Thirteen-year-old Jeremiah Cannon was home alone two years ago in 2018 when he suffered an asthma attack.

“I was watching TV and all of a sudden I couldn’t breathe,” Cannon, who lives in the Old Redford neighborhood, recalls. This was just one of many times Cannon has had to seek emergency services due to the severity of his asthma. He has lived with the disease his whole life, and each year it causes him to miss school. This year, before the COVID-19 pandemic, he had already missed 16 days. 

“I wake up and my throat hurts,” he said. 

Cannon was born and raised in various neighborhoods in Detroit — the city that has the highest childhood asthma rate and highest chronic absenteeism rate of any major U.S. city, and also ranks 10th worst in the country for particulate pollution. 

“Children with asthma are particularly sensitive to pollutants,” says Stuart Batterman, professor at the University of Michigan School of Public Health, and co-principal Investigator for Community Action to Promote Healthy Environments (CAPHE), a program seeking to improve air quality in Detroit. 

Exposure to air pollution has been linked to triggering and worsening asthma due to the inhalation of particulate matter and ozone emitted by vehicles and factories. In addition to missing more school, students with asthma may perform worse than their peers. In one research study, the researcher found that on high ozone days, students with asthma scored 10% lower in math and reading. Nationally, asthma is one of the leading causes of school absence.

In Detroit, the adult asthma rate is double, asthma hospitalization rates are triple, and asthma-related mortality is more than double the average for the state of Michigan. 

University of Michigan Professor Paul Mohai researches environmental burdens around schools, and the links between students’ health and performance. He found that schools are often located on polluted land because it is cheap. “Almost two-thirds of all schools in Michigan are located in the more polluted parts of their respective districts,” Mohai said. “I don’t think people are aware that this is happening,” he said. 

Mohai’s team developed a set of recommendations to guide school decision makers when considering the environmental conditions of prospective school sites. Legislation was introduced in 2017 that would have required such consideration by Congresswoman Rashida Talib and Senator Stephanie Chang, but was not passed. 

“Anything related to environmental justice issues is a little bit of an uphill battle in the current makeup of the legislature in Michigan,” Chang told Planet Detroit. She also notes that some school groups are resistant to any increased requirements on them, regardless of topic. 

Currently only 10 states require environmental hazard considerations in school siting decisions. “It’s unconscionable to me that we wouldn’t take into consideration the environmental conditions of schools.” said Mohai. “It’s a real injustice.” 

Asthma and school performance

More than 10 million days of school are missed nationally each year due to asthma. One research study found that missing two days of school in the month before taking the National Assessment of Educational Progress Exam resulted in a lower score — and the significance increased with additional days missed. In Detroit, researchers found a “near linear relationship” between attendance and performance in ELA and math for the Michigan Student Test of Educational Performance (M-STEP). Chronic absenteeism is also associated with lower rates of graduation. 

Researchers from the Wayne State College of Education analyzed data from 33 major U.S. cities and identified seven structural and environmental barriers nationally associated with chronic absenteeism, including asthma. Detroit ranked highest out of the 33 cities in all seven categories. 

Cannon is a student at the Detroit Leadership Academy (DLA), a K-8 charter school in Detroit located right off of I-96. It’s located just a few blocks from Detroit Diesel Corporation Headquarters, which violated the Clean Air Act in 2016. DLA’s chronic absenteeism rate hovers around 50% —  the same as the city average, which means that 50% of students are missing at least, or in many cases, more than 10% of school days a year. 

To be sure, asthma is not solely to blame for these absences. Erin Wills, Principal at DLA, estimates that 10% of DLA’s students have asthma. While she believes it is an issue, the number one reason parents give her for absence is lack of transportation. 

Reverend Larry Simons, the Executive Director of Brightmoor Alliance, has been on the frontline of chronic absenteeism for many years in Detroit.  

“It’s actually a braid of many social problems.” says Simons. He believes some of the reported missed days due to asthma are actually due to other causes such as domestic violence, alcoholism in a parent, or having to watch a younger sibling. “What we suspect is that people will use illness as a socially acceptable reason for what is in fact other reasons.” 

Inequitable access to care

Dr. Mark Beard owns and runs Medicina Urbana, a clinic that serves Southwest Detroit 

“Part of the problem with asthma in Detroit is basic access to good, reliable care and medications to treat the problem,” he says.

“What I found with a lot of our families is that they don’t necessarily have a primary care physician. They go to the emergency room for everything,” said Wills.

Consistent and regular maintenance care is key to managing asthma. Tori Scheday, Cannon’s grandmother and caregiver, says they have struggled at times with getting what they need to manage his asthma. 

“Trying to convince his doctor I actually need an inhaler for him to have at home and at school, is like talking to a wall.” said Scheday. “Is this stuff made of gold? It’s plastic,” she told Planet Detroit. 

According to a report by Dr. Elliot Attisha, Chief Health Officer of Detroit Public Schools, and pediatrician, 95% of students with asthma problems who visit a school nurse can return to class. However, Detroit has a severe shortage of school nurses, so many students go home sick or even go to the ER for treatment.    

Asthma and COVID-19

Some are optimistic that the COVID-19 crisis will lead to more support for the problem of air pollution in Detroit, because of the disproportionate impact coronavirus has had on the city’s residents. A recent study by Harvard showed an increased risk of complications from coronavirus for those living in more polluted areas. Mohai points out that the Flint Water Crisis was a catalyst for a lot of environmental policy change in Michigan, and hopes that the coronavirus crisis will do the same. 

Whether or not it will remains to be seen. But Dr. Ronald Ruffing, Chief of the Division of Pediatric Emergency Medicine at the Children’s Hospital of Michigan, told Planet Detroit that he saw less than half the number of asthma-related visits to the emergency room this spring than he has in previous years.

“It was just such a shocking change this spring that we all are sort of speculating,” he says. “Is it really a difference in the quality of air?”

Levels of nitrogen dioxide, one pollutant that can contribute to the development of asthma, were reduced in March and April of 2020, compared to the same timeframe in 2019, as seen in maps released by Descartes Labs. Nitrogen dioxide dropped 30 percent, and fine particulate matter dropped 10 percent in April 2020 compared to April 2019, according to the Michigan Department of Environment, Great Lakes, and Energy. 

“Clearly we’re being affected here more than some other areas of the country,” said Dr. Beard. He says, “and the government and others diving into why that might be the case and trying to resolve some of the core issues will be absolutely essential in the years to come.”