Decades in crisis: adapting a social-ecological framework to assess structural elements impacting asthma rates in the South Bronx
Keywords:
structural violence, asthma, South Bronx, environmental racism, social-ecological modelAbstract
Disturbingly high rates of asthma-related hospitalizations have been documented in the South Bronx for several decades. The crisis has been typified by structural violence, health inequity, and disproportionate exposure to environmental harms, with the disease burden of poorly controlled asthma falling primarily on socioeconomically vulnerable racial and ethnic minorities. This review adapts the Social-Ecological Model (SEM) as a theory-based framework to critically analyze disparities in asthma care and control in the South Bronx. The analysis is grounded in historical considerations of structural violence, particularly the legacy of brownfields, toxic dumping, backroom politics and social arrangements that perpetuate disparities in medical care and health. This model can guide the development of multi-level interventions, including the sustainable medical management of asthma, particularly in the context of the ongoing asthma crisis in the South Bronx and its more recent disastrous overlap with the COVID-19 outbreak that has devastated New York City.References
Restrepo C, Zimmerman R. South Bronx Environmental Health and Policy Study: Public Health and Environmental Policy Analysis, Final Report for Phase V. New York University, New York, NY: Institute for Civil Infrastructure Systems. 2008 Apr. Available at https://wagner.nyu.edu/files/publications/6%20NYUWagnerPhaseVIReport1April2009.pdf
Butini, C. Asthma in the South Bronx. The Medium. 2018 Jan 18. Available at https://medium.com/asthma-in-the-south-bronx/asthma-by-the-numbers-73553b2c9621
United States Centers for Disease Control and Prevention (CDC) Division of Population Health: The PLACES Project. Available at https://www.cdc.gov/places/
Lugogo N, Que LG, Gilstrap DL, et al. Asthma: Clinical Diagnosis and Management. In: Broaddus VC, Mason RJ, Ernst JD, et al., eds. Murray and Nadel’s Textbook of Respiratory Medicine. Philadelphia: Elsevier Saunders, 2016.
Maantay J. Asthma and air pollution in the Bronx: methodological and data considerations in using GIS for environmental justice and health research. Health Place. 2007 Mar; 13(1):32-56.
Gosavi S, Nadig P, Haran A. Factors Contributing Towards Poor Asthma Control in Patients on Regular Medication. J Clin Diagn Res. 2016 Jun;10(6):OC31-5.
National Institute for Health and Care Excellence; Asthma: diagnosis, monitoring and chronic asthma management. (NICE guideline [NG80]) London, UK: National Institute for Health and Care Excellence
Baiardini I, Braido F, Brandi S, et al. The impact of GINA suggested drugs for the treatment of asthma on Health-Related Quality of Life: a GA(2)LEN review. Allergy. 2008 Aug; 63(8):1015-30.
Braido F. Failure in Asthma Control: Reasons and Consequences. Scientifica (Cairo). 2013 Dec 18. doi:10.1155/2013/549252
Whitehead M. The concepts and principles of equity in health. Int J Health Serv. 1992; 22(3):429-445. doi:10.2190/986L-LHQ6-2VTE-YRRN
Jones CP. Confronting institutionalized racism. Phylon. 2003; 50(1-2):7-22.
Farmer PE, Nizeye B, Stulac S, et al. Structural violence and clinical medicine. PLoS Med. 2006 Oct; 3(10); e449
Gee GC, Ford CL. Structural Racism and Health Inequities: Old issues, New Directions: Du Bois Review. 2011 Apr; 8(1):115-132.
Pasquel D. Health Disparities and Environmental Justice in the Bronx. The EJBM Blog. New York: 2015 Mar. Available at: https://theejbm.wordpress.com/2015/03/23/health-disparities-and-environmental-justice-in-the-bronx/
U.S. Census Bureau. Quick Facts: Bronx County (Bronx Borough), New York. Available at https://www.census.gov/quickfacts/bronxcountybronxboroughnewyork
Office of the New York State Comptroller. An Economic Snapshot of the Bronx, 2019. (Report 4-2019). Available from: https://www.osc.state.ny.us/osdc/rpt4-2019.pdf
United States Environmental Protection Agency. Green Book, New York, 2019. Available at https://www3.epa.gov/airquality/greenbook/multipol.html
Transform Don’t Trash NYC. Cleaning the Air: How Reforming the Commercial Waste Sector Can Address Air Quality Issues in Environmental Justice Communities. New York. 2019 Aug. Available at http://transformdonttrashnyc.org/wp-content/uploads/2016/09/Final-draft-v3_TDT-Air-Qual-Report_Clearing-the-Air-1.pdf
Zimmerman R. South Bronx Environmental Health and Policy Study: Public Health and Environmental Policy Analysis, Final Report for Phase I. New York University, New York, NY: Institute for Civil Infrastructure Systems. 2002 Sep.
Bass P. Effects of Asthma on Your Quality of Life. Very Well Health. Available at https://www.verywellhealth.com/asthma-impact-200775
Pejham S. Asthma Statistics. AsthmaMD. Available at https://www.asthmamd.org/asthma-statistics.
Golden SD, Earp JL. Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education & Behavior Health Promotion Interventions. Health Education & Behavior. 2012; 39(3):364-372.
National Institute for Health and Care Excellence; Asthma: diagnosis, monitoring and chronic asthma management. (NICE guideline [NG80]) London, UK: National Institute for Health and Care Excellence. https://www-clinicalkey-com.ezproxy.ad.bcomnm.org/#!/content/nice_guidelines/65-s2.0-NG8
Elder JP, Lytle L, Sallis J, et al. A description of the social–ecological framework used in the trial of activity for adolescent girls (TAAG). Health Educ Res. 2007 Apr; 22(2): 155–165.
United States Environmental Protection Agency. NAAQS Table, 2019. Available at https://www.epa.gov/criteria-air-pollutants/naaqs-table
Yassi A, Kjellstrom T, Kok Td, et al. Basic Environmental Health. Oxford University Press, New York, 2001.
United States Environmental Protection Agency. Air Quality Trends 2019. Ground-level Ozone Pollution. Available at https://epa.maps.arcgis.com/apps/Cascade/index.html?appid=8a1e202950a34b5782edd05acafbab1e
Jingchun F, Shulan L, Chunling F, et al. The impact of PM2.5 on asthma emergency department visits: a systematic review and meta-analysis. Environmental Science and Pollution Research. 2016;23(1):843-50
George D, Thurston ASC, Lung CC. South Bronx Environmental Health Policy Study, Final report. New York University: Tuxedo, NY: Nelson Institute of Environmental Medicine
BroadStreet. Area Deprivation Index and Poverty Index for South Bronx Zip Codes. Retrieved from https://www.broadstreet.io
Starr P. The Social Transformation of American Medicine. New York: Basic Books; 1982
Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: What Health care Providers Need to Know About Racial and Ethnic Disparities in Health care. Washington DC. Institute of Medicine; The National Academies Press. March 2002.
Kaiser Family Foundation. Talking about Medicare: Your Guide to Understanding the Program, 2012. Available at https://www.kff.org/wp-content/uploads/2013/03/7067-02_medicare-at-a-glance.pdf
Hoffman KM, Trawalter S, Axt JR, et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA. 2016 Apr;113(16):4296-301.
Riley WJ. Health Disparities: Gaps in Access, Quality and Affordability of Medical Care. Trans Am Clin Climatol Assoc. 2012; 123:167-174
Gamble VN. A legacy of distrust: African Americans and medical research. Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):35-8.
Nossiter A. Asthma common and on rise in the crowded South Bronx. The New York Times. 1995 Sep 5; Sect. A:2 (col. 1).
Kochman B. Troubled medical waste firm Stericycle to appeal to Bronx locals at public hearing. The New York Daily News. Available at: https://www.nydailynews.com/new-york/bronx/troubled-medical-waste-firm-stericycle-hold-bronx-public-hearing-article-1.1960145
Troubled medical waste disposal firm Stericycle to hold Bronx public hearing. Biohazard Waste Regulations. Available at: http://biohazardwasteregulations.com/medical-waste-disposal/
New York State Office of Attorney General. Attorney General Cuomo Sues South Bronx Fertilizer Company to End Noxious Odors That Threaten Health and Well-being of Hunts Point Residents. 2009, Feb 5. Available at: https://ag.ny.gov/press-release/2009/attorney-general-cuomo-sues-south-bronx-fertilizer-company-end-noxious-odors-threaten
Kilani H. ‘Asthma alley’: why minorities bear burden of pollution inequality caused by white people. The Guardian. 2019 Apr 4. Available at: https://www.theguardian.com/us-news/2019/apr/04/new-york-south-bron-minorities-pollution-inequity
Briquelet K. FreshDirect gets City Hall to back off on campaign promise. The New York Post. 2014 Oct 5. Available at: https://nypost.com/2014/10/05/freshdirect-gets-city-hall-to-back-off-on-campaign-promise/
Slattery D. Mayor Bloomberg approves FreshDirect as more than $100 million in subsidies flow to keep online grocer in the city after threat to move to New Jersey. The New York Daily News. 2013 Aug 13. Available at: https://www.nydailynews.com/new-york/bronx/freshdirect-move-south-bronx-approved-article-1.1425887
Goldenberg S, Nahmias L. De Blasio, MV meet with foes of FreshDirect. Politico. 2015 Nov 10. Available at: https://www.politico.com/states/new-york/city-hall/story/2015/11/de-blasio-mark-viverito-meet-with-foes-of-freshdirect-027765
City of New York Int 0495-2014. A Local law to amend the administrative code of the city of New York in relation to reducing non-putrescible solid waste transfer stations in overburdened districts. 7 Oct 2014.
Giambusso D. In a major shift, city to launch zoned collection system for private carting industry. Politico. 2016 Aug 16. Available at: https://www.politico.com/states/new-york/city-hall/story/2016/08/following-years-of-protest-city-to-undertake-radical-change-in-private-carting-industry-104763
Clean S. The Bronx is Breathing. Gotham Gazette. 2015 Feb 15. Available at: https://www.nyenvironmentreport.com/the-bronx-is-breathing/
Rosengren C. New York City Council passes long-awaited transfer station capacity reduction bill. Waste Dive. 2018 Jul 16. Available at: https://www.wastedive.com/news/new-york-city-council-vote-transfer-station-capacity-bill/527839/
Fein EB. Giuliani withdraws money for a Bronx asthma program. The New York Times. 1998 Feb 27.
Nunez M. Officials: Health care cuts would hit hard locally. The Mott Haven Herald. 2017 Mar 15. Available at http://www.motthavenherald.com/2017/03/15/officials-health-care-cuts-would-hit-hard-locally/
Pares M, Frasier C. South Bronx Unit: Case Study. The Social Innovation Against the Crisis Project, Spain. Institute for Government and Public Policy Universitat Autonoma de Barcelona, 2015. Available at http://www.socrisis.net/wp-content/uploads/2017/07/SouthBronxUnite_report.pdf
Murphy EM. Promoting Healthy Behavior, Health Bulletin. Washington DC: Population Reference Bureau. No. 2, 2005.
Jones CP. Towards the science and practice of anti-racism: launching a national campaign against racism. Ethn Dis. 2018;28(Suppl 1):231-234.
Mays JC, Newman A. Virus Is Twice as Deadly for Black and Latino People Than Whites in N.Y.C. The New York Times. 2020 Apr 8. Available at www.nytimes.com/2020/04/08/nyregion/coronavirus-race-deaths.html
Washington, HA. How Environmental Racism Is Fueling the Coronavirus Pandemic. Nature. 2020 May 19. Available at www.nature.com/articles/d41586-020-01453-y
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
