photo: breathproject.org

Dorchester, MA- An orange flag flies above the corner of Codman Square Health Center in North Dorchester, a neighborhood just south of Boston. This flag acts as a warning for a significant percentage of the community. What does it mean? That the air they are breathing is not safe.

The presence of an orange air quality flag in Dorchester is unusual given the progress that the U.S. has made in reducing air pollution since the passage of the Clean Air Act in 1970. The Clean Air Act is viewed to be one of the most successful pieces of environmental legislation, with emissions dropping an average 72 percent amongst targeted air pollutants since its enactment. The subsequent reduction in air pollution has, in turn, led to a reduction in pollution-related deaths and illnesses such as respiratory and cardiovascular disease, lung cancer, and asthma. The benefits of these improvements in public health services are estimated to reach almost $2 trillion by 2020, surpassing the costs of meeting clean air standards by more than 30-to-1. So with air quality steadily improving and negative health effects decreasing nationwide, why does the community of North Dorchester need to worry about the air that they breathe?

Glenn Flores of the University of Texas Southwestern Medical Center conducted a recent study that addressed the issue of racial and ethnic health inequality among children. A set of health disparities, including pediatric asthma, was examined from 2003 to 2007 using U.S. Census Data. The results of the study uncovered some shocking trends given what we know about the steady improvement of overall air quality and public health benefits.

Between 2003 and 2007 most existing trends in racial health differences either did not change, or they worsened for minority groups. Indeed, 10 new indicators of unequal health emerged during this period of time in the areas of specialty care, access and quality of health services and health insurance. So, not only is there a continued imbalance in the prevalence of asthma, but once contracted this disease becomes even more burdensome amongst racial and ethnic minorities due to insufficient treatment and healthcare. This lack of change and increase in health disparities over time points to an ambivalence in both policy and practice for addressing health inequities, and calls into action the need for urgent change.

These inequities can be seen here in the Boston area. Of the Boston neighborhoods, North Dorchester has one of the highest concentrations of racial and ethnic minorities and over 20 percent of the community lives below the poverty level. In North Dorchester, 17 percent of all adults have asthma, and these numbers are even higher for children. The asthma hospitalization rate is nearly 80 percent higher than the citywide average. The Boston Indicators Project was started in 2000 in an effort to accumulate and disseminate information about the progress of civic goals in Boston. In their most recent report, data shows that within the entire Boston metropolitan area, African American and Latino children have asthma hospitalization rates three to four times greater than white children. What is worse, data corroborates Flores’ results and shows these rates are steadily increasing over time, but only for minority groups.

Though we know that certain groups are being unequally affected by air pollution, there is still the question of “why?” Dorchester has a very high frequency of resident and non-resident commuters that pass through the neighborhood on Dorchester Ave or I-93. Automobile, commercial truck, and diesel bus traffic is also coupled with a lack of green spaces in the neighborhood. Add to this that many homes in the area are poorly ventilated, and we begin to see how the environment can quickly turn toxic. These poor infrastructure conditions can often date back to housing, school, zoning, and transportation policies that emerged shortly after World War II. These policies have historically subsidized suburbanization, and invested in more affluent neighborhoods at the expense of poorer communities.

The idea that certain groups of people suffer more from the effects of environmental problems than others is not a new concept and yet surprisingly little has been done in order to address it. In the United States air pollution standards, like those in the Clean Air Act, often identify populations believed to be more “sensitive” and of a higher risk. These groups have historically included infants, persons of chronic heart and lung disease, as well as the elderly. However, despite clear evidence that socioeconomic indicators play a significant role in determining health equity, and despite an executive order mandating the inclusion of environmental justice concerns in federal decision-making, clean air rules have devoted little attention to these concerns.

It is important to note that a lot can be achieved with leadership outside of the state and federal government. Organizations have emerged in the Dorchester community, such as Green Dorchester, Alternatives for Community and Environment (ACE), and Health Resources in Action. These groups are working on initiatives to promote environmental justice by increasing green spaces, decreasing heavily polluting diesel bus traffic, and promoting awareness through programs such as the Air Quality flags. Click on the links to support these local efforts, today.

But this is only the start. We cannot close our eyes, hold our breath, and wait for air quality to change. Flores’ study shows health disparities in asthma prevalence and access to health services increasing with time, despite overall improvements in air quality since the introduction of the Clean Air Act.  The problems that North Dorchester faces require more just policies. Bring these growing inequities to the immediate attention of local governments by emailing Dorchester’s district congressman, or contacting the EPA about the need for equal improvements in air quality regulation for all communities.  

Glenn Flores’s study “Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: has anything changed over the years?“, published in International Journal for Equity in Health in 2013.