One night in early October 1997, Felipe G., a nine-year-old child of Dominican immigrants to New York City living in East Harlem, woke up struggling for breath. Felipe had had asthma attacks before, and his parents knew, or thought they knew, what to do: they called for an ambulance, which rushed him to the emergency room of Harlem Hospital nearby. But this time he stopped breathing on the way to the hospital, and could not be revived there. His younger sister Ana also has asthma, but so far has never had to go to the emergency room. The tenement building in which Felipe’s family lives is three blocks from the Harlem River Drive, a highway on which thousands of cars travel each workday, emitting, in spite of their catalytic converters, large quantities of oxides of nitrogen, carbon monoxide, and incompletely combusted gasoline. Several blocks north is a parking garage for the diesel trucks of the New York City Department of Sanitation. The drivers of the trucks that use the lot often keep their motors idling, so that great quantities of diesel exhaust particles are emitted to the surrounding area. The Harlem district of New York City, inhabited mainly by African-Americans and Hispanics, is shielded to a large extent from the prevailing west winds by higher areas on the west side of Manhattan. Hence, air pollution produced within Harlem—for example, by cars, diesel trucks, and buses, and by an electric power generating plant located there—tends to remain longer than in other areas of the city. The New York City Department of Environmental Protection operated a network of air monitoring stations from the 1940s to the 1970s, during which time Harlem was consistently found to be the most polluted area in the city. It had then, and still has, one of the highest rates of hospitalization for asthma in the city. In most countries, asthma is more common among children of higher social class. In the United States this pattern is reversed: people living in the inner cities of the United States, mostly low-income minorities, have higher rates of asthma than other Americans.
THE PHYSICAL EXAMINATION OF THE EMPLOYEES OF THE NEW YORK CITY DEPARTMENT OF HEALTH