It’s happening again. Another outbreak of Legionnaires’ disease in New York City — this time in central Harlem, where 73 people have fallen ill and three people have died, according to the NYC Department of Health as of August 7, 2025. Officials believe the likely culprit is a cooling tower — those big rooftop structures that help regulate temperature in buildings but can become deadly if they aren’t properly cleaned and maintained. When they’re contaminated with Legionella bacteria, they can spew mist into the air, carrying an invisible, lethal threat into the streets below. But if you’ve followed Legionnaires’ outbreaks over the years, you’ve probably noticed a disturbing trend: they often strike in the same kinds of places. Neighborhoods like the South Bronx. Harlem. West Philadelphia. Flint. Places where aging infrastructure, under-resourced public health departments, and systemic inequality intersect. And it’s not just anecdotal. A major review published in Current Environmental Health Reports — “Racial Disparities in Incidence of Legionnaires’ Disease and Social Determinants of Health: A Narrative Review” — lays it out clearly: Black Americans are more likely to be diagnosed with Legionnaires’ disease than white Americans, and those disparities track closely with broader patterns of environmental and socioeconomic inequality. It’s not race that increases risk. It’s racism — and all the broken systems that flow from it. Legionnaires’ disease doesn’t discriminate biologically — anyone can breathe in aerosolized Legionella and fall ill. But not everyone lives in a building with a functioning water management plan. Not everyone has a landlord who cares enough (or is legally required) to maintain cooling towers. Not everyone has easy access to health care, or a doctor who knows to test for a rare bacterial pneumonia instead of dismissing it as the flu. The review article highlights housing quality, chronic disease prevalence, access to care, and historical disinvestment as key social determinants. In other words, the same reasons Black communities have higher rates of asthma, hypertension, and COVID-19 are also driving higher rates of Legionnaires’. Let’s be honest: Harlem didn’t become a hot zone for Legionella by chance. After a major outbreak in 2015, New York City passed what was hailed as the strongest cooling tower regulation in the country — requiring registration, routine testing, maintenance plans, and penalties for noncompliance. And yet, here we are again. The law exists. The bacteria persist. That’s not a legislative failure — it’s an implementation failure, a monitoring failure, and perhaps most of all, a justice failure. Are cooling towers in wealthy Manhattan neighborhoods being checked more regularly than in Harlem or the Bronx? Are violations being enforced equitably? Are landlords in marginalized communities simply allowed to keep cutting corners because they think no one will notice? Here’s what public health professionals already know (and what the general public should hear more often): Legionnaires’ disease is preventable. That means every new case is, in some way, a policy failure. A systems failure. A human failure. The Harlem outbreak — like the ones before it — is more than a microbial problem. It’s a mirror. And the reflection it offers is uncomfortable. It shows us that the neighborhoods most at risk are often the ones most ignored. That building codes, like civil rights laws, are only as good as their enforcement. That public health must do more than track bacteria — it must confront the structural racism that allows certain communities to get sick again and again. If Legionnaires’ disease is the canary in the coal mine, then Harlem’s outbreak should set off every alarm. Because until we stop pretending this is just about cooling towers — and start treating it as a matter of environmental justice — we’ll be right back here next summer. And above all, listen to what the science and the people in these communities are already telling us: this is preventable — and we can prevent it.Where You Live Shouldn’t Make You Sick
Policy on Paper vs. Policy in Practice
A Public Health System That Doesn’t Account for Inequality Isn’t a System at All
What can be done?
