Of my many childhood memories, most of which can be looked back at with a smile and involved sports in some way, one that stands out with a great deal of clarity was my first asthma attack. It was during August football practice in the 8th grade. I had suffered from allergies as a card-carrying, weekly allergy shot club member; mild to very annoying respiratory issues were not unusual.
The asthma attack was an entirely different experience, though. What followed has gotten foggy over the years, but after some time, which must’ve seemed an eternity, the attack cleared up. I got the news that it was likely an asthma attack and given an inhaler as a constant companion. But over the years it diminished as a concern and labored breathing chalked up to being woefully out of shape.
But asthma is a serious concern. Nearly 26 million Americans suffer from asthma (which works out to about 1 in every 12 Americans). This number includes 7 million children, which is eye-opening as a parent — and brings back thoughts of how truly frightening an attack was for me, especially not knowing what was happening. (And only slightly less frightening when I did know what was going on.)
Asthma is a real drag on the economy — to the tune of $56 billion each year from hospital costs, missed school and work, and treatment. More importantly, it can be deadly. In 2009, it was estimated that asthma accounted for over 3300 deaths and that was not an extraordinary year.
So asthma deserves awareness and attention as a serious public health threat. In keeping with that, May is Asthma awareness month. Much of the activity is focused on providing information about what asthma actually is, what exacerbates asthma and can lead to attacks (including numerous triggers in your home), and outlets for information and guidance, such as Centers for Disease Control, National Institutes of Health, and American Lung Association. You can even get tips on how to tell your asthma story to the media.
The recipe for dangerous air
Outside of the home, outdoor air pollution is a primary driver of asthma attacks and risk of experiencing one. More to the point, ozone is a leading culprit. Mention ozone and people may think of the ozone hole, which indeed would be correct. This, though, is ozone we want around as it protects people and wildlife from damaging ultraviolet radiation from the sun by blocking it very high up in the atmosphere. Ozone closer to the ground, on the other hand, is very harmful to human health and a primary component of smog.
Ozone is not emitted directly into the air. Instead, it takes a handful of ingredients to form this “bad air soup”. On the chemical pollutant side, nitrogen oxides (NOx) and volatile organic compounds (VOCs) are the main ingredients. Sources for these include activities such as driving cars, electric power generation from fossil fuels, and some industrial processes. The other two key ingredients for dangerous ozone being formed are heat and sunlight, which is why ozone alerts tend to be most common with the elevated temperatures of summer. It’s probably not surprising then that high ozone levels often occur in urban areas. It’s also these areas that are densely populated with more people at risk for exposure to ozone pollution.
We have a few control knobs with which we can dial down ozone levels and reduce asthma risk. There has been success in dealing with the chemical pollutants that form ozone. Thanks to the Clean Air Act, NOx emissions have dropped by 52 percent in the U.S. over the past three decades. Likewise, VOCs emissions fell by 63 percent over the same period. And most likely as a result, average ground-level ozone concentrations have dropped by 28 percent. This is good news and shows that those particular control knobs can work, though most states in the U.S. still have counties that violate current EPA ozone standards.
The “climate penalty factor”
There is also a climate story here and one that threatens to offset some of the success we’ve had in cleaning up the air. I came to this connection through an EPA study that found a relationship between increased temperatures and higher ozone levels based on numerous measurements throughout the eastern half of the U.S. They termed the resulting number (i.e. the increased amount of ozone per degree of warming) the “climate penalty factor” on ozone. This relationship between temperature and ozone has also been confirmed in many other modeling studies and measurements. The risk climate change poses to harmful ozone levels has also been highlighted in the “Human Health” chapter of the recent draft National Climate Assessment report.
Rising temperatures, worsening ozone pollution, real impacts
A colleague and I at UCS took this concept a step further and asked what this climate penalty factor means in a future, warmer U.S. Basically, we used projections of warming temperatures for the country under a couple of widely used future climate scenarios (which may be optimistic based on recent carbon emission trends) and determined how much ozone levels could increase from this warming in the years 2020 and 2050. We then ran these numbers through the EPA’s BenMAP model to see what the health and economic impacts are from these ozone increases.
The full report is of course worth reading (author bias, perhaps), but the top-line finding is that climate change’s potential impact on ozone may indeed be costly (economic and otherwise). Health impacts could total an additional $5.4 billion in 2020 alone. It’s projected that there could be 2.8 million more occurrences of acute respiratory symptoms, such as asthma attacks. And most importantly between 260 and 510 additional premature deaths are projected in that single year. All of these numbers go up in 2050 with further warming in the U.S. Not surprisingly the states projected to be hardest hit are those that are most populated, with California, Texas, and New York leading the way.
Steps in the right direction
It’s fitting that this month of asthma awareness has seen a couple of important steps in dealing with the problem. First, Representative Lois Capps of California introduced the Climate Change Health Protection and Promotion Act last week. This bill directs the Secretary of Health and Human Services to develop a national plan to help the health community in creating plans for both responding to and preparing for public health impacts of climate change. Although, not named specifically, ozone pollution would surely fall under this effort.
It is also an acknowledgement of the growing body of evidence of adverse and costly climate impacts on public health in addition to air quality concerns. Also, it is not just a matter of responding to climate impacts here and those on the way, but there remain the critical efforts to reduce climate change itself to limit the severity of the impacts. Fortunately, there are myriad solutions for that, but much room for improvement on actually implementing them.
Activities and efforts to raise awareness around asthma is also a critically important step, but perhaps should extend beyond the month of May into the summer months when ozone levels are elevated and people are at higher risk. I’m not sure how to penetrate through to people’s lists of concerns beyond a steady drumbeat and clear explanation of risks.
Turning the lens on myself, having lived in areas prone to extreme weather of various sorts I’m very aware of and tuned into warnings around the more “acute” events (fairly infrequent, but high impact). On the other hand, even having studied the serious impacts associated with bad air, I still don’t notice air quality warnings until they become a deep shade of purple. That goes for heat advisories and warnings, as well.
The more “chronic” events that don’t appear as destructive and happen more frequently than say a hurricane or a blizzard tend to get minimized. But ask anyone who has lost someone to a heat-related death or an asthma attack and you’ll see quickly how it takes just one instance of high ozone or a day of extreme heat to change lives.
There’s undoubtedly more to be done, but there are clear solutions and fortunately people out there talking about them. Now we need to do some listening.