Every Breath You Take Air pollution kills tens of thousands of Americans each year.
It doesn't have to be that way. by Monika Bauerlein
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"I can clean up my house and follow all the rules, but I can't clean up the air," says Maureen Damitz, in her son Kyle's room.
When the Clean Air Act was passed 36 years ago, these dangers were a matter of speculation. But in recent years, researchers have crunched massive amounts of real-world data--hospitalization records, air-pollution logs, and the like--and discovered a clear nationwide correlation between particulate levels and rates of death and hospitalization. One major study by Johns Hopkins found between 20 and 200 particulate-related deaths annually in each of 20 large U.S. cities. By applying current technology, another study found, tens of thousands of lives could be saved each year across the country. Teenagers living in areas with high particulate pollution incur about the same damage to their lungs as teens who smoke. Babies born in such places die of respiratory-related causes at twice the rate of those born where pollution levels are low. In one particularly dramatic study, Columbia University researcher Frederica Perera gave pregnant women backpacks that measured pollution in the air they breathed. When their babies were born, Perera found about a 50 percent increase in the rate of persistent genetic abnormalities among those with the highest exposures.
The situation reminds Janice Nolen, director of national policy at the American Lung Association, of another public-health crisis: "Back in the '60s, we knew that cigarettes kill people. But now we know how it actually happens. In the same way, we knew that air pollution was related to killing people prematurely, but now we are beginning to understand how that happens. It's the difference between seeing people dying and understanding what the mechanism is that kills them."
ONE OF THOSE MECHANISMS--perhaps the best understood--is asthma, the chronic airway inflammation that over the past two decades has morphed from a relatively rare condition into one of the nation's most vexing health problems. Between 1980 and 1996, the latest year for which continuous data are available, U.S. asthma rates increased by 74 percent; one of the largest increases was seen in children between the ages of 5 and 14. The disease is the leading cause of missed school days due to a chronic condition and the third-leading cause of hospitalization for kids.
Between 1979 and 1998, the death rate from asthma increased by 55 percent, and it more than tripled among children between the ages of 5 and 14. In Chicago, 115 people died from asthma in 2000, 17 of them children. Among those kids was a 13-year-old boy who collapsed in school on an "ozone action day"--a day when Chicagoans were breathing smog in excess of federal guidelines. Ozone exacerbates asthma, as does heat; many of Chicago's schools don't have air-conditioning.
Maureen Damitz, who works at the American Lung Association of Metropolitan Chicago, has a son with asthma the same age as the boy who died, and she knows the dilemma the 13-year-old's parents likely faced. Doctors often tell parents to keep their kids home on ozone days. "But you have to make a choice," she says, "your children's education versus the risk to their health."
There's no way of knowing, Damitz adds, exactly what caused the fatal asthma attack; the boy could have missed taking his medication, or he could have been exposed to a particular allergen in class. But on top of all that, he would have struggled to breathe in the polluted air. Asthmatics die, notes Damitz, when conditions conspire: "It takes a perfect storm to create that kind of terrible outcome, and air pollution is part of that."
Chicago is one of the country's most ozone-polluted cities. Once restricted to the hazy Los Angeles basin, smog is now a regular occurrence in many U.S. cities--Washington, D.C., for instance, had dangerous ozone levels 8 times in 2004, Atlanta 11 times, Dallas 20. The EPA has been involved in a controversial review of whether tighter standards are in order. Even under current rules, nearly 50 percent of Americans are regularly exposed to pollution levels that violate safety guidelines, making ozone perhaps the nation's most egalitarian pollutant. Besides asthma, ozone has been linked to a variety of respiratory problems as well as birth defects.
Damitz didn't know any of this when her son Kyle was first diagnosed. A hairdresser by trade, she just did what the doctors told her: "We took out the carpeting," she recalls. "His bedroom had no curtains; he had no stuffed animals on his bed. If there was an ozone alert, we kept him home." Kyle's symptoms eased up a bit but persisted. "I finally realized that I can clean up my house and follow all the rules, but I can't clean up the air," says Damitz. She hooked up with the American Lung Association, and Kyle became its poster child for clean-air legislation, appearing on television, Capitol Hill, and before the EPA. Today Kyle is 17 and still struggling with asthma. His healthcare costs, Damitz says, have run as high as $150,000 a year, forcing her husband to switch jobs several years ago because they were about to exhaust his health plan's benefits.
Yet Kyle and his brother, who also has asthma, are comparatively lucky. They live in northwest Chicago, at a reasonable remove from the city's industrial neighborhoods. They have access to the healthcare they need. Their parents can afford to fix up the house to reduce allergens. None of those things is true for most of the nation's asthma patients, who are disproportionately poor. In one study, children of families with annual incomes below $20,000 were found to be twice as likely to have asthma as their better-off counterparts.
Black, Latino, and poor people are also much more likely to breathe dirty air. In 2000, more than 70 percent of African Americans and Latinos lived in counties that violate federal air-quality standards. Sixty-eight percent of African Americans live within 30 miles of a coal-fired power plant, the range at which the highest exposures occur.
Air pollution isn't the sole culprit in the asthma epidemic; asthma rates have skyrocketed even as the nation's air has, in many ways, gotten cleaner. But neither is it a negligible factor. Researchers believe that 10 to 35 percent of the disease is attributable to pollution, including ozone, particulates, and sulfur dioxide. More than 350,000 asthma attacks nationwide could be avoided, one study estimates, by cleaning up power plants. And, of course, for children like the 13-year-old in Chicago, preventing just one is all it takes.
CARMEN VELÁSQUEZ doesn't have to look very far to see pollution's toll. The community clinic she runs, Alivio Medical Center, sits directly across from the Fisk plant. Most of the families that fill the clinic's waiting rooms live in Pilsen. Founded 17 years ago to provide better medical services to the neighborhood's immigrant residents, Alivio is a cheerful place, its yellow and orange decor evoking a nursery school as much as a doctor's office.
The most common ailments among Alivio's patients, Velásquez says, are the same conditions that have been straining healthcare systems nationwide. Rates of asthma and respiratory problems are exploding, and so are those for diabetes. Learning disabilities and other neurobehavioral conditions such as autism are also on the rise. Of that list, only asthma is generally accepted as an environmentally linked disease. Yet recent research has found clear connections between pollution and the others too. People with diabetes suffer more complications when air-pollution levels are high, and neurobehavioral conditions have been linked to mercury exposure. Some of the relationships are so well documented that researchers have calculated the share of each disease attributable to pollutants: For lead poisoning, that share is 100 percent, since lead does not naturally occur in the human body. For neurobehavioral disorders, it's 10 percent (a figure determined from National Academy of Sciences data), and so on.
"I'm not saying that they are responsible for all the problems," Velásquez says, pointing to the smokestack outside her window. "But I do know that having these plants here makes the health of our community worse."
Velásquez notes that patients aren't the only ones who pay; it's costlier for everyone to have to deal with a high-risk, sickly population that frequents emergency rooms. "People need to understand that this is not only impacting the physical health of individuals but the actual economy."
Velásquez is talking about what is known in economic circles as the problem of "externalities": Cleaning up the Fisk plant would be a cost to its owner, Midwest Generation, and maybe to its shareholders and ratepayers. So, rather than paying for the cleanup itself, the company "externalizes" those costs, passing them on to society as a whole.
Passing on such costs has been one of the unintended consequences of the Clean Air Act. Older power plants like Fisk were grandfathered in under the act: They got exemptions from the law as long as they continued operating unchanged, on the theory that they would soon be replaced or significantly upgraded. Thus, it became cheaper for power companies to keep their dirty plants going than to fully upgrade them and put in pollution controls. Over the years, the companies often expanded or improved their equipment--a new boiler here, a full-scale overhaul there--but they rarely reported such actions to the EPA, since doing so would have triggered the act's cleanup requirements.
It wasn't until the mid-1990s that the EPA began suing companies that had expanded their older plants without cleaning up their emissions. The agency won a slew of settlements in which companies pledged to dramatically cut pollution. But the Bush administration pulled the plug on the enforcement campaign. Midwest Generation was among the corporations investigated but never sued. (Midwest Generation did not return Sierra's phone calls.) In all, more than 500 power plants around the nation still operate with pollution controls from the beehive-hairdo era.
