Last week, David* didn’t come to school for two days. He came back with a note from his mom: “David was absent because his asthma was really bad.”
Two years ago, I worked with a girl named Diana, who seemed to be in a perpetual fog. I checked her Individu-alized Education Plan, talked with our special ed teacher, and learned that she literally was in a fog: She had lead poisoning and a learning disability, and she had an extremely difficult time understanding, processing, and recalling information.
That same year, two of my students were diabetic and others were overweight and out of shape. They, too, were part of a national trend. (See sidebar.)
But what does this have to do with life in my classroom? Diana has a hard time retaining and processing information. Martin, an outgoing, athletic boy, has to take it easy it in gym class and on the playground because exercise can trigger an asthma episode. Overweight nine-year-old Shayla can’t run halfway around the school without stopping to walk. María has to have a special nurse come to school every day to give her insulin and monitor her diet. So what should I do?
Of course, it is my job as a teacher to make sure individual children are cared for and to be sensitive to their medical needs. But asthma, lead poisoning, obesity, and diabetes are more than individual health problems. They are public health problems that plague my city (and all others in the United States) and that disproportionately affect poor people, people of color, and other populations that are concentrated in urban areas.
Kids’ Health Stats
Nationwide, asthma is the number one reason that students miss school, according to the Centers for Disease Control.
Seven percent of children in the United States suffer from asthma. But in urban areas, the rate shoots up to 14 percent-twice the national rate.
While the rate of lead poisoning cases is 4.5 percent nationwide, it too is much higher in urban areas. In Milwaukee it jumps to 22 percent. And, according to the Milwaukee Journal Sentinel, in some neighborhoods in Milwaukee as many as 80 percent of children have lead poisoning.
According to the American Diabetes Association (ADA), more and more children are developing Type 2 diabetes, a condition that has generally been more common among adults. Type 2 diabetes commonly occurs in children who are overweight, older than 10, have a family history of Type 2 diabetes, and are African-American, Latino, or Native-American.
According to the Centers for Disease Control, the child obesity rate in the United States has tripled in the last two decades, and 15 percent of children ages 16 to 19 are overweight.
Because many of my students are affected by these issues, I decided to engage my class in a study of public health problems. I also required them to do their science projects for our annual science exhibition on health topics.
With this unit, I wanted my students to learn about asthma, lead poisoning, obesity, and diabetes. I wanted them to link their personal experiences with these illnesses with new information. I also wanted them to know that these diseases plague some communities more than others because of environmental and economic injustice. I wanted them to understand that the illnesses we were studying disproportionately affect poor communities and people of color. And I hoped we could think through as a class some actions that young people might be able to take to change that.
We began by studying some basic facts about asthma and lead poisoning: What causes the illnesses? What are the symptoms? What can we do to protect ourselves from the things that can trigger or cause these illnesses?
I used materials on asthma that I got from a nurse at a local health clinic called the Sixteenth Street Health Clinic and from the American Lung Association website. The materials included several handouts that the clinic uses with families and asthmatic children. The flyers illustrate what healthy lungs look like and contrast them with lungs during an asthma attack. Another flyer shows several different possible asthma triggers, and another shows some symptoms that could signal the onset of an asthma attack. All of the flyers were child friendly with drawings and age-appropriate language for my fourth graders. Best of all, the materials were in Spanish, the target language of my two-way bilingual classroom.
We also read the book De modo que tú también tienes asma ( So You’ve Got Asthma Too ), which explains and illustrates what happens to the body when lungs are breathing normally and then again during an asthma attack.
The class worked together to make a poster of asthma triggers-things that bring on asthma attacks in asthmatics. We took the triggers from the health clinic’s flyer: cigarette smoke, dust, strong odors, mold, humidity, pets, abrupt climate change, cold and dry air, air pollution/ozone, cockroaches, pollen, food allergies, colds, exercise, being overweight, strong emotions and stress, and the night.
Each child created a 3×5 card with a picture of the trigger and wrote a short paragraph that read something like: “Dust could be an asthma trigger. Kids with asthma should stay away from dust.” (In reality, people with asthma must learn to recognize and avoid only those triggers that provoke attacks for them personally-but I wanted the kids to have an awareness of the wide range of things that can cause attacks in asthmatics.)
After learning about what triggers asthma attacks, we studied what an asthmatic should do during an attack. We read and discussed a flyer from the American Lung Association’s Open Airways curriculum that explains the basic steps an asthmatic should follow during an episode.
Obviously this information is of use to a child with asthma, but for my students without asthma, I think it is useful for them to know how to respond when a classmate or relative has an asthma episode. It is especially important for children to know how to behave toward an asthmatic child. Children sometimes treat asthmatic kids differently-especially if exercise is a trigger and an asthmatic child is not able to play or participate in physical education the same as the other children. Kids need to be able to ask questions and get answers about asthma, and they also need to know that we expect them to treat asthmatic classmates with respect and compassion.
Public Health Implications
Thus far, our study was purely about the causes and symptoms of asthma, and how asthmatic children could avoid or respond to asthma episodes. But I needed my students to go beyond that. I wanted them to understand asthma as a public health issue and as a disease that targets poor people, people of color, and people living in cities.
We began to discuss the numbers and percentages of people with asthma. I shared with them the statistic that 7 percent of children in the U.S. have asthma. Because percent is not an easy concept for fourth graders to understand, I asked the students to take a blank grid of 100 squares and color in 7 of the squares. Under that grid we wrote: “Seven of every 100 kids in the United States have asthma.” Then I gave them another copy of the same grid and told them that in big cities in the United States, 14 percent of children have asthma. They colored in 14 squares and wrote underneath: “In big cities in the United States, 14 of every 100 kids have asthma.”
We discussed why it might be that more children in cities have asthma. One student mentioned that there are more factories in cities and another said that there are more cars and traffic. We talked about older houses and schools like ours where there is a lot of dust in the vents and the air is not as clean. I asked why the asthma rate might not be so high in the suburbs or in rural areas. Their responses were limited: They guessed it was because there were fewer factories and cars, that the houses were newer, and the air was cleaner.
The students’ knowledge of asthma as an illness that targets specific groups was superficial at this point. I asked them: If we do a research project in our class, what percent of kids do you think will have asthma? They hypothesized that a lot of kids would have asthma, but did not state their hypotheses in terms of percentages, and did not link their hypotheses to the national or urban percentages we had discussed. Instead, their hypotheses were anecdotal: “I think a lot of the kids in our class will have asthma because a lot of my friends have asthma.”
We did the study with both groups of students I worked with. In one group, two of 25 kids (8 percent) had asthma. In the other group, six of 25 kids (24 percent) had asthma.
Studying Lead Poisoning
We moved on to study lead poisoning.
I explained that lead poisoning is a sickness that’s kind of like asthma in that it affects people much more in big cities, especially in old houses in poorer parts of the city. As a resource, I used a packet that I downloaded from the National Institute of Environmental Health Sciences website called “Aventuras del club de los detectives del plomo”-Adventures of the Lead Detectives Club. (See resources, next page.)
Another Spanish-language, kid-friendly resource, this website walks students through the dangers of lead, discusses the causes and symptoms of lead poisoning, and shows actions kids can take to protect themselves and their younger siblings from lead poisoning. The website is interactive. It asks student visitors to respond to questions, click on lead poisoning hazards, play board games, and do word searches. Unfortunately, my classroom did not have the technology needed for students to visit, read, and interact with this website online, so I gave them a hard copy of the information instead. The next time I do this unit, I would like to provide Internet access and have students visit the site and do the activities with a partner.
After learning about what causes lead poisoning and how students can protect themselves and their younger siblings from lead hazards, I reminded the students that lead poisoning is much more of a problem in big cities than in suburban or rural areas. We talked about why this might be true. We discussed how most of the homes in the neighborhoods we live in are older homes, and I told the kids that paint used to be made with lead, but it is not made with lead anymore. (Lead paint was banned in the United States in 1978, and leaded gasoline was banned in 1986.) I told the kids that newer homes in suburban areas would not be as likely to have lead paint. We also discussed what happens in rental homes where landlords don’t keep up with repairs. Because we had read about peeling paint, some students were able to make the connection that homes that are well maintained are safer for kids. We discussed the fact that landlords and homeowners need money to fix peeling paint-and that sometimes people cannot make the repairs they need to make because there’s not enough money.
I did not share statistics with the students on lead poisoning, because we moved on quickly to their science projects. But looking back, I think I should have spent more time working on percentages and helping kids to see and understand the drastic inequalities in how different populations experience lead poisoning. Here are some statistics I might share next time I teach this: 4.5 percent of children in the United States have lead poisoning, but 22 percent of all the children in Milwaukee have lead poisoning. It’s even worse in some neighborhoods in Milwaukee: 66 percent of all children on the north side and 31 percent of all children on the south side had lead poisoning in 1999, according to the Milwaukee Journal Sentinel . I could envision having students color a map of the country and a map of Milwaukee that was divided into neighborhoods to show where the highest concentration of lead poisoning cases is.
For their science projects, I asked students to do an investigation that had something to do with children’s health. I offered the two illnesses we’d studied, asthma and lead poisoning, and I also offered the general area of nutrition, diabetes, and obesity. (Although we had not done any previous study of these issues, several students in my class had expressed an interest in doing projects related to diet, obesity, and diabetes.)
As a class, we brainstormed several different questions that could be investigated for a science experiment. The process of arriving at questions that are appropriate for a fourth-grade science experiment is grueling: Fourth-grade students typically don’t know how to write a question that lends itself to a science experiment, and they need a lot of guidance. But I find that starting with the students’ own questions and reworking them one by one into appropriate questions is the best approach, rather than just providing students with a list of questions and asking them to choose.
Questions we came up with included: How many second graders take medication for asthma? What provokes asthma attacks for fourth graders who have asthma? How clean is the air in our classroom? Which classroom has the cleanest air, Room 33 or Room 32? How many fourth graders have lead paint in their homes? How many first graders know what lead poisoning is before and after a lesson on lead poisoning by fourth graders? What is the difference between the diet of a non-diabetic student and a diabetic student? What is the difference between the diet of a person who eats a lot of fast food and the diet of a person who eats a lot of home-cooked food?
Working in pairs, students had to choose a question, write a hypothesis, write a procedure, conduct the experiment, make observations, gather data, display their data, and write a conclusion. Then they had to create a display with all these pieces of their project for our science exhibition. This process took several weeks and a lot of guidance. Students needed support not only with the content they were studying and the steps of the scientific process, but also with Spanish language arts skills. I worked with students in partners and in focus groups (the asthma group, the lead poisoning group, and the nutrition group).
Along the way, we made several discoveries about public health in our school: Marcela, Lorenzo, and Diana found out how many second-grade students had asthma. Anita and Cristina learned that of 15 first graders surveyed, not one knew what lead poisoning was-but they all claimed to understand what it was after Anita and Cristina’s lesson. Rosa and Michelle found out what triggered third graders’ asthma, and Roberto and Jason learned that many fourth graders didn’t know whether their house had been tested for lead paint or not. Rosario and Julia found out that there are more calories and fat in a fast-food diet than in a home-cooked diet (what a surprise), and Raquel and Sara unfortunately found out that the air in our classroom was not very clean at all. (Their experiment involved placing a Tupperware lid smeared with Vaseline in the room for several days, then examining it under a microscope to see what kinds of particles had settled on it-not pretty, but revealing.)
As a result of this learning, we made some changes in our classroom. We tried to keep things cleaner so that the air would be cleaner. We got rid of our carpet after we learned that it could harbor dust and mites that can trigger asthma episodes. I became more aware about pets and animals in school, and helped asthmatic students stay away from animals that were brought into the school. I began to sweep more often behind bookshelves (always a struggle) and tried to make sure my return air vent wasn’t blocked.
All these changes, though, were only at the classroom level. What about all of the sources of air pollution in our community that seem to be beyond our control: cars, buses, power plants, and factories, to name a few? In the future when I teach about asthma, I would like to help students see the connection between air pollution and asthma, and to help them think of creative ways to speak to their community about the importance of improving air quality to improve children’s health.
There are several other aspects of my teaching that I hope to improve upon. To start with, I need better materials and more resources. I need to engage students in more meaningful lessons that will do a better job of helping students understand how race, poverty, and health intersect, so that they will come away with a clearer understanding of how these illnesses afflict poor, urban communities.
I also need to do a more thorough job of teaching the content about what these illnesses are, their symptoms, and how to prevent them. I realized this when four of my students asked me to proofread a coloring book on lead poisoning that they were preparing for first graders. One page showed a dead girl lying in front of a house with peeling paint and the text said, “Lead paint can make you sick and even kill you.” When I talked about it with the girls I realized that although we had covered exactly how lead paint makes you sick (i.e. brain damage, flu-like symptoms, learning disabilities), they had not retained that information-and they were ready to teach the first graders misinformation. We went back to the website and reread the part about what lead poisoning does to the body, and they corrected that page of their book before doing their lesson with the first graders.
The next time I teach this, I want to include community outreach and require the students to educate their own families as a major part of their work. I can envision students producing a pamphlet explaining what causes asthma, why asthma is more of a problem for people living in cities, why that’s unfair, and what we could do to change it. Likewise, students could create a similar pamphlet about lead poisoning and include it as one piece of a lead-poisoning prevention kit. Their kit could also include a coloring book to teach kids how to avoid lead poisoning, information for parents on how to have their homes tested for lead paint, and possibly even a lead-test kit. We could distribute the pamphlets and kits to fourth-grade parents or make them available to any interested parent from our school at an all-school event like conferences or open house. Students could also prepare an education/outreach packet on nutrition and obesity explaining what child obesity is, why it affects so many children in our country, and some things kids and families could do to prevent it.
This project, although time consuming, offers children an opportunity to use science, math, reading, and writing to understand-and hopefully have some impact on-serious problems in our community. Right now, too many students are sick: asthmatic, lead poisoned, learning disabled, diabetic, obese. Their illnesses are not their fault. The environment they live in is sick-and that is not their fault either. Someone has to make changes in our community and in our environment, so that they can be healthy. Why shouldn’t they help make those changes?
Resources for Teachers
Chicago Asthma Consortium: www.chicagoasthma.org
The American Lung Association, Minorities and Air Pollution: www.lungusa.com/air/minority_factsheet.html
National Institute of Environmental Health Science: www.niehs.nih.gov/
“Open Airways For Schools: A School-Based Asthma Health Education Program for Children with Asthma.” Also available in Spanish under the title “Respiro abierto.” American Lung Association: 1992. Order from National Asthma Education Program, National Heart, Lung, and Blood Institute, Room 4A18, Bethesda, MD, 20892
Materials to Use with Children
“Aventuras del club de los detectives del plomo” (Adventures of the Lead Detectives Club), interactive website for children on preventing lead poisoning. www.niehs.nih.gov/kids/
De modo que tú también tienes asma , by Nancy Sander. Children’s book available in Spanish or English that describes what happens during an asthma attack. Distributed by Allen & Hanburys (a division of Glaxo Inc.), Five Moore Drive, Research Triangle Park, NC 27709
Todo acerca del asma , also available in English as All About Asthma . Children’s online book explaining what asthma is. Available at www.aaaai.org/patients/just4kids/all_about_asthma/asthma_spanish.pdf