For the most part, Zaniah Whitfield’s mornings are nothing out of the ordinary. The four-year-old brushes her teeth, changes into school clothes, and eats breakfast with her mother, Claunisha Frazier, in their East Oakland home. But before stepping out of the front door, Whitfield also takes a dose of her Flovent, a prescribed steroid that prevents asthma attacks.

Medication is one of several ways Frazier controls her daughter’s asthma. “I usually check her oxygen all the time to make sure she’s cool before she goes to school,” Frazier said. She also sends Whitfield to school with an albuterol inhaler to use in an emergency. Whitfield has been to the emergency room four times because of asthma complications and hospitalized twice.

Whitfield is one of the thousands of children in Oakland who suffer from asthma, a chronic respiratory condition that disproportionately impacts Black and Latino children, who are more likely to live near freeways and factories with emissions that can cause and worsen the condition. 

In Oakland, Black residents account for over half of the asthma-related emergency room visits by children under five years old, even though they make up only about 20% of the city’s population under five, according to a 2018 report by the Alameda County Public Health Department. 

A 2021 study of air pollution’s disparate impacts on the Bay Area by the Environmental Defense Fund found that up to half of new childhood asthma cases in West and downtown Oakland, where more than 70% of the population is Black, Latino, Asian, and Native American, were caused by exposure to traffic-related air pollution. In the Oakland Hills, where more than 70% of the population is white, only one in every five asthma cases was estimated to have been caused by traffic-related pollution. 

Despite the grim statistics, Oakland residents have organized and created multiple programs that can help residents treat asthma and also address the causes of respiratory illnesses. From sharing strategies to reduce asthma triggers in the home, to providing accessible healthcare in Oakland’s schools, and advocating for a less-polluted city, community members are working tirelessly to let their children breathe easier. 

Coping with asthma and preventing hospital visits

It was after her daughter’s second asthma-related emergency room visit at UCSF Benioff Children’s Hospital-Oakland that Frazier learned about Asthma Start, a program that provides education and other resources to families of asthmatic children in an effort to prevent asthma-related missed school days, emergency room visits, and hospitalizations. 

Asthma Start’s approach is to educate children with asthma and their parents on how to best manage the condition. Some of the major causes of asthma attacks include irritants like dust, pests, and other conditions common in most people’s homes. Asthma Start participants are given mattress and pillow covers that protect them from dust mites, and additional resources like cleaning products, mops. Spacers, tube-shaped holding chambers that help hold asthma medications in place, making them easier to inhale, are also provided as needed.

In order to quantify the effectiveness of the program, every newly enrolled parent is asked to take an entry quiz, which contains 10 true or false questions to assess their knowledge of asthma. The quiz includes questions like “asthma is a chronic condition” and “smoke can make asthma symptoms worse.” On average, newly enrolled parents score 64%, but scores rise to 86% for those who complete the program.

With a better understanding of how to control asthma, parents and children are able to prevent visits to the hospital. According to Brenda Rueda-Yamashita, Alameda County Public Health Department’s chronic disease program director and manager of Asthma Start, 65% of the children who enroll in Asthma Start have been to the emergency room in the last 12 months, and about 45% have been hospitalized. After working with Asthma Start, those rates drop to 13% and 4%, respectively.

“I used to smoke in my bathroom, not knowing that it still seeps out even though the window’s open,” said Frazier. “So now I smoke outside. I don’t have her around smoke at all.” Frazier was also given a designated smoking jacket by the Asthma Start program to further limit her daughter’s exposure to smoke, which, according to Frazier, is her biggest asthma trigger. 

Frazier said her daughter hasn’t had to visit the emergency room in almost a year, even in the midst of wildfire smoke and other pollution, thanks to the education Asthma Start provided her with. “I’m just proud of everything I learned, and how now when I take the tests, I get 100% right.”

Bringing asthma education into Oakland’s schools

Before parents can enroll their children in Asthma Start, the children must first receive a formal diagnosis. This step can be a challenge for families who lack access to affordable healthcare or simply don’t have time to visit a doctor’s office. To address these access issues, La Clínica de la Raza, a network of community-based health clinics, has established multiple school-based health centers across Oakland.

The staff at La Clinica’s school-based health centers are able to diagnose asthma, as well as prescribe and dispense medication. While many children utilize school-based health centers as their primary source of medical care, others visit the centers in addition to their own primary care provider.

Karen Gersten-Rothenberg, a nurse practitioner and the associate medical director of school-based health centers at La Clínica, said the centers have one strong advantage over traditional pediatric offices: the ease of follow-up visits. 

“We see a patient, adjust their medication or start on a new medication, and then we have them come back in a few weeks, just to make sure that they really understand how to use their inhalers and that their symptoms are improving,” she said. Without the burden of the extra time and transportation costs it would take to schedule a follow-up visit at a traditional pediatric office, parents are able to have their children receive consistent care. 

“It’s kind of amazing to have a patient who hasn’t been able to do things or has thought that they couldn’t do things, and then through something as simple as providing some education and perhaps a prescription for an inhaler, their life is significantly changed,” said Gersten-Rothenberg.

Three of the school-based clinics, in addition to serving students on their campuses, are open to children and young-adult patients from anywhere in Alameda County: the Hawthorne clinic at Hawthorne Elementary School in East Oakland, which serves children 3 to 18 years old; the Youth Heart Health Center in La Escuelita’s Education Center, which serves people 3 to 23 years old; and the Fuente Wellness Center within San Leandro’s REACH Ashland Youth Center, which serves those between 11 and 25 years old.

Another way in which La Clínica helps achieve its goal of accessible care is by helping enroll uninsured students in Medi-Cal, which Gersten-Rothenberg said many children in the low-income schools she serves are eligible for. 

A partnership with the East Bay Community Law Center also allows La Clínica to help students address socioeconomic conditions that impact their health, like immigration status and access to quality housing.

A 2005 study by the Journal of Adolescent Health found that the implementation of school-based health centers, of which there are over 300 across California, significantly reduced the rate of emergency room visits and hospitalizations for asthmatic children, saving an estimated $970 per child in medical fees. Despite the success of this approach, Gersten-Rothenberg said that further intervention is needed in order to address the root of Oakland’s childhood asthma crisis. 

“We can prescribe medication after medication, but if the triggers are still there, then really, the medication is not going to solve the problem,” she said. “It might just make a dent, but the patient is still going to be experiencing asthma.”

Fixing substandard housing

La Clínica de la Raza’s school-based health centers often refer students with respiratory problems to Alameda County’s Department of Healthy Homes.

Healthy Homes works with tenants and landlords to make them aware of any substandard housing conditions, defined by the city as conditions that put the health and safety of residents and the public at risk. Using a method called co-operative compliance, Healthy Homes staff members reach out to landlords on behalf of tenants in order to improve common issues like pest or mold infestations. 

“Oftentimes, just helping them to better understand what they’re putting their tenants through is effective,” said Larry Brooks, director of Alameda County’s Healthy Homes program. “We will also try to refer landlords to resources that may be available to assist them in terms of addressing conditions within their rental unit.” 

Substandard conditions include everything from leaking water pipes that lead to mold, to damaged ventilation systems that keep cooking smoke and moisture from exiting a home.

When faced with landlords who won’t comply with the Public Health Department, Brooks said Healthy Homes reaches out to code enforcement agencies to intervene, but that cases rarely reach this point. 

After a participant enrolls in Healthy Homes, a staff member makes a home visit to assess their living conditions. In the case of asthma, common recommendations made by Healthy Homes are for tenants to reduce clutter and remove stuffed animals, especially around the bed, regularly replace heating system filters, and clean surfaces regularly with non-triggering cleaning products like baking soda, soap, and water. 

In 2015, Alameda County’s Public Health Department partnered with Healthy Homes to pilot the Pay for Success Asthma Initiative. The project combined the resources offered by both Asthma Start and Healthy Homes in order to support 250 children in the county who had been hospitalized or visited the emergency room for their asthma within the previous 12 months.

While the initiative is currently paused due to lack of funding, the number of emergency room visits by participants dropped by about 52%, and hospitalizations fell by 80%. The average asthma control test score of participants also increased from “not controlled” to “well controlled” status. A team of analysts and professors involved in the Pay for Success Initiative are currently working on analyzing more data to prove its effectiveness and secure more funding.

While Healthy Homes has made significant progress in reducing asthma triggers across Oakland, Brooks said he would also like to see the city of Oakland adopt a proactive rental inspection program that monitors housing conditions before a tenant complains. Currently, inspections are triggered when a renter files a formal complaint with the city. 

“It’s not fair to expect people who are living from paycheck to paycheck, who are hardly able to pay their rent and keep a roof over their head, to go and complain to landlords about conditions within their rental units that are affecting their health,” he said. 

Organizing to create a cleaner, healthier environment

As much attention and care as Oakland residents place upon their households, it’s what’s outside that poses one of the greatest threats to their respiratory health. With 7 out of 10 schools in the Oakland Unified School District located within 500 feet of a major freeway and pollutant-emitting industries scattered throughout the city’s low-income neighborhoods, many Oakland children are exposed to toxic air on a daily basis.

“Nitrogen dioxide is one of the pollutants that we will need to control to make improvements in childhood asthma rates. And we know that vehicles, and specifically diesel trucks and buses, are major sources of nitrogen dioxide,” said Maria Harris, an environmental epidemiologist who worked on the Environmental Defense Fund’s 2021 study about the Bay Area’s air pollution problems. Harris said accelerating the transition to electric vehicles would be expected to save lives and prevent thousands of asthma-related emergency room visits.

While communities of color have long called attention to the ways racist policies have negatively affected their health, a 2020 study by The Lancet recently confirmed historically redlined communities in Oakland face the highest rates of asthma-related emergency department visits. Activists of all ages are working to change this. 

Some Oakland youth are taking their future into their own hands by forming groups like Youth Vs. Apocalypse, commonly known as YVA. In addition to organizing demonstrations across the Bay Area, the group’s members also visit schools and share information with other students about how they can create their own clubs to advocate for climate justice. 

YVA has been organizing since 2015 but wasn’t officially named until 2017, when students began campaigning against a plan to transport coal throughout West Oakland, bringing even more pollution to the already overburdened area. In 2019, they drew national attention after their conversation with Senator Feinstein about the Green New Deal went viral, and they organized a Bay Area-wide school walk-out that brought thousands of students into the streets to demonstrate their concern for the climate. 

That same year, the students began calling upon The California State Teachers’ Retirement System to divest teacher’s pension funds from fossil fuel companies. The student members of YVA see climate change as being directly related to asthma issues many of their peers deal with.

“Asthma is the most common reason for school absences, and climate change is linked to several well-known asthma triggers, including extreme heat, air pollution, allergies, and mold,” YVA organizers wrote in a message to school administration explaining the walkout. “Students around the world are asserting their right to inherit a livable planet, and we stand with them in this fight.”

According to a 2018 report by the Alameda County Public Health Department and Healthy Homes, “17% of Oakland’s schoolchildren diagnosed with Asthma were chronically absent—missing 10% of the school year and reducing Average Daily Attendance by $894 per student per year.”

Fourteen-year-old Ra’Mauri Cash remembers being picked up from his third-grade classroom by paramedics while suffering an asthma attack. Raised in both East and West Oakland, Cash said he’s struggled with asthma for as long as he can remember. 

In fifth grade, wildfire smoke left him practically unable to leave the house. “I could only leave to go to school, and I had to be picked up right away so I wouldn’t breathe in the ash,” he said.  

Cash soon after was introduced to Youth Vs. Apocalypse through his middle school creative writing teacher, Carolyn Norr, who works with the group as an adult organizer. Cash said he knew that he wanted to work towards ending the environmental degradation happening around him.

“The entire reason that I got involved with the whole climate justice movement was that I wanted to help kids out there who are suffering from severe asthma like I was,” he said. Soon after, Cash became one of the students to launch his middle school’s first Youth Vs. Apocalypse chapter.

Now a freshman at Skyline High School, much of Cash’s spare time is spent designing posters for climate justice rallies, co-leading art-builds and other events to involve his peers in the movement, and writing rhymes inspired by his activism. With plans to continue his environmental advocacy in college, Cash said he hopes to involve more people of all ages in holding polluting industries accountable. 

“This is affecting everybody,” said Cash. “We all have to do what we can to help out—to make sure that we keep this planet and this city alive and well for as long as we can.”