Although Shoshanah Brown no longer does home visits as often as she would like, she still remembers the conditions of the South Bronx apartments on which she used to check up. Chronic mold growth and the presence of rats, cockroaches, and other pests are all too common in low-income neighborhoods such as the ones that Ms. Brown’s organization, a.i.r. nyc (a nonprofit that serves asthmatic children and adults in New York City), primarily operates in.
The solution to the mold and pests? It’s an ordeal. First, tenants have to file a complaint with the Department of Housing Preservation and Development (HPD), which can entail waiting up to three years. Then, when a maintenance man finally arrives, he does little more than “throw Clorox at the wall” for the mold, or spray a little pesticide for the vermin, says Ms. Brown, Executive Director at a.i.r. nyc. It’s hardly a sustainable fix: when the mold and pests inevitably come back in a few months, the whole process repeats itself.
While the presence of mold and cockroach infestations are nothing more than an annoyance for some tenants, it is a much more serious issue for the estimated 200,000 children suffering from asthma in New York City. Poor housing conditions are some of the most common triggers of asthma attacks, according to Rebi Connors, Director of Care Coordination at a.i.r. nyc.
Avoiding these triggers is often simply impossible in public housing projects in poorer neighborhoods around the city, because some of the triggers -- dust mites, mold, cockroaches, mice, strong odors -- are especially common in low-income housing where maintenance is meager and landlords are not held accountable.
The consequences are dire, and the disparities are visible. Depending on its severity, asthma, when left uncontrolled, causes wheezing, chest tightening, coughing, and shortness of breath. In severe cases, it can lead to hospitalizations and fatalities.
Hospitalization is rare in rich neighborhoods that have limited exposure to indoor triggers, but is quite common in others. The rate of childhood asthma hospitalizations in areas of the South Bronx, one of the poorest areas of the city, is 14-18 times higher than that of the rate in affluent neighborhoods of Lower Manhattan or Brooklyn.
Similarly, although the national rate for asthma in children is 1 in 11, in some low income areas of New York, such as Central Harlem, the childhood asthma rate is 1 in 4, largely due to poor housing conditions that are prevalent in these areas. Even in non-fatal cases, asthma dramatically reduces a child’s ability to receive a consistent education, and is one of the leading causes of absenteeism in schools.
Although risk factors for asthma partially depend on genetic predispositions, location is even more important, according to Ms. Connors at a.i.r. nyc. If given the right resources, asthma is almost entirely controllable.
Asthma is thus well managed in affluent areas, but poses a serious health risk to low-income communities. Residents of affordable housing complexes often have unresponsive landlords and lack the resources or knowledge to minimize asthma triggers. These triggers are not immediately dealt with, and often spread to other buildings in the community, exacerbating the problem. Mold, for example, can spread through apartment complexes very quickly, while infestations of mice and cockroaches in neighboring units build populations and infiltrate more housing complexes if not immediately culled.
Much of the problem stems from the fact that the city does not hold ineffectual landlords accountable. Although landlords are technically required by city law to provide maintenance under penalty of fine, as Ms. Brown’s descriptions indicate, landlords of public housing projects continue to get away with far too much.
Landlords can neglect repairs for prolonged periods of time without penalty, and, as pressure gradually mounts, often perform perfunctory measures as temporary solutions that don’t address the root of the problem. All the while, asthmatic residents suffer from constant exposure to triggers inside their own homes, exacerbating their condition and increasing their risk for asthma attacks.
Residents have little recourse to deal with their conditions, which is why non-profit organizations like a.i.r. nyc use reactive measures such as home-based interventions led by community health workers to ameliorate housing conditions and minimize triggers when landlords won’t. Although home visits can be daunting for residents and are often viewed as a “home investigation,” according to Ms. Brown, a.i.r. nyc has had success in reducing school absenteeism and avoidable asthma-related emergency room visits by 65%.
Policy change is on the horizon as well. The Asthma-Free Housing Act would require landlords to properly inspect for ‘indoor allergen hazards’ that can trigger asthma, and require the HPD to correct violations for these hazards should landlords ‘fail to do so promptly.’ The bill has made great strides in the New York City Council since its introduction in 2014, and currently enjoys 94% of support from the council.
The long-term solution to issues of structural poverty and asthma is nothing short of “revolution,” Ms. Brown said. But in the short-term, stopping the “neglect of certain communities” is a great step towards addressing the root cause of the problem.
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