The Question of Asthma and Race

In ther 1980s, studis were publishesoi a h between rc and environmental risk, raisin concern that minoritypouainweebignfrl affec b polton. Around thi time, resecs a to notichasthma prevalence was signifcat higher in minority communities. In one 1990 study publish in the Amew s Dis hma pre len in bac chiildreni ~was found to~be 7.2%, as compared w'ith3.% amoongwie chdrz A 1994 study publise in P ric nd x h in NewYorkWsCit/sminoi Bronx n ooodsa hh as 12.8%. For many the reatonhi between race an stm eemed~ toblearevid,~enc that the heal o m com e b inequibleenviromentl pr . A stud 0pulsh in hie 23 October 1996 isu ormfe Pubihelh sug t h r ta diffrces in asthmaprd as much to diffirrences in diagnosisa to) dfifflirnces in environment. Ti stud by Joan Cunninga Douls W. Dockery andFrank E. Sier of the Harvard Scho ofPic Hea fcused on the prevaence of asthm anid persistentwh among 1,416 blc and wtPhilade ia col cidrenge 9-11I. Wheezing is one of th pi s miahes found, as most previous stud ha that black rae was a sigfntLpredcr of dia a ; 9.4% of blc children were reprted to be astmi while ony 5.2% of whte childen were repe t be dagnosd with the diea Howev when the prevalence of wheeze in the two group as analzd no statistically sigifcant difference was found(9.1% prevalence fo black childrng versus &8% fbr4whie chil-

1980s, studis were publishesoi a h between rc and environmental risk, raisin concern that minoritypouainweebignfrl affec b polton. Around thi time, resecs a to notichasthma prevalence was signifcat higher in minority communities. In one 1990 study publish in the Amew s D is hma pre len in bac chiildreni~was found to~be 7.2%, as compared w'ith3.% amoongwie chdrz A 1994 study publise in P ric nd x h in NewYork WsCit/sminoi Bronx n ooodsa hh as 12.8%. For  Wheezing is one of th pi s miahes found, as most previous stud ha that black rae was a sigfntLpredcr of dia a ; 9.4% of blc children were reprted to be astmi while ony 5.2% of whte childen were repe t be dagnosd with the diea Howev when the prevalence of wheeze in the two group as analzd no statistically sigifcant difference was found (9.1% prevalence fo black childrng versus &8% fbr4whie chilof drn) Thes results le the rtesearhers to concluded that part of the disrepncy in tihma 0pr ence between races could be xlained by differences in diagnosis. "Th issue tat we're rasing is that blacks end to g the diagosis of astm more tanri wieDokrsaid.
Why symptomatic blacks are diagnse wAithdathma mrae often than symptomatic whiei p D said but he offer :one scenario dta may exin the diffeence: It may be that low-incm minoite are less likel to have a genral practit rthat vi r nsta te are meli to see emergency room car. If these chin come into the hospit on an basis wih a betigproblem.. and if thyrspond to abrnhoiarte are veylkely to be labeled as atmic." On te other hand, Dockery said, more affluent chdiden may be threat for breatin problemsicuigpritn wheeze, by a famil doctor, but because this tpe of care i leepi0sodc doctors d't fe psred to make an Immediate asthma dignsis.:An Witori by Peter Gergn, a health scientist administratOr tteAgn for HealCare Pcq Research, tha  Poor rural residents often depend on shallow wells, putting them at particular risk for exposure to groundwater pollution caused by the hog operations. The project hopes to better inform residents and health professionals, to encourage them to help prevent and remediate environmental health problems, and to develop educational materials that can be used throughout eastern North Carolina.
"Actual chemical or bacteria contamination is only part of the issue in environmental justice," says Wing. "The hog factories are also driving down land prices, putting local farmers out of work, and changing the food supply by flooding the market with cheap pork. Plus, the odors are a very noxious presence in the community. These are all environmental justice issues; they all have health effects."

In the Future
The environmental justice grant program also supports projects in southeast Los Angeles, Baltimore, Yukon Flats, Alaska, urban Appalachia, Alabama, Texas, and the Navajo, Shoshone, and Cherokee nations. Each region has shaped its objectives and methods to effectively respond to the needs of their communities.
While the grants provide for efforts in public education and community outreach, they do not support medical or epidemiological research in their underserved communities. However, Wing hopes the program will help develop stronger ties with local residents and allow researchers to better analyze environmental health problems and propose solutions in the future.
"In the rural South, there's a history of unethical treatment of poor blacks," says Wing. "They have a real mistrust of the medical establishment. To have doctors say they want to see them just to draw blood, it turns them into research [subjects]. I feel this is wrong. So the only right way is to 376 Volume 105, Number 4, April 1997 -Environmental Health Perspectives