When Olga Santana’s 7-year-old daughter, Emma, had trouble breathing during a serious asthma attack—something that would happen about every three weeks—she would take her to the emergency room for costly treatment. The visits to the hospital stopped, however, when Santana, a mother of six, made a few changes to her home that made a big difference to her daughter’s health. She swapped her rug for a mat and switched out drapes for blinds to minimize particulates in the air. She also made the house fragrance-free and hypoallergenic. “The last time she went to the hospital was eight months ago,” Santana says.

Santana knew what changes to make after Maria Garcia, a community health worker with the Long Beach Alliance for Children with Asthma, came to her door last year. For more than a decade, Garcia has been one player in a dedicated network of local government agencies, childrens’ clinics and community health organizations in Long Beach that have been tenacious—and successful—in identifying and treating the disproportionately high number of residents who suffer from asthma in the seaside city. Now, their main source of funding, the Port of Long Beach, is drying up, even as air quality in the Los Angeles-Long Beach area was rated among the worst in nation, according to the American Lung Association’s 2015 State of the Air Report.

The pollution is incongruous with the city’s idyllic palm trees and blue-green surf. Poor air quality is one trigger for the symptoms of asthma, a chronic disease characterized by inflammation of air passages that temporarily narrows the airways that carry oxygen to the lungs. In Long Beach, 14 percent of residents suffer from asthma, compared to 12.5 percent in Los Angeles and 8 percent in the U.S., according to a 2009 assessment by the city’s health department. People of color and low-income communities are hardest hit. Rates of asthma-related emergency department visits, hospitalizations, and mortality are 2 to 4 times higher, for example, among African Americans than among non-Hispanic Whites, Long Beach Health Department statistics show.

City health officials have long been clear about the cause of the disparity. Diesel truck fumes from the Port of Long Beach—one of the busiest shipping ports in the nation—combined with truck corridors, rail yards, oil refineries, and the steady stream of exhaust from the 710 and 405 freeways, hike the region’s ozone, smog and fine particulate matter to unacceptably high levels.

Renee Moilanen, the Manager of Air Quality Practices for the Port of Long Beach, said they voluntarily established the Clean Air Action Plan in 2006 to address this problem on two fronts. To mitigate the effects of pollutants by reducing dangerous emissions generated by cargo ships, equipment, tugboats and trucks, the Port improved their inventory, tracking every piece of equipment operating nearby. Since 2005, port-related diesel particulate matter has dropped by 85 percent, according to a 2014 report. The second prong of their plan was to award $6 million in grants to fund wide-ranging approaches to improve health care and treatment for asthma. The funds expanded time-tested efforts by childrens’ clinics and deployed hundreds of home health aides to go door-to-door to transform indoor air quality, one home at a time.

Moilanen says there will be continued investment in environmental air quality improvement but it’s unclear what shape that will take down the line. She says they are working on a study that would evaluate potential effects on air quality, public health and maybe noise and traffic and identify what share of the pollution emits from the port (versus the railyards and refineries) before they decide what kind of grants will be the most effective.

The CAARE program, which served thousands of adults with asthma so far, has yielded significant results. After completing between 2 and 4 home visits, 61 percent of clients no longer visited emergency departments for asthma care and 52 percent of the clients no longer missed any days of work, according to city environmental health officials. When Long Beach built on that model and launched the Asthma Life Skills Academy for Adults, funded through 2014 with a $798,000 grant from the Port, they had similar results. For example, reliance on emergency and inpatient services for treatment of acute asthma symptoms declined by more than 90 percent.

“Asthma is the leading cause of work absenteeism and loss of productivity,” says Judeth Luong, who manages the city’s Environmental Health Bureau’s asthma programs. “Clients are getting the message that it’s chronic and they have to keep it up. This empowers them to let them know they have tools and they can do this.”

Sylvia Betancourt, Project Manager for Long Beach Alliance for Children with Asthma, is proud that their efforts have gone a long way to help alleviate suffering. Their partnership with the Children’s Clinic in Long Beach, which received an $825,000 grant from the Port, has been a productive collaboration between health educators, physicians, community health workers and families at six clinic sites around the city.

Sustaining those efforts is critical, Betancourt says. “There is a reduction of pollution at the Port, but there will also be a larger number of containers being pulled through the neighborhoods,” she says. “The Port of Long Beach has made huge efforts in the way they operate and engage the community, but there’s work that needs to be done.”

“We want to get the point where families can play at the park, in playgrounds and schoolyards and not have to worry about diesel fumes from trucks going by,” Moilanen says. “The ideal would be that our local community can enjoy the economic benefits of the Port without suffering the public health and environmental consequences. We have room to go but we are on our way.”