NY Battles Legionnaires': Poverty Wins War

Nearly 400 New York City and State health inspectors, private water cooling tower cleaning crews, and even Fire Department ladder companies were deployed across the city this month following the biggest outbreak of Legionnaires' disease in local history. It killed a dozen people while 120 others fell ill.

"It's like a wartime response," the president of the Metro Group, which cleaned more than 100 cooling towers in one week, up from their usual five, told The New York Times. "We've never seen anything like this."

Governor Andrew Cuomo and Mayor Bill de Blasio are engaged in battle and actively throwing resources to address the immediate problem all the while ignoring the war that claimed those dozen lives and has left many more to suffer.

It is the underlying poverty and poor health that characterize the place where the fatal victims of this outbreak lived that are the main culprits.

The conditions of living in concentrated poverty and vulnerable health in New York's South Bronx make residents here more susceptible to disease and death than other New Yorkers. It is so bad, that according to the Robert Wood Johnson Foundation, the Bronx is the unhealthiest county in the state and one of the unhealthiest in the entire country.

The Foundation reports that a quarter of Bronx residents report poor or fair health, compared to 15 percent of New Yorkers. Their premature death rate is 1.3 times higher than the rest of the state. In Mott Haven and Morrisania, where the outbreak is clustered, the asthma rate is three times the national average.

Further, Bronxites disproportionately contend with chronic health conditions like diabetes, hypertension, HIV, obesity and depression.

These conditions make the South Bronx ground zero for diseases that prey on the most vulnerable -- of which Legionnaires' disease is just one. If New York caught a cold, the South Bronx would get pneumonia.

And compromised populations aren't only more likely to contract diseases; they are likelier to die once they do. No wonder this Legionnaires' outbreak has claimed 12 lives of 115 known cases.

We have no doubt that we have been exposed to the bacteria.

Diana regularly walks by Lincoln Hospital on her way to the gym in the Opera House Hotel where inspectors have found the Legionella bacteria lingering in the air. Eddie bikes through the neighborhood almost daily on his way to Manhattan. We have been spared because we are young and healthy nonsmokers.

But on this route, we see the dire consequences of living in New York's 15th Congressional District, which has long held the distinction of being the poorest in the nation. The next poorest congressional district in the U.S. is in Detroit.

Here in New York's 15th, 38 percent of the population lives below the federal poverty line. Half the children live in poverty. This neighborhood of concentrated poverty is also saturated with poor health.

Countless children clutching inhalers to their mouths to catch a breath crowd the streets where asthma is worse than anywhere in the city, partly because of the many trucks clogging the streets.

Women and men who should be in their prime stroll with oxygen tanks with plastic tubes, feeding oxygen directly into their noses, to fill their lungs, due to chronic obstructive pulmonary disease which makes it difficult to breathe.

Residents faces are worn with the stress of poverty. Many cope by smoking, creating further problems, including increased risk of contracting Legionnaires'.

What makes matters worse is these individuals are also often uninsured or underinsured, so the emergency room is a first, rather than a last resort. By the time they seek medical care, it is often too late to ensure full recovery and survival from otherwise treatment ailments.

Diana is a sociologist and public health researcher who studies the social and environmental determinants of health, so she is well aware that buildings contribute to poor health conditions. This time, the cooling towers atop large buildings with central cooling systems are responsible for serious health hazards. But chronic exposure to poor housing conditions -- including mold, pests, extreme home temperatures, secondhand smoke and poor indoor air quality -- commonly lead to asthma, heart disease, cancer, poor mental health, and premature death.

Eddie is a writer who first observed the politics of poverty in the Bronx as a reporter for The New York Daily News in the 1990s.

The competition for headlines among politicians does not address the real problem that has caused this outbreak to claim so many lives now or to protect generations to come.

Furthermore, while passing legislation to ensure the proper maintenance of cooling towers is a critical first step, we wonder about The Pew Foundation report released just a couple of weeks ago that indicate that today more Latino children live in poverty than the children of any other group. This is the first time that the largest number of children in poverty in the U.S. aren't white.

Albeit less newsworthy, this too is a crisis. And neither the governor or the mayor have stepped up with plans to deploy resources to attack this calamity as it relates to kids in the Bronx.

Perhaps it's because this is not a new problem. As early as 1966, anthropologist Oscar Lewis wrote La Vida; A Puerto Rican Family in the Culture of Poverty about the roots of the problem. He hoped that his book might encourage elimination and alleviation of poverty.

In 1967, the year La Vida won the U.S. National Book Award, a fifth of the people living in the Bronx County in New York City lived in poverty. Since then, the U.S. Census reports the number of people living in poverty in the Bronx has grown to a third of the population.

Drilling even deeper into the numbers, we've found that Latinos living in the Bronx today, not just the Puerto Ricans, like the Ríos family who Lewis wrote about, but the Dominicans and Mexicans, who also live there now, comprise 75 percent of the poor in some neighborhoods.

This is where diseases with life-long complications are most concentrated, making the population more vulnerable to the Legionella bacteria.

In a recent campaign speech on the economy, the presumptive presidential candidate for the Democratic Party, in a speech about the challenges of the middle class, said, "Previous generations of Americans built the greatest economy and strongest middle-class the world has ever known. If you work hard, you should be able to get ahead."

But no one in this presidential race is competing to talk about poverty. The problem is access to health care, a good public education, and securing a fulfilling and well-paying job that can support their families, is less likely for the people in the Bronx than winning La Lotería.

Even before the Pew Foundation report, several years ago, the American Academy of Pediatrics (AAP) recognized the dire impact of poverty on children in the U.S. and changed their mission to work to eliminate childhood poverty because they felt that no one else was stepping up.

AAP President Benard Dreyer, M.D., felt compelled to do something because he's been working in the pediatric emergency room at Bellevue Hospital since the early 1970s, where he daily sees patients whose poverty contributes to levels of infant mortality and low birth weights comparable to that in undeveloped countries. He sees children who are unstably housed and go to bed hungry every night.

As vice-chairman of the Department of Pediatrics and director of the Divisions of General Pediatrics and Developmental - Behavioral Pediatrics at the New York University School of Medicine, he understands that if there is no significant intervention in the early lives of these children, they will never develop the cognitive, emotional and social capacity to rise out of poverty. They are likely to live in persistent poverty throughout their lives, creating an intergenerational transfer of disadvantage.

"There are big issues for children, issues that affect their lives and their life trajectories, about which we as pediatricians have talked but not shouted, and have not affected much change," said Dr. Dreyer in his annual address to pediatricians. "Poverty and its consequences is an issue that hovers over, and dwarfs all other issues; and the gross inequities among children based on race/ethnicity are very much related to and interwoven with poverty. I would like to focus on childhood poverty and on making a case for ending or at least dramatically decreasing childhood poverty as well as alleviating the effects of poverty on poor children."

The AAP position was backed up by a JAMA Pediatric study published this summer, Poverty Disturbs Children's Brain Development and Academic Performance. New York's state capital or City Hall have yet to affirm a plan on how to handle this problem.

This crisis of poverty is not merely a problem for New York City, but the nation.

The U.S. Gross Domestic Product (GDP) drops by an estimated 1.3 percent annually as a consequence of poor children growing up to be poor adults with lower productivity and lower earnings. The total cost of childhood poverty is almost four percent of the GDP when the cost of increased crime and increased health expenditures are totaled. That's seven trillion dollars.

For New York, the problem is more egregious: Latinos comprise nearly a third of the city's population and are its fastest growing segment. Today's poor Latino children, who are the poorest of all New York City residents, are going to grow up to be tomorrow's poor adults.

The fastest growing segment of this population in New York City is Mexican. According to New York City's Community Service Society, the fastest growing segment of poor Latino children in New York City are of Mexican descent. Half of them already live in poverty.

While Latinos have historically benefitted from an "immigrant health paradox" that spares first generation immigrants from serious chronic health conditions, those benefits dissipate in the second and third generations.

Therefore, the children of the South Bronx today are likely the unhealthy and vulnerable adults of tomorrow -- unless our leaders actively intervene to create enhanced health opportunities for Bronxites.

The Bronx is known for its path-breaking cultural contributions as the birthplace of hip-hop and salsa. It's also considered a winner as it is home to an all-star baseball team. So, the real opportunity now is to spur a culture of health in the Bronx that will leave a lasting legacy and once and for all win the war on poverty and poor health now and for generations to come.

Excerpts of this article first appeared in an op-ed in The New York Daily News on August 12, 2015.