Bushwick's Struggles With Asthma: What's Poverty's Role?

Photo by: Jennifer Mora
Devin O'Grady at age three.

In a neighborhood with high asthma rates, it's not hard to identify risk factors for the condition. The trick is determining which factor is most important.

By: Eric Jankiewicz and Sara Sugar

In the summer of 2009, City Limits spent several weeks in the 11237 ZIP code in Bushwick, Brooklyn—the area that contains the geographic center of New York City—to gauge how the neighborhood had changed, for better or worse, during Mayor Bloomberg's first two terms. This spring a group of students at the City University of New York Graduate School of Journalism went back to Bushwick for a set of stories you can read here. This article on health in the neighborhood is one of their reports.

Jennifer Mora lives with her 4-year-old son Devin in an apartment with one window. For most people, the lack of natural light would be an inconvenience, but for Devin, it's potentially life-threatening: poor ventilation can trigger his asthma.

Even before his first birthday, Devin had trouble breathing.

"His body would get tight like a piece of wood and he would hold onto me," Mora says, recalling her son’s asthma attacks when he was 1 and 2 years old. "I couldn’t do nothing. I felt helpless. He just couldn’t breathe."

When Devin’s asthma was at its worst, Mora was lucky to get an hour of sleep. But this rarely happened  – her son would wake every few hours short of breath.

"He used to always have to be in the hospital every three days. It was horrible," says Mora, a lifelong resident of Bushwick, as she keeps an eye on her preschooler one sunny afternoon. Don’t run too fast or else, she warns, "you’ll get the bad feeling in your chest."

Devin reflects a significant problem in north Brooklyn.  An estimated one in 20 children in Bushwick and Williamsburg suffer from asthma. In 2009, child asthma-related hospital visits in Williamsburg and Bushwick ranked fifth highest in all of New York City.

A range of triggers

According to the Centers for Disease Control, there is no known cause for asthma, but attacks can be triggered by a number of factors, including allergies and environmental and lifestyle factors, such as secondhand smoke.

Dr. Natalie Langston-Davis, pediatrician and medical director at La Providencia Family Health Center in Bushwick, says that parents often tell her that if they do smoke they don’t do it around their children. But Davis says this doesn’t take into account third-hand smoke that stays in clothing.

Pollution also plays a role in the prevalence of asthma, experts say.

The air quality in Bushwick, with its heavily trafficked streets and few parks, has one of the highest concentrations of pollution in New York City, as reported in the New York City Community Air Survey. According to the city, the polluted air led to 292 out of 100,000 asthma-related hospital visits in 2010.

Devin’s mother suspects his asthma could be related to his father’s smoking and admits that she often limits his outdoor activity.

"Last year he didn’t go to the beach. Nothing," Mora says. "Because I was so afraid he would get an attack."

The role of poverty

Though income and asthma are not directly related, there is a socioeconomic dimension to the impact of the condition. According to a 2009 health report, the rate of child asthma-related emergency room visits was three times higher in poor neighborhoods than in wealthy ones. In Bushwick, more than 41 percent of children under the age of 18 are living in poverty, according to the 2007-2009 American Community Survey, compared with the rest of Brooklyn, where the rate is slightly above 30 percent.

Davis says that the majority of those seen at her clinic rely on some sort of Medicaid managed care.

Older housing stock, Davis says, is partially to blame for the high number of children in Bushwick with asthma. That's the case with the poorly ventilated apartment Mora shares with her son.

Asthma is also exacerbated by children’s allergies to rodent and cockroach droppings, Davis says.

According to the New York City Housing and Vacancy Survey, in 2011 an estimated 39.1 percent of households in Bushwick reported seeing at least one cockroach in the last month. Almost 50 percent of households reported seeing at least one mouse or rat within the previous 90 days.

Symptom of a larger health problem

Generally among children growing up in poverty, there are more incidences of asthma, diabetes and obesity, says Dr. Curtis Skinner of the National Center for Children in Poverty.

"Chronic health conditions can help perpetuate the cycle of poverty," he says.
Dr. Lynn Roberts, a professor at the CUNY School of Public Health at Hunter College, says that poor health conditions are merely symptoms of a larger problem in low-income neighborhoods characterized by lack of access to healthful foods, adequate housing and health education.

"Poverty itself is the issue," Roberts says.

Obesity, for example, cannot be attributed to a single factor in poorer areas of the city, and no one issue is more concerning than another, she says.

The rate of obesity in Williamsburg and Bushwick is one of the highest in the city at 24.5 percent, according to 2011 data from the Health Department. More than one in four children in Head Start programs and public elementary schools in Bushwick and Bedford-Stuyvesant suffer from obesity, according to a report put out by the New York City Department of Health and Mental Hygiene in 2007.

Local doctors in Bushwick  don’t have the personnel and infrastructure they need to combat the problems, says Davis, who has been practicing medicine for 15 years.

"You begin to look for resources outside of your institution and it’s not there," Davis says one Monday morning as her health clinic’s waiting room quickly filled with patients.

Though there have been recent improvements, pockets of Bushwick still have a dearth of access to healthy food choices. Supermarkets and fresh produce can be hard to find, and fast-food restaurants are plentiful.

Davis says that she refers patients needing nutrition counseling to the Brooklyn Hospital Center. Some children who suffer from low hemoglobin have long-standing anemia that requires treatment with iron supplements. A large number of children with anemia are also obese. It again is linked to their access to healthy food options, she says.

No outgrowing it

Davis doesn’t talk to her patients about "outgrowing" asthma – she says it’s a chronic disease.

"Although you may be a mild intermittent asthmatic that has not had symptoms in years, there may be something, an environmental allergen or other cause that triggers you into an attack," she says.

Now four, Mora’s son lives a relatively normal life. He can’t run as much as the other kids and he must always wear a sweater to protect his chest. But even when things are good, Mora worries.

"He’s a strong boy but I still wake up at night to check up on him and I pray that his condition doesn’t get worse like it use to be," she says. "When your kid has asthma it’s the worst. No one knows what I go through at night."