How Bourbon and Big Data Are Cleaning Up Louisville

LOUISVILLE, Kentucky-Two years ago, Mary Ann Stansberry responded to an ad that popped up on her Facebook page asking for people to participate in an asthma study. A start-up company called Propeller Health was running the program, and it sent her silicon chips in sleeves to slip over her inhalers, and apps to put on her phone and laptop. The goal of the study was to track how often Stansberry and nearly 1,200 other residents of Louisville experienced respiratory distress, by tracking their puffs and correlating them with levels of pollution.

Studying asthma in Louisville made sense. It sits within a bowl of low hills around the Ohio River and has a notorious reputation for sooty air, Saharan heat islands and pollen-clogged skies that make it the fourth-worst city in the country for springtime allergies and asthma. For much of its history, the pollution has been a gritty badge of the city’s economic vitality, a sign that it’s dominant industries-rubber, chemicals and whiskey-were thriving even if it meant that coal dust shrouded the city like black fog. But over the past few decades, Louisville has also been a city with innovative approaches to that pollution, including the creation in 2005 of local air quality standards that are far stricter than those of the federal government.

The asthma project was called Air Louisville and it had arisen from inside the offices of Mayor Greg Fischer, a second-term mayor with a tech entrepreneur’s interest in data-driven decisions and a Democrat’s belief that environmental health is fundamental to economic growth.An aide to the mayor, Ted Smith, was newly arrived from the White House technology office. He brought an electronic Rolodex of start-ups including Propeller Health, an information technology company that used sensors, wireless gadgets and apps to give lung disease patients real-time feedback on their conditions while nudging them to properly use their medications. After a discussion with Propeller’s founder, Smith got an idea: He would organize a grand study to see whether Propeller Health could help Louisville asthmatics get better control of their disease. At the same time, he thought, the city could use data from patients participating in the study to help identify the environmental factors driving their symptoms to begin with. And that, in turn, might push the city leaders to take further action to clean up the air.

Stansberry, who sells commercials for TV station WBKI, emerged from the Air Louisville study feeling pretty good about it. Prior to the study, she had a severe asthma attack about once a year, treating it by going to the emergency room. They’d give her an adrenaline shot and put her on antibiotics and steroids, which, she said, “make your face flush and weaken your bones if you use them too long.” She hadn’t been back in the ER since the study began, and now she mainly got by with daily use of a single maintenance drug, a powder she inhaled from a small can. Stansberry also has an emergency inhaler with a different drug for severe attacks, but it’s best to control the disease with maintenance therapy. “Anybody on medication knows that you don’t like to take it, but if you’re an asthmatic you need to breathe,” she said. The app reminded her each week how often she had taken her maintenance drug. That information prodded her to take it every day, which reduced her symptoms, and her need for emergency medicine.

By the time the Air Louisville study wrapped up this summer, Stansberry was one of many people whom it had helped.On average, the participants ended the study using their emergency inhalers 84 percent less frequently than when they started, and they had, on average, twice as many symptom-free days. The study also showed a strong correlation between environmental factors like sulfur dioxide and ozone and episodes of asthma requiring emergency inhaler use. While previous studies looked at the “downstream” effects of pollution-hospitalization, death-the novel Louisville study was compelling because it demonstrated impacts in real time. “It showed the symptoms that people experienced as a result of the pollutants,” says Meredith Barrett, Propeller’s vice president for research. “And we showed that the threshold of impact is at far lower concentrations than where the current limits are.”

The data that Fischer’s administration gathered about the city were just as important. As expected, many of the asthma “hot spots” were located in the poor, industrial West Side of Louisville, but some were downtown or on the generally wealthier East Side. In a way, this changed the narrative, in theory making it easier to get broad support for action from the entire city. It provided local officials with hard datato solve concrete problems at a timewhen the role of science in policy making, at least at the federal level, is under threat.

In his office at Louisville’s ornate City Hall last month, on the day that the president announced he was canceling subsidies that have helped millions of poor people get insurance, Fischer said that for many mayors like him, the federal government’s antagonism to environmental regulation was an obstacle cities would have to steer around. “Cities are platforms for innovation: What other experiments and pilots could we run around the country to increase population health?” he asked. “We’re at a new point with these new tools we have to do this.”

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Fischer is less certain about what, exactly, should be done with the Air Louisville results, but he does have a few ideas. “Industry is one way. Reducing cars is another. Increasing our tree canopy,” he said. He’s running for a third term and his goal is to make Louisville an increasingly attractive, healthy city, one that serves its entire population including young, entrepreneurial people and the businesses that need them. He knows that a wheezing, red-eyed populace is no kind of advertisement for corporate relocation scouts.

Next year the city will embark on the $20 million Green Heart study, directed by an National Institutes of Health-funded University of Louisville professor. It will plant 10,000 mature trees in a south Louisville neighborhood, with assistance from the Nature Conservancy, then compare the impact of the trees on pollution and health with a comparable neighborhood that won’t get any plantings. Like Air Louisville, the project will rely heavily on community engagement. Local young people, some of them recruited through a community group called YouthBuild, will help plant the trees. The Air Louisville project, says Fischer, is “leading us forward in a virtuous way to get cleaner air quality and target either people or parts of our city that have unequal outcomes.” It helped “build horizontal trust in the community. We’re living in a time right now when certain elected officials are trying to destroy trust by pitting different groups against each other. You can’t build a great city or a great country that way.”

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“The air in Louisville has never been cleaner since the industrial age began,” says Tom Nord, spokesman for Louisville’s special air pollution control district, which was created in 1952. It’s come a long way since 1842, when Charles Dickens visited the city and observed buildings “smoky and blackened” from burning coal. As a Londoner, he wrote, he was “well used to that appearance, and indisposed to quarrel with it.”

It didn’t get better for a long time. Quite the opposite. The use of cheap western bituminous coal filled the air with black soot, which grew thicker as Louisville’s industrial base expanded.

A 1939 report, quoted in a 2008 article by engineer Sarah Lynn Cunningham, said Louisville’s air ranked the third dirtiest in the country. Neighborhood names said it all: Smoketown, Butchertown, Rubbertown. The federal government added to the problem by choosing Louisville as the site of three synthetic rubber plants during World War II. Bourbon distilleries cranked up production to make industrial alcohol for rubber. Eye-burning soot and sulfurous fumes obscured views of the downtown skyline, creating an uproar among shopkeepers and housewives over the befouling of storefronts, laundry and lungs. But King Coal held sway. A 1941 industry leaflet warned that a proposed cleanup ordinance and its proponents were enemies of progress, “far more dangerous and devastating than coal smoke.”

In the end, market forces and federal legislation cleared the worst of Louisville’s air problem. Railroads abandoned coal-fired steam locomotives and switched to faster, more efficient diesel power in late 1950s. Home heating switched almost entirely from coal to natural gas and oil by 1960. The creation of the EPA and the Clean Air Act of 1970 led the city’s utility company to pioneer technology that “scrubbed” stack emissions of sulfur dioxide, and Louisville was one of the first cities to require vehicle emissions inspection. In 2005, the air pollution control district adopted the nation’s first comprehensive air toxics regulation, the Strategic Toxic Air Reduction, or STAR program, with requirements up to 100 times more stringent than those of the EPA.

It would be nearly impossible to attribute any of the pollution remediation that has occurred in Louisville over the decades directly to citizen action. On the other hand, it was obvious that without citizen action nothing would ever have changed. One of the leading citizens for clean air today is Christy Brown, a philanthropist fixture of the Louisville environmental scene whose late husband chaired whiskey conglomerate Brown-Forman, a company whose stock has skyrocketed as Americans discover bourbon.

Brown’s non-profit, the Institute for Healthy Air, Water and Soil, provided seed money for Air Louisville and then oversaw the project with a $900,000 grant from the Robert Wood Johnson Foundation in 2015 (The mayor’s aide, Ted Smith had asked Brown’s institute to host the study because the foundation won’t fund government projects). Brown’s roots in the local business community are as deep as they get. But that doesn’t mean her environmental mission gets a free pass from other Louisville industries. “People who look like me don’t get the fact that if you have unhealthy air, you’re going to be unhealthy,” she says. “Someone like me is seen as a fanatic. Corporate people turn a deaf ear-I’m sure I’m in that category even with my children. But I’m working on my grandchildren.”

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One morning in October, Veronica Combs, the executive director of Brown’s non-profit, spoke before 15 business leaders in a top-floor conference room overlooking downtown. She had come to explain the asthma study and to make some recommendations about what could be done with the data it produced. Representatives from the chemical, bourbon and health care industries, an industry toxicologist and several lawyers listened carefully and politely, and took notes, as she described the evidence that air pollution was partly responsible for Louisville’s asthma problem. Some expressed admiration for her work, but the general mood was guarded resistance.

About 13 percent of Louisville adults had asthma, Combs said, compared to an 8-percent national rate. Asthma and COPD were the third and fourth leading causes of hospitalization. According to the Air Louisville data, concentrations of sulfur dioxide, nitric oxides and ozone could provoke asthma attacks at levels lower than the current EPA standards. She drove home the point with a striking piece of data: halfway through the study, the Louisville power company spent hundreds of millions of dollars to put state-of-the-art scrubbers on its biggest coal-fired plant, and switched a second plant from coal to methane fuel. The result was an 89 percent drop in sulfur dioxide at EPA monitoring sites. The impact on asthma appears to have been pretty dramatic, too, as Combs demonstrated with an eye-opening graph depicting declining spikes in asthma attacks following the plant modifications.

The business leaders’ questions reflected skepticism about the study, which, to be sure, had no control group and no information on the history of its patients, who were not recruited in a scientifically rigorous way. A lawyer who suffered from asthma herself stated that anyone using a rescue inhaler excessively was not being treated properly. Her comment pointed to the current received wisdom on asthma, which is that it can be well-controlled with good health care-indisputably true-and that it’s caused by a mixture of genetics, early immunological responses, and house-bound antigens like cat dander and cockroach feces (although previous studies have also shown a clear link to ozone). Air Louisville suggested that it was a bit more complicated. “The line on preventing asthma is, ‘Try not to be poor, try not to be black,'” says Ted Smith. “We found exacerbations on the east side of town, and air pollution was the most significant correlate.” And air pollution, more than cockroaches, for example, was something that the city’s business leaders were definitely in a position to address.

Combs explained that the rescue medicine is cheaper, which is why poor people are sometimes more inclined to puff their emergency inhalers until they get in trouble and go to the hospital. According to the study, the 33 days of last year in which Louisville exceeded EPA limits on certain pollutants resulted in $14.8 million in additional emergency room and hospital spending. “We’re not tree huggers at the institute,” she said. “We want to look at the data to figure out how we can improve health and save health care costs in our city.”

“Are you planning to ban diesel trucks?” asked a woman from one of the chemical plants which depends on those trucks to keep her operation going.

No, explained Combs, but it might be possible to create routes for trucks that lower the exposure of residents to their fumes. Combs, in fact, isn’t in a position to ask for anything definitive. She represents a non-government organization-albeit one with strong mayoral support. Her group also recommended increasing requirements for tree planting by developers, and thick tree buffers between busy roads and hospitals, schools and nursing homes.

Objectively speaking, there are some reasons to be pessimistic about Louisville’s environmental future. The city just spent $2.3 billion building two new bridges over the Ohio that bring new cars, traffic and pollution into the area. “No one calculated the health care costs of that many more cars and congestion,” Combs notes. The city just approved a big meat packing company’s request to park dozens of refrigeration truck trailers in its lot that will spew diesel combustion byproducts into a residential neighborhood near downtown. “We try to appeal to the city boosters,” Combs says, “‘Do you want to be known for Ohio Valley crud, or do you want to attract startups?'”

But last year’s budget for tree planting was $400,000. The mayor asked for $600,000 this year, but city council gave him $200,000. James Bruggers, the Louisville Courier-Journal ‘s longtime environmental affairs reporter, gave Fischer a “B-minus” on an environmental report card in March. Air quality was as clean as it had been for a long time, the report said, and toxic emissions from Rubbertown were down. But the city’s ozone levels were still slightly higher than EPA limits, and the city wasn’t planting trees as fast it it needed to.

To be sure, Louisville meets most federal pollution standards, though ozone proliferates on hot days, especially in the tree-starved heat islands in parts of the city. But the goals and focus of the environmental movement have expanded and changed in recent years. Just as health care increasingly focuses on the social determinants of health-all the things about being poor and disconnected that can make a person sick and harder to cure-social activists have increasingly concentrated on what might be called the environmental determinants of wealth.

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While cleaner than ever, Louisville’s air isn’t clean enough for Eboni Cochran, an alert 45-year-old who leads a coalition of West Side residents fighting for environmental justice.

Cochran, who was born in Louisville, spent part of her youth in Bloomington, Ind., while her father studied law there, and has a personal interest in air quality because of the 10-year-old son she homeschools in the house she owns near Rubbertown. Before she joined the campaign in 2003, she hadn’t particularly noticed the pollution, or read about it. But as she learned more she got angry. “It doesn’t seem just to me that the burden of clean air has to be put on the people impacted by it, rather than the people who cause it,” she says. Her group is suspicious of claims that the enormous chemical factories of Rubbertown-which have dramatically reduced the release of toxic chemicals over the past decade-aren’t still threatening the health of her community. She feels residents aren’t getting the full story, that chronic illness and cancers in the area are due partly to pollution. Her group’s activism-including speaking up at council meetings every week for more than a decade-has paid off with more attention to the cause, which is more about environmental justice than environmentalism per se.

In early 2016, her group helped crush a proposal to create a biodigesting plant that would have produced methane in the middle of a West Side neighborhood. The plant, which would have recycled waste from bourbon distilleries and other garbage, was backed by some environmental groups. “It was a tricky thing,” she said. The waste plant would have reduced landfill and saved money, but neighbors would have been exposed to increased odors and lowered property values–and even the threat of an explosion. “Some environmentalists only see the impact to nature and not to the people,” she says. “Our mortgage is going to be paid off in three years. When we pay this house off I don’t want to buy an RV. I want to be able to save some money to buy a place with cleaner air. I want to be able to sell my house.”

This year, activists focused on the American Synthetic Rubber Co., which sought a slight relaxation of the pollution control district’s standard for the release of 1,3-butadiene, an airbornecarcinogen, from its plant. It wasn’t much of a change; the company wanted to release enough butadiene to-according to a complex, statistically derived estimate-cause three excess deaths over 70 years, instead of the current standard of one excess death. The entire city council-with the urging of Cochran’s group-opposed the relaxation, but Fischer supported it and the pollution control district allowed it. The excess butadiene release was nearly impossible to control because trace amounts leak from thousands of fittings and joints in company pipes. Cochran doesn’t trust the companies’ reports; she notes the control district has abandoned some of the monitors it uses to measure toxics. From Fischer’s perspective, though, the company is doing the best that it can. “They are still in compliance with regulations that are stricter than EPA regulations.” And he suggests it wouldn’t be wise to push too hard. Theoretically, corporations could challenge the legal basis of STAR, which is “much harder-core than EPA. We haven’t had anyone do that yet.”

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A mayor has many constituencies and a lot of responsibilities. A cleaner city will encourage people to move in with their families, to eat at the chic new cafes opening downtown, to work in health care and tech. But you can’t chase off the older industries, like chemicals and like bourbon, an $8.5 billion business last year. Kentucky distilleries sold four times more bourbon last year than in 1999, and bourbon tourism-“Bourbonism,” Fischer calls it- has brought millions to the city, creating its first year-round source of tourism. “A bourbon a day,” he likes to say, “keeps the doctor away.”

For the mayor of a medium-sized city, would it really be worth the risk of alienating a rubber company that employs 350 workers, when most of the city-and a just-announced GOP challenger, Councilwoman Angela Leet-were focused on problems like opioids (not as bad as in some parts of Kentucky, but bad enough), and violence (not like Chicago, but bad enough)? In announcing her candidacy, Leet said, “We have an important decision to make. We can either keep building bike lanes, or we can begin building a better city by solving the tough issues.”

Although they’re theoretically pulling in the same direction, it’s almost as if the mayor and his left flank are living in parallel realities. Neither Cochran nor other activists seem more than distantly aware of the Air Louisville project. One exception is Martina Kunnecke, a writer and local activist, and she saw it as a waste of time. “They think it’s so great to do a study about where people are having asthma attacks. We know where they’re having asthma attacks. But absolutely no effort is being given in this city to improve the conditions that are causing it,” she says. “They substitute spin for actually moving the needle on some of these problems.”

On a tour of West Louisville, graduate student Dwan Turner, a research assistant to John Gilderbloom, an activist University of Louisville urban affairs professor, points to the continuing blight that troubles many residents. We drive through Rubbertown, where the pond in a local park carries warnings against eating the fish in it. Two major Superfund sites are located smack in the middle of West Louisville; one of them, the former Black Leaf Pesticide Co., sits on a hill, protected with a rusty fence in the middle of a residential area. Not far away is the Heaven Hill whiskey distillery and a 10-story Brown-Forman warehouse full of oaken barrels of aging whiskey. Some of the alcohol evaporates and settles on surrounding buildings. The Angel’s Share, as this evaporate is known, has the odd quality of serving as an excellent growth medium for Baudoinia compniacensis, a black fungus that covers the sides of nearly every house in the area.

Turner is a distant relative of Louisville’s most famous son, Muhammad Ali, and he points out a small house on Dumesnil Street, in the California neighborhood, where Ali’s grandfather lived and the boxer was a frequent visitor as a child. The pale yellow dwelling, now abandoned, sits halfway between the Superfund site and the whiskey warehouse, and it’s covered with black scum. According to Zillow, the house is worth about $26,000-a decline of 5 percent from a year ago. There’s no evidence that the Angel’s Share or Baudoinia cause any human health problems-a judge recently threw out a 6-year-old class action lawsuit against the distilleries in Louisville–but they don’t do much for property values. And that has its own impact on health in a neighborhood that has shootings but no supermarket.

“Everyone tells us there’s no harm from these factories, but the people on the East Side wouldn’t stand for them,” says Cochran.

On the other side of town, Christy Brown, the wealthy philanthropist who feels lonely in her social class, acknowledges that Air Louisville leaves many questions but not a lot of answers. As to what comes next, she responds, “Each one of us is the problem. We should be asking the corporations, the community and the mayor, what are the learnings and the next steps.” Brown is a major shareholder, though not an officer, in Brown-Forman, and she has talked to company officials, she says, about the distilleries and the fungus they create. “That’s part of what I’m saying, about each of us being part of the solution.”

Fischer sees things very much the same way. “Americans haven’t always been that responsible about their own health, but a city or state can try to look for environmental aspects of health as well,” he says. “We spend 18 percent of our GDP on health care, twice most of our competitors who cover everyone and get better results. We have to get our act together. And the environment is part of that.”

Arthur Allen is eHealth editor at POLITICO.

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