AIR Louisville data identifies strong link between air pollution and asthma attacks

Louisville KY, June 28, 2017- Today marks the close of AIR Louisville, the first-of-its-kind data-driven collaboration among public, private and philanthropic organizations to use digital health technology to improve asthma. The program leveraged Propeller Health’s medication inhaler sensors which tracked when, where and how often residents of Louisville experienced asthma symptoms. These data helped patients to better manage their asthma symptoms, and aided city leaders in making smarter decisions about how to keep the air clean.

One of the main goals of our project was to help individuals get better control of their symptoms.

Over a two-year period, the program enrolled over 1,147 participants, collected over 570 patient years of data, 251,000 medication ‘puffs,’ and over 5.4 million environmental data points. The data were matched with environmental conditions including nitrogen dioxide, particulate matter, ozone, sulfur dioxide, pollen levels, temperature, humidity, and wind speed to identify the most significant triggers of asthma and COPD in the Louisville area.

The project’s findings identify potential gaps between federal limits on air pollution and the air quality needed to protect human health. In 2015, the ozone standard was lowered to 70 parts per billion (ppb). Analysis of the AIR Louisville data suggests that a limit of 65 ppb would be appropriate, based on the impact this pollutant has as a trigger for asthma. AIR Louisville has created a unique dataset that includes both medication use and environmental conditions at the time of use. Analysis of these data shows that asthma attacks and healthcare costs both increase when pollution levels reach even moderately unhealthy levels.

One of the policy recommendations that came from our 1.2 million data points is to plant more trees in Louisville.

“The health of our residents is critical to the overall health of our community, and Louisville’s location within the Ohio River Valley provides particular challenges for residents with asthma,” Mayor Greg Fischer said. “Data and research show that asthma can become more severe on days of extreme heat and poor air quality. As the city and our many partners, including AIR Louisville, work to plant trees, improve air quality and #cool502, I look forward to seeing asthma sufferers enjoy cleaner air and easier breathing.”

The program was a collaboration between Propeller Health, Louisville Metro’s Office of Civic Innovation and the Institute for Healthy Air Water and Soil. This unique combination helped the project reach enrollment goals and form new partnerships, said Veronica Combs, executive director of the Institute for Healthy Air Water and Soil.
“AIR Louisville is a perfect example of how communities have to work together to change our definition of healthcare,” said Combs. “We need an urban environment that supports our health just as much as we need access to medical care.”

Participants saw a 82% reduction in asthma rescue inhaler use, a significant increase in the number of symptom-free days, and 14% increase in nights without symptoms.

“Propeller’s mission is to better understand patterns of respiratory disease through individual and community data,” said David Van Sickle, CEO Propeller Health. “The collaboration with AIR Louisville has been a profound opportunity to put the data that we’re collecting to work to help improve people’s lives with asthma and COPD, improve public health for the community of Louisville and to move the conversation towards prevention of respiratory disease. We’re excited to expand this work in other cities globally.”

Three air pollutant and high temperatures are the most likely to trigger an asthma attack in Jefferson County.

The AIR Louisville team created a report card that highlights the project’s accomplishments, policy recommendations and next steps.

Participating in AIR Louisville were the Louisville Metro Department of Public Health and Wellness, Air Pollution Control District, local employer partners such as Brown-Forman, Humana, Papa Johns, WHAS-11, Seven Counties Services, Kindred Healthcare, JenCare Neighborhood Medical Centers, local health plans such as Passport Health Plan, and local asthma specialty clinics like Family Allergy & Asthma and the University of Louisville.

AIR Louisville funded by a grant from the Robert Wood Johnson Foundation, and additional financial support from the Midland States chapter of the American Lung Association.

Corporate and city leaders need to address the higher health risk in Rubbertown

This chart illustrates the goals of the STAR Program and is from a presentation from the AIR Pollution Control District on an emission modification request from American Synthetic Rubber Company.

Everyone in the standing-room-only audience laughed.

Guillaume Coiraton, the plant manager of the American Synthetic Rubber Company, had just explained an illustration that showed the range of 1,3 butadiene emissions from the plant. He said the reach of this cancer-causing pollution is very small, barely reaching beyond the fence around the plant. He said that the emissions were not a problem for most people in West Louisville.

Coiraton started his presentation with pictures of smiling employees, green lawns and even a family of geese with the goslings in the foreground and the plant’s big tanks in the background. No one believed him when he said the exposure to butadiene emissions was minimal.

This was the second public hearing that the Air Pollution Control District has held on this topic. ASRC wants permission to increase emissions of 1,3 butadiene. The company claims that this is necessary despite their use of toxics best available technology to control emissions. Butadiene is linked with cancer and many other health problems. The Air Pollution Control District uses exposure modeling techniques to understand the risk of exposure. The exposure limits in the STAR program are expected to cause one cancer per million people over the course of 70 years. At the last public hearing on the ASRC request, a resident of Rubbertown testified about living near the plant, sharing that she had recently had surgery for thyroid cancer.

I attended both hearings and noticed a disconnect between two realities described in the meetings.

ASRC is a company operating in Louisville and emitting toxic chemicals, sometimes within legal limits and sometimes above those limits. The company, and the Air Pollution Control District, say that the risk of exposure is small and within legal limits.

Then, there are the people living and working in Rubbertown. They describe a day-to-day life that is not reflected in the official rules or in any exposure model. Resident and air activist Eboni Cochran spelled out the impact on daily life at the hearing. She called out the educational impact of kids missing school due to an asthma attack, the financial impact of a parent missing work to care for the child and the health impact of not being able to play and exercise outside due to air pollution.

Modeling the risk of exposure is a good way to write regulations to limit emissions. Modeling does not reflect the day-to-day experience of living in the neighborhood. The best models can estimate risk but they do not reflect the daily reality of smells and health issues.

We are asking these residents to take on a higher risk due to the operations of the American Synthetic Rubber plant. How can ASRC and the city recognize this additional risk? What about creating a community benefit fund to recognize this additional risk and balance these two realities?

Creating a community benefit fund would recognize the risk of exposure to butadiene. Providing these funds and giving control of this fund to residents would recognize this risk and give some measure of control to the people living in the neighborhood.

This approach also could make the dialogue between the Air Pollution Control District and Rubbertown residents more productive. Right now the decision is us or them, increased risk or current level of risk, corporation vs. citizens.

The ideal solution would be no risk at all – meaning the residents or ASRC would relocate. That option is not on the table.

A small step forward would be a community benefit fund that residents could use to find solutions to reduce the exposure risk. This specific action would recognize the increased risk of living next to a chemical plant, the increased risk that city leaders and ASRC are asking residents to accept.

A map of Rubbertown from an APCD presentation, “Ten Years Later: STAR and Louisville Air Toxics”

Welcome to our 32 new Ambassadors for Health in All Policies

The Founding Class of Ambassadors for Health in All Policies represent non-profits, companies, and schools all over Jefferson County.

The Institute is proud to share our founding class of Ambassadors for Health in All Policies. We selected 32 Louisville leaders, including students, teachers, artists and executives, to launch this new effort to make Louisville a healthier place. We celebrated with 120 people on April 18 at the Frazier History Museum.

You can see pictures and short biographies of each Ambassador here. We are planning several lunches for the Ambassadors over the summer to share ideas and get to know each other. We plan to induct a second class this fall. Nominations are open now for the second 2017 class. We’ll start reviewing nominees in August and announce a second class in September. In October, we’ll have a day-long event to discuss ideas, share strategies and plan new collaborations.

Congratulations to all 32 Ambassadors. We are honored to work with all of you.

Ambassadors Jackie Floyd and Julia Robinson

Ambassadors George Fischer and Father Bill Hammer

Ambassadors Brittney Ridge and Stacie Steinbock

Ambassador Charlotte Gay Stites, MD

Ambassador Michael Olsen

Ambassadors Nasra Hussein and Sadia Abdirahman

Ambassador Joe Franzen

AIR Louisville Progress Report: Watch us on KET tonight at 9

Matt Mehalik from the Air Quality Collaborative in Pittsburgh describes the challenge of raising awareness of unhealthy air.

Matt Mehalik from the Air Quality Collaborative in Pittsburgh describes the challenge of raising awareness of unhealthy air.

The AIR Louisville team been busy hosting events, discussing policy ideas with stakeholders and continuing our data analysis.

Watch Crowd & Cloud tonight on KET
Our work is featured on a documentary showing on KET tonight at 9. AIR Louisville is proud to be featured in The Crowd & The Cloud, a new 4-part documentary funded by the National Science Foundation about the power of citizen science, big data, and mobile technology. We are featured in Program 3 and will air tonight at 9pm EDT on KET.

You also can watch Program 3 online.

AIR Louisville Policy Summit
We had a great turnout in March for our AIR Policy Summit. Seven speakers covered everything from how air pollution gets into our blood stream to asthma trends in Jefferson County to government policy on diesel trucks. We also heard from three special guests from out of town:

• Matt Mehalik, executive director, Air Quality Collaborative, Pittsburgh
• Lindsay Pace, Tennessee Chapter Leader, Moms Clean Air Force
• Mary Peveto, Mary Peveto, executive director, Neighbors for Clean Air, Portland

Each person shared ideas that were very relevant to Louisville. Matt described Smell Pittsburgh, an app built in collaboration with Carnegie Mellon.

Lindsay shared the goals of the Mama Summits she has hosted in Nashville. These yearly events connect parents and legislators to discuss how air pollution affects children’s health.

Mary explained how her organization helped the community take action after the Forest Service
used moss to detect high levels of air pollution linked to glass manufacturing plants. A public health study revealed a cancer cluster near the same plant.

These two news stories motivated the entire community to start torewrite the rules around air quality. Mary and I also spent time at the Air Pollution Control District on Friday to learn more about our STAR program. Mary wants to launch a similar program in Portland to track toxic air pollution.

You can see the presentations from our guests in this Google drive folder.

Policy survey
A central goal of our work is to turn data into policy. We are working with city leaders and project stakeholders to do just that. This collaborative process will end with our final report release, highlighting community priorities and policy recommendations. I surveyed the AIR Summit audience and other project supporters to gauge support for these ideas. You can see the full results here. Some of the most popular ideas were:

• A statewide smoking ban
• More tree planting
• New rules for diesel trucks

If you have any policy thoughts, please send them my way. I’ll be back soon with an update on our data analysis.

New Ambassadors for Health in All Policies make decisions through the lens of health

PinsThe Institute for Healthy Air Water and Soil is proud to announce the founding class of Ambassadors for Health in All Policies. These 32 community leaders represent businesses, schools and philanthropic organizations around the city. There are students, doctors, entrepreneurs, artists and poets in this class.
The Ambassadors include Sadia Abdirahman, PACT In Action; Joe Franzen, Fern Creek High School; Lindsay Gargotto, Athena’s Sisters; Kent Oyler, Greater Louisville Inc; Yonbretta Stewart, Humana; Paul Varga, Brown-Forman, and Eddie Woods, LIFE Hope Center for a Safe Louisville. Scroll down for the full list or see everyone here with a list of pictures and titles.

There are three types of Ambassadors: students, business leaders and community leaders. These individuals understand the interconnections and interdependence among the many factors that influence human health. Each Ambassador is working in at least one of the eight areas of health represented the Circle of Health and Harmony:

• Cultural
• Environmental
• Financial
• Intellectual
• Nutritional
• Physical
• Psychological
• Spiritual

The Institute launched the Ambassadors for Health in All Policies to start a health in all policies movement and to build a well-grounded, long-term culture of health in Louisville said Christina Lee Brown, founder of the Institute for Healthy Air Water and Soil.

Christina Lee Brown

Christina Lee Brown

“We have selected thoughtful caring health leaders who are helping all of the individuals and institutions they work with to understand that all decisions must always be made through the lens of health,” said Christina. “Louisville’s founding Health in All Policy Ambassadors represent our city’s circle of harmony and health in all eight dimensions of health. It is our hope that Louisville’s newly designated health in All Policies ambassadors will work together in new kinds of innovative partnerships so as to have Louisville recognized nationally as a model Health in All Policies Urban laboratory.”

The Institute’s work is inspired by Aruni Bhatnagar’s work in understanding the connections between human health and the health of the environment. Aruni states that while many factors contribute to the poor health of Kentuckians, there is little doubt that living in clean, health conducive environments will help in significantly addressing the problem.

“To understand the extent of the problem in greater depth, we must assess how urban environments affect human health,” he said. “Based on this understanding, we have to empower citizen scientists to exert greater control of their environment and to develop new paradigms for urban living in which clean, healthy, and harmonious environments foster human health and promote human flourishing.”

The Public Health Institute defines health in all policies as a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across all sectors, such as; government, corporate, and non-profits.

The Institute will host a reception for the new Ambassadors for Health in All Policies at 5:00pm on Tuesday, April 18 at the Frazier History Museum, 829 West Main Street, Louisville. The public is welcome to join us to learn more about the program, the Ambassadors and their work.
Nominations for a second class of Ambassadors will be accepted through the summer on the Institute’s website. The second class of Ambassadors will be announced in the fall to coincide with a Health in All Policies Summit. Contact Veronica Combs, 812-987-6076; Kelsie Smithson, 502-2437497 for more information.

2017 Ambassadors for Health in All Policies

Sadia Abdirahman, PACT In Action
Susan Buchino, PhD, Commonwealth Institute
Ebonique Burns, Russell Walks
Ben Chandler, Foundation for a Healthy Kentucky
Linda Danna, WHAS-TV
Pam Darnall, Family & Children’s Place
Keisha Dorsey, Humana
Hannah Drake, IDEAS xLab
Theo Edmonds, IDEAS xLab
George Fischer, Family Community Clinic
Jackie Floyd, Center for Neighborhoods
Michael Fraade, Jewish Community Center of Louisville
Joe Franzen, Fern Creek High School
Lindsay Gargotto, Athena’s Sisters
Chanda Glover, National Black MBA Association – Kentucky Chapter
Ali Haider, MD, World Sight Inc.
Rev. William D. Hammer, St. Margaret Mary Church and School
Nasra Hussein, PACT In Action
Chris Lavenson, Chef Space
Coretta McAllister, Office of Mayor Greg Fischer
Nora Miodrag, Louisville Girls Leadership
Michael Robert Olsen, The Mike Olsen Project
Kent Oyler, Greater Louisville Inc
Lyndon Pryor, Louisville Urban League
Brittney Ridge, Metro United Way
Julia Robinson, Russell Walks
Stacie Steinbock, University of Louisville
Yonbretta Stewart, Humana
Charlotte Gay Stites, MD, Smoketown Family Wellness Center
Pat Sturtzel, Kentucky Center for the Performing Arts
Paul Varga, Brown-Forman
Eddie Woods, LIFE Hope Center for a Safe Louisville

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