Waiting to Inhale 

It's a killer we seldom hear about, discriminating by race and locale and afflicting more people every year. So why don't we even know what causes asthma?

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According to the Port of Oakland, diesel trucks make more than ten thousand trips each day through West Oakland, which flanks the port and is bounded by highways on several sides. With the port's planned expansion, daily truck trips are projected to double to 22,000 by 2020. Diesel exhaust aggravates asthma and contains 41 toxic air contaminants, including acetaldehyde, benzene, and arsenic. And why, Nitoto asks, should West Oakland bear the brunt of the increased pollution while the rest of the city benefits? That's why his organization is pushing for a fee of $1 per truck to fund traffic mitigations and neighborhood restoration projects.

The high asthma hospitalization rate in West Oakland and other low-income communities of color highlights the disproportionate impact the disease has on the poor, says Wendell Brunner, director of public health for Contra Costa County.

"Even if you have asthma, even if there's a lot of asthma in the community, if people have access to primary outpatient care, they shouldn't end up hospitalized and in the emergency room," he says. "Hospitalization is a marker for lack of access to primary health care."

Consider the fact that no pharmacy or big grocery store exists in West Oakland, much less a pulmonary specialist. Inhalers can cost between $50 and $70 each, and using them correctly isn't easy: a person must inhale at just the right moment to ensure the dose hits the lungs, not the stomach. With so many meds and so many different ways to take them, patients often become confused without proper guidance. "It's a disease of the urban poor," says Meena Palaniappan of the Pacific Institute, a think tank based in Oakland.

Working with community groups, the institute collected and analyzed data on West Oakland and published it in a report called the West Oakland Environmental Indicators Project. The report found that while toxic emissions have fallen citywide since 1995, they have increased dramatically in West Oakland, which by 1998 accounted for nearly half of the city's toxic releases. The largest polluter in West Oakland (and one of the six biggest in Oakland) is Red Star Yeast factory, according to the Toxics Release Inventory, an EPA database established under the Emergency Planning and Community Right-to-Know Act of 1986. Although no one has studied the plant's effect on its neighbors, it releases roughly thirty thousand pounds of acetaldehyde each year. Acetaldehyde, which forms when sugar is metabolized by yeast during fermentation, causes respiratory and cardiovascular problems, says the EPA. The state of California puts it more bluntly, calling the pollutant a "known carcinogen."

Nitoto, who has organized protests outside the plant, stops outside its tall chain-link fences one afternoon to peer at its stacks. As he dramatically holds his nose, the door to a semi-truck parked in the plant's driveway pops open. Its driver, a tough-looking, ponytailed man clad in a Marines T-shirt and leather vest, hops down from the cab and approaches Nitoto. The two begin to argue loudly, the trucker defending the century-old plant against Nitoto's assertions that it causes cancer, asthma, and who-knows-what else.

"That's just like moving near an airport and complaining about the noise," the trucker says.

But poor people often don't have the luxury of moving away, especially in the Bay Area's housing market, Nitoto points out. He's not pulling assertions from thin air. In 1998 West Oakland children were seven times more likely to be hospitalized for asthma than the average California kid, according to the Pacific Institute report.

West Oakland isn't the only part of Alameda County with bad asthma. Though state data doesn't drill down below the county level, one group, the Regional Asthma Management and Prevention Initiative (RAMP), broke down hospitalization data from 1994 to 1996 by zip code to obtain a clearer picture. Fruitvale, the Coliseum area, 98th Avenue, downtown Oakland, and Emeryville all had high asthma rates. What stands out on a map are the eastern parts of Alameda County along the bay, the southeast portion of San Francisco County, and Richmond and Concord in Contra Costa County.

"Notice when you look at the numbers, it's along the 880 corridor," says Palaniappan. "When you look at the numbers and where they are located according to zip code, it's definitely an environmental justice issue."

Studies confirm her assertion. In 2000, Communities for a Better Environment worked with youth living in the Bayo Vista housing project, located alongside the Phillips oil refinery in Rodeo, to conduct a health survey. Though not scientific, it found asthma in half of the households questioned. Investigators have also compared people's health before and after a 1994 chemical release at the Unocal refinery in Crockett and concluded that health problems, including respiratory ailments, were linked to that exposure.

Still, it is difficult to trace sickness to specific refineries, and chemical exposure is just part of the asthma puzzle. Home and school environments are also important, says Chuck McKetney, an epidemiologist for Contra Costa County's health department. Just compare Contra Costa and Alameda counties, he says. Contra Costa has all the refineries, but Alameda has the higher asthma rate. The prevailing wind in Contra Costa might have something to do with that because it comes off the bay and pushes up the Sacramento River, he says.

"There's no doubt in my mind that it's a bad combination to be living in an area where there's a lot of refineries that have releases and do probably make asthma worse for people who have asthma," says McKetney. "But whether or not somebody who is otherwise healthy and starts living in that area would get asthma, I don't know. There hasn't been any kind of study that gives us that evidence."

The lack of studies is one thing that troubles Meena Palaniappan. "It's curious they have so many studies on indoor air pollution, and it's worth noting who funds a lot of these studies," she says. "The question needs to be asked, how big is the role that outdoor air pollution plays, and why isn't it studied more?"

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