Feeling powerless to prevent asthma, Richmond doctors turn to advocacy

When Dr. Amanda Millstein started treating children in Richmond five years ago, she quickly discovered something she wasn’t prepared for: Many of the families she was seeing feared it was just a matter of when, not if, their child would develop a respiratory illness. 

“For people living in communities that are so highly impacted by pollution, it’s a totally reasonable question,” said Millstein, a primary care pediatrician at Hilltop Pediatrics. “This is a community that’s highly impacted by asthma.” 

People in Richmond are exposed to more air pollution than many other parts of Contra Costa County and the state, especially in areas near the Chevron oil refinery and high-traffic roadways such as I-80 and I-580 — exposure that puts them at higher risk for health problems such as asthma, heart disease, diabetes and stroke. People in Richmond also visit the emergency room more frequently for heart attacks, and babies are more likely to be born with low birth weights than in less industrialized parts of the county. 

The prevalence of asthma in Richmond, or the number of people experiencing the illness at a point in time, is around 25%, compared to 13% in California as a whole, according to a joint study on the local causes of asthma by researchers at LifeLong Medical, UC Berkeley, and UC San Francisco.

A family exposed to air pollution from freeways and industrial rail lines

When it comes to asthma, TJ Sykes’ family is typical for Richmond. Sykes, 32, is one of four siblings who grew up in the city. One developed asthma as a child. Sykes didn’t but was diagnosed with bronchitis and prescribed an inhaler when he began experiencing shortness of breath at age 14.  

Sykes’ childhood home was an apartment on Stege Avenue, close to the I-580 freeway, busy Cutting Boulevard and railway lines used for industrial shipping. Although it’s impossible to be certain, Sykes is convinced that his bronchitis and his sibling’s asthma are the result of their long-term exposure to air pollution.

“That was the impact of air quality, for sure,” said Sykes, who is now a multi-disciplinary artist and community activist.

Millstein said she can give families like the Sykes information about the warning signs of asthma, help them understand air quality ratings, and prescribe treatments when symptoms are present. But there’s otherwise little that she can offer.

“There is nothing I can do in my exam room that’s going to prevent somebody from developing asthma,” Millstein said. “There just isn’t.”

Millstein, who, in addition to her medical practice, leads the Committee on Climate Change and Child Health for the American Academy of Pediatrics, said the health of local residents is especially impacted by a type of pollution known as fine particulate matter, or PM 2.5, which is most often caused by the burning of fossil fuels, wood and other carbon-based materials. PM 2.5 has been linked to cardiovascular disease, cognitive decline, various types of cancers, and respiratory illnesses such as asthma.

“It’s the most insidious (type of air pollution) precisely because of how small it is, that it can cross the blood-brain barrier. It can get very deep into the organs in our bodies,” Millstein said. “Unfortunately, we’re just at probably the beginning of really understanding just how consequential exposure to PM 2.5 is.”

Doctors seek solutions outside their clinics

The frustration of not being able to do more to protect her patients from local air pollution has sent Millstein, herself the mother of two young children, looking for solutions outside of the clinic. 

In May, she went to a Richmond City Council meeting to express support for a proposed tax increase on local fuel refiners, which promised to generate $60-$90 million in city revenue to help offset negative health effects associated with fuel emissions. During the public comment portion of the meeting, Millstein told the council about the many parents she sees who are worried about their children developing asthma.

“I think it’s really important for families to understand that this isn’t their fault,” Millstein told Richmondside, speaking about her reasons for advocating at the council meeting. “I’ve definitely talked to parents and caregivers who understandably feel a lot of guilt around potential exposures.”

Councilmembers approved the measure unanimously at a meeting on June 18, putting it on track to appear on the November ballot. But the measure was strongly opposed by Chevron, which described the $1 per barrel tax as “exorbitant.” And after a short-lived court battle over the tax measure’s language, it was scrapped altogether on Aug. 14 when the council voted unanimously to instead accept a 10-year $550 million payout from the oil company. 

It wasn’t the first time Chevron has successfully fought back a proposed tax measure in Richmond. In 2008, the company mounted a legal challenge against Measure T, the “Fair Share for Richmond” bill that would have increased business taxes on Chevron and other large manufacturers, and it was ruled unconstitutional by a Contra Costa County Superior Court judge the following year.

Evidence in the exam room

Dr. Emily Hunter-Adamson, a physician with LifeLong Medical Care, began treating families in Richmond and San Pablo about two years ago and sees the refinery whenever she looks out her office window at William Jenkins Health Center in the Iron Triangle.

“It’s just kind of a known fact among every healthcare provider that works here [that] the air quality is terrible. There’s tons of asthma,” she told Richmondside. “It’s so sad to feel helpless about improving air quality for patients.”

Because air pollution comes from a variety of places, drawing a straight line between specific sources and health outcomes is difficult. But recent research gives an idea of the extent to which local pollution may be impacting the health of residents. A 2021 air district study on industrial factories in the Bay Area estimated that fine particulate matter from the Chevron refinery could result in about 12 premature deaths and up to $118 million in health-care-related costs per year in Richmond. 

Across California, PM 2.5 from all sources is responsible for 5,400 heart and lung-related premature deaths each year and about 2,800 hospitalizations for cardiovascular and respiratory diseases, according to the California Air Resources Board (CARB). Air pollution is also responsible for an estimated 6,700 emergency room visits for asthma each year in California.

While air pollution doesn’t discriminate, multiple studies have shown that lower income communities carry a disproportionate health burden. This is true in Richmond and San Pablo, where more than half of all residents are Black, indigenous, and people of color  — communities that are more likely to live within 1,000 feet of a major highway or the refinery. These groups are also more likely to experience homelessness, which increases a person’s exposure to air pollution.

“What we’re talking about is very related to redlining and racism and environmental racism,” Millstein said. “Redlining” refers to discriminatory housing and banking policies that targeted Black people and ethnic minorities, resulting in segregated neighborhoods and economic inequality.

The air district has cited in its air pollution reports “the legacy of generations of disinvestment” in Richmond’s Black and immigrant communities as one reason why certain neighborhoods experience worse health outcomes than wealthier and less diverse parts of Contra Costa County. 

“It’s because these folks have been marginalized, forced to live in places where they don’t have clean air, and that’s how the asthma rates come about,” Hunter-Adamson said. “I think it’s a matter of environmental justice to start to ramp up the efforts to mitigate climate change and clean up our energy sources in the places that have been the most historically affected and damaged by these things.”

Pollution map shows high burden on three Richmond neighborhoods

California’s Environmental Protection Agency has measured and mapped the “pollution burden” of local communities by combining pollution data with socioeconomic and demographic information. On the agency’s map, areas less affected by pollution are in green while more impacted areas are shaded yellow, orange and red, in order of severity. 

The only parts of the Richmond area that are shaded green are the hills furthest away from industry and highways, while the red areas — those with the highest pollution burden — are in North Richmond, the Iron Triangle and the area south of Cutting Boulevard, between I-80 and I-580. 

Hunter-Adamson said she regularly sees patients from these neighborhoods who exhibit telltale symptoms of living in a place with chronically bad air: shortness of breath, coughing at night, coughs that won’t go away, and respiratory infections followed by lingering wheezing.  

“In younger kids, we often see they’ll get a viral infection, and they just can’t get better from it,” she said. 

When the symptoms are mild, Hunter-Adamson counsels her patients on how to avoid risks they have control over, such as exposure at home to cigarette smoke, cooking over fires and using gas stoves. But there’s only so much that can be done to decrease the chance they’ll one day develop asthma or other long-term respiratory problems. 

“I can prescribe someone healthy food, and I can prescribe someone exercise, but I can’t prescribe them a place to live where they have clean air, and that is affecting so many patients in Richmond,” she said.  

Of the nearly 6,000 children receiving care at William Jenkins Health Center, more than 700 — or roughly 12%, which is almost double the national rate — have asthma-related diagnoses on their chart, said Hunter-Adamson.

“If you find twice the national rate of anything anywhere, you’re going to be wondering, what kind of environmental exposure is happening in this area?” Hunter-Adamson said. 

Competing priorities such as food and housing insecurity, which can present more immediate needs for families, can make it difficult to treat ongoing health conditions such as childhood asthma, she said. 

“It’s kind of a double whammy, because the circumstances in which you are forced to live creates this health problem and also makes you have more difficulties in managing it later on,” she said.

Niyi Omotoso is a community pediatrician who currently works at Native American Health Center in Oakland. But until this past June, he worked the previous 12 years at LifeLong Medical in Richmond. It was there, treating children from Richmond and San Pablo, where Omotoso says he first started realizing the full extent to which families are being impacted by local air pollution.

“They’re up all night. They’re having trouble breathing and their parents are hearing wheezing, noisy breathing,” Omotoso said. 

Like the other providers interviewed by Richmondside, he said there’s little he can do to help protect his patients from chronic air pollution beyond providing families guidance on limiting secondhand exposure to cigarettes and smoke. 

“How do we tell families to limit what is widespread?” he said. “That kind of helped me learn to realize that I had to do something bigger than just treating patients for what could be or not be. How do we actually change the environment that they’re living in to improve their health?”

Omotoso started looking for opportunities to use his research skills and medical expertise to address the systemic issues that are beyond a parent’s control. After AB 617 was signed into law in 2017 by then Gov. Jerry Brown to address air pollution in Richmond-San Pablo and other highly impacted California communities, Omotoso became a resident representative on several local committees, including one focused on public health and reducing residents’ exposure to air pollution, and another on the planting of more trees and greenery in local urban areas. 

Like Omotoso and Millstein, Hunter-Adamson is finding other outlets to have an impact on the long-term health of her patients. She’s among a group of Richmond doctors who are lending their voices to Richmond’s environmental justice efforts because they believe diseases linked with chronic exposure to air pollution are preventable. 

Hunter-Adamson also wrote a letter in support of the Path to Clean Air, an ongoing initiative involving state and local agencies and community-based groups that provides a framework for reducing local pollution levels.

“There seems to be a really active community here in Richmond that’s working toward justice for the people who live here,” Hunter-Adamson said. “As a medical community, we’re starting to look around and pay attention to these things and realize that there are ways we can help, and it’s not going to be in the clinic, necessarily. We need to get out there and use our voices to help with these kinds of issues, because … anything we do later is only a Band-Aid.”