into account when screening factors that might worsen asthma. “We look at environmental conditions, but also quality of housing,” he said.
Drix leads the Home Asthma Response Program, a harm reduction strategy that focuses on reducing indoor asthma triggers. HARP sends professionals into the homes of asthma patients who sign up for the program, helping them identify triggers and ways to mitigate them, such as using mattress covers or keeping dust to a minimum.
So far, the program has produced positive results, bringing “a real change in conditions inside people’s homes,” said Drix. He added that “the most successful public health interventions … address the underlying environmental and socioeconomic determinants of health.”
According to Drix, community organizations are best positioned to introduce legislation to improve air quality. RIDOH can collaborate with these organizations by providing data from evidence-based research.
While Drix doesn’t know that any legislators are working on specific bills aimed at reducing the asthma crisis, he is “hoping there will be growing interest in this.”
Air quality standards are unlikely to change
If Providence air pollution continues at current levels, “we’re going to continue to see … asthma exacerbations due to these different pollutants,” Nassikas said. “If we start to install policies that try to reduce pollution emissions, then we should see a reduction in asthma exacerbations.”
An example of such policies might be increasing bike lanes, which would reduce the number of polluting cars on the road and promote exercise, Nassikas said.
Policy changes aimed at lowering the current standards for ambient air pollutants would also have a positive impact on health, but would be much harder to pass due to the interests of multiple stakeholders, Nassikas said. “There are people who would say that it would be too harmful to the economy,” he said, adding that changing the standard “would definitely be better for health.”
According to Karen Slattery, supervising air quality specialist at RIDEM, Rhode Island abides by the National Ambient Air Quality Standards set by the EPA, and is not considering establishing its own, more stringent pollution standards. “That’s a very difficult task,” she said. “We’d have to have the science behind that, and the science … doesn’t show that we need a lower standard.”
Slattery added that “We don’t have reason to set a lower standard in Rhode Island because we’re not even close to the federal standard at this point.”
The EPA has the authority to make the NAAQS more stringent, but lowering the standards at the federal level has historically been a complicated process. Even the current NAAQS were established after decades of political battles involving multiple lawsuits.
Instead of focusing on the standards, RIDEM is increasing its air monitoring in areas with higher rates of pollution, as shown by the I-95 contamination study, said Slattery. This includes communities around Providence’s port.
“We can do our part: We’re going to look at what’s out there, making sure (pollution) sources are compliant,” said Slattery, adding that RIDEM has received grant money to plant trees along I-95 to filter particulate emissions, which would reduce harm to frontline communities.
For Huertas, any initiative taken to combat pollution and its adverse health effects on frontline communities must include neighborhood voices: “We can’t move forward unless the most marginalized and most affected are at the forefront.”
Pick up a copy of next week’s paper to read the second part of “A look into asthma in Providence.”
