By Austin Cummings, Senior Research Associate
The Cleveland metro area was named the 31st most polluted metro area in the country for ozone pollution and 73rd worst in the nation for short-term particle pollution in the American Lung Association’s 2024 State of Air report. The report grades areas by how much residents are exposed to unhealthy levels of air pollution, specifically ozone pollution, particle pollution, and other spikes in air pollution from 2020-2022. Cuyahoga County received a failing grade on ozone pollution and air pollution levels above the federal standards outlined by the Environmental Protection Agency. The State of Air also found that communities of color are disproportionately exposed to unhealthy air, with a person of color in the U.S. more than twice as likely than a white individual to live in a community with a failing grade.
In the 2024 State of Fair Housing in Northeast Ohio report, The Fair Housing Center provides an analysis of exposure to environmental hazard throughout Northeast Ohio, specifically analyzing residential exposure to airborne carcinogens, respiratory hazards, and other airborne neurological hazards. The analysis suggests that the racial composition of a census tract is correlated with environmental hazard exposure. The racial geography of Northeast Ohio – at the neighborhood, city, and county level – appears to highly structure residents’ exposure to environmental hazard, which ultimately shapes their health outcomes. The report concludes that the current geography of exposure to environmental hazard illustrates non-white communities are disproportionately exposed to and harmed by the pollution and toxins concentrated in the neighborhoods they reside.
Exposure to environmental hazard, such as air pollution, ozone, and lead particles, is harmful, leading to detrimental health outcomes, socio-economic outcomes, and possibly leading to premature death. The geography of exposure to environmental hazard is built on the legacy of segregation, redlining, predatory lending, discrimination, exclusionary zoning, highway development, and a host of other government policies. For example, a 2022 report published by the American Chemical Society found that historically redlined neighborhoods have higher exposure to air pollution than neighborhoods that were not redlined and within previously redlined neighborhoods significant racial disparities in exposure to air pollution persist.
This blog post hopes to illustrate the connections between exposure to air pollution and the prevalence to asthma in Cuyahoga County. The health, social, psychological, and financial impacts of living with asthma are built upon the history of segregation in Cuyahoga County. Black and Latinx residents are more likely to live in areas that are exposed to air pollution, more likely to live next to sources of air pollution like factories and highways, and more likely to suffer the burdens of exposure to air pollution. Where we live shapes our health. To live up to the promise of the Fair Housing Act and Affirmatively Further Fair Housing, policy makers, practitioners, and advocates alike need to weave an environmental justice and public health framework into their fair housing work.
Air Pollution, Asthma, and other Health Impacts
Researchers have long linked developing asthma with exposure to air pollution. Adults and children with asthma are especially vulnerable to air pollution because exposure to air pollution can trigger asthma attacks and generally make asthma symptoms worse. Moreover, research has illustrated that exposure to air pollutants like ozone and coarse particulate matter (PM 10-2.5) decrease lung function and associated with developing asthma, other respiratory diseases, and cardiovascular diseases. Coarse particulate matter can come from a variety of sources, including road dust, metals, and particles from brakes, tire wear, and other roadway materials. Both ozone and particle pollution have been linked to causing premature death, asthma attacks, heart attacks, strokes, preterm birth, impaired cognitive functioning later in life, and lung cancer. Due to decades of residential segregation, highway development, and other government policy, Black residents in Cuyahoga County and across the nation tend to live where there is greater exposure to air pollution.
The Racialized Geography of Asthma
Using the Climate and Economic Justice Screening Tool (CJEST) developed by the White House Council on Environmental Quality, I analyzed the distribution of asthma, exposure to ozone, and particulate material (2.5), and diesel across Cuyahoga County census tracts. This analysis doesn’t make any statistical claims about the extent to which exposure to air pollution is causing asthma outcomes in the region. However, the maps and findings suggest that the residents of minority-majority communities are disproportionately exposed to air pollutants and the highest prevalence of asthma in Cuyahoga County.
The CJEST ranks burdens of environmental exposure and health outcomes using percentiles. Percentiles show how much burden each census tract experiences when compared to other tracts. The lowest score is a 0 and the top score is a 100. A variable that lists a census tract as “80th percentile” means that the tract has a higher measurement on the variable than 80% of the census tracts. Standardizing the data in this way makes it easier to compare and identify the relative burden that each census tract, or group of similar census tracts, experiences compared to others. There are different advantages and disadvantages to using this method, which are noted in in the CJEST Technical Support Document.
The highest asthma rates and burden are experienced in minority-majority communities in Cuyahoga County, with the average percentile burden in communities that are at least 80% non-white being 1.5 times higher than in white-majority communities (See Table 1). The distribution of asthma burden (Figure 2) directly reflects the concentration and distribution of non-white population in Cuyahoga County (Figure 1).
Figure 1: Demographic Map of Cuyahoga County
Figure 2: Distribution of Asthma Burdens in Cuyahoga County
Table 1: Average Asthma Burden and Air Pollution Exposure across Cuyahoga County Communities
| Percent Non-White | Ozone | Diesel | PM 2.5 | Average Asthma Percentile Burden |
| Below 50% | 59.1 | 55.4 | 49.3 | 62.7 |
| 50 to 80% | 87.5 | 79.6 | 76.1 | 91 |
| Above 80% | 92.6 | 87.9 | 84.6 | 98.1 |
Data: CDC PLACES: Local Data for Better Health. Accessed through Climate and Economic Justice Screening Tool.
White-majority communities have the lowest burdens of exposure to air pollution in Cuyahoga County. These patterns follow long-standing segregation patterns and can have devastating health, social, and economic impacts for individuals and the communities they live.
Racial Disparities in Asthma Hospitalizations and Emergency Department Visits
The Ohio Department of Health reports rates of asthma hospitalizations and emergency department visits at the county level. Rates of asthma hospitalizations and emergency department visits for both Black adults and children are significantly higher than their white counterparts.
Figure 3: Rates of Asthma Hospitalization & Emergency Department Visits, Cuyahoga County Adults
Table 2: Rates of Asthma Hospitalization & Emergency Department Visits, Cuyahoga County Adults
| 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | |
| Cuyahoga White Adults | 9.4 | 15.3 | 20.8 | 24.8 | 20.4 | 18.5 |
| Cuyahoga Black Adults | 76.7 | 115.4 | 139.8 | 184.4 | 144.1 | 148.7 |
| Cuyahoga Latinx Adults | 58.7 | 29.5 | 73.9 | 97.3 | 91.2 | 117.4 |
Data Source: Source: Ohio Hospital Association Clinical-Financial Data Set, Years 2016-2021 CDC WONDER On-line Database 1990-2020, Years 2016-2021.
From 2016 to 2021, Black adults in Cuyahoga County experienced asthma hospitalizations and emergency department visits at a rate of almost 7.5 times that of Cuyahoga white adults. Cuyahoga Latinx adults experienced almost 4.2 times more asthma hospitalizations and emergency department visits due to asthma than Cuyahoga white adults. Black and Latinx adults in Cuyahoga County also experienced higher rates of asthma emergency department visits and inpatient hospitalizations compared to Black and Latinx adults across all of Ohio. In Cuyahoga County, Black and Latinx adults experience higher rates of asthma related hospitalization than whites who reside in the county and other Black and Latinx adults in Ohio.
Figure 4: Rates of Asthma Hospitalization & Emergency Department Visits, Cuyahoga County Children
| 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | |
| Cuyahoga White Children | 19.6 | 23.5 | 40.8 | 46.2 | 19.8 | 32.9 |
| Cuyahoga Black Children | 164.8 | 190.2 | 222.5 | 254.9 | 111.6 | 198.3 |
| Cuyahoga Latinx Children | 47.4 | 42.6 | 131.6 | 157.8 | 67.6 | 130 |
Data Source: Source: Ohio Hospital Association Clinical-Financial Data Set, Years 2016-2021 CDC WONDER On-line Database 1990-2020, Years 2016-2021.
Black and Latinx Cuyahoga children also experienced higher rates of asthma hospitalizations and emergency department visits than white Cuyahoga County children. On average, Black Cuyahoga children experienced 5.8 times and Latinx Cuyahoga children experienced 3.3 times more asthma hospitalizations and emergency department visits than Cuyahoga white children. Lastly, Black and Latinx Cuyahoga children also experienced higher rates of asthma related hospitalizations than other Black and Latinx children throughout Ohio.
Asthma mortality rates for Black Cuyahoga adults and children are significantly higher than white Cuyahoga adults and children. Between 2016 and 2021, the Ohio Department of Health reported the average asthma mortality rate for Cuyahoga County was over 3 times higher for Black adults when compared to their white counterparts. Asthma mortality rate for Black Cuyahoga children, however, was over 9 times higher than the rate for white Cuyahoga children. Lastly, the mortality rate for both Black and white children in Cuyahoga County were nearly twice the rate of Ohio’s childhood asthma mortality rate. In Cuyahoga County, Black and Brown residents are experiencing worse air quality, higher rates of asthma, higher rates of hospitalization due to asthma, and higher rates of asthma mortality than whites in the County and other Black and Brown Ohioans.
The Need for Fair Housing to Address Air Quality
Environmental hazard exposure and its harmful impacts on human health are unevenly distributed throughout Northeast Ohio and Cuyahoga County. Residents living in census tracts with a persistent poverty designation are exposed to almost twice the amount of environmental hazard as residents living in other areas in Northeast Ohio. Black and Brown Cuyahoga County residents, especially those living in highly segregated communities, are disproportionately exposed to harmful air toxins and air pollution. Exposure to air pollution and harmful air toxins is linked to developing asthma and triggering asthma symptoms, which can require hospital visits, trips to the emergency room, or cause someone to die. The racial differences in exposure to environmental hazards, air toxins, airborne carcinogens, and other harmful forms of air pollution are heavily shaped by a host of policies that segregate communities, develop highways through Black and Brown communities, and site factories and other major polluters in and adjacent to Black and Brown communities. Moreover, white flight from the City of Cleveland and inner ring suburbs contributes to higher amounts of air pollution being concentrated in Black and Brown communities in the Cleveland metro area. As people drive from the Outer Suburbs of the County to work or access the amenities in and around the City of Cleveland, their cars release harmful air toxins that negatively impact human health and contribute to climate change. Lastly, addressing air quality issues will become even more important as the region experiences high amounts of smoke in the air from wildfires in Canada.
To Affirmatively Further Fair Housing in the region requires intentional efforts to significantly alter racial and socio-economic disparities in exposure to environmental hazards. To address these issues requires deeper collaboration between transportation, housing, and land use planners, policymakers, and advocates, along with public health experts and advocates. The voices and perspectives of residents that are experiencing the harmful and sometimes deadly impacts of exposure to airborne pollutants also need to be centered in developing solutions to address this multifaceted policy and public health issue.