hoenix, Arizona, a fast-growing, sprawling desert city, is one of the most ozone-polluted cities in the country. In mid-September, not long after dawn, I drive there to visit the Breathmobile, a mobile asthma clinic of the Phoenix Children's Hospital. Though the desert air feels crisp at this hour, from the highway I can see the thick green-gray stripe of smog that has already spread across the horizon. On especially polluted days, flashing signs on the road are turned on to warn drivers that the air is bad.
Children in Phoenix's urban schools have a lot of asthma. Maricopa County, where the city is located, has one of the highest death rates of asthma in the nation -- 2.1 percent in 1999.
This morning the Breathmobile is at William T. Machan Elementary School. To get there, I drive through a residential neighborhood with tree-lined streets, single-story homes, and semi-green lawns. Though it doesn't fit the stereotype, this is an inner-city school. Downtown Phoenix and its heavy automobile traffic are only blocks away. Students here face the same challenges that children in most inner cities in America face: low family incomes, poor access to health care, and abnormally high rates of asthma.
The Breathmobile is a large motor home. On the outside, drawings of smiling children and large colorful letters advertise the Phoenix Children's Hospital and the project's main sponsor, Wal-Mart. Inside, it looks very much like a doctor's office. Children referred by teachers and school nurses are tested here for pulmonary function on a computer that measures the force of air exhaled from their lungs. Just asking children whether they're having trouble breathing isn't enough, explains Judy Harris, director of the Breathmobile. "Often the actual function of their lungs is different from what kids say they feel, because they're used to living with low-level asthma," she says. If asthma is diagnosed, the children and their parents get free medicine and training in asthma management.
Fifth-grader Elizabeth Vargas, back for a checkup, is the first patient of the day. Her lungs don't look good. Each time she exhales into a tube connected to the computer, its screen shows a picture of a balloon being blown up. A healthy child would be able to pop the balloon. But until Elizabeth inhales the bronchiodilator medication albuterol, she can pop only two out of five balloons. After her appointment, Elizabeth will take home a supply of Advair, a steroid-based preventive daily medication. Unless her asthma becomes less severe as she grows up, as sometimes happens, she may have to take it for the rest of her life.
Elizabeth is a typical Breathmobile patient. Like her, 75 percent of the Breathmobile's patients are Hispanic. Also like her, many of them get their first real medical help here. Elizabeth has suffered from tight lungs all her life, so much so that when Harris asks in Spanish what happens when she runs, she answers, "My lungs get agitated, and it hurts here" -- putting a hand to the center of her chest. She missed thirty days of school last winter because of asthma. Yet her condition went undiagnosed until her first visit to the clinic several months ago.
When asthma gripped my own lungs, I had the middle-class advantages of good air -- we lived on a quiet street in a small college town -- and good health care. My parents even bought a special vacuum cleaner that sucked dust into a vat of water so it wouldn't blow back into the house. But today, those who lack such socio-economic cushions suffer disproportionately from asthma. This fact infuriates many environmental justice advocates, who believe the link between asthma and air pollution is as obvious as the sooty air in inner-city neighborhoods.
"It's certainly no accident that the neighborhoods with the highest rates of asthma also have a high incidence of polluting facilities, and that they're also low-income communities of color," says Omar Freilla. Freilla works at Sustainable South Bronx, a New York City group that seeks to reduce pollution and promote parks in one of the city's most environmentally blighted areas. The South Bronx, he points out, is the site of twenty-six waste facilities and the largest food distribution center in the world. The number of trucks passing through the food distribution center's neighborhood has been estimated at 11,000 daily. And Freilla believes that the asthma hospitalization rate in the South Bronx -- six times higher than the national average -- is directly related to all those tailpipes.