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Higher Education Module

Race, Medicine, and Health in America

Class 1: Created Suffering and the Rise of Asthma


By the 21st century some fifty-million Americans suffered from asthma and hay fever in the United States. Asthma represents a complex interaction between the biological, physical, and social factors of environmental landscapes; yet minorities who make up the majority of the economically poor and uninsured are more likely to suffer and die from asthma. Importantly, environmental historian Gregg Mittman describes the concept of “asthma zones” in which a large percentage of a population suffers disproportionately from asthma, in part a result of their inability to control the environmental escalators that cause asthma. Carla Keirns’ article reifies the different strategies that physicians and community organizations employ to raise awareness and resources for asthma.

Class Resources

Mitman, Gregg. Breathing Space: How Allergies Shape Our Lives and Landscapes. New Haven: Yale University Press, 2008, pp. 1-89; 134-147.

Keirns, Carla C. “Asthma mitigation strategies: professional, charitable, and community coalitions.” American Journal of Preventive Medicine, 37(6 Suppl 1):S244-250.

Additional online resources

“Age Healthier, Breathe Easier.” Images from the History of Medicine. National Library of Medicine collection. Available online at //

Discussion Questions:
  1. How does Gregg Mittman define the concept of an asthma zone?
  2. What are some of the escalators of asthma in the environment described by Mittman?
  3. We are often bombarded with media representations of public health. What is the message the “Age Healthier, Breathe Easier” poster is trying to convey?
  4. The “Age Healthier, Breathe Easier” poster advises people to avoid certain triggers of asthma. Thinking about your own personal circumstances, is it difficult or easy for you to adhere to this advice?
  5. Mittman talks about controllable and uncontrollable environments. In particular, people living in certain spaces find it difficult to control their asthma environments based on what people around them are doing. Think about your living environment and whether you can control the known triggers to asthma.
  6. Carla Keirns’s article makes an important distinction between individual and structural approaches to asthma research. What are some additional infrastructural causes of high asthma rates not discussed in the readings?