Cameron Sparks’ son Prince has grappled with a relentless struggle to breathe ever since he had his first asthma attack at age 5. Now, at the age of 7, the attacks, triggered by food allergies, viruses, and seasonal changes, landed Prince in Atlanta’s Children’s Egleston Hospital emergency room three times in 2023 alone. It’s a routine riddled with physical, emotional, and financial distress.
“This is just part of our story,” said Sparks, a 40-year-old co-parenting father living in West End. “It’s almost like having a weight on you that you don’t have the strength to lift up and remove.”
For thousands of Black residents around metro Atlanta, that weight delivers the most pressure this time of year. Pollen can be a key environmental trigger for respiratory ailments like asthma. The 2023 pollen season delivered multiple records, and 2024 may be worse — for Black children and adults alike.
According to a medical study published in Environmental International last July, Black Atlantans are visiting emergency departments for pollen-related asthma at double the rate of their white counterparts.
Increased emergency department visits, along with excessive health care costs, place undue financial burden on Black communities, said Brooke Lappe, an environmental health doctoral student and first author of the study.
This burden was echoed by Sparks, a construction scheduler, who has a stack of emergency department bills totaling $18,000 that he can’t afford to pay.
“Without insurance, those bills are astronomical,” he said. “But even with insurance, it’s [$400] or $500 or more.” He said he was once billed $4,500 when he was in between jobs and didn’t have health insurance. “That bill is just sitting.”
The new study, conducted from 1993 to 2018, analyzed pollen data and emergency department visits for asthma and wheezing across numerous hospitals in metro Atlanta over a 26-year period. Of the 13 pollen species examined, the study found six pollen species, namely birch, pine, oak, willow, sycamore, and mulberry, caused twice as many emergency department visits among Black patients for the same amount of pollen exposure.
However, with only one pollen monitor in metro Atlanta — located in Marietta — everyone was assigned the same exposure level each day.
The researchers speculate that a combination of factors may be responsible for racial disparities in ER visits, with medical racism suspected as the main reason.
Several studies have found that underdiagnosis and undertreatment of Black patients with asthma in Atlanta is common compared to their white counterparts. This is partially because Black people often have less access to preventive asthma care, in part due to poor or no health insurance and fewer, if any, health care facilities in their neighborhoods.
To make matters worse, two hospitals that served Black communities were shut down last year: Atlanta Medical Center South in East Point and AMC’s main campus in Old Fourth Ward. This is part of a larger urban hospital closure trend across the US that further devastates communities of color.
When Black folks do get medical care, lung function tests often fail them.
This is because doctors use a device called a spirometer to measure how much air a patient can breathe in and out of their lungs when they visit for asthma, said Dr. Jayne Morgan, cardiologist and executive director of health and community education at Piedmont Healthcare. The spirometer’s software includes a race factor that automatically estimates that the lung capacity of Black patients is 15% lower than that of white patients, she added.
“More than a hundred years ago, it was determined that slaves had a lower lung capacity than whites even though there was no scientific basis for that,” Morgan said, “And that [belief] has just continued on in medicine to where it’s actually gotten incorporated into software.”
“What that means is that the values from the [spirometer] show Black people have normal lung capacity, when that same lung capacity for whites is read as abnormal,” Morgan added. “So whites are then referred on to specialists for higher levels of therapy and get access to medication, whereas Blacks are then sent home.”
As a result, Black patients experience reduced or delayed medical care, allowing their disease to worsen since they are not being referred to specialists and consequently not receiving appropriate medications.
In April 2023, the American Thoracic Society released an official statement for clinicians explaining why race and ethnicity should no longer be considered factors in interpreting the results of spirometry.
Other reasons Black people may experience greater adverse health effects from pollen may be due to less access to air conditioning and air filtration systems or a higher reliance on public transit, leading to more outdoor exposure, Lappe said. On top of that, Black communities are disproportionately impacted by air pollution, which could make pollen even more allergenic and worsen health outcomes, she added.
“Higher exposure levels of [air] pollution seems to be across the board for Black people, even when taking into account various socioeconomic statuses,” Morgan said. “Because of that, we more commonly have low birth weight babies, and those babies have an increased risk of asthma throughout their lifetimes.”
With pollen seasons starting earlier, lasting longer, and growing more intense, climate change could worsen allergy and asthma sensitivities in Black communities.
“I would say that this year is worse than normal,” Sparks said regarding his son’s asthma attacks. “I don’t know if it’s [due to] solely pollen or anything, but when seasons change, that’s a dangerous time.”
A more extensive pollen monitoring network is needed to better understand if pollen exposure disparities might exist under a warming climate.
“The one pollen monitoring station in Marietta is probably not representative of the larger Atlanta area,” Lappe said. “We know that if you have a lot of trees outside your house, then you’re getting a different exposure than what the monitor is capturing.”
