This post was originally published on The Washington Informer

By Kayla Benjamin

Houston-based organizations and partnerships are pushing to address causes of indoor air pollution linked to childhood asthma, including gas kitchen appliances, poor ventilation, and housing conditions issues like mold and pests. 

Michelle Hall, 63, has been fighting for clean air in Ward 7’s River Terrace neighborhood for more than two decades. For years, she organized alongside both her mother and her daughter. She joined with neighbors to collect health data and to protest nearby industrial facilities spewing fumes into the air. 

“We’ve had a lot of encounters with environmental injustice—you have the highway here, trash transfer stations, the power plant [on Benning Road],” she said. “We’re being exposed to so much in such a small area.”

Hall had not expected the next air pollution battleground to be inside her own home. But on Dec. 5, she stood in her kitchen with two fellow advocates from the Washington Interfaith Network, closely watching an air quality monitor. It registered high levels of nitrogen dioxide, a gas produced by burning gas-powered ovens and stoves, which over time can cause serious respiratory issues. For Hall, an asthmatic, the results proved particularly concerning.

When a young child is exposed to a lot of pests or mold, then they can develop an allergy to that, and that can change the way their immune system develops. And that change is permanent. It’s something that they carry around with them for the rest of their lives.

Dr. Janet Phoenix, public health expert and advocate for childhood asthma solutions

Hall’s home air assessment contributed to a data collection project run by the Beyond Gas DC coalition, which includes the Washington Interfaith Network along with several other local advocacy groups. The project is just one of several new initiatives by local organizations aimed at tackling the District’s high asthma rates by tracking, addressing, and raising awareness about environmental health hazards inside homes. 

“People don’t know to make that connection,” said Rosa Lee, 75, another River Terrace resident and WIN organizer. “People are not going to come up and tell you that their children have asthma and it’s associated with environmental concerns.”

How Housing Conditions Cause Asthma in Kids

A number of irritants in the air, from traffic-related particle pollution to indoor dust mites, can increase children’s risk of developing asthma. Consistent exposure over a long period of time makes it more likely a child will have an immune reaction. Since kids spend a lot of time each day at home, clean air there makes a big difference. 

Recently, health issues associated with gas-burning appliances gained attention as yet another reason to cut down on fossil fuel use. Legislative efforts on the federal and local levels have sought to provide low-income households with funding to swap gas-burning appliances with electric ones. That could make a big difference for childhood asthma: one analysis found that children in homes with gas stoves are 42 percent more likely to develop asthma than children in homes without them.

But gas appliances are far from the biggest household contributor to childhood asthma. Dust, mold and pests all introduce allergens into the air that contribute to children developing asthma and triggering serious or repeated asthma attacks.

“When a young child is exposed to a lot of pests or mold, then they can develop an allergy to that, and that can change the way their immune system develops,” Dr. Janet Phoenix, a public health expert and longtime advocate for childhood asthma solutions in the District said. “And that change is permanent. It’s something that they carry around with them for the rest of their lives.”

Awaab Ishak, a toddler residing on a Freehold housing estate in the U.K., died as a result of prolonged exposure to mold in his home.  Ishak’s breathing deteriorated rapidly while under the care of physicians for constant chest infections, coughing, and colds.  Though using an inhaler several times a day, the child’s lung capacity and oxygen levels reduced to a grave condition, and lead to his death just eight days after his second birthday. The coroner’s ruling was the first, ever, to assign household toxins as a cause of death. 

D.C. has the highest asthma prevalence of any U.S. city, according to a 2021 report by the Asthma and Allergy Foundation of America. More than one in 10 District residents have it, including almost 16,000 children and adolescents. 

A screenshot from Children’s National’s “Healthy Housing and Pediatric Asthma in DC” map on Dec. 7. The blue circles represent mold reports and the red dots show where an ER asthma patient came from.

Extreme inequality also characterizes childhood asthma in the District: more than 70 percent of D.C. kids and teens with asthma are Black, and more than 65 percent use public health insurance, according to a study published in the Journal of Asthma earlier this year. Children from Wards 7 and 8 are 20 times more likely to visit the emergency room for asthma than children from Ward 3.  

While outdoor air pollution from industrial facilities and traffic ways — the kind Hall  protests — contributes greatly to that inequality, pediatricians and experts increasingly point to housing issues as a crucial factor in asthma prevalence and severity. And that factor hits low-income families in the District the hardest.   

When Healthy Housing Becomes a Legal Struggle

Many renters face serious barriers when they try to address mold or pest issues in their home. That’s especially true for families who rely on subsidized housing or vouchers that limit their housing options.

“The problem is, if you’re renting, you don’t have a lot of control,” Phoenix said. “Dealing with the pest infestation, promptly fixing the leak so that it doesn’t lead to mold—those things would be the responsibility of the landlord.”

Pediatricians across the city have developed a partnership to help repeat asthma patients with unresponsive landlords: clinics can direct families to the Children’s Law Center, which provides pro bono legal resources to D.C. parents. 

So far this year, the Center has reached 1,700 children and families across hundreds housing conditions cases, according to communications director Allyson Boucher. More than 70 percent of those cases involved a child with asthma.

“We had a case just recently that we got an emergency hearing on: the child had been in the ER three times in the past two months. They had a mushroom growing out of their wall,” Evan Cass, a supervising attorney at CLC, said. “The landlord was told about the mold, and they came in and painted over it.”

Mold doesn’t go away after getting painted over. But if the problem isn’t visible, city housing inspectors can’t issue citations or a referral to the Department of Energy and Environment for an official mold inspection. 

Pediatricians and experts increasingly point to housing issues as a crucial factor in asthma prevalence and severity. And that factor hits low-income families in the District the hardest.   

“It got to the point where the child had to stay with his grandma, he couldn’t stay with his mom, because of the asthma attacks,” Cass continued. “We filed an emergency case, and we were able to get a hearing within 48 hours.” 

The judgment in that hearing, Cass said, required the landlord to put the family up in a hotel and do a full mold remediation with proof from a licensed mold inspector that the problem was gone. Still, Cass pointed out that families should not have to go to court to have healthy housing. 

D.C. law requires landlords to keep their units “clean, safe, and [in] sanitary condition, in repair, and free from rodents or vermin.” Historically, the city’s Department of Consumer and Regulatory Affairs has struggled to meaningfully enforce housing conditions laws, with inspections rarely leading to fines or other action. After D.C. Council required a reorganization in early 2021, the agency officially split into two in October.

“We are cautiously optimistic that major reforms in D.C. government will lead to better enforcement,” Cass said. Tenants can call on the new Department of Buildings to conduct an inspection, and the agency can potentially issue fines. 

“Rental housing safety is a top priority for us,” a DOB spokesperson said in an emailed statement. The department cited a 98% response rate to tenant requests and said that when their inspectors find violations, property owners receive citations within 48 hours over 99% over the time. 

However, the DOB’s statement also referenced a key friction point when it comes to enforcement in asthma-related housing cases: its agency’s inspectors are not licensed to verify mold. Instead, they need to refer mold issues to DOEE, which holds little enforcement power. 

Many of CLC’s asthma-related cases also highlight longstanding and well-documented problems at the D.C. Housing Authority, including widespread mold issues. Cass said the Center tries to work directly with the agency to address tenant complaints, as it does with all landlords, but it’s not rare to have to bring DCHA to court in order to fully fix mold or pest problems. D.C. Council Chair Phil Mendelson is currently pushing legislation that would completely overhaul the agency. 

DCHA had not responded to a request for comment at the time of publication.  

Healthcare, Housing, and Justice Organizations Pick Up the Slack

It remains to be seen whether the reorganization of DCRA or the scrutiny currently focused on DCHA will make a difference for families struggling with environmental triggers for childhood asthma. In the meantime, researchers, healthcare providers, and housing and environmental nonprofits are working to fill the gap with an all-hands-on-deck approach. 

Last year, Phoenix worked with a team from the housing justice group Yachad, Children’s National Hospital, and two other partner organizations on a new project to identify and support families struggling with asthma triggers at home. The pilot program offered virtual home visits to pediatric asthma patients so service providers could identify potential asthma triggers in the home in the midst of the COVID-19 pandemic. 

The pilot project brought together a multidisciplinary team to help the families who completed virtual home visits. Each video call included a medical provider, a visit coordinator, and two housing specialists, according to a report summarizing the project. Following the visit, families received an individualized plan to address those specific triggers, which could include anything from access to an air purifier to help communicating with landlords. Of the 57 families to complete a virtual home visit, 46 received remediation services, mostly to address dust mites and pest issues. 

Other organizations have focused on pushing city government to provide those kinds of interconnected health and housing services. NAACP DC launched its Lead Exposure and Childhood Asthma campaign in March, partnering more than 30 other groups, including the Washington Interfaith Network. As part of the Beyond Gas DC coalition, WIN also helps document indoor air pollution caused by gas-burning appliances and push for cleaner, more electrified homes.

As of December, the coalition had tested just under 100 kitchens in the DC area. The data is still in early stages, but around half of the tests so far have found unhealthy concentrations of nitrogen dioxide in the air after running the oven and stovetops, according to project coordinator Barbara Briggs. 

In Michelle Hall’s kitchen, with the gas oven and two gas stovetops running, the numbers ticked steadily up. After about 20 minutes, the device showed nitrogen dioxide concentrations more than twice the Environmental Protection Agency’s definition of a healthy level for most people to breathe for one hour. Since Hall has asthma, it was more than three times the healthy exposure level for her to breathe for an hour. 

Even after Hall turned the appliances off, the nitrogen dioxide levels remained high for more than 20 minutes. She glanced at the device, then at her stove, which she uses to make home-cooked meals most nights. 

“I’ve loved cooking since I was a little girl,” Hall said. “I guess I will be cracking my windows all the time.”

The post The Air Inside the House: The Connection Between Our Homes and Asthma appeared first on The Washington Informer.