Sarah Baez, a homeless mother of two, was waiting for the city to find a shelter for her family at the notorious Emergency Assistance Unit in the South Bronx earlier this month, but even when the temperature dipped into the 40s, she preferred standing on the sidewalk across the street from the crowded, noisy intake facility.
“The place is too dirty for my son, and the security guards are always yelling at people,” she said. “My son starts crying as soon as we go in there. I have to calm him down or he can have an attack.”
She is talking about an asthma attack. Her two-year-old, Nathaniel, has been hospitalized with asthma and needs frequent treatments with albuterol, a medication that dilates constricted bronchial tubes.
Nathaniel has plenty of company. Fully half of the homeless children entering New York City family shelters show some symptoms of asthma, according to the authors of a study published this month. Four in ten reported serious, persistent asthma attacks; and a third of those children have never been diagnosed with the disease by a physician. By contrast, about one in 18 children have asthma in the United States as a whole, according to the Centers for Disease Control.
This was not the only alarming report about asthma in New York. Another new study, published in the Journal of Allergy and Clinical Immunology, of 205 children with asthma who lived near the World Trade Center, according to Newsday, "says their condition was worsened by the 9/11 attack, seeing the doctor more often and taking more medication the year after the attack than the year before."
Medical experts have known for a long time that New York City has the worst asthma rate in the country, and that asthma is the childhood disease of the poor. The chronic lung ailment is triggered by environmental agents that occur most often in the poorest neighborhoods, such as dust, industrial pollutants and roach droppings. Once poor children get asthma, their condition suffers from such aggravating factors as persistent psychological stress, and limited access to health care. And the poor children who suffer the most, the new study found, are those who are homeless.
“We knew there were very high asthma rates in some of the city’s poorest neighborhoods,” said Dr. Irwin Redlener, one of the eight authors affiliated with Columbia University and Montefiore Medical Center in the Bronx. “But we were taken aback by the high rates we found.”
The 15-month study, which spent years wending its way through the peer review process before finally appearing in Archives of Pediatrics and Adolescent Medicine this month, began in 1998. Researchers struck an agreement with the city to screen children entering three family shelters, one each in Brooklyn, Queens and the Bronx. The city allowed the scientists to add a questionnaire to the standard medical intake interview, if the researchers would agree not to identify the homeless shelters used in the study.
Parents of 740 children were interviewed; for nearly 13 percent of the children, parents described symptoms in their children consistent with serious persistent asthma, but said that their children had never been diagnosed with the disease
“The study confirms what we know,” said James Anderson, from the Department of Homeless Services. “Homeless children come from communities with the highest risks of asthma, and most come from the most vulnerable families in those communities.”
The researchers have continued collecting data since the formal study ended in 1999. Redlener, who also heads the Children's Health Project, said that a few children may be getting better treatment. But he also points out that the number of children in the shelter system has nearly doubled to about 16,000.
For many such children, the very process of entering the homeless system can trigger asthma attacks. Sarah Baez, her boyfriend, and their two children spent two weeks shuttling between the emergency unit and a variety of shelters and motels for one-night stays. Often, she says, they return too early to get a full night’s sleep or too late to get her daughter to school on time.
“If they wanted to help cut down on asthma attacks, one thing that the city could do immediately is to cease the practice of overnight shelter placements,” said Patrick Markee of the Coalition for the Homeless. The coalition filed suit against the city four years ago, asking for increased services for asthmatic children, the same year that WE ACT, the West Harlem advocacy group, filed a federal complaint against the city for locating diesel bus garages in poor neighborhoods.
The city introduced a policy last fall of trying to place homeless families in shelters near the neighborhood where they once lived, in part to help them stay connected with familiar schools and medical providers. In these shelters, health care educators, such as Shelly Moore of Care for the Homeless, help them learn to manage the triggers in their home environment, and help connect them to medical providers.
“Community placement sounds good,” Moore says. “But the families are telling us a different story. They say the city is pressuring them to take the first apartment that becomes available, even if it has roach infestation or carpeting, which is very inappropriate for children with asthma.”
Ron Feemster has written for The New York Times, City Limits, and National Public Radio.
URBAN ISSUES - HEALTH CARE
Edward’s health care plan would cover an additional 21 million Americans at a cost of $53 billion per year. He would require that every American under the age of 21 has health insurance. Parents would have the primary responsibility to insure their children, but he would provide tax credits to help them pay for it. He would also expand existing programs for small businesses and employees between jobs.
Kerry’s health care plan would cover 27 million uninsured Americans. Kerry proposes allowing every American access to the healthcare plan currently offered to federal employees. He would reimburse employee health plans for the most expensive cases. He also plans to spend $72 billion over five years to offer health coverage for low-income people and children.
Kucinich would replace the current health care system with a national health insurance policy. He would finance it with a 7.7 percent tax on employers. It would be similar to the Canadian system. The plan to give all Americans health care coverage would cost an estimated $1.5 trillion a year.
Sharpton would create a national health care plan that is publicly financed by the government through taxes on the wealthiest Americans.
In 2003, President Bush signed into law the most sweeping changes to Medicare since the creation of program in 1965. As part of the reforms, he added a prescription drug benefit for senior citizens. Health experts are still divided on what these changes will mean for New York City in the long term. For the future, Bush advocates for greater patient choices and $117 billion in tax breaks to help the uninsured pay for health care.
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GOTHAM GAZETTE’S RELATED ARTICLES
• Urban Agenda: Health Care
• Medicare Reforms and New York City
Many New Yorkers think of their city as tough, rough, and a tad more perilous than most; a place where armed muggers lurk in ambush, bike messengers and speeding cabbies mow down pedestrians, air conditioners and giant chunks of ice occasionally fall from high buildings to sidewalks below, peeling lead paint tempts infants, and the air quality downtown is more suspect than ever.
But while the city certainly presents some hazards to life and limb, the health department's annual report on registered deaths and causes of death, as well as other vital data, actually reveals that the number of deaths in the city reached a historic low in 2002, infant mortality rates were also at an all-time low, and the life expectancies of New Yorkers were longer than ever before – longer, in fact, than the national average.
The city's Department of Health and Mental Hygiene released the 67-page report, the Summary of Vital Statistics for 2002 (available in pdf format), on January 30. The year 2002 is the most recent for which data was compiled and analyzed; because the annual report is a formidable undertaking, it tends to lag a year or two behind the year of its release.
2002 saw 59,651 deaths recorded in the city, down from 62,964 in 2001. If not for the 2,746 deaths from the World Trade Center disaster, 2001 would have set the previous record for lowest number of deaths in the city. And even if one excludes the World Trade Center deaths from the 2001 total, there was still a decline in deaths of about one percent from 2001 to 2002, continuing a trend that started in the 1990s.
But since the report breaks down the city's deaths by ethnicity and location as well as age, cause, and gender, it also makes it clear that infant mortality varies dramatically among ethnic groups and neighborhoods. As the health department notes in a separate statement about the 2002 infant mortality numbers, the infant mortality rate is a critical indicator of a given community's social welfare. It reflects the health of the mothers before, during, and even after pregnancy, as well as the accessibility and quality of local healthcare services. Among the factors that the health department cites as influencing infant mortality rates are the mother's access to prenatal care and the quality of such care; her overall health; her socio-economic status; her stress level during pregnancy; her use of alcohol, tobacco, and other drugs during pregnancy; and the infant's birth weight (which can be affected by all of the preceding). It is unsurprising though grim news that babies born in the Brownsville section of Brooklyn have infant mortality rates of 10.3 per 1,000 births, 50 percent higher than the city average; or that black babies are more likely to die than white.
Dr. Thomas Frieden, the health department's commissioner, emphasized the need for more to be done to eradicate these variances in infant mortality among different ethnicities and geographic locations around the city. “Six-point-zero is the lowest rate ever in the city's history, and continues a longterm trend of declining infant mortality rates in New York City," Frieden said. "However, unacceptably high disparities persist in some communities. We will address these disparities by targeting resources to those communities in greatest need and connecting at-risk women to available services.”
While acknowledging the narrowing of the gaps as progress, health department commissioner Frieden nonetheless called the remaining disparities "unacceptable." Indeed, despite the record-breaking lows represented by the latest citywide mortality figures, Frieden emphasized the need for future improvements as much as he did the progress that has taken place.
“More than eighteen thousand New Yorkers died [in 2002] before they reached age sixty-five," he said. "Most of these deaths were preventable." More than half of the under-65 deaths were due to only three causes -- cancer, heart disease, and HIV/AIDS – all of which Frieden considers preventable, at least in that age group. "Nearly one out of six New Yorkers who died was killed by tobacco," he added. Tobacco use was implicated in many of the cancer and heart disease deaths; for example, nearly 20 percent of the cancer deaths were from lung cancer, and as much as 90 percent of lung cancer has been shown to result from tobacco use.
They might also be interested to know that the prevalence of the causes of deaths differed by gender. Cancer was clearly the biggest killer of women who died before 65, accounting for slightly more than a third of these deaths; while heart disease tied with cancer for the leading cause of death of men under 65, each killing 22 percent of the total.
And the fact that the third leading cause of death among city residents, especially those over age 75, is the flu may come as a surprise to the many New Yorkers who think of it as just another of winter's commonplace ordeals, unpleasant but not especially dangerous. Flu can quickly prove deadly, however, if it progresses into a more serious illness such as pneumonia. Those obsessing about West Nile Virus (which caused a total of three fatalities in 2002) and Lyme Disease-carrying ticks in the Hamptons would do better to get an annual flu shot than to waste more time worrying about exotic but rare and/or less lethal diseases.
No New Yorker, by the way, had died of mad cow disease as of 2002.
Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF