In February 2022, 7-year-old Cayden Dillon was playing with other kids in his kindergarten class.

“His gym teacher had started to notice that he was having trouble breathing,” said his mother Tracy Dillion. “They ended up calling 911 because they just didn’t know what was happening or if it was something bad.”

Cayden was rushed to the emergency department by ambulance.

“They gave him some kind of steroid to keep his airway [open] so it wasn’t so hard for him to breathe,” said Dillon, who called the ordeal “very scary.”

When he arrived at the hospital, Cayden was officially diagnosed with asthma.

Dillion and her children live in Slavic Village on Cleveland’s southeast side, in the same five-bedroom home where she was raised in the 1990s.

Cayden's mother, Tracy Dillon, said she is in the process of getting the family’s home tested for mold and other allergens, but had trouble accessing home inspections free of charge.

The home has been in Dillion’s family for nearly 50 years, and she has lived there her entire life. Now, she’s raising her own kids — Tavion, 10, Cayden, 7, and Neveah, 6 — in the same house.

The Dillons are very familiar with asthma: All three children have it. They're not the only ones in the neighborhood struggling to breathe.

Children living in Slavic Village face some of the highest childhood asthma rates in the nation — regardless of race or ethnicity. But there are other Northeast Ohio neighborhoods where the asthma rates for kids are nearly as grim.

Brenda Lee Elkins-Wylie grew up in Cleveland's Hough neighborhood. In the 1960s, she often watched kids play outside the one-bedroom apartment where she lived with her mother. Her asthma symptoms were so severe that she was often stuck indoors, she said.

Brenda Lee Elkins-Wylie stands on the sidewalk near the home she rents in Cleveland’s Slavic Village neighborhood with her cat and two dogs.

“One year, I missed two months of school,” she said. “It was really hard at times.”

About 30 miles south, Tee Tee Bonnie, who grew up in Akron's North Hill neighborhood, sometimes wakes up in the middle of the night wheezing and reaching for her inhaler.

Before moving to Akron’s Summit Lake neighborhood, Bonnie, who is now in her 30s, lived with her mother in a century-old house in North Hill, where dust, cigarette smoke and lack of ventilation triggered “terrifying” asthma symptoms.

“I started getting chest pains and real shortness of breath,” Bonnie said, describing one particularly frightening asthma attack she had during middle school. “It was hard to breathe, and I started wheezing.”

People who live in Hough and Slavic Village in Cleveland and North Hill in Akron are more likely to suffer from asthma than the national average — which is about 8% among adults, according to data from the University of Richmond and the Centers for Disease Control and Prevention.

But higher asthma rates are not all the neighborhoods have in common. Parts of each were likely redlined more than a century ago, Home Owners Loan Corporation (HOLC) maps show.

In the 1930s, a federal agency called the Home Owners' Loan Corporation created color coded maps of neighborhoods in nearly 250 cities across the country. These maps reflect the thinking behind housing policies that denied credit and encouraged disinvestment in Black, immigrant and poor neighborhoods now known as 'redlining.' HOLC rated neighborhoods from A, green, 'best' to D, red, 'hazardous.' This map shows the grades given to Cleveland neighborhoods.

Instituted in the 1930s, redlining is a discriminatory lending practice used to refuse home loans or insurance in any neighborhood deemed to be a high financial risk. Because neighborhoods, where Black people and other people of color lived, were devalued, the practice often resulted in a lack of resources for predominantly Black and immigrant neighborhoods.

Ultimately, HOLC's maps were not used to deny people mortgages based on race — but they informed real estate practices at the Federal Housing Authority and private banks and mortgage lenders that did, historians say.

At least two studies, one in California and another in Pittsburgh, have suggested there is a connection between living in a neighborhood that was subject to redlining in the past and an increased likelihood of suffering from asthma today.

In terms of asthma, the situation is particularly acute in Slavic Village, according to data collected by the Better Health Partnership, a regional health collaborative.

About 28% of Black children living in the Broadway-Slavic Village neighborhood have been diagnosed with asthma. That’s more than twice the national average for Black children, according to U.S. Department of Health and Human Services’ Office of Minority Health and more than 3.5 times the CDC’s national average.

This block of older homes is located in Cleveland’s Slavic Village neighborhood, where Tracy Dillion and her three young children all live with asthma symptoms.

The Pittsburgh study also concluded that redlining contributed to long-term environmental and asthma-related inequities that disproportionately affect Black residents.

“We directly link racist loaning practices more than 80 years ago to the maintenance of poor environmental quality in the most redlined neighborhoods today,” said lead author Alexander Schuyler, an M.D. and Ph.D. student in Pitt’s Medical Scientist Training Program. “Our data, in turn, connects the higher pollution exposures to worsened asthma outcomes. In short, institutional racism — not race-based biology — is why many Black Pittsburghers experience severe asthma.”

Today’s children continue to suffer from yesterday’s problem

Elkins-Wylie, who grew up in Hough, now lives in a single-family home with her cat and two dogs in Slavic Village. Dr. David Margolius, director of Cleveland Public Health, used to work at a MetroHealth Clinic on Broadway Avenue in Slavic Village, not far from where Elkins-Wylie lives now.

“I think any visitor to Slavic Village and Broadway would be struck by the amount of industrial and commercial traffic that is all around you,” said Dr. David Margolius, director of Cleveland Public Health, who used to work at a MetroHealth Clinic on Broadway Avenue in Slavic Village, not far from where Elkins-Wylie lives now.

Margolius pointed to recent studies that suggest a link between living near freeways and both increased incidents of asthma and reduced lung function.

Cleveland's industrial valley lines the banks of the Cuyahoga River between Cleveland's Tremont and Slavic Village neighborhoods. As far back as the 1930s, air pollution created by industry close to the neighborhood was noticeable.

For Black children, the outlook is even worse, often triggering other negative health outcomes as they grow, Margolius said.

Dr. Kristie Ross, chief of the pediatric pulmonary division at University Hospitals’ Cleveland Medical Center, focuses on children with asthma and sleep apnea in her practice — conditions Ross says are “plagued” by health disparities.

Families in historically redlined and impoverished neighborhoods are facing a “perfect storm” when it comes to environmental factors harming their health, she said.

In the late 1970s, Elkins-Wylie moved from Hough to Lakeview Terrace, a neighborhood that was also redlined, HOLC maps show.

Positioned between the reinforced bank of the Cuyahoga River and the West Shoreway freeway, Lakeview Terrace was one of the first federally-funded public housing complexes in the nation.

Surrounded by industry, poor air quality has been an issue for Lakeview residents for decades. Today, the neighborhood’s asthma rate is nearly 12%, University of Richmond data show.

Smoke discharges from a large vent in Cleveland’s Industrial Valley, where heavy industrial pollution has historically affected residents in the adjacent Slavic Village.

Elkins-Wylie's struggles with asthma are not unique in Cleveland. Cleveland ranks first among the five major cities that make up the Ohio Valley Asthma Belt — with higher asthma rates than Columbus, Dayton and Detroit, according to the Asthma and Allergy Foundation of America’s 2021 Asthma Capitals report.

Today, Elkins-Wylie says several of her adult children also live with asthma.

Nationally, Cleveland ranks sixth in the nation on the Asthma and Allergy Foundation’s list of “asthma capitals,” where living with and managing asthma symptoms is most difficult and expensive.

The environmental factors people experience growing up affect the likelihood that they will develop asthma, explained Ross.

“All of those things, whether it’s toxins from air pollution or toxins from stress, that exposure impacts the way the genes are expressed at the genetic level,” she said. “Not just the DNA you’re born with, but how it gets turned on.”

How did we get here?

In the 1930s, the Home Owners Loan Corporation (HOLC) began to research what the financial risk was like for bankers and other real estate professionals in Cleveland's Slavic Village.

The environment wasn't great. The area was “detrimentally affected by smoke, soot, fumes and dirt,” according to a description card of the neighborhood created by the HOLC sometime in the 1930s.

Search our interactive map based on HOLC maps to see how different Cleveland communities were described. Click on your neighborhood to see the original HOLC description card.

Further concerning to the authors of the description cards, were the kinds of people who lived in the neighborhood.

About 70% of the Slavic Village neighborhood was Polish immigrants, according to the card. And although they kept up their lawns and trimmed their shrubbery, the "limited income of these residents leaves much to be desired in the renovation."

This description card from the Home Owners Loan Corporation describes part of what is now Slavic Village on Cleveland's southeast side. There were no Black people living in the neighborhood, but the area was given a "hazardous" rating because the majority of residents were "foreign" low-income factory workers and the area suffered from a high level of pollution, the card shows.

HOLC gave the neighborhood a D rating. The area was "hazardous" for mortgage lenders and banks, it determined.

On HOLC’s maps, neighborhoods fall in one of four categories: Neighborhoods that were coded green for “Best,” were given an A rating. B neighborhoods are blue for “Still Desirable,” C neighborhoods are yellow for “Definitely Declining” and D neighborhoods red for “Hazardous.”

Black and immigrant neighborhoods were often deemed "hazardous" risks, which led to decades of disinvestment, according to the University of Richmond.

Today, Black Americans are still more likely than white Americans to live in historically redlined neighborhoods, data journalists have found. In Northeast Ohio and across the country, those areas are often plagued by aging homes and higher levels of air pollution that can make asthma and allergen triggers like mold, dust and lead paint nearly impossible to manage, according to public health experts.

During the mid-20th century, white Clevelanders moved out of the city core, in some cases heading further east to suburbs like Maple Heights and Shaker Heights, both coded blue or green for “Best” and “Still Desirable" on the HOLC maps, historians say.

Black residents, however became more concentrated in older neighborhoods. By the mid-1960s, about 90% of Black Clevelanders lived in a cluster of redlined neighborhoods on the city’s East Side, according to Cleveland Historical, a project by Cleveland State University.

In the 1940s, a highway cut through the Cedar Central neighborhood, which drove many of the Black residents who lived there into Hough. As Hough's population exploded, city officials failed to enforce housing codes meant to keep residents safe and healthy, according to Cleveland Historical:

“Vacant homes deteriorated, becoming hazards to the community and breeding grounds for vermin. Even as Hough’s physical condition declined, residents were regularly charged high rents due to the limited housing options available to the Black community in Cleveland and the refusal of suburbs to accept Black residents.”

Elkins-Wylie, who grew up in Hough and now lives with asthma, remembers the apartment where she lived falling to pieces and overrun with pests and rodents.

“I remember seeing the rats come out from a hole under the sink," she said. "I was so scared. I used to cover my face, but once I felt something run across me. I was absolutely terrified.”

Today, she said doctors have linked her childhood exposure to pest and rodent droppings, mold and other household environmental factors to many of her lifelong allergies — which often trigger or intensify asthma symptoms, making the diagnosis more difficult to treat and manage over time.

“The allergies upset the asthma,” Elkins-Wylie said. “When you’re around mold, dampness, rats, mice or roaches, that’s going to affect it.”

Before she signed the lease for her current home in Slavic Village, Elkins-Wylie said she checked everywhere for evidence of rodents, cockroaches and other pests.

The pattern of white flight repeated itself in the Slavic Village neighborhood too. The former Polish enclave is today a predominantly Black neighborhood — about 50% of residents are Black and 8% Hispanic, according to the Center for Community Solutions. About two out of every five residents live in poverty.

Tracy Dillion said it’s not easy to live with asthma or to care for children suffering from the disease — and it’s not cheap either. When her son was rushed to the hospital because of breathing problems the out-of-pocket cost for the ambulance ride was about $700.

The pattern also played out in Akron’s Summit Lake neighborhood, where summer cottages for the wealthy have now become year-round homes for people with lower incomes.

“In terms of air quality, we’re doing great,” said Sam Rubens, a longtime lab analyst for the Akron Regional Air Quality Management District. But the health risks posed by the aging housing stock is concerning.

Summit Lake was originally built as summer homes for the wealthy. They moved out when the area became polluted. The homes are now year-round residences for people - many of whom have low incomes, said Sam Rubens, a lab analyst for the Akron Regional Air Quality Management District.

“The houses in Summit Lake were never meant to be year-round,” Rubens said. “They were all just summer houses for the rich. When everybody moved on and the rich people moved out to the west side and they stopped using Summit Lake because it became too polluted, [the houses] became year-round residences for people with low incomes.”

What can people do now?

Sue Cummings fights asthma with vacuum cleaners, dehumidifiers and HEPA air purifier units, furnace filters and mattress and pillow covers.

Cummings is the director of Summit County’s Managing Asthma Triggers at Home (MATH) program and has worked in public health for 20 years. Her program operates in partnership with Akron Children’s Hospital and currently serves about 400 of Summit County’s most vulnerable pediatric asthma patients.

She said she has seen the difference simple asthma mitigation strategies can make firsthand.

Search our interactive map based on HOLC maps to see how different Akron-area communities were described. Click on your neighborhood to see the original HOLC description card.

MATH follows high-risk patients and their families for a year, providing in-home assessments, helping with mitigation strategies and providing valuable resources like those vacuum cleaners and other appliances free of charge.

“My families are [living in] poor housing stock. Typically, it's older homes, and the older homes have issues,” Cummings said. “They have basements that leak that create mold or mildew. They have lead paint.”

Cummings, who is also a healthy homes specialist and lead paint risk assessor for Summit County, said lead often produces a fine, toxic powder that can affect lung and brain health when ingested.

“Often what we see with [lead paint] is a dust issue,” Cummings said. “As these houses fall into disrepair and you open and shut windows, you cause friction and friction creates dust [that] falls on the floor and the kid’s pacifier falls on the floor or the toys fall on the floor or they crawl on the floor and put everything in their mouth.”

Now in its third year, Cummings also said data collected via the MATH program has proven that simple asthma mitigation strategies were effective in reducing hospital visits and healthcare costs for families of pediatric asthma patients — potentially by thousands of dollars per year.

“I am actually making a difference to these kids,” Cummings added, noting that when asthmatic kids are able to sleep, play and learn without being interrupted by asthma symptoms, their quality of life can improve drastically.

In Cleveland, the regional nonprofit Environmental Health Watch (EHW) is also working to create safer and healthier living environments.

Executive Director Kim Foreman said asthma mitigation has been part of EHW’s mission since the organization was founded in 1980.

Like the MATH program, EHW previously distributed resources like vacuum cleaners, dehumidifiers and mattress covers through the Healthy Homes Assessment Service pilot program. EHW currently does not offer that program to the public, as it is looking for a new managed healthcare organization to work with and additional funding, but Foreman said the program did help families identify asthma triggers and other health-related issues in the home.

A recent $67 million contribution to the Lead Safe Cleveland Coalition from the city of Cleveland and the Cleveland Clinic may possibly help expand the Resource Center’s Work, Foreman said.

While installing air purifiers in homes helps individuals improve their environment, the U.S. needs higher air quality standards to address the systemic problems that are worsening people's asthma symptoms and shortening their lives, said Yvonka Hall, executive director of the Northeast Ohio Black Health Coalition.

This older home in Akron’s North Hill neighborhood show signs of deterioration. Living in an older home can contribute to breathing problems in residents because of exposure to mold and lead.

Her organization recently asked the Office of Management and Budget (OMB) at the White House to raise standards to cut pollution that aggravates asthma, chronic pulmonary disease and COVID among all people — but especially among Black Clevelanders, Hall said.

"We know that the African American community faces greater health risks even when they meet standard health risks," she said. "The standards are so low that we’re being poisoned. We have to raise the standards."

Redlining’s legacy is certainly part of that, Hall said. But the air quality problem is personal and affects everyone.

"When we look at the historical picture around redlining and how African Americans are dying, we have been redlined to death," she said. "We have been put in situations that are beyond our control that have affected how long we live. We have been forced into these toxic communities that are costing our lives."

Since 2016, life expectancy has fallen for all Americans, but Hall said that African Americans lost five years.

"When we started doing this work they said, 'These kids are going to be the first generation that won't live longer than their parents,'" she said. "But, hell, nobody said it was going to be me. It’s you."

While public health experts and policymakers across Ohio work to create systemic solutions to address the problem, Dillion is doing everything she can to help her kids cope.

Tracy Dillion and her children live in the Slavic Village house her grandmother purchased in 1975. All three of Dillon's kids have asthma.

After Cayden’s diagnosis, she worked with doctors to develop a care plan that includes two separate inhalers: one Cayden uses twice daily and another for emergencies — when he can feel an asthma attack coming on.

Dillion said she’s also in the process of getting the family’s home tested for mold and other allergens but had trouble accessing home inspections free of charge.

Nearly 50 years after Dillion’s grandmother purchased the home in 1975, a few storm windows are cracked in their frames. At the corners, the siding has peeled away to reveal the layers beneath it.

“When Cayden was born, on the papers from the hospital, they said he had issues with his lungs,” Dillion said. “But I didn’t know that. Nobody ever told me that.”

Today, Cayden’s asthma symptoms are under control in large part because he has access to the daily medication he needs. But it’s not easy to live with asthma or to care for children suffering from the disease — and it’s not cheap either.

While Dillon’s children’s insurance covers their treatment, she has to pay out-of-pocket for her own inhalers and medicine. Plus, ambulance transport for her son can cost almost $700 out-of-pocket.

“Like with medical bills, yeah, they’ll give you time to pay them, but if you don’t pay them on time they’re continuing to send bills,” Dillon said. “It’s a day-to-day struggle.”