Metropolitan Phoenix ranks in the top five US cities for asthma-related deaths. Approximately 8% of the Phoenix population has asthma, and research conducted in a low-income Latino neighborhood found that 16% of children under 19 years old had been diagnosed by a doctor as having asthma; this is twice the national average.
Sara Grineski investigated the relationships between socioeconomic status, race, ethnicity, indoor hazards, ambient environmental hazards, and asthma hospitalization rates, to understand how these factors contribute to the incidence of childhood asthma and how families cope with childhood asthma. The study asked:
- Do socio-spatial inequalities explain patterns in uncontrolled childhood asthma?
- How do parents have differential control of children’s asthma?
- How have historical and geographical processes influenced inequalities associated with asthma control?
Socio-spatial Inequities
Grineski mapped the incidence of children’s asthma hospitalizations by zip code and found that clusters of high-hospitalization rates were located in the center of the metropolitan area and along the freeways (Fig. 1). These areas correspond with concentrations of industries with high emissions levels and concentrations of minority populations (Fig. 2).
She used Poisson regression models to analyze what factors best predicted asthma hospitalizations. An analysis of socio-demographic factors only found that areas with lower social class and higher proportions of African Americans had significantly higher rates of uncontrolled asthma. However, the most important predictor of asthma hospitalizations was a composite pollution measure of three criteria pollutants: nitrous oxides (NOx), ozone (O3), and carbon monoxide (CO). Areas high in these criteria pollutants positively predicted areas of high hospitalization rates.
Differential Control of Asthma
The research contrasted family experiences with childhood asthma in two different areas: South Phoenix and Ahwatukee. South Phoenix has historically been marginalized. This process has resulted in distinct spatial, social, and economic segregation of undesirable land uses (such as polluting industries) and minorities from “Anglo” Phoenix. Ahwatukee is representative of newer, upper-class developments in metropolitan Phoenix, although it is geographically separated from the rest of the metropolitan area by South Mountain City Park. The City of Phoenix promotes the area as a series of master-planned communities with desert landscaping, golf courses, and lakes.
In-depth interviews with 53 parents of asthmatic children revealed the nexus of race, class, and place. Comparing families’ experiences in South Phoenix and Ahwatukee, the study investigated how access to, and control over, asthma resources differed between the two areas. Two important resources emerged as crucial for coping successfully with the disease: health care and the environment.
Major findings on healthcare were:
- Upper-income families in Ahwatukee were satisfied with their health insurance and health care, and their children received preventive care.
- Families with public health insurance were generally satisfied with their insurance but complained about getting approval for preventative medicines.
- Lower-income families with job-based insurance struggled with rising health-care costs, which affected their children’s health negatively.
- Uninsured families relied on the Phoenix Children’s Hospital Breathmobile for asthma care.
- Spanish-speaking parents reported a lack of translation services at some local emergency rooms.
Control over environmental conditions was also critical for managing asthma:
- Higher-income families had the means to take measures to create appropriate indoor environments for managing asthma.
- The 40 lower-income families in the study lived in conditions that made it more difficult to manage asthma (e. g., housing in ill repair, rodent and pest infestations, evaporative coolers instead of air conditioning).
- Immigrants tended to live in the poorest-quality environments in South Phoenix, facing a double jeopardy of poor housing and location near pollution sources.
- African-American families in the study were less likely to own their own homes, affecting their ability to make changes to control allergens known to trigger asthma attacks.
Historical and Geographic Processes
The research findings highlight the links among race, class, health, and place, and how historical legacies of racism and discrimination shape contemporary experiences with asthma. Historic processes have relegated minorities to neighborhoods in South Phoenix, which are in close proximity to polluting industries. Households in South Phoenix are chronically vulnerable to environmental conditions that trigger asthma and have fewer coping strategies than higher income households in Ahwatukee. The experiences of families with asthmatic children in South Phoenix underline historical legacies of class and racial privilege in the city.
Grineski, Sara E. 2006. Social Vulnerability, Environmental Inequality, and Childhood Asthma in Phoenix, Arizona: A Report to the Community. Unpublished report.
Grineski, Sara E. 2006. Social Vulnerability, Environmental Inequality, and Childhood Asthma in Phoenix, Arizona. Unpublished Ph.D. thesis, Arizona State University.
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