By Aneri Pattani/Special to the Gazette
Joel Marin is never caught without his inhaler. He always carries one with him and keeps another in the car as a backup. The 27-year-old from Roxbury has suffered from asthma since childhood.
“As the years went by, it got worse and worse,” said Marin, who used to work in carpentry, but was forced to leave his job when the conditions aggravated his asthma.
Marin is just one of many Roxbury and Mission Hill residents who suffer from the chronic disease. About 15 percent of adults in Roxbury have asthma—the second-highest rate for a Boston neighborhood after Dorchester, according to the Boston Public Health Commission’s “Health of Boston 2012-2013” report. It was also higher than the overall asthma prevalence rate of Boston, at 11 percent.
Asthma is a chronic lung disease where airways becoming inflamed and tighten up, affecting breathing. It has been a longstanding concern in Mission Hill for two decades, according to Dr. Christopher Fanta, director of the Asthma Center at Brigham and Women’s Hospital.
While the causes are difficult to pinpoint, experts say the air quality and housing environment in Mission Hill/Roxbury, as well as the socioeconomic status of its residents, are important factors. A lack of medical and educational resources makes it difficult for patients to handle their symptoms and leaves them with few resources but the emergency room for care.
“There is no health center in Mission Hill that is easy for people to get to,” said Maggie Cohn, executive director of the nonprofit Mission Hill Health Movement (MHHM). “We need a real system of community health workers…to get information to people who are busy or scared or don’t have transportation,” she added.
Children in Roxbury are particularly vulnerable. They are nearly twice as likely as children from the rest of Boston to visit the emergency room due to an asthma-related concern, according to a recent report by the Boston Public Health Commission.
The BPHC’s annual “Health of Boston” report—the latest was released last year—includes asthma stats from phone and hospital surveys. It includes Mission Hill as part of Roxbury.
The report says the average annual rates for asthma emergency department visits for children under the age of 5 were 59.7 per 1,000 visits in Roxbury , versus 31.5 in Boston overall. The average is based on data from 2005 to 2011.
Marin said he went to the emergency room “all the time” as a child because he didn’t know how to control his breathing. He thinks a program in which doctors visit people’s homes to help them develop a plan for reducing and handling asthma attacks would be useful in Roxbury neighborhoods.
One of the most effective ways to decrease the occurrence of asthma attacks, according to Fanta, is to have consistent medical care.
“One big area that I would love to see someday improved is what happens when people come to the emergency room or hospital with an asthma attack,” Fanta said. Too often, patients are simply treated for the most recent incident and then advised to seek medical care, he said. He said there should be services in place to follow up on missed appointments and provide transportation to doctor’s visits, without putting the burden of seeking care onto patients.
It is Fanta’s dream to create a health asthma van, which would travel through the neighborhood to provide check-ups, education, medication and other services to residents.
School nurses could be another vehicle to provide community care, said Mission Hill resident Betty Commerford, a board member of MHHM.
“If they had the time or support, they could do programming with the students at school to educate them on asthma and asthma prevention,” she said.
As of now, the main service that Mission Hill residents can access is the Boston Asthma Home Visitors Collaborative, through the BPHC. The program sends community health workers into people’s homes, based on medical provider referrals, to deliver asthma education and advice on how to reduce the potential for an asthma attack. But it is limited; it currently reaches about 200 families a year, said Anjali Nath, BPHC director of asthma prevention and control.
In neighborhoods like Mission Hill, people are often living in unhealthy environments because the housing is old and not well maintained, said Nath. That makes it even more important to recognize factors that can be controlled.
“Even if we can’t change the structure of our building, we can change our home environment,” Nath said.
Typical changes include removing scented candles or air fresheners, not leaving food out which might attract rodents, or using more natural cleaning products.
In addition to poor housing conditions, air quality is a concern because trucks, buses and trains often are routed through lower income neighborhoods, Cohn said.
Mission Hill is home to MBTA stops on the Green and Orange lines, as well as bus routes 39 and 66.
Research links living in high-traffic areas with the onset of asthma, Nath said, and dense neighborhoods such as Mission Hill are particularly susceptible to this risk factor. Schools in Roxbury are often near high traffic areas, so exposure to air pollution is higher for children.
A study done in 2007 by the Harvard School of Public Health (HSPH), in collaboration with MHHM, found a high concentration of pollutants near major roads, where many schools are located, according to Jonathan Buonocore, a research fellow at HSPH’s Center for Health and the Global Environment.
The study found high concentrations of harmful “ultrafine particles” in Mission Hill in areas of high traffic, construction sites and places with idling vehicles, such as delivery trucks.
These tiny, airborne particles are a byproduct of burning fuels, according to the Massachusetts 2013 Air Quality Report by the Department of Environmental Protection.
Burning cleaner fuels, using liquid natural gas, and implementing more electric hybrid buses like those on the Silver Line might help to improve air quality and thereby lower asthma triggers, Buonocore said. Since the time of the 2007 study, the MBTA has introduced hybrid vehicles on the local routes.
Fanta, from Brigham and Women’s, acknowledged that it would take time to implement such changes.
“Progress is slow,” Fanta said. “We still have a long way to go, and that’s why [asthma] still is an issue in the community after more than 20 years.”
Editor’s Note: This story was produced under a partnership with the Northeastern University School of Journalism.