BHA begins to tackle rise in asthma cases

30 March 2001

Poor people in Boston suffer from asthma at rates five to six times that of everyone else.

What's going on?

For years, rumors circulated about the many cases of asthma in poorer neighborhoods. But the reports were anecdotal; some dismissed them as unwarranted griping. Now new research suggests the problem is real.

A scary, debilitating and sometimes deadly disease, asthma affects only about 5 percent of all Americans - unless they happen to be poor.

In that case the numbers rise dramatically. At South Boston's West Broadway public housing development, for example, 26 percent of adults have asthma. In Mattapan, over half of all children in the Franklin Hill development have been diagnosed with the disease. It's a pattern that seems to be repeated at public housing developments around the city.

The inescapable conclusion seems to be: public housing makes people sick.

It has been a mystifying - and somewhat embarrassing - situation for the Boston Housing Authority, which is landlord to 27,000 residents. To its credit, the agency has been looking for answers.

Asthma is an odd disease. Genetics play a role in determining whether one is susceptible to it. But asthma attacks themselves appear to be triggered by things in the environment. Depending on the person, almost any irritant - mold, smoke, pollutants, even rapid changes in temperature or humidity - can provoke an attack.

But what is it about BHA housing that causes such high rates of the disease?

Some argue that the high rates of asthma are self-inflicted. Mites in unchanged bedding, high rates of smoking and even filthy and unvacuumed carpets can all potentially create allergens that trigger asthma. So too can droppings from rodents and insects.

Yet those explanations seem unsatisfactory. For one thing, the rise of asthma among the poor seems to be a relatively recent thing. Dirty floors and beds have been around for a long time; it isn't as if today's poor are significantly less neat than those of yesterday. Moreover, while smoking rates are higher among those in poverty, they are still lower than they were decades ago.

One intriguing possibility is that the rise in asthma is the direct fault of a program that the U.S. Department of Housing and Urban Development initiated two decades ago.

During the 1970s, the United States was hit by oil embargoes that severely increased the cost of energy.

In response, the Carter administration took bold action. Jimmy Carter started to wear sweaters and HUD was told to do all it could do to cut energy usage at public housing across the country.

HUD spent millions to curb the often-profligate use of energy. Windows were sealed and roofs and walls were insulated. The results were impressive. Energy consumption dropped and the program was regarded as a major success.

But it may also have created the conditions that caused asthma to rise. The sealed-up buildings allowed molds and spores to thrive. Moreover, they exacerbated the effects of environmental contaminants like smoke, dust and rodent droppings. The result, health authorities speculate, was the epidemic of asthma we see today.

A confession: In the early 1980s, I worked on the HUD programs that so successfully saved energy. Back then, energy conservation was regarded as an unadulterated good thing. Now, it appears, we were wrong.

Proof again that no good deed goes unpunished.

The task now before the BHA is to figure out how to conserve energy while at the same time not jeopardizing its residents' health.

To do that, the agency has teamed up with Boston's three schools of public health (Harvard, Boston University and Tufts). Their efforts, a $7.9 million program called Healthy Public Housing, will track residents in four different developments for five years. They hope to be able to document the causes of asthma in public housing and test out various solutions. The effort is being watched nationally. BHA believes it will influence the ways public housing authorities across the nation ultimately manage their own properties.

An important part of the study has been to involve residents from the very beginning. That contrasts with HUD's original energy conservation programs, which were imposed from the top down with little input from tenants. BHA hopes to avoid that mistake this time, recognizing that residents usually know more about what's going on in their buildings than do landlords.

It makes for an interesting lesson in public policy. The point isn't that government always messes up. But it does suggest that, in any endeavor - even something as seemingly simple as cutting down on the energy bill - a little humility, and a sense of just how much you don't know, matters a lot.