Commentary: Asthma and Pollution: a Puzzling Picture

By Harold Brown

The picture of air pollution, asthma and other respiratory diseases has been imprinted as a clear image on the minds of Georgians, especially in metro Atlanta. High ozone days bring on warnings to people subject to asthma and other respiratory conditions to curtail their outdoor activities.

Newspaper descriptions reinforce the image, reporting that, “When ozone builds up, it literally takes some people’s breath away. It can fill emergency rooms with gasping asthma patients and send coughing joggers toward home.” So commuters are encouraged to carpool or ride MARTA, while government agencies devise strict regulations to reduce air pollutants and protect public health.

What could be clearer this month, which is Asthma Awareness Month and the start of ozone season? The image shows that urban traffic and power plant emissions cause heavy air pollution, diminishing our health. As a result, people with respiratory illness, especially asthma, suffer. Some die. Technology, health surveys and government regulations have fit the pieces of the puzzle together so palpably that few doubt the image.

Look closer at the picture, however, and see pieces buckled, forced into place. In the picture, three pieces especially don’t fit, because numbers give rise to contradictions.

First, urban areas do not have more respiratory sickness; they have less. State hospitalization rates for asthma average 122 per 100,000 residents in 2000, according to the Georgia Department of Human Resources. Only two of the Atlanta metro “ozone non-attainment” counties were significantly above the state average, one county’s rate was average and 10 were significantly below average.

The 10 counties with the highest asthma rates averaged 3.6 times the metro region’s rate. None were urban counties – not even close to or downwind from the non-attainment area. In fact, eight of those counties were below the Fall Line. The other two were Gilmer, in the north, and Hancock, east of the not-so-large urban area of Milledgeville.

It is not just asthma. Prevalence of four lung diseases (cancer, emphysema, bronchitis and asthma) averaged 128 per 1,000 residents in Georgia in 2001. None of the Atlanta “non-attainment” counties were above average. There were 74.3 deaths per 100,000 residents from all respiratory disease in Georgia in 2002. For non-metropolitan statistical areas (rural areas) the average was 96.8. For the Atlanta MSA, which had a population about equal to the rural areas, the rate was 54.5.

The second warped piece of the puzzle is that asthma rates increased in the 1980s and 1990s, at a time when Georgia’s air was becoming cleaner. Across the nation, asthma cases increased from about 35 per 1,000 population in 1982 to 55 in 1996; increases in Georgia were similar. During that time, four of the six main air pollutants in the Atlanta area decreased by 30 percent to 80 percent and none increased. Clearly, if asthma or other respiratory diseases became more prevalent in the last quarter-century, it was not because of increased pollution.

The third ill-fitting piece is the timing of asthma and ozone pollution. In 2000, there were 101 days and/or places in Georgia exceeding the federal eight-hour ozone standard of 85 parts per billion. Ninety percent occurred in summer months (June-July-August). Yet 83 percent of asthma hospitalizations occurred in non-summer months that year. According to the 2000 Georgia Asthma Report, “Asthma hospitalizations and deaths are highest in the winter.”

Missing from the image is the short shrift that publications primarily about asthma give to air pollution. The Georgia DHR published two recent reports online about asthma (“Asthma in Georgia, 2000,” and “The Burden of Asthma in Georgia, 2003”). Air pollution was mentioned only once (in the 2003 report), last in a list of seven causes of asthma. To manage asthma, the reports advised:

1)      Reduce cigarette smoking and exposure to environmental tobacco smoke.

2)      Improve access to quality health care.

3)      Increase receipt of annual flu shot.

4)      Increase physical activity and improve diet to reduce overweight and obesity.

Nowhere did they advise reducing physical activity or staying inside in urban areas when the weather is hot and muggy, as the news media frequently do. In fact, it is unclear how much lower ozone levels are inside the home, if any.

It is perfectly acceptable for government regulations not to make perfect sense to all citizens; there are many scientific nuances to public health and air pollution that are beyond the layperson’s grasp. Common sense, however, is a fair yardstick for questioning government regulations.

If the worst respiratory sickness occurs in sites and seasons that don’t coincide with the worst pollution, we should be re-examining the regulations intended to reduce that sickness. After all, evidence that respiratory illness was worse in places and times with high pollutant levels was the basis for those regulations.

Let’s spend public funds on problems where the benefits to health and life are easily counted and ties between cause and sickness are not so contradictory. Perhaps the picture will be clearer when we answer whether more lives and suffering will be saved by spending billions of tax dollars on removing the last air pollutants or on other public projects that more clearly alleviate suffering, like, for example, separating grade levels at busy intersections. But not, of course, at intersections where the risk is below average.

University of Georgia Professor Emeritus Harold Brown is an Adjunct Scholar with the Georgia Public Policy Foundation and author of “The Greening of Georgia: The Improvement of the Environment in the Twentieth Century.” The Georgia Public Policy Foundation is an independent think tank that proposes practical, market-oriented approaches to public policy to improve the lives of Georgians. Nothing written here is to be construed as necessarily reflecting the views of the Georgia Public Policy Foundation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.

© Georgia Public Policy Foundation (May 7, 2004). Permission to reprint in whole or in part is hereby granted, provided the author and his affiliations are cited.

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