Decades in crisis: adapting a social-ecological framework to assess structural elements impacting asthma rates in the South Bronx

Disturbingly high rates of asthma-related hospitalizations have been documented in the South Bronx for several decades. The crisis has been typified by structural violence, health inequity, and disproportionate exposure to environmental harms, with the disease burden of poorly controlled asthma falling primarily on socioeconomically vulnerable racial and ethnic minorities. This review adapts the Social-Ecological Model (SEM) as a theory-based framework to critically analyze disparities in asthma care and control in the South Bronx. The analysis is grounded in historical considerations of structural violence, particularly the legacy of brownfields, toxic dumping, backroom politics and social arrangements that perpetuate disparities in medical care and health. This model can guide the development of multi-level interventions, including the sustainable medical management of asthma, particularly in the context of the ongoing asthma crisis in the South Bronx and its more recent disastrous overlap with the COVID-19 outbreak that has devastated New York City