Breathe Easy: Respiratory Illness in Context

Above: The use of indoor cookstoves is ubiquitous in Ethiopia where burned solid fuels pollute the air within homes that more often than not have inadequate ventilation. Respiratory illnesses are the direct result of such indoor pollutants. (Image Courtesy: Indrik Myneur)

Asthma is often caused or exacerbated by elements of poor housing such as dust mites, cockroaches, rodents, pet dander, molds, dust, smoke, pollution, and cold air. (Image Courtesy: NIAID)

Our understanding of health is often shaped by our environment.  The health problems that plague one country can be alien to another.  In the developed world, our daily health-promoting behaviors are informed by attempting to avoid non-communicable diseases such as heart disease, obesity, and cancer, but not, for example, necessarily familiarizing ourselves with the bug that carries the parasite which causes Chagas disease.  For this reason, diseases of the developing world breed fear of the unknown, both distant and far away.  I thought tuberculosis was cured in the 19th century…  I’ll never contract a parasite, how do you get one anyway-the jungle?  How do you even pronounce that one – Chikungunya!?!?

The health challenges that each country faces are caused by a specific variety of factors. Environmental challenges, inefficient/insufficient health care systems, and geographically specific threats can be crippling to one country, while completely absent from public awareness in another. Thus, it is interesting when two seemingly juxtaposed regions deal with a similarly endemic problem.  What causes this problem in both areas, and are the solutions the same?  The city of Camden, New Jersey and the capital of Ethiopia, Addis Ababa, are two vastly different places which face a similar challenge – respiratory illness.  High rates of asthma, poor housing conditions, and rampant poverty plague the urban community in Camden.  Meanwhile in Addis Ababa, acute respiratory diseases plague communities due to the pervasive use of inefficient indoor cooking stoves within homes that lack appropriate ventilation.

Despite vast cultural, ethnic, and regional differences, both Camden and Addis Ababa are linked by the common difficulties associated with respiratory illness.  In turn, these illnesses are exacerbated by characteristics found in poor housing.  Insufficient ventilation, mold, dampness, and household air pollution are major contributors to respiratory disease.  The health consequences of these poor housing conditions particularly affect young children.  In Ethiopia, cookstoves are the single greatest contributor to indoor air pollution in the home. .  According to the WHO these solid fuels are defined as the combustion of coal or biomass such as wood, charcoal, dung, and crop residues. These fuels are burned for heating, or used for indoor cookstoves which are largely inefficient and used in poorly ventilated areas.  These fuels produce polluting emissions which damage health, particularly causing acute lower respiratory infection, chronic pulmonary obstruction, and lung cancer.  Women and children are disproportionally affected by the damaging pollutants found in these burned fuels, because traditional family roles reinforce that women do most of the cooking.

40% of people live below the national poverty line in Camden, New Jersey. Poor housing conditions and their health consequences are rampant in this economically depressed urban area. (Image Courtesy: Adam Jones)

For the residents of Camden, respiratory morbidity from diseases like asthma is especially prevalent.  Asthma is a chronic respiratory illness triggered by environmental factors such as dust mites, cockroaches, rodents, pet dander, molds, dust, smoke, pollution, and cold air.  These triggers are common to impoverished communities and can exacerbate or cause the symptoms of asthma.  According to the U.S. census 18% of residents in Camden suffer from asthma (compared to about 13% in the state of New Jersey).  Camden is also one of poorest urban areas in the United States with 40% of residents living below the poverty level.  That is 35% of all families, and 52% of people under the age of 18.  Housing conditions in Camden are dismal, with aging structures that have not been renovated due to poor economic conditions. The public health burden of uncontrolled asthma is great, overburdening the health care system through costly overutilization of emergency care services.


The community in Camden, New Jersey may be a world apart from the people in Addis Ababa, Ethiopia but the mirror being held up to these two realities shows that vulnerable communities are forced to deal with chronic health illnesses which are aggravated by the conditions of their housing.  Though foreign to one another, Camden and Addis Ababa are faced with similar problems that have similar solutions.  The housing and health connection remains strong, despite the lack of focus that public health institutions may place on it.  Improving housing conditions is a universal prescription for many of the health problems people face all over the world.  In this case, illness knows no boundaries.

-Cleo Stern | Communications Officer

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