A Place-Based Malady
The scream of chainsaws gnawing through full-grown oak trees abruptly announced summer’s arrival in 1987 in the leafy enclave of Lake Forest on the Lake Michigan shore north of Chicago. Most residents of the exclusive historic neighborhood treasured the trees that shaded their mansions, but Laurence Tureaud wasn’t like most residents. Tureaud, known to Americans as Mr. T, star of the 1980s hit TV show The A-Team and Rocky’s nemesis in Rocky III, had moved to his seven-acre estate the previous fall, when the hundreds of oaks and other native plantings lay dormant. That spring, as the trees came into bloom, the six-foot-tall, 220-pound, well-muscled actor suffered terribly. Pity the fool, or in this case the tree, that tangled with Mr. T. Saying that allergies to tree pollen provoked him, the man who wore gold chains to remind him of his slave ancestors took action. With a chainsaw in hand and the help of hired workers, Mr. T cleared the property of more than seventy trees, many of which had been planted in the early twentieth century under the direction of famed landscape architect Jens Jensen.
Laurence Tureaud had grown up on Chicago’s South Side in the Robert Taylor Homes, home then to the largest concentration of poverty in America. Degraded housing stock, high levels of environmental pollutants, and the residents’ lack of money and inadequate access to healthcare had turned this space and other public housing projects across urban America into asthma zones. In the projects of Chicago, African Americans were almost five times more likely to die of asthma than whites. As a child, Mr. T had little control over his environment. As an adult, armed with a chainsaw and empowered by money he had earned as a Hollywood star, he had the ability and luxury to alter his surroundings as he saw fit.
Today, allergic diseases, including rhinitis (hay fever), asthma, dermatitis, and food allergy, affect more than 50 million Americans. Allergy, an adverse immunological reaction to normally innocuous substances in the environment, fuels a $5 billion industry in antihistamines — not to mention the market for other drugs, home care products, and foods and cosmetics targeted at allergy sufferers. Money (translated as healthcare benefits and the relative freedom to choose where to live) gives those who have it the ability to reduce their exposure to allergens, just as wealth afforded nineteenth-century Americans the luxury of escaping the urban industrial environment.
Hay fever in America first appeared in the 1850s as an upper-class disease, and was attributed to the stresses of modern city life. Unlike Mr. T, nineteenth-century allergy sufferers looked to nature not as the problem but as the cure. On their suburban estates or in fashionable mountain and lakeshore resorts, the affluent shaped the environment in ways they thought would alleviate their symptoms. Aiding them were some of the country’s leading landscape architects, like Frederick Law Olmsted and Jens Jensen, who believed that natural surroundings provided healthful benefits. Of course, the natural spaces created so attentively would, a century later, let loose the pollen that bedeviled Mr. T and other allergy sufferers.
As changes in the natural and built environment have brought other allergens into being — air pollutants and molds, for example — we have modified the spaces, both indoors and out, where we live, work, and play, hoping to breathe more easily. But by ignoring the complexity of environmental interactions, preferring to search for simple solutions, we have helped to create America’s allergic landscape. The creation of artificial indoor climates through air-conditioning, for example, together with the trend toward more airtight, energy-efficient buildings, increased the risk of exposure to dust mites, second-hand tobacco smoke, and other noted indoor allergens.
Altering the body’s interior environment is the most recent chapter in the search for a breathing space free from allergic disease. Antihistamines, bronchodilators, and corticosteroids, introduced after World War II, made physicians optimistic about their ability to change the body’s immune landscape and insulate allergy sufferers from the increasing presence of indoor and outdoor allergens. As an allergic child in the 1950s, I benefited greatly from these new drug therapies. They probably saved my life.
But environmental illnesses have not yielded to the sort of biomedical model that triumphed over killers such as cholera and consumption in the nineteenth century. The drugs and vaccines targeting those infectious diseases worked their miracles regardless of people’s economic status, gender, or race, or the environments in which they lived. Allergy, however, is not easily universalized because it is so much a disease of place. Allergenic pollens and molds, for example, thrive only in some places; air contaminants differ from place to place in number, amount, and kind. In the case of asthma, the various ecologies that give rise to the disease mean that it is experienced in different places and times in different ways. Few middle-class suburban whites are likely to view asthma as a deadly illness, but in inner-city communities, it is a life-threatening disease, and a window on environmental injustice. A disproportionate share of bus depots, hazardous waste facilities, and polluting industries, as well as high levels of indoor exposures to cockroach allergens and pesticides, are just a few of the ecological conditions that make impoverished urban residents more vulnerable to asthma.
Such environmental disparities are exacerbated by inequities in treatment. Underprivileged asthma sufferers seek relief in the cough and cold section of the local store or the hospital emergency room rather than the clinical allergist’s office. Drug therapies benefit those with money more than those without. At an estimated cost of $12,000 a year, Xolair, Novartis’s newly touted wonder drug for asthma, is not likely to arrive in uninsured inner-city neighborhoods any time soon.
Biomedical research on asthma has largely ignored the role of the environment, but at a price. Allergic diseases have stubbornly and increasingly persisted, yielding inestimable costs in healthcare dollars and social and economic consequences. Asthma costs the U.S. economy at least $14.5 billion per year. Yet most federal research dollars for asthma in 1999 were spent on biomedical research aimed at treatment. Less than 10 percent funded tracking and monitoring programs that could better reveal when and where asthma occurs and its potential links to environmental exposures.
We have narrowly focused our attention on the body within because we have been lulled into complacency by symptomatic relief. We have also been compelled by the momentum of corporate capital and biomedical research, a powerful combination that continuously holds out the promise of the next magic bullet, a cure for all our ills. But there is no magic cure-all. Allergy is not a thing, like bacteria, to be eliminated from our bodies, but a relation. It is not separate from the complex of environmental relations — physical, social, economic — out of which it came into being.
Each morning, when my son and I breathe in fluticasone propionate, GlaxoSmithKline’s inhaled steroid, we line our bronchial airways with a chemical intended to isolate us from the irritating effects of allergens. As consumers, we buy into the idea of escape from place. Drugs let us get on with our lives, to work and play without regard to our environment. It is an alluring solution, easier than moving to the mountaintops or lakeshore or desert — so much easier than addressing issues of land use, rethinking building construction, or confronting structural inequities in housing and health care in American society. We take a pill or a puff, feel better, and conveniently ignore how that chemical moving inside our bodies connects us to a larger political economy and ecology of allergic disease.