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In a small manufactured home in south Phoenix, 6-year-old Jonathan Hendrix is hiding behind a chair, pretending to be shy.
"I don't want to go to the doctor," he mumbles to his mother, when a stranger arrives at his house to talk about his medical condition.
Jonathan has chronic asthma. He's intimately familiar with the doctor's office. What started as an attack that landed him in the hospital when he was 2 has led to years of breathing treatments, missed school days (despite his mother Jennifer's best attempts) and, too much of the time, shortness of breath.
This kid has an understanding of his disease that goes beyond his years. He can lay out all of the equipment that helps manage his asthma and demonstrate how to use each piece. His mother, who works more than 50 hours a week for the U.S. Postal Service, says Jonathan's asthma isn't as bad as she's seen in other kids, but still, they've had some scary moments.
She wishes her son didn't have to think about his next breath.
"When I see him breathing like that, I feel myself taking less breath. When he takes his inhaler and he holds it in and counts to 10, I hold it in," she says. "I'll never know what it feels like. Maybe like choking."
In Arizona, which has the second highest asthma rate after Maine, according to the American Lung Association, Jonathan's story is a familiar one for school-aged children especially in low-income school districts. Janet Napolitano got headlines in 2003, early in her administration, for talking about asthma and other environmentally triggered hazards to children, but as her first term comes to a close, the governor's done almost nothing to change public policy.
She's too late for one little girl.
Earlier this year, a fifth-grader at Rose Linda Elementary School in south Phoenix died of an asthma attack triggered by bad air while she played outside during recess. By all accounts, the school did what it was supposed to sent the 10-year-old home with strict instructions to her mother that she needed to go to the hospital. But because the mother is an undocumented immigrant, she kept her daughter home and tried to stop the attack herself.
The child was not taken to the emergency room until the next morning, and by then, it was too late.
Of course, not every child who has an asthma attack at school dies, but many are unable to sit through class. Mary Chick, head nurse for Roosevelt Elementary School District, which includes Rose Linda, says that in 2004 there were more than 10,000 missed school days in the Roosevelt district because of asthma. She estimates that she treats at least 12 asthmatic children a day, and that only counts those who come in for daily medication. Even more come in complaining that they can't breathe.
It took a death to create public policy, and even then it hasn't reached beyond a school district in this case. Roosevelt School District has implemented a flag program, modeled after a successful endeavor in California's San Joaquin Valley, that helps schools monitor air quality.
Each school flies an air quality flag: Green means the air is good, yellow is cautionary, and orange and red indicate poor to very poor air quality. Children are not supposed to play outside on orange and red days, and highly sensitive kids should stay inside on yellow days as well.
If the flag had flown the day of the fifth-grader's death, it would have been orange. The flag system may have prevented her asthma attack and saved her life, yet even now it's not mandated statewide, and it's up to individual Roosevelt principals and the superintendent to enforce it.
The state's not involved in such efforts at all.
As soon as she took office in 2003, Janet Napolitano gave Steve Owens, her newly appointed director of the state Department of Environmental Quality, an initiative to focus on children's health.
Owens and his staff at DEQ came up with the Children's Environmental Health Project. They kicked it off with a lot of hype at a press conference that April.
One month later, DEQ followed up with Arizona's first Children's Environmental Health forum, which pulled together policymakers, university researchers, private health advocates like the Arizona Asthma Coalition, parents, and teachers to talk about children's health and figure out what issues DEQ should focus on. There have since been two additional forums.
From the 2003 forum, DEQ developed four main goals: to fight environmental triggers of asthma, to improve air quality in and near schools, to address lead in drinking water, and to lower or eliminate the use of pesticides in schools.
Asthma was the Number 1 priority.
Lori Faeth, the governor's policy adviser for natural resources, agriculture and environment, says this is an issue Napolitano thinks is important.
"The governor is really committed to the children of Arizona, and obviously health issues with children has an impact on the ability to study, so she thought it was an important place to dig in," Faeth says. (Napolitano's deputy chief of staff Michael Haener said it wasn't necessary for New Times to talk to the governor about the issue, since Faeth had already been interviewed.)