Environmental to air pollution increased in the United

Environmental
Health, as stated by Friis (2012), “comprises those aspects of human health,
including quality of life, that are determined by physical, chemical,
biological, social, and psychological factors in the environment”. Additionally
he points out that “it also refers to the theory and practice of assessing, correcting,
controlling, and preventing those factors in the environment that potentially
can affect adversely the health of present and future generations” (Friis,
2012). Large proportions of current diseases are associated with environmental
sources. It is estimated by the World Health Organization (WHO) in the report Preventing Disease Through Healthy
Environments – towards an estimate of the environmental burden of disease that
“24% of the global disease burden and 23% of all deaths can be attributed to
environmental factors” (Pruss-Ustun, 2006). Diseases with large environmental
contribution include diarrhea, lower respiratory infections, malaria, chronic
obstructive pulmonary disease, malnutrition, cerebrovascular disease, asthma, and
tuberculosis and lung cancer. Worldwide “children suffer a disproportionate
share of the environmental health burden” (Pruss-Ustun, 2006).

According
to WHO, air pollution is defined as “a major environment-related health threat
to children and a risk factor for both acute and chronic respiratory disease”.
Air quality is degrading worldwide. Friis (2012) states that “many European
cities do not meet WHO air quality standards for at least one pollutant” and “in
the United States (U.S.), about 25% of the population lives in areas that do
not meet the U.S. air quality standards”. The
American Heritage Science Dictionary defines air pollution as “contamination
of air by smoke and harmful gasses, mainly oxides of carbon, sulfur and
nitrogen” and The New Dictionary of
Cultural Literacy states that “the most serious air pollution results from
the burning of fossil fuel, especially in internal-combustion engines”. Combustion
of fossil fuels is the major source of air pollution in the U.S. Acute effects
of air pollution include the following: irritation of eyes, nose and throat,
asthma, bronchitis, pneumonia, coughing, nausea, and headaches. Chronic effects
of air pollution include heart disease, chronic obstructive pulmonary disease
and lung cancer.

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According
to Center for Disease Control and Prevention (CDC), the prevalence of asthma
and mortality due to air pollution increased in the United States by 58% since 1980.
It is stated by the United States Environmental Protection Agency (EPA) that “asthma
is a serious, sometimes life-threatening chronic respiratory disease that
affects the quality of life for more than 23 million Americans, including an
estimated 6 million children”. Mayo Clinic defines asthma as “a condition in which
airways narrow and swell and produce extra mucus” that “makes breathing
difficult and triggers coughing, wheezing and shortness of breath”. Irena Buka
(2006) reports that “the Committee on Environmental Health of the American
Academy of Pediatrics issued a policy statement in 2004 emphasizing the link
between ambient air pollution” (defined by WHO as pollution emitted from
industries, households, cars, and trucks) “and children’s health”. “Children
are known to be more vulnerable to the adverse health effects of air pollution
due to their higher minute ventilation, immature immune system, involvement in
vigorous activities, the longer periods of time they spend outdoors and the
continuing development of their lungs during the early postneonatal period”
(Buka, 2006). According to Coordinated
Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities announced
by EPA, “approximately 7 million children age 0 to 17 in the U. S. have asthma,
with poor and minority children suffering a greater burden of the disease”.

James
Gauderman (2004) reports that “in 1993, the Children’s Health Study recruited
1759 fourth-grade children (average age, 10 years) from elementary schools in
12 southern California communities as part of an investigation of the long-term
effects of air pollution on children’s respiratory health”. The children were
followed for up to 8 years and the results of the study provided robust
evidence that “lung development… from the ages of 10 to 18 years, is reduced in
children exposed to higher levels of ambient air pollution” (Gaudermna, 2004). The
GALA II and SAGE II studies of early-life air pollution and asthma risks in
minority children led by UCSF (University of California, San Francisco) observed
of 5,000 participant from Chicago, Bronx, Houston, San Francisco and Puerto
Rico from 2006 to 2011. The results of these studies showed that African
American and Latino infants living in communities with poor air quality due to
traffic-related pollutant are more likely to develop childhood asthma (Thakur, 2013).

Boston
Children’s Hospital Community Asthma Initiative (CAI) was developed owing to
the fact that “asthma hospitalization and Emergency Department visits are
disproportionately high for African American and Hispanic children”, according
to the hospital’s website. CAI is meant to help improve the health and quality
of life of children with asthma and their families (Community Asthma
Initiative). 2 to 18 years old children who live in Boston and have been either
seen in Boston Children’s Emergency Department or hospitalized for asthma can benefit
from the initiative (Community Asthma Initiative). The program “works with each
family to understand their child’s asthma and the medications used to treat it,
and to identify and reduce asthma triggers in the home and other places where
the child spends time” (Community Asthma Initiative). CAI has proved to be an
effective program and has been adopted in other cities and states.

In
May 2012 EPA released Coordinated Federal
Action Plan to Reduce Racial and Ethnic Asthma Disparities (the Plan). It
proposed “to build on the strength and lessons learned from past and existing
federal asthma problems and combined efforts among federal programs at the
community level” (Coordinated Federal Action Plan, 2012).  The Plan
outlines the following four strategies to reduce the disproportionally high
burden of asthma for minority children: (1) “reduce barriers to the
implementation of guidelines-based asthma management”; (2) “enhance capacity to
develop integrated, comprehensive asthma care to children in communities with
racial and ethnic asthma disparities”; (3) “improve capacity to identify the
children most impacted by asthma disparities”; (4) “accelerate effort to
identify and test interventions that may prevent the onset of asthma among
ethnic and racial minority children” (Coordinated Federal Action Plan, 2012).

WE
ACT for Environmental Justice (WE ACT) is a community organization described on
their website as “a Northern Manhattan membership-based organization whose
mission is to build healthy communities by ensuring that people of color and/or
low income residents participate meaningfully in the creation of sound and fair
environmental health and protection policies and practices”, noted in the
August 10th, 2017 press release that “more federal support is needed
to reduce asthma disparities nationwide” (Report, 2017). The report Unequal Air and Care: Federal Impacts on
Pediatric Asthma Disparities in 4 U.S. cities states that “the federal
government’s Coordinated Federal Action
Plan to Reduce Racial and Ethnic Asthma Disparities needs more support to
have an impact on asthma disparities in communities of color and low-income” (Report,
2017). The report “highlights work done to assess and discuss the strategies
outlined in the Federal Action Plan,
and to assess their effectiveness at reducing the disparate burden of asthma in
disadvantaged children aged 0-8 in four U.S. cities: Jackson, MS, New Orleans, LA,
Detroit, MI and New York City, NY” (Unequal Air and Care, 2017). Key finding of
the project stress that “federal approaches to asthma disparities are too
broadly focused” and do not adequately take into consideration the “social and
political factors that children of color and low-income face”, such as stress,
poverty, poor housing, and access to quality health care (Unequal Air and Care,
2017). The report provides recommendations which include: (1) “addressing the
social and environmental determinants of health that contribute to pediatric
asthma disparities in America”; (2) “establishing a Health-in-all-Policies
agenda across federal sectors by adopting an inter-sectoral approach to building
a culture of health for disadvantaged children”; (3) “expanding the capacity to
deliver integrated comprehensive asthma care to children in communities with
racial and ethnic asthma disparities”; (4) “building the capacity of state and
local governments, as well as clinical and non-clinical community-based
organizations / institutions, to provide community-level care for asthmatic and
at-risk children” (Unequal Air and Care, 2017).

It
is stated by WE ACT that, “nationally, about 1 in 11 children have asthma, but
in some low-income areas of New York City, the childhood asthma rate can be
upwards of 1 in 4” and that high indoor levels of pollutants (mold, pests, etc.),
which can be 2 to 5 times higher than outdoor pollutant levels, directly
contribute to the high prevalence of asthma in the city (Coalition for Asthma
Free Homes). With the goal for asthma free homes, “WE ACT and members of the
Coalition for Asthma Free Homes created a prescription to address asthma and
asthma disparities: the Asthma-Free
Housing Act” (Coalition for Asthma Free Homes). If passed, the act would “prioritize
prevention measures in homes of susceptible persons”, “require landlords to
inspect for Indoor Allergen Hazards and correct them and their causes using
approved methods”, and “create a system for physician referrals for housing
inspections by the City for patients with asthma” (Coalition for Asthma Free
Homes).

WHO
provides leadership worldwide in minimizing adverse environmental health
outcomes associated with air pollution. In the United States, EPA was
established in July of 1970 due to the growing public demand for clear water,
air and land. The agency monitors environmental quality. The Clean Air Act
(CAA) of 1970, “a comprehensive federal law that regulates air emissions from
stationary and mobile sources, authorizes the EPA to establish National Ambient
Air Quality Standards (NAAQS) to protect public health and public welfare and
to regulate emissions of hazardous air pollutants” (Summary of the Clean Air
Act). The Clean Air Act Amendments of 1990 strengthened regulations for auto
emissions, toxic air pollutants, acidic deposition, and stratospheric ozone
depletion. Steps to reduce emissions of harmful air pollution include:
technological controls (mechanical devices used to reduce industrial emissions
of particular matter), energy conservation and strengthening of national and
international air quality laws.