Katie Balderas works as a Policy Liaison for Los Angeles County Department of Public Health, Tobacco Control and Prevention Program, Project TRUST and is active member of the Asthma Coalition of Los Angeles County.  In this article, she discusses the economic and social obstacles to combating asthma, as well as the legal and other steps families can take to improve the conditions that trigger asthma.

Every night in Los Angeles County, children with asthma wake up coughing and gasping for each breath. And each day, parents work tirelessly to provide a safe, healthy home for their kids to live in. Unfortunately, given the abundance of substandard housing and the limited availability of quality affordable housing, their efforts are wasted.

Mold lurks and spreads when old plumbing begins to leak. Trucks and cars clog nearby freeways and streets, filling the air with dust and fumes. Drifting tobacco smoke and cockroaches meander through cracks and crevices in the old, deteriorating buildings.

Meanwhile, emergency rooms and hospitals are filled with children with asthma, their lungs constricted and tight, making each breath a struggle. Unfortunately, it isn’t enough to treat the symptoms of asthma when the triggers still remain inside their own home.

Meet Joanne

Joanne* is the primary caregiver for four of her grandchildren. Along with all of the kids, she also has asthma. The children also suffered from eczema and their asthma was not well controlled. They were using their rescue inhalers often, Joanne as much as two times per day. They had mold in their bathroom, rodents, and deteriorating kitchen tiles and missing ceiling paneling.

Why don’t they just move?
Many people in Joanne’s situation would try to move out of an unsafe or unhealthy home, but the costs associated with finding a new place to live and moving can be cost prohibitive for many families. Despite the fact that rent control helps families by keeping costs at a stable rate, it also discourages landlords from maintaining and repairing units until the end of a tenancy. Additionally, for many families, moving could result in a loss of an established social support network, like free childcare provided by nearby family or friends, the familiarity of a local grocery store, and the network of parents at their children’s school.

If the family is renting their home, why don’t they request that the landlord make repairs?

Legally, landlords are responsible to make necessary repairs to the property without retaliation, but in reality, many tenants are unaware of their rights and still fear eviction. Many families live barely within their means, and losing their home could swiftly leave them out on the streets. For many families, rent remains higher than they can afford, so they may live with another family, contributing to overcrowded conditions that could jeopardize their tenancy. Undocumented residents may fear deportation and avoid interaction with authorities, including city officials who could ultimately offer assistance. The sheer lack of knowledge and financial resources means that many landlords can get away with illegal and discriminatory practices against tenants.

On a larger scale, what is being done to address poor housing conditions in Los Angeles?

The Asthma Coalition of Los Angeles County, in its Call To Action, describes several evidence-based priority areas to promote healthy housing in Los Angeles County including:

1) Promote home-based interventions that provide families with home environment assessments, education and support, and assist with environmental remediation to reduce asthma triggers.
2) Conduct public information campaigns to raise awareness about smoking as a trigger for asthma and encourage efforts to provide smoke-free apartment units as well as non-smoking common areas in apartment buildings and condos.
3) Require landlords to bring all properties up to health and safety standards, including the Los Angeles Housing Authority, and educate tenants about which City and County departments to call to report sub-standard conditions.

What steps can families take to reduce asthma triggers on their own?

Fortunately, many health providers and programs are working in local communities to gain the trust of residents and provide resources to empower them to achieve healthy housing. As patients of St. John’s Well Child and Family Center in South Los Angeles, Joanne and her grandchildren received comprehensive health education and case management services.

The St. John’s Community Health Worker showed Joanne how to use non-toxic cleaning supplies to get rid of the mold in her bathroom. She also showed her how to keep the house clean using products that wouldn’t irritate their asthma, like baking soda and borax. Joanne learned how to use copper wool to plug up holes in the walls and other areas of the home to keep out the mice and rats. Joanne requested that her landlord make repairs in her kitchen. The landlord told her that because she had Section 8 he didn’t have to make repairs but Joanne knew her rights and she continued to push until the repairs were made. In addition to the actions taken by Joanne, families can also reduce asthma triggers by making their home a smoke-free environment, and by removing items that attract dust and mold, like plants and stuffed animals.

Now Joanne’s grandchildren are eczema free, and their use of their asthma rescue medications has significantly decreased. They no longer have any signs of rodents and Joanne’s health has also significantly improved. Prior to participating in St. John’s program, she was using her rescue inhaler at least twice a day and now it isn’t even used on a daily basis. Her whole family is healthier and now she knows how to keep them that way.

*Name has been changed to protect the confidentiality of the patient.

Suggested Resources:

Asthma Coalition of Los Angeles County (Los Angeles County Public Health Department)
Los Angeles County Department of Public Health, Tobacco Control and Prevention Program, Project TRUST
Turning Data into Action (UCLA Center for Health Policy Research, Health DATA Program)