Car traffic took a big dip beginning in late March, and headlines celebrated clean air around the U.S. But an NPR analysis of EPA data tells a more troubling story.
PITTSBURGH—Two environmental advocacy groups are suing Allegheny County to stop the health department from using Clean Air funds for an office renovation project.
Editor's note: This story is part of "Breathless," EHN's in-depth look at asthma in Pittsburgh and what can be done to help children breathe easier.
Pharmacist Dr. Jennifer Elliott discusses asthma treatment with Ciara Cosby during an asthma screening at Clairton Elementary School in Clairton,PA. (Connor Mulvaney/EHN)<p> In 2016, the Pennsylvania Department of Health put out a <a href="http://www.paasthma.org/wp-content/uploads/2013/10/Strategic-Asthma-Plan-For-PA-2015-2020.pdf" target="_blank">strategic asthma plan</a> for the state with goals through the year 2020 in partnership with the American Lung Association and the Pennsylvania Asthma Partnership. </p><p> One of the stated goals of the state asthma plan is to "improve environmental factors that cause/exacerbate asthma in Pennsylvania," and one of the strategies listed to support that goal is, "work with partners to improve and increase enforcement of indoor and outdoor air quality regulations and laws." But the plan doesn't include benchmarks or quantifiable goals toward that end, and doesn't include any mention of particulate matter pollution, despite evidence that pollution in Clairton is a primary asthma trigger, and that reducing it—even a little—goes a long way toward reducing asthma. </p><p> A recent study by the Allegheny County Health Department found that ER visits for asthma and chronic obstructive pulmonary disease (COPD) in the neighborhoods surrounding the former Shenango Coke Works Plant <a href="http://www.ehn.org/shenango-coke-works-closed-asthma-dropped-2566777141.html" target="_blank">dropped nearly 38 percent</a> the year after the facility shut down. Emission levels in Clairton are significantly higher than what was seen in Shenango, and according to another Allegheny County Health Department report, the Clairton plant had at least 6,700 air pollution violations over a three-year span between 2012 and 2015. </p><p> "Most asthma initiatives are effectively either individual behavioral change programs or population-level programs, some of which may have policy components," Polly Hoppin, a program director at the Lowell Center for Sustainable Production at the University of Massachusetts, tells EHN. Hoppin is a former Senior Advisor at the US Department of Health and Human Services and Environmental Protection Agency, and an expert on policy initiatives aimed at reducing the burden of asthma. </p><h3><em>Related: </em><a href="http://www.ehn.org/shenango-coke-works-closed-asthma-dropped-2566777141.html" target="_blank"><em>ER visits for asthma dropped 38% the year after one of Pittsburgh's biggest polluters shut down</em></a></h3><p> "There's a lot that can be helped by getting students on the right meds and getting them consistent care and monitoring. But asthma is a multifactorial disease, so there should be multifactorial approach if you want to reduce it at the population level. And one of the ways to do that is by reducing outdoor air pollution, in particular from major point sources like you have in Pittsburgh." </p><p> Allegheny County is uniquely poised to tackle its asthma problem on multiple levels at once—it's one of very few places in the nation to have a local air district that's overseen by a county health department. </p><p> In general, air quality is overseen by state environmental regulatory agencies, while in Allegheny County, the health department has been empowered by the state to interpret and administer the Clean Air Act. There are a handful of other places with local air districts, including all of California; Salt Lake City; and Louisville, Kentucky—but in most other localized districts, air quality is overseen by a separate, non-health department agency that's solely responsible for air quality.</p><p> The benefit of this unusual arrangement is that the Allegheny County Health Department has the power to set stricter air quality standards than in other parts of the state to address local concerns. One major shortfall is that a health department has a lot of other issues on its plate—everything from lead in the water and the opioid crisis to restaurant cleanliness, safe housing, and flu prevention—and doesn't necessarily have a direct mandate to protect and improve air quality in the same way an environmental regulatory agency does. </p><p> Another potential shortfall is that it's much easier for a local air district to become influenced by local politics, especially if major sources of emissions have political influence.</p>
Clairton Elementary School in Clairton, PA. (Credit: Connor Mulvaney/EHN)<p>Pittsburgh environmental groups have long complained that the fines leveled by the health department against some of the region's largest emitters for Clean Air Act violations are so low that polluters are incentivized to treat them as a routine cost of doing business rather than cleaning up their operations. On more than one occasion, they've even <a href="http://www.post-gazette.com/news/environment/2018/03/05/Environmental-group-says-it-will-sue-over-inactivity-on-Allgheny-County-air-pollution-permits/stories/201803050175" target="_blank">announced intentions to sue the EPA</a> unless they force the health department to enforce the Clean Air Act.</p><p>"The lack of fines that have been issued against violators of the Clean Air Act suggests to me that perhaps the board of health and health department are not able to use public health, from an air quality perspective, to address the continuing violations and lack of compliance," Matt Mehalik, the executive director of the Breathe Project clean air advocacy group, tells EHN.</p><p>The Allegheny County Health Department's director, Dr. Karen Hacker, says reducing pollution and lowering asthma rates are both priorities—though she emphasizes that asthma has many causes and triggers.</p><p>"There is no question that on a bad air quality day, you're going to see an increase in asthma attacks," Hacker tells EHN. "We are going to do everything we can as a Health Department to improve the air quality. There's no question there, and I would certainly hope that as that improves, we would see a diminution in new asthma cases and a reduction in emergency room visits for asthma."</p><p>The Allegheny County Health Department has also begun assembling an "asthma task force," which Hacker says includes 20 to 30 groups and individuals representing physicians, housing programs and insurance providers, including Gentile. As of now, the task force is still in the process of gathering data, which they're working to get from the region's major insurers. Some community organizers feel the task force is moving too slowly.</p><p>"More research and more data is always helpful," Jamin Bogi, policy and outreach coordinator at Pittsburgh's Group Against Smog and Pollution (GASP), tells EHN. "That said, we know we have high rates of asthma, and we know it can be caused or exacerbated by air pollution. We should not be delaying action to wait on yet another report when we already know we could help these kids by improving the air quality."</p><p>Dr. Sally Wenzel, the director of the Asthma Institute at University of Pittsburgh Medical Center, says initiatives aimed at asthma at both the county and state level in Pennsylvania have been inadequate to date. Wenzel was not asked to participate in the health department's asthma task force, despite being a leading expert on severe asthma.</p><p>"There have been some attempts at the local and state level to pull people together and work on the asthma problem, but I think it's still just a lot of disintegrated approaches," she says. "No one seems to be doing it in a very cohesive manner."</p>
US Steel's Clairton Coke Works in Clairton, PA. (Connor Mulvaney/EHN)<p> Dr. Gentile and her team will treat any student referred by a parent, teacher, or school nurse through the CARES clinic, which means some of the students they see on a regular basis have mild asthma that's easily managed with occasional rescue inhaler use. </p><p> "But we've also encountered several [students] that have very severe asthma," Gentile says, "meaning that they're up every night with trouble, going to the emergency room, often missing school, not able to exercise and play." </p><p> Through the program, she says, they've managed to successfully help those students control their disease with the goal of minimizing missed school days and ensuring that they can exercise and play as much other kids—both of which have been linked to healthier and more successful long-term outcomes. </p><p> "We're addressing the problem head-on, but our long-term goals should definitely include prevention," Gentile says. "Again, asthma has many triggers, so clean air isn't the only thing, but it's certainly a big part, especially in places like Clairton. Changing that is going to require policy change, and to see that, we'll need to see members of these communities stand up and say they're not going to tolerate any more." </p><p> She adds, "The Allegheny County Health Department does appear to be on board to help. I think that's new, and not something we've necessarily seen with prior directorships, which is promising." </p><p> When Montaziyah Evans finishes reviewing her medications with Elliott, Gentile notices that she's scratching at a cluster of bumps on her arm. She asks the girl about them, and after learning that she's been waking up at night because she's so itchy, Gentile adds a prescription for atopic dermatitis cream to her asthma medications. She explains that many parents in the area lack reliable access to transportation, which can make it difficult to get to the doctor's office, so she tries to address as many of the kids' health issues as she can while they're in front of her. </p><p> Before she leaves for the day, Montaziyah is presented with a spread of colorful slap bracelets. She's allowed to pick two, and chooses one printed with smiley face emojis and one covered in rainbow hearts. She slaps one onto each forearm, then skates excitedly around the room in her socks before dropping into full split on the linoleum floor and throwing her arms in the air triumphantly, which elicits laughs and a small round of applause from the asthma clinic team. </p><p> "Alright," Dr. Gentile says, handing the girl her shoes, "good job, sweetie pie. Let's get you back to class now."</p><p><em>Editor's note: This article has been updated to clarify Dr. Hacker's statements on asthma and air pollution<br></em></p><p><em>*CARES and EHN <em>receive support from the Heinz Endowments.</em></em></p>
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