Detroit is one of the worst cities in the country for people with asthma, leaving adults and children to deeply struggle with what can be a fatal disease, according to a new report published Thursday by the Asthma and Allergy Foundation of America (AAFA).
The nonprofit’s “2023 Asthma Capitals” report ranks Detroit as the country’s fifth “most challenging” city for those with asthma, a disease that affects a person’s lungs and can cause wheezing, breathlessness, chest tightness, and coughing. While often manageable with medication, the disease can be deadly. In 2021, the last year for which there is federal data available, 3,517 people in the U.S. died from asthma – including 94 people in Michigan and 17 people in Wayne County, where Detroit is located.
AAFA’s report listed the top four most challenging cities for people with asthma as Allentown, Pennsylvania; Lakeland, Fla.; Charleston, S.C.; and Cleveland, Ohio. The full list can be seen here.
“This report highlights the major risk factors for those who have asthma,” said Kenneth Mendez, president and CEO of AAFA. “AAFA’s Asthma Capitals report offers insight into how poverty, uninsured rates, and air quality impact the quality of life for the 27 million people in the United States living with asthma. Understanding where these risk factors are hitting folks the hardest can help us develop long-term solutions.”
The report ranked cities based on the prevalence of asthma, emergency department visits for asthma and deaths due to asthma. Last year, AAFA named Detroit as the nation’s most challenging city for people with asthma. This year, its drop to the fifth worst city does “not necessarily reflect an improvement in Detroit in terms of asthma outcomes,” said Melanie Carver, the chief mission officer for AAFA and the co-author of the Asthma Disparities in America 2020 report and the 2023 Asthma Capitals report. Instead, Carver said the placement reflects that other cities fared worse in terms of asthma rates, emergency department visits and asthma-related deaths.
The number of people living with asthma in the United States has increased in recent years, going from 20.3 million people in 2001 to about 27 million individuals in 2022 – or about one in 12 people, according to federal data. Asthma triggers vary from person to person but commonly include indoor and outdoor air pollution, dust mites, smoke – including from wildfires, cigarettes and cigars, mold spores, pollen, cold weather, and health conditions like the flu and COVID-19, according to the U.S. Centers for Disease Control and Prevention (CDC). The AAFA report notes that poverty, a lack of health insurance and minimal or no access to medical specialists also exacerbates the effects of asthma.
“Poverty plays a major role in the development of asthma and a person’s ability to manage it,” the report states. “This can be because people with low income and low wealth are more likely to have poor quality of housing, live near highways and other highly polluted areas, and struggle to pay for treatment. Many cities in our report have poverty as a top risk factor. Good asthma management can be difficult when families are worried about paying for housing, clothing, utilities, and food. The cost of care may affect the decision to seek medical care. A lack of reliable transportation and paid sick leave may influence a person’s ability to attend regular health care appointments.”
Black Americans and Puerto Ricans are disproportionately diagnosed with asthma compared to white Americans; mortality rates among Black and Puerto Rican people with asthma were three times higher than among white people with asthma, according to AAFA’s 2020 “Asthma Disparities in America” report. Emergency department visits and hospitalization rates for Black and Puerto Rican individuals with asthma were two to three times higher than white people, AAFA reported.
In Detroit – where Black residents are three times more likely to be hospitalized for asthma than white residents, according to the state health department – people have long dealt with high rates of asthma. The city in 2016 was called the “epicenter of the asthma burden in Michigan” in a state-issued report.
“We have levels of air pollutants that are high,” Stuart Batterman, a professor of environmental health sciences at the University of Michigan’s School of Public Health, said of Detroit. “We have a lot of substandard housing with water damage that leads to mold infestations. We have a lot of demolition and renovation and earth moving that leads to exposed soils where allergenic plants, like ragweed, move in very quickly and produce tremendous amounts of allergens in the air. You have poverty and racism, and all of these things are the combination that is promoting these environmentally-related diseases.”
AAFA’s report also notes that an increase in smoke from wildfires due to climate change and a lack of access to medical specialists also contribute to higher asthma rates across the country. This summer, Detroit faced some of the worst air quality in the world as smoke from Canadian wildfires settled over the city.
All of these factors leave Detroit to navigate “a serious disease that can kill people,” said Batterman, whose research looks at the environmental factors contributing to asthma, asthma in children and interventions that can lessen the burden from the disease, such as school absenteeism.
“Pockets of Detroit seem to be doing OK, but the majority has been transformed into a rental community with very little control over their housing,” Batterman said. “We have truck traffic and industrialization that’s unabated. You couple that with intense rainstorms, floods and smoke from wildfires, and there’s a lot of factors that can relate to asthma.”
Tackling asthma rates in Detroit
There are a number of ongoing programs to curb asthma rates in Detroit, including the Wayne County Community Air Quality Project that launched this year with funding from the American Rescue Plan Act (ARPA). The three-year project, which was highlighted in AAFA’s report, will provide 500 mobile air quality monitors to children and families and install 100 stationary air monitors in 43 communities across Wayne County. About 10.6% of the county’s population lived with asthma in 2021, according to the most recent statistics from the CDC – including 29,417 children and 158,651 adults.
Some of the mobile monitors in that program will be placed on top of quick-relief inhalers used by children with asthma. Those monitors will measure air quality at the time the children need to use the medicine. That data, according to AAFA, will be used to “help advocate for additional clean air standards for local industries contributing to poor air quality.”
Wayne County contracted with JustAir, a Michigan-based air quality monitoring company, for the initiative. AAFA noted that the company’s CEO, Darren Riley, developed asthma as a young adult when he moved to Detroit.
Last year, AAFA and the AAFA Michigan chapter launched what’s known as a “HEAL” (health equity advancement and leadership) program in Detroit to provide a “holistic asthma management intervention,” Carver said.
“Participants are provided with comprehensive self-management asthma education, connected with an asthma specialist and a nutritionist, and receive a virtual home environmental assessment from a certified community health worker,” Carver said of the program. “Participants are also provided with a local farmers market food box, a membership to a local YMCA, and asthma-friendly products for their homes.”
In the first year, more than 30 individuals ages 18 and older enrolled in Detroit’s HEAL program; an additional 30 individuals will enroll in the program in its second year, Carver said.
Chelsea Wuth, a spokesperson for the Michigan Department of Health and Human Services (DHHS), said the state’s “MI Asthma Program” conducts a wide range of work aimed at reducing asthma rates in Detroit. For example, the program facilitates the Asthma Collaborative of Detroit and meets bimonthly with some 20 Detroit and state organizations working to alleviate Detroit’s asthma burden.
We have levels of air pollutants that are high. We have a lot of substandard housing with water damage that leads to mold infestations.
The state’s MATCH (Managing Asthma Through Case Management in Homes) program teaches adults and children the skills they need to avoid emergency department visits and hospitalizations, Wuth noted. That program also offers at-home environmental assessments to help residents determine if there are things they can do at home to address asthma. MATCH is currently being implemented by Kid’s Health Connections, a Detroit-based nonprofit, in Wayne, Oakland and Macomb counties.
Other efforts to address asthma in Detroit include the state’s Electric Coalition, which Wuth wrote “is working to help speed up the transition to electric school buses in Michigan.”
“The coalition helps make it easier for school districts to plan and incorporate electric buses into their fleet,” Wuth wrote to the Advance on Thursday.
The DHHS spokesperson also pointed to the school indoor air quality program from the Community Action to Promote Healthy Environments, a coalition of community-based organizations, residents, health service providers, and public health researchers who aim to decrease pollution. That group is looking to measure air pollutant levels in various school buildings, place enhanced air filters in schools and measure the impact of those filters on indoor air quality.
Batterman said a multi-pronged approach to addressing asthma in Detroit is crucial, from reducing air pollutants and improving air filtration systems in schools to improving the city’s housing.
“Other interventions are reducing the allergenic pollen – this would have to do with using plantings that don’t produce allergenic pollen,” said Batterman. “So not allowing ragweed to grow over abandoned lots.
“We also need to be concerned about the housing stock,” Batterman continued. “We have a lot of properties in Detroit that are deficient, and they need to have intact roofs; they need to have healthy environments. This is expensive, but it has to be part of the solution.”
Carver, of AAFA, said policymakers should tackle asthma rates by funding programs that provide free asthma screenings; encourage flu, COVID-19, RSV, and pneumonia vaccines; build and implement asthma education and intervention programs; offer smoking cessation programs and fund tobacco-free youth campaigns that include information about vaping; take immediate action to mitigate climate change; and take steps to reduce outdoor air pollution and ensure indoor air quality is a top priority in public buildings, including public housing.
Ultimately, Batterman said, “we know what to do” to tackle asthma rates.
“It’s a question of getting it done,” Batterman said.