Healthy Homes, Healthy Lungs: Improving Indoor Air Quality to Alleviate Childhood Asthma in Chicago
A program to mitigate and educate about indoor air pollutants
Authors: Emily Packard Dawson, PhD, Kavitha Chintam, Matt Cowan, Laura Hancock, Alicia Hendrix, PhD
Summary
Asthma takes a massive toll on the health, financial, and educational wellness of affected children and their families. Children in Chicago living in poverty have poor asthma outcomes and increased exposure to indoor air pollutants — such as pet dander, mold, and nitrogen dioxide — that can exacerbate symptoms. We recommend that Chicago adopt a holistic program that focuses on mitigating key indoor air pollutants to give all of its children a healthy future.
Introduction
Chicago has among the highest childhood asthma rates in the United States, with over 16% of families affected. Furthermore, there are striking racial and economic disparities in asthma-related care in Chicago (Figure 1). Black children are twice as likely as White children to visit the emergency department (ED) for their asthma, and children living in zip codes with high economic hardship account for nearly half of asthma-related emergency medical services visits to schools. Asthma also exacts a staggering financial toll: asthma-related pediatric visits to Chicago EDs cost over $18 million annually. In addition to encountering racial biases within the healthcare system, Chicagoans from minoritized groups tend to have less wealth and thus often face structural factors that contribute to asthma, including poor indoor air quality.
Indoor air hazards — such as pet dander, mold, dust, and nitrogen dioxide (NO₂)— exacerbate asthma symptoms, particularly in children. Because over 50% of homes in Chicago were built before 1950, Chicagoans are at risk for exposure to these hazards as homes may not have been appropriately maintained over the years. Furthermore, older housing and public housing are more likely to have gas stoves, a principal source of the harmful pollutant NO₂ that aggravates asthma symptoms. Properly installed exhaust hoods can relieve asthma symptoms associated with NO₂, however, families living in poverty often lack access to adequate ventilation. Given that poorly controlled asthma may impair a child’s ability to attend school and result in more ER visits, it is imperative to improve indoor air quality for asthmatic children in poverty who are disproportionately burdened by indoor air pollution.
Current Policy Landscape
The Chicago Department of Public Health (CDPH) recently outlined a strategy to decrease ED visits due to asthma in Black children by 10%. This strategy includes developing asthma care implementation programs, including a partnership with the CHICAGO Plan, and promoting self-management programs. These efforts fail to address health hazards in the home that exacerbate asthma symptoms and disproportionately affect children in poverty.
Passed by Illinois’ House, the Tenant Radon Protection Act (HB 2217) would allow tenants to break a lease if radon levels are high and require landlords to disclose possible radon exposures. HB 2217 illustrates that Illinois is willing to explore options to address pollutants in homes.
Recently, 33 organizations across the Midwest joined to answer the Consumer Products Safety Commission (CPSC) request for information regarding “Chronic Hazards Associated With Gas Ranges and Proposed Solutions.” Lessons learned from this comment informed our recommendations, which speak to actions that entities other than the CPSC can take.
Addressing the Indoor Air Hazard Gap: Proposed Policy Action
- Develop an Asthma Mitigation Program focused on indoor environmental remediation. After a child receives an asthma diagnosis, patients’ families would receive education and resources from CDPH (Figure 2). Families living below the poverty line would be supplied with free HEPA air purifiers fitted with activated carbon filters, which mitigate several indoor air hazards, including dander, mold, and NO₂. Provided air purifiers would meet certain safety and energy efficiency standards and delivery of filters to homes every 3 months by mail would ensure purifiers were working effectively. The Illinois State Legislature has already recognized the effectiveness of HEPA air purifiers through a $30 million investment to place them in schools. Families would also be offered an in-home visit during which a home visitor would optimally place the air purifier and help identify and eliminate other sources of air pollution including mold, dust, and pests. This program would be modeled off of the Bay Area Healthy Homes Initiative (BAHHI), but rather than put the onus on residents to sign up, asthmatic children would be identified and provided resources by CDPH. Limitations for the proposed program may include cost, social barriers to accessing families’ homes for assessment, insufficient workforce, and barriers to setting up a new program.
- Redirect funding from Peoples Gas System Modernization Program to implementation of electric stoves. The Peoples Gas System Modernization Program began in 2011 and has exceeded its budget each year while simultaneously failing to meet its goals to replace outdated and unsafe gas pipes. Customers pay a surcharge for the program, leading to a strain on low-income households in particular. Because gas stoves contribute to health problems, funding should instead be used to replace gas with electric stoves. Electric stoves decrease NO₂ concentration by 50%, significantly more than air filters or ventilation hoods, and thus would be an impactful measure, albeit expensive. However, the projected future cost of the program, if redirected, would cover the cost of up to three electric stoves for every customer served (Figure 3). The Inflation Reduction Act already provides a starting point for this transition; it grants rebates to households based on total income, depending on state guidelines. Therefore, any additional funding would make the transition even more accessible, and allow families who may not have the upfront funds to install appliances. This action could face political resistance.
- Launch an educational campaign to communicate best practices for residents to implement. Residents may be unaware of the existence or importance of ways to improve indoor air quality. Illinois legislators already recognize the importance of this; HB3572, if enacted, would require all gas stoves to include a warning label indicating associated health risks and steps to mitigate them, like ventilation. In addition to the passage of this bill, providing information to the public through community outreach efforts would help bridge the knowledge gap. Programmatic details are outlined in Figure 4. Although this cost-effective action would offer immediate educational resources, residents would have to resolve air hazard issues independently.
The urgency of childhood asthma in Chicago must be met with prioritized actions. Compounding variables like socioeconomic status, race, and location leave certain groups more vulnerable than others. The City of Chicago must reassess approaches to improving indoor air quality for its residents to ensure all children live in healthy homes.
