Thread by @societyforepi

Today's theme is "breath."

Breathing is an essential autonomic function necessary for life. Yet, by definition, we often don't even think about breathing until we have a problem doing it, or mindfully observe it.

For those of us with asthma (like me @zinzinator -- your SER Twitter guide for the week), breath is always on our minds. It's scary to think about taking a walk outside without the backup of this bad boy.

This makes a simple foray into nature formidable for a great deal of us.

Asthma is one of the most common childhood diseases, and is disproportionately concentrated Black, indigenous, and Latinx communities, particularly those most burdened by structural and social determinants of health inequities.

link.springer.com/article/10.100…

In an ecological analysis in @TheLancetPlanet, authors note "associations between govt-sponsored, discriminatory redlining practices from the 1930s & present-day age-adjusted rates of emergency department visits due to asthma in eight major cities in CA."

thelancet.com/journals/lanpl…

Mott Haven, a neighborhood in the South Bronx (NYC), is often called "asthma alley" -- residents are hospitalized for asthma at 5 times the national average and 21 times higher than other NYC neighborhoods.

Why?

@black_epi #epitwitter #MedTwitter
theguardian.com/us-news/2019/a…

In @PNASNews, the authors highlight a 'pollution inequity' -- Mott Haven, composed 97% of Black & Latinx residents bear a pollution burden of trucks transporting @FreshDirect and @WSJ_Online products to disproportionately white residents elsewhere in NYC.

pnas.org/content/116/13…

"...non-Hispanic whites experience a “pollution advantage”: [experiencing] ∼17% less air pollution exposure than is caused by their consumption. Blacks & Hispanics [...] bear a “pollution burden” of 56% & 63% excess exposure... "

pnas.org/content/116/13…

@black_epi

In essence, Black & Latinx folks subsidize the cost of *disproportionately* white consumption with their very life force -- their breath.

Why do we still continue to build/expand cities like this?

Hypothesis: If people actually thought #BlackLivesMatter, then we wouldn't.

These examples are not isolated incidents.

Nationwide, Black Americans, regardless of income, are more likely to be exposed to air pollution compared to white Americans -- exposures linked to asthma & other lung disease, heart disease, etc.

ajph.aphapublications.org/doi/10.2105/AJ…

Structural racism isn't clustering of isolated incidents.

"Black communities like Grays Ferry shoulder a disproportionate burden of the nation’s pollution..."

nytimes.com/2020/07/28/mag…

"...from foul water in Flint, Michigan..."

**STILL**

npr.org/2020/08/07/899…

"...to dangerous chemicals that have poisoned a corridor of Louisiana known as Cancer Alley..."

nbcnews.com/science/scienc…

@NBCNews

"...which scientists and policymakers have known for decades."

But have not addressed for decades.

Now, the renewed recognition of structural racism and its real human impacts are brought to the fore by the COVID-19 pandemic... A little too late.

iaphs.org/racism-in-the-…

Black communities have been calling out for decades that THEY CAN'T BREATHE, whether from pollution or police brutality.

"...which scientists and policymakers have known for decades."

#BlackLivesMatter #BlackEpiMatters
@black_epi

As epidemiologists, we must go beyond a quantitative estimate to think about the why, the how, and the so what. To know that, we must be steeped in our history.

@TheLancet @DrMaryTBassett @natalialinou @MadinaAgenor

thelancet.com/journals/lance…

“You can’t understand environmental racism without understanding the legacy and the history of residential segregation, which created the disinvestment that has happened in communities in Philadelphia like Grays Ferry for decades” --@HealthEquityDoc

nytimes.com/2020/07/28/mag…

We can't understand health inequities re: police brutality, overpolicing, mass incarceration, or any of the structural inequities revealed by the COVID-19 pandemic without understanding the legacy and mechanisms of structural racism.

@CovidPrison @KathrynNowotny @RubysHarmonium

We cannot simply go back to normal. Normal is killing us.

thelancet.com/journals/lanin…

Beloved -- it is the time not to despair, but to rest and recharge, so that we can fight another day.

Breathe.

For many of us, simple breath is an act of resistance, an act fighting for our collective survival.

theguardian.com/commentisfree/…

So.

Breathe.