Air sick

Pollution and environmental injustices are hurting — even killing — our children.

By Lance Frazer

Historically, air pollution was probably first brought jarringly to Americans’ attention in 1948, when the town of Donora, Pennsylvania, was enveloped in a “lethal haze” believed to be triggered by a local zinc plant. Over a five-day period, nearly half of the town’s 14,000 residents became seriously ill. More than 20 died. Seven years later, the Air Pollution Control Act of 1955 became the United States’ first federal attempt to control air pollution, a battle that continues to this day.

Air pollution plagues areas nationwide, and a large — and growing — body of research indicates that some areas and people are more strongly impacted by air pollution than others.

“Disproportionate exposures and resulting health disparities continue to be a problem for BIPOC (Black, Indigenous and People of Color) communities,” says Kristie Trousdale, deputy director of the Children’s Environmental Health Network. 

These disparities are the result of decades of discriminatory urban planning and housing policies, such as redlining, that segregated people of color into neighborhoods adjacent to industrial facilities. In addition, construction of highways and freeways from the 1950s through the 1970s were concentrated in Black communities, swallowing up needed greenspace and exposing residents to exhaust emissions and other pollutants. 

New polluting facilities are also more likely to be situated in these communities, says Trousdale, and residents often lack the resources, time and political power to push back.

Trousdale cites the American Lung Association’s State of the Air (SOTA), which has been published each of the past 20 years and analyzes air-quality data from the Environmental Protection Agency. SOTA consistently notes these disparities, she says. The 2022 report found that between 2018 and 2020 “people of color are 3.6 times more likely to be breathing the most polluted air than white people.”

In addition, the increased frequency and severity of climate-related disasters is causing more pollution spikes from facility shutdowns and breaches, power failures and other occurrences. 

“And again,” Trousdale says, “people of color are more likely to live near these facilities, or near hazardous waste sites or other sources of pollution vulnerable to disaster destabilization.” 

The problem is compounded by the fact that people of color in the U.S. are more likely to have limited access to quality health care. 

“Thus, Black children not only have two times the rate of asthma compared with white children,” Trousdale says, “but they’re also two times more likely to be hospitalized for — and four times more likely to die from — asthma than their white peers. They’re more likely to be living in neglected neighborhoods that are under-resourced where other factors such as limited educational services and social capital can compound environmental injustice and perpetuate a cycle of health disparities.”

In these areas, she adds, the primary sources of air pollutants for which acceptable levels of exposure can be determined, and for which an ambient air quality standard has been set, are industrial facilities, electrical utilities and motor vehicles. 

And that’s the outside air. 

Indoor air quality can be equally important — and equally bad. 

“Indoor air quality is critical, as it can be two to five times worse than outdoor air,” Trousdale says. “People living in substandard housing can be exposed to mold and pest infestations, which exacerbate respiratory illness.”

Many children attend schools that don’t even have working HVAC systems, she says, and the result is that they inhabit poor indoor air quality. And air quality has only become a more pressing issue since COVID-19 struck.

Noting the discrepancies
Research shows that groups including Black Americans and Indigenous peoples endure a greater and more severe range of health conditions.

There’s asthma, for example.

Hannah Jaffee, a research analyst with the Asthma and Allergy Foundation of America, says that race and asthma disparities go hand in hand.

 “The more dominant cause of asthma disparities … ties into social and structural determinants of health,” Jaffee says. “These determinants include economic stability, physical environment, healthcare quality and access, and environmental justice, to name just a few.”

Money isn’t necessarily a buffer. In early 2021, a study from the University of Illinois Urbana-Champaign showed that nearly all emission sectors have a greater impact on people of color, regardless of income. That goes against some traditional thinking, says Dr. Christopher Tessum, the civil and environmental engineering professor at the university who led the study.

“For a long time, the Econ 101 way of thinking was that more wealth buys better living, better areas, better environments,” Tessum says. “Our study adds to a growing body of research that indicates that’s not the way it works.”

 Dr. Jun Wu, Professor of Environmental Health at the University of California Irvine Program in Public Health, has worked for several years on the impact of air pollution on Southern California communities. Orange County, she says, shows an urban city environment with problems similar to other areas across the U.S., with many communities living near freeways or industrial sites. 

“It could be from a variety of reasons — land is cheaper, a lack of political power, lack of awareness among the citizens of an area,” Wu says. “My research and that of many others shows that … minority populations, regardless of income, are more exposed.”

To correct these problems, she says, requires action on many levels.

“Local, state and federal agencies need to be aware of the issue and be willing to work together,” Wu says. “Lately, there has been some change at the federal level to be more willing to invest in environmental justice, but they need to work with community groups to develop solutions. And we need to work in a holistic way, not just address air pollution and leave the other factors behind. This is a major issue and cannot be solved quickly.”

Links to illness
So what, exactly, is asthma?

“Asthma is a chronic disorder of the airways in the lungs where people have airway inflammation,” says Dr. Anjeni Keswani, associate professor of medicine and director of the Division of Allergy/Immunology at the George Washington University School of Medicine and Health Sciences. “Triggers such as allergens, irritants, viral infections and weather changes can generate airway inflammation and spasming of the airways.” 

There is no cure for asthma and regular treatments are usually required.

Asthma cases continue to rise. The disorder currently affects about 300 million people worldwide. It’s believed about 8% of people in the United States live with asthma, which is triggered in part by air pollution caused by “traffic-related air pollutants, which include particulate matter, carbon monoxide and nitrogen dioxide,” Keswani says.

In fact, a recent study conducted by researchers at George Washington University indicated that nearly two million children worldwide develop asthma every year as a result of breathing in one particular pollutant: nitrogen dioxide. And where does nitrogen dioxide come from? Vehicle tailpipe emissions, power plants and industrial sites. 

Another study sheds similar light. 

“Pediatric Asthma: A Global Epidemic,” by Dr. Denise Serebrisky, director of the pulmonology division and codirector of the pediatric asthma collaborative team at NYC Health and Hospitals/Jacobi, finds that:

Among children, asthma is the most common chronic disease, ranking among the top 20 conditions worldwide for disability-adjusted life years in children.

Air pollution is particularly hazardous to the health of susceptible populations like children and the elderly, with children at the highest risk because they inhale a higher volume of air per body weight.

Children living near traffic have increased risk of asthma symptoms, school absences and asthma hospitalization.

Worldwide, the main sources of outdoor pollutants are fuel combustion from vehicles, construction and agricultural operations, power plants and industries.

Rapid urbanization and industrialization around the world have increased air pollution, and therefore population exposures.

There are reasons why children are more susceptible to asthma than adults, says Abheet Solomon, a senior program manager in UNICEF’s health division. For example, children breathe more rapidly, their immune systems and lungs have not yet fully developed, and they are smaller than adults. 

“They live closer to the ground, where pollutants concentrate,” Solomon says, “and asthma can create a series of lifelong problems.”

Those problems place a huge burden on the world’s health systems. Globally, the economic costs of asthma exceed those of tuberculosis and HIV/AIDS combined (an estimated US$56 billion annually in the U.S. alone), with developed economies spending 1-2% of their healthcare budget on asthma. 

Solomon even points to impacts beyond health.

“There’s an impact on education as children miss school, out-of-pocket health expenditure which increase poverty, as well as an unmeasurable potential for a lost future,” he says.

One problem is a lack of worldwide attention. 

“Medicine in low- and middle-income countries has been focused on infectious diseases,” Solomon says. “So we are not prepared to deal with the impact of pollution. Look at lead. Two years ago, we did a study that found that one in three children was poisoned by lead. But local authorities and health systems are not prepared to detect or treat children for lead poisoning. The basic capacities don’t exist.” 

It’s a point echoed by Serebrisky’s study, which states that “for the governments of much of the world’s population, asthma is not a healthcare priority. Asthma management must compete with other prevalent chronic illnesses for a share of available medical care resources.” 

Next steps
A variety of solutions have been proposed to deal with the myriad problems created by air pollution and its devastating impact around the world. Many of them will require shifts away from courses we have long tread. 

For example, a coalition of environmental and business groups recently sent a letter to the White House demanding the elimination of pollution from all new freight trucks and buses by 2040. 

That, says Kristie Trousdale, would be a good start.

“Consider that the U.S. school bus fleet is the largest transit system in the country, serving over 25 million students each day,” she says. “Transitioning this fleet to electric would benefit the health of these children riding these buses every day throughout their childhood. Children living near major roadways with significant traffic, or near warehouse distribution centers where larger numbers of heavy-duty and diesel-powered trucks frequent, will also benefit.” 

But could politics stand in the way? Trousdale maintains a positive outlook, noting the transition to electric vehicles.

“Many automakers are investing in production of new models and aiming for superior performance to their gasoline-powered counterparts,” she says. “And demand continues to grow.”

She also notes that federal spending will invest significantly in electric vehicles and charging infrastructure following the bipartisan Infrastructure Investment Jobs Act, which provides approximately US$350 billion for federal highway programs through 2026. That includes funds for electric school buses.

According to the American Lung Association study, “The Road to Clean Air,” shifting to zero-admission transport technology could reduce emissions. By 2050, this could result in 6,300 premature deaths avoided, 416,000 lost work days avoided, and global health benefits of an estimated $72 billion — with climate benefits totaling $113 billion.

“However,” Trousdale adds, “we need to be careful and intentional about who benefits and has access — and how our investments in clean transportation will prove equitable and meet Justice40 initiatives.”

Justice40 initiatives aim to deliver 40% of the overall benefits of federal investments in climate and clean energy, including sustainable transportation, to disadvantaged communities.

“Vigilance is needed to ensure compliance and enforcement of child-protective policy,” Trousdale says. 

As the factors associated with health disparities compound, she adds, a coordinated government approach becomes necessary. So does community involvement in decision-making around prevention and research. 

“We need a paradigm shift,” she says. “We focus a great deal on treatment of illnesses. If we could focus more of this support on prevention, the results may not be as visible — how can you see diseases being avoided? — but they would be significant.”

Education is key
Abheet Solomon says UNICEF’s focus has been on the impact of pollution in low- and middle-income countries. Ultimately, he believes, pollution — and how it relates to children’s’ health —  is an equity issue. 

“Even in high-income countries, you still see people living in heavily polluted areas, in homes without filtering systems or using coal in antiquated stoves for heating and cooking,” Solomon says.

So, what needs to happen?

Solomon says part of the problem is that the focus of healthcare systems has been on pathogens rather than pollutants. We need to improve awareness of the impact of pollutants on human health when training the world’s healthcare workers. In fact, he says, education is vital not just for the world’s healthcare workers, but for others who interact with vulnerable children.

“In addition to training health workers, we need to improve awareness in teachers and caregivers about the dangerous impact of pollution on children’s health,” Solomon says.

He cites Georgia and Mongolia as countries worthy of “cautious optimism.”

In Georgia, a 2018 study found that 41% of the country’s children had lead levels equal to or greater than 5 mg/dL. (For context, the Centers for Disease Control uses 3.5mg/dL to identify children who have higher levels of lead in their blood than most children do.) Lead exposure can lead to complications such as learning disabilities and growth and developmental delays.

The government of Georgia, working with UNICEF, has developed a multiyear plan to identify and control the major sources of lead exposure, as well as short-, medium- and long-term measures to manage the problem. The national strategy also includes additional training and education among the country’s medical personnel. 

In Mongolia, meanwhile, UNICEF has been working to address air pollution.

“The big issue is the use of solid fuel for both cooking and heating,” Solomon says. “The country has been making progress, working to move toward safer fuels and educating and involving the young people of the country. But it’s a long road. It won’t happen overnight.”

But Solomon remains optimistic that it will happen. Of course, the road ahead is by no means clear — whether in Mongolia or anywhere else.

“To date, much of our investment in caring for the world’s children has been in the arena of communicable diseases,” he says, “but pollution is a very different arena, and there is a tremendous future that’s being wasted.” 

Even children who survive the effects of pollutants such as nitrogen dioxide can suffer for the rest of their lives from developmental delays, damaged cognitive ability, cardiovascular difficulties and other problems. And all of that places a greater burden on families. 

Some studies indicate that when children become asthmatic, as much as half of the annual household budget can be spent caring for them. Such economic burdens also extend to local and regional healthcare systems. 

And there are, of course, the children — who don’t get the kinds of happy, healthy lives that all kids deserve.

“These problems require the same level of commitment as we showed in dealing with COVID,” Solomon says. “I know that problem is not yet solved, but the diagnoses and treatments we developed are examples of what we can do when we put our mind to it. It will take a whole-society approach, but I don’t believe it’s impossible if we have the will.”

No-coal goal

Eliminating solid fuels as a global heat source is an important step in reducing air polution.

By Lance Frazer

Dr. Jay Turner, vice dean and professor in the James McKelvey School of Engineering at Washington University of St. Louis, has too many jobs and qualifications to list.

But we’ll say this: He knows more than most about the effects of air quality on children’s health.

He is part of a team selected to evaluate a U.S.-government funded program to subsidize the replacement of high-polluting, low-efficiency residential coal burning stoves. He’s been working in Mongolia since 2012 and was part of a team funded by the Mongolian government to assess a range of possible emission control strategies over a 10-year horizon.

“I’m currently leading a project for UNICEF to better understand air pollution in Mongolia’s secondary cities and to evaluate children’s exposure to air pollution in kindergartens,” he says.

Ulaanbaatar is Mongolia’s capital city and home to more than one million residents. It’s been growing, Turner says, because of “internal migration driven by economic/education opportunities, but also climate migration, as the nomadic lifestyle becomes unsustainable. Most of these people move to ger-dominated neighborhoods (a ger is similar to a yurt) on the perimeter of the city, and have little access to standard services.”

People living in these areas, he says, typically heat their homes with coal and other solid fuels. Given the extreme wintertime conditions, the rate of coal consumption can be enormous. 

“These stoves tend to have high pollutant emissions,” he says, “and can lead to neighborhood, and larger-scale pollution. The topography exacerbates the problem, with pollutants trapped in the valley where the city is located.”

As in many countries around the world, he says, poorer neighborhoods are the hardest hit.

“Poorer neighborhoods typically lack the infrastructure to heat their homes using (anything other than) solid fuels, and/or the pricing structure drives them to fuels like coal. In some cases, the government tries to help these populations by subsidizing coal purchases, but this in turn reinforces the use of this high-polluting fuel.”

As in many areas, transportation exhaust is also a problem in both Ulaanbaatar and the capital of Kyrgyzstan, Bishkek. 

“In both cities, vehicle emissions are a significant source (of pollution) in the downtown area, with heating sources less so, because most buildings are connected to district (systems) from a power plant,” Turner says. “However, as you move away from the city center and into areas with coal-heated households, this heating source clearly dominates.”

Thanks to research programs like Turner’s and action by the Mongolian government, the city has begun to improve. But there are still hurdles, Turner says.

“While some claim the future is cleaner coal, at some point, ideally sooner rather than later, there needs to be a pivot away from residential heating with solid fuels. Working with UNICEF and Public Lab Mongolia (an in-country NGO), we are launching a kindergarten teacher education program to raise awareness about air quality and what can be done at school to reduce exposures. These teachers are also a key conduit to teach parents about what can be done at home to reduce these exposures.”

A project by the Asian Development Bank (The Ulaanbaatar Air Quality Improvement Program) included funding to support the ban on raw coal burning and to establish technical standards for vehicle pollution. New building codes were adopted for programs such as the application of thermal protection requirements to new buildings and the renovation of apartment buildings and public, industrial and warehouse buildings. Governments also adopted measures on pollution reduction and health protection. Other programs included subsidizing loans to eligible low-income households and entities to promote the use of electric heaters, insulation materials, clean heating solutions, improved stoves and other solutions to improve living and working conditions in ger areas.

In Kyrgyzstan’s capitol Bishkek, Turner has been fighting a similar battle. In 2021, he was asked to join a team responding to a UNICEF call for proposals. It’s a new project that faces many of the same obstacles.

“There are several compounding factors,” Turner says. “The city’s population is growing because of internal migration, and many of these people are living in informal settlements on the perimeter of the city, where living is cheaper, but housing stock quality is often poor and poorly insulated, with little-tono access to standard services. In these and other areas, it’s common to heat homes using solid fuels — especially coal — in a stove. These stoves tend to have high pollutant emissions, and can lead to neighborhood, as well as large-scale air pollution. Second, hydroelectricity is an important energy source, and droughts in recent years have reduced output and driven a shift to solid fuels. And third, in the downtown areas, vehicles contribute to local-scale air pollution.”

There are a variety of other factors, including what Turner refers to as “aged” power plants, an energy infrastructure both “antiquated and inefficient,” and the available supply of local coal, which he describes as “plentiful and cheap.” 

As in Mongolia, Turner and his team have been working closely with residents and a number of institutions. 

“Many institutions are engaged,” he says. “Indeed, well before we started in Kyrgyzstan, they included national and city government, UN organizations including UNICEF, financial institutions including the Asia Development Bank, donor organizations and others.

“(I am) particularly interested in opportunities to shift the conversation from being a strictly environmental issue to being a public health issue — and thus the opportunity to work with UNICEF with its focus on child and maternal health and well-being was a natural fit.”

In Bishkek, Turner says, both the national and city governments have formed a committee to address air pollution. The committee listed 40 possible measures to improve air quality. The measures need to be prioritized, Turner says, based on science and feasibility before being put into action. 

“The crux is to move away from residential heating with solid fuel,” he says. “An example could be widespread adoption of air-to-air heat pumps. It does take some electricity but overall has high efficiency and is quite clean.” 

Donor organizations are now funding a pilot study for this technology. 

“Widespread adoption could dramatically help the shift away from household heating with coal,” Turner says. “Also, energy savings from better thermal control of buildings could be an opportunity to expand the area served by district heating.”

What you can do

There are things you can do right now to help improve the quality of air both inside and outside of your home. Here are just a few.


  • Carpool if possible.
  • Avoid excessive idling of your vehicle.
  • Keep the engines of cars, boats and other vehicles properly tuned.
  • Reduce, reuse, recycle.
  • Purchase energy-efficient appliances.
  • Refuel your car in the evenings when it’s cooler, and be sure to tighten the gas cap.
  • Avoid burning trash and leaves.
  • Purchase electric if and when possible — cars, lawn equipment, etc.
  • Conserve electricity.
  • Mulch or compost yard waste and leaves.


  • Do not smoke cigarettes or electronic cigarettes in the home.
  • Reduce or discontinue use of household cleaning supplies that contain harsh chemicals that can trigger asthma or other lung-related illnesses. Instead, use all-natural cleaning supplies.
  • Remove carpeting inside the home where and if possible.
  • Use a dehumidifier.
  • Run the air conditioner when possible.
  • Take your shoes off when inside to avoid tracking pollutants into the home.
  • Wash bedding weekly in hot water.
  • Dust and vacuum often.
  • Ensure exhaust fans are working properly in kitchen and bathrooms.
  • Make sure your gas stove is well-ventilated.

What can my Kiwanis club do to help?

  • Offer education about air quality at your next meeting. Invite an environmental expert to talk about the issues. Consider inviting this expert to speak to members of your club’s Service Leadership Programs as well.
  • Carpool to your events and meetings.
  • Stage a recycling program in your community. Collect old batteries, electronics, appliances and other hazardous materials and correctly discard them. 
  • Partner with your local children’s hospital to support children’s asthma awareness.
  • Offer a Christmas tree pickup service and work with your local officials to discard them properly.
  • Work with your local energy providers to offer education and to spread awareness about ways families can be more energy efficient.

Sources: United States Environmental Protection Agency, Cleveland Clinic

This story originally appeared in the June/July 2022 issue of Kiwanis magazine

One thought on “Air sick

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  1. Thank you for republishing this article. It is a topic we all need to work together to solve. Environmental racism is nothing new, but few seem aware of it. Children are being hurt by this and our mission is to serve children. Thank you!

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