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This story was originally published by MinnPost. It’s part three in a four-part series on health conditions affecting Black Minnesotans. You can read Part I, about breast cancer disparities, here. Part II on sickle cell disease here.
Zhara Danelle Dooley grew up in the historic Rondo neighborhood of St. Paul, very close to Interstate 94.
And for as long as she can remember, she’s had asthma.
“I grew up next to a highway,” she said. “You never really think about it because it’s just part of life. It’s not a big deal. But then, when you think about how bad the air quality can be, that’s a big thing.”
While Minnesota is in the top 50 percent of U.S. states for lung health, Black Minnesotans face stark health disparities compared to white Minnesotans. One reason: When it comes to lung health in Minnesota, there’s a line connecting it to air pollution exposure.
In the Twin Cities, the highest estimated rates of air pollution-related death and disease are found in neighborhoods with the largest percentage of Black, Indigenous and people of color (BIPOC), low-income and uninsured residents, and people who live with disabilities.
Nationally, that is also true. Black people are 42 percent more likely than whites to have asthma, and have a mortality rate from asthma 2.8 times that of white Americans, according to data from the American Lung Association.
“In Minnesota, overall, we have relatively good health outcomes, but of course, some varying disparities in a variety of areas for people of certain races and other groups,” said Dr. Abbie Begnaud, an associate professor at the University of Minnesota Medical School and a physician at M Health Fairview. “With regard to lung health, a lot of the racial differences that we see are related to almost certainly systemic inequities, probably in terms of environmental exposures.”
Zip codes with the largest percentage of BIPOC residents had more than five times the rate of asthma emergency room visits related to air pollution than areas with more white residents, according to the 2022 Life and Breath report by the Minnesota Department of Health and the Minnesota Pollution Control Agency .
“That’s pretty stark evidence of disparities and who’s bearing the brunt of air pollution,” said Stephanie Fitzgerald, an attorney with the Minnesota Center for Environmental Advocacy.
State Senator Bobby Joe Champion (DFL-Minneapolis) views pollution as a threat to health and wealth.
“Whether it’s an incinerator, brownfield, landfill, pollutants in the air from commercial areas, traffic congestion … [pollution sources] are usually placed in our communities of color,” said Champion.
Historically, people of color have been subjected to environmentally poor living conditions. For example, in St. Louis, Missouri, in the 1950s and ’60s, as part of a military experiment, certain neighborhoods that were predominately Black were regularly sprayed with a mist later revealed to be zinc cadmium sulfide, a toxic substance.
Living with asthma
Asthma affects people’s day-to-day lives and many of the choices they make. Dooley, for example, is cautious about poor air quality and making sure she doesn’t worsen her asthma.
Her asthma attacks would sometimes put her in the hospital, she said.
“The only way I can describe it is, if you’re in a pool, and the water is up to your neck and you’re trying to breathe, but there’s pressure on your neck,” she said.
She keeps her inhaler handy, but that wasn’t financially possible until 2018, when insurance from her new job began covering it. At one point, an inhaler cost $40 out of pocket, even with insurance coverage. That’s not always affordable, she said.
“Even if you have a full-time job, you might just not have the money to pay for it,” Dooley said. “There are plenty of times where you get sent home from the hospital and they will give you a bunch of prescriptions and you have to figure out, which ones can I afford? And although I need the inhaler, the prednisone might be more affordable at the time.”
Because of that financial barrier, there have been times when she hasn’t had an inhaler.
“Not having one, it’s like if a plane didn’t have emergency exits, and the plane crashes and no one can get out. For me, that’s my safety exit,” she said. “If I can’t breathe, at least I know that little puff of albuterol could save my life.”
During the COVID-19 pandemic, Dooley constantly worried about what an asthma attack might bring.
Back in February 2020, before COVID was widespread in the United States, she went to an urgent-care clinic with symptoms that included shortness of breath and low oxygen saturation levels.
“It was dipping; it just kept getting lower and I couldn’t breathe, and they kept sending me home,” she said. “One night I get home, and I’m just like, if I don’t wake up in the morning, there’s nothing I can do about it. It was a scary time for me because I didn’t know what would happen if I got COVID.”
Biases in the health care system and from providers often minimize the pain Black patients are facing and lessen the quality of care, Dooley said.
“I went to urgent care several times, and they basically told me, ‘You’re fine.’ They thought I was over-exaggerating what I was going through,” she said. “Being Black, a lot of times, you don’t get listened to when you go to the doctor. It’s really disheartening when you go to seek help and you can’t get it.
“One of my biggest fears is that there’s gonna be a day where I’m having an asthma attack, and I go to seek help, and I don’t get it and I die.”
What can be done to reduce asthma rates?
Champion and other community advocates, including the Environmental Justice Table and COPAL (Comunidades Organizando el Poder y La Accion Latina), are advocating for a bill that would tighten permitting requirements across the state. It would require regulatory agencies to look at all the factors in a suggested permit zone when the zone is located in an “environmental justice area of concern,” defined by census tracts as a place where at least 40 percent of residents reported income less than 200 percent of the federal poverty level, or at least 45 percent identify as people of color, or areas that are recognized as Indian country.
The bill also would require the permit seeker to conduct an analysis of the cumulative impacts of its suggested expansion or alteration, and mandate at least one public meeting before the requested permit was issued or denied.
The impact analysis would include a look at the project’s effect on people of color. Champion and other advocates of the bill, including Fitzgerald, see a need for more research into the impacts of factors like pollution on the health of people of color.
“The idea is to get something passed where decision makers, the PCA [Pollution Control Agency], have to look at environmental justice neighborhoods and say, ‘Is this community already overburdened with pollution?’ That has to be a serious factor in deciding whether or not to grant a permit,” said Fitzgerald.
Champion believes state leaders must advocate for such accountability because the people directly impacted often can’t.
“[Pollution] is usually in poor communities, impacting the people who are usually not as politically savvy, or they’re just trying to make it from day to day from paycheck to paycheck,” Champion said. “They don’t have time to even concentrate on what’s happening or advocate for themselves, and therefore their voice isn’t heard.”
Minneapolis’ East Phillips neighborhood is one such neighborhood facing an environmental challenge right now. Community members have been trying for several months to stop the city from expanding its public works location.
Advocates such as the East Phillips Neighborhood Institute say expansion would worsen pollution and lung health issues in the neighborhood. Asthma rates in the area are more than two times higher than the state average, according to the Minnesota Department of Health.
About 71 percent of East Phillips’ roughly 4,700 residents are people of color, and nearly one-third live below the poverty line, according to Minnesota Compass.
Dooley says reducing pollution by going carbon-free could help reduce asthma rates in such communities. But she doesn’t see that happening any time soon.
“Those changes cost a lot of money. Who knows if they’re willing to spend the money to really invest in the health of the people?” she said.
“If a lot of white kids were dying from asthma attacks, we’d hear more about it,” Dooley added. “Just like [how] Black and brown people were at the center of the crack epidemic, and no one did anything about it. But now we have opioids, which is a white-centered thing, and now it’s like, ‘We have to do something about it.’ Until it becomes a quote-unquote white problem, nothing’s going to happen. They’re not gonna fix anything.”