The burning of fossil fuels – such as gasoline in cars, or coal and natural gas for electricity – is the root cause of a frighteningly broad range of illness and death as it pollutes the air and drives the accelerating climate crisis.

Once, while working an overnight shift in the emergency department during the spring, I saw a young girl with asthma. It was her third visit that week, and her small chest was heaving up and down as she struggled to breathe. As treatments began to open her daughter’s airways, the mother’s eyes began to fill with tears as she shared their recent challenges.

“I have done everything the doctors have told me – and she just keeps getting worse. What am I missing?”

The patient’s pediatrician and lung specialist had been following the latest medical guidelines, which left me asking: What have we been missing? As I outline further in The New England Journal of Medicine, I looked up my patient’s address and found that her home was in very close proximity to a highway. She had been breathing in air polluted by the exhaust of gasoline-burning vehicles during her young life.

Economic injustice and racism are behind why some communities have health-protective infrastructure – such as parks – and others, like my patient’s, have health-harming highways and industrial complexes. Research shows that low-income neighborhoods and communities of color have been disproportionately exposed to air pollution from nearly every emission source, independent of factors like geographic region.