Philadelphia’s smoky air is making it hard to breathe. My young asthma patients are suffering the most. | Expert Opinion

With smoke from the Canadian wildfires shrouding the skies over Philadelphia, our clinics for the city’s youngest asthma patients are busier than ever.

The children we serve in North Philadelphia have more asthma diagnoses, more asthma attacks, and more pediatric deaths from asthma than their peers elsewhere. In our large outpatient clinic, 30% of our children have a diagnosis of asthma, the highest in the city. The national average is 16% for Black children and 7% for white children.

Twenty children have died of asthma in Philadelphia over the past few years. All of them were Black children, even though they make up just 44% of our population.

What is the cause of this inequity? For a child to develop a certain disease or trait, there is usually some “family history” of that disease. We talk about certain diseases being passed down, and asthma is one of them.

But in Philadelphia, pediatric asthma is more closely related to your zip code than your genetic code. Systemic issues such as racism and poverty, and underinvestment in quality health care, all contribute to higher rates of death and disease.

I have worked at St. Christopher’s Hospital for Children for over two decades, and every day my colleagues and I spend a good portion of our time trying to calm our patients who struggle to catch their breath. We comfort their parents, too, who fear their child’s wheezing and coughing will get worse, and who must cope with the added stress of missed school, work, and extracurriculars.

With our collective experience of asthma care, I would like to submit a new word to the medical lexicon: “Asthmagenic.”

For a child to become an asthmatic, there must be some genetic component, such as a parent having asthma, along with asthma triggers. Classic asthma triggers, in addition to the kind of pollution we are seeing now, include allergies, secondhand smoke exposure, temperature changes, stress, acid reflux, insects in the home, and viral illnesses. Yet even all these don’t explain why we have almost 2.5 times more children with asthma than the national average.

What is the genesis of this disparity, this asthmagenesis?

David Williams, a Harvard University expert on how racism affects health, says that “we are looking at societal policies, driven by institutional racism, that are producing the results that they were intended to produce.”

What policies relate to asthma in certain communities and races? How about redlining? Environmental racism? The daily stress of poverty?

Redlining was created by the federal government’s Home Owners Loan Corp. (HOLC) in the 1930s after the Great Depression to help people from defaulting on their mortgages and to help families regrow their wealth through homeownership. Green-mapped areas were the best investments, red the “most hazardous.” The HOLC labeled majority Black neighborhoods red, and investments in these communities dried up.

Multiple studies have shown that even today, nearly a century later, people in neighborhoods that were redlined in the 1930s have much higher rates of asthma. They also have more highways, more dumping grounds, and more air pollution. At the same time, they have fewer trees to provide shade, so they can be upwards of 10 or 15 degrees hotter in the summer.

All of these factors help to trigger asthma. Children living in poverty are twice as likely to have asthma as their more affluent peers. The U.S. is the wealthiest country in the world, yet we have over 13 million children living, and dying, in poverty. About 33% are Black and 26% are Latinx.

The most effective way to reduce childhood asthma would be to fix all the socioeconomic and environmental issues that contribute to the problem.

To work toward that goal, we should invest in proven asthma home visiting programs, such as the Community Asthma Prevention Program and Room 2 Breathe Program, and school-based health centers such as those run by the Pennsylvania School-Based Health Alliance.

We should also prioritize screening children for social needs through www.cap4kids.org/philadelphia and 311, to make sure eligible families have access to needed resources, such as food assistance and Medicaid.

Children who have had an asthma attack say that it feels like they are trying to get air through a straw. It’s terrifying. It’s affecting more children in our disinvested communities, and this is not fair. All children should be able to play, to learn, and to breathe without fear.

Daniel R. Taylor is advocacy director at St. Christopher’s Hospital for Children.