Air Quality and Asthma

Throughout my time serving in the legislature, I have tried to bring attention to an issue that has been slow to gain traction, until now – indoor air quality. As students around the Commonwealth are beginning to return to the classroom, of the many issues that arise, one must be a focus on the air that our students, teachers, and school staff breathe each day. The pandemic and the threat it poses to our health has forced us inside far more than ever, igniting concern for indoor air quality in a way that never registered before. Yet, it shouldn’t take the potential for a serious respiratory illness for us to improve the way we address indoor air.

Even without the resurgence of COVID-19, poor air quality and pollutants can cause significant immediate and long-term health effects. According to the United States Environmental Protection Agency, these include headaches, fatigue, respiratory illness, heart disease, and cancer. 

Sources of indoor air pollution include hazardous building materials, excess moisture, and poor ventilation. Health conditions related to air quality are preventable through better enforcement of laws and regulations that require adequate ventilation and restrict pollutant sources. Certainly, while this is an important health issue in all settings, schools merit special concerns.

Our children, teachers, and other employees are entitled to a safe and healthy indoor environment and, in particular, children’s growing lungs are highly vulnerable to harm.  The typical classroom has many more occupants than the same floor space in an office building. With most students returning to schools full-time, this is a time to ensure that air quality in schools is addressed.

Air Quality and Asthma
The Centers for Disease Control and Prevention states that patients with moderate-to-severe asthma could be at greater risk for more severe disease resulting from COVID-19. To add to that, it is commonly known that unhealthy indoor environments are sources of triggers for individuals with allergies or asthma. In the Asthma and Allergy Foundation of America’s 2019 study ranking the top 100 metropolitan cities that are most challenging to live in with asthma, Springfield was rated top asthma ‘capital’ in the country, with Boston ranked eighth, and Worcester ranked thirtieth. So this is an issue that clearly impacts us heavily here in the Commonwealth.

This pandemic has also exposed deeply underlying systemic inequalities in our society, easily seen through the disparities when it comes to asthma. Significant racial and ethnic differences exist with the prevalence of asthma, as communities of color are disproportionately burdened by this condition. When comparing cases to white people, Black Americans specifically are 1.5 times more likely to be diagnosed with asthma, 5 times more likely to visit the emergency room with asthma, and are up to 3 times more likely to die from asthma.

While these differences are not new, when you add these systemic health inequalities to the disproportionate impact that communities of color have suffered from COVID-19, we are facing a problem that must be addressed. A Commonwealth Fund study found that COVID-19 cases and deaths were disproportionately higher in communities with larger Black populations. It was concluded from this study that these worse outcomes are due to the increased likelihood that Black and Latino Americans reside in areas with overcrowded households, increased air pollution, and inadequate access to health care. In other words, we are seeing some correlation when it comes to these alarming COVID-19 and asthma case numbers, and poor indoor air quality is one culprit in this equation.   
   
Things need to change. Change can begin with schools, roughly 12% of children in Massachusetts have asthma, with some schools seeing rates as high as 30 – 40%. While the Commonwealth’s asthma rates are unsettling, there is positive news. Evidence-based data informs us that better asthma management — including creating safer and healthier environments by reducing poor air quality — will result in better health outcomes for those living with this disease. The CDC reports that with improved self-management, and avoiding environmental triggers, asthma can be controlled. In fact, the Massachusetts Department of Public Health’s Strategic Plan for Asthma in Massachusetts 2015-2020, states that getting rid of and reducing exposure to triggers can help prevent asthma from ever developing. We have options. We just need to make the changes.

Legislation
In response to the rising need to address school air quality, I filed H2393, An Act relative to improving asthma in schools. Stemming from the impassioned advocacy and great help from Cambridge resident Lizzie de Rham, I have filed this legislation each session over the past eight years. While it has been filed  many times over the years, it is clear that there is no greater moment than now for the Legislature to act to improve indoor air quality throughout the Commonwealth. This bill seeks to improve the air quality in public schools and reduce the rate of asthma. Specifically, if passed, public schools in the highest quartile of pediatric asthma (prevalence of 20% or higher) will be required to develop indoor air quality management plans that describe concrete measures to provide improved indoor air quality. These plans must include the use of “HEPA vacuums”, or high-efficiency particulate air filter vacuuming devices. Schools that fall into this category will also be required to create environmental health committees.

Beyond requiring the creation of indoor air quality plans, this legislation also sets standards for the cleaning products that can be used in these schools. Evidence shows that fumes from some cleaning products can also exacerbate asthma, and so this measure requires that schools with high asthma rates purchase cleaning products that meet “environmentally preferable criteria”.

This bill is also a matter of financial savings within the healthcare system. A Boston Children’s Hospital study found that asthma prevention measures greatly reduced health care costs for children with asthma, largely by improving indoor air quality at home. This study revealed that each dollar spent on prevention saved an average of $2.04 in health care costs and $0.52 from fewer missed school days and workdays. Asthma-related emergency room visits fell by 68% for participants, who missed 41% fewer school days, and whose working parents missed 50% fewer days of work due to needing to care for their children.

Beyond the legislation specifically addressing schools, I filed another bill to raise the profile of the indoor air quality issue generally, H2392, An Act to establish a division of indoor environments within the Department of Public Health.  This bill would create a brand new division within DPH to administer and enforce all laws and regulations relating to indoor air quality. By creating a new division, I believe we will elevate the issue of indoor air quality to its rightful place as a critical public health issue. The creation of a Division of Indoor Environments to focus on indoor air quality will allow one department, staffed by experts, to take a broad view of the issue of our indoor spaces an issue that has been heightened by the ongoing pandemic.

We are living in an increasingly indoor-oriented world. Offices are re-opening, schools are re-opening, yet we have not done nearly enough to ensure that these spaces are the safest that they can possibly be. As I noted earlier, improving indoor air quality in the Commonwealth is something that I have been working on for some time now and I hope to make progress this legislative session.