Each year, the Asthma and Allergy Foundation of America declares May to be “National Asthma and Allergy Awareness Month.” Asthma is one of the most common chronic conditions affecting children and it continues to disproportionately impact children of color. In California, three out of four children are from communities of color. Children of color continue to face stark disparities in health – many attributed to the environment in which our children live.
Our health is connected to the many facets of our environment – from the air we breathe, to the food we eat, to where we live, learn, work and play. For communities of color that are disproportionately exposed to toxic conditions, such as poverty or poor living standards and air quality, addressing these social determinants of health can substantially improve health outcomes for children and families.
Nearly 1.5 million children in California have asthma. African-American children have almost twice the rate of asthma as white children (23% v 12%) and almost one in every three children of Pacific Islander descent is diagnosed with asthma. Latino and African American children make up two-thirds of children in California and yet they account for 91% of emergency department visits related to asthma.
The costs of asthma are also significant: In California, medical costs for childhood asthma, such as hospitalizations, ER visits and doctor visits amount to $460 million annually plus $233 million in indirect costs of parents’ lost wages due to children’s missed days at school.
Asthma can often be triggered by environmental factors such as toxic air quality, including the traffic pollution from freeways built near neighborhoods or the air inside our homes. For example, mold in the carpets or rodents in the living space or crawl space can trigger asthmatic episodes. Yet families who rent their homes may also have limited options to modify carpeting, mold, or other apartment conditions that impact the air quality of their homes.
Promising new health care models to address social determinants of health can play a role. Across the nation, study after study is showing that when in-home asthma triggers are assessed and remedied, asthmatics are less likely to need to visit the ER. Addressing in-home triggers not only has a tremendous impact on children’s asthma conditions with fewer missed school days and more symptom-free days, but also creates an astounding return on investment: For every dollar spent on in-home assessment and remediation, studies have found a resulting savings between $5 to $14 from averted asthma care!
In projects across the country, including in some California counties, physicians are prescribing to asthma patients an in-home assessment of asthma triggers when it appears that the patient’s condition is exacerbated by their in-home air quality. Community health workers are trained to identify in-home asthma triggers and, in turn, propose appropriate remediation, such as having moldy carpets removed, pest control or sealing up crawl spaces. In rental homes, tenant rights advocates can work with families to move landlords to make necessary in-home remediation.
In our state, the Let’s Get Healthy California Taskforce and Framework, which articulates a vision for California that advances health equity, includes the rate of asthma emergency room visits as one of its major metrics of health. California is also one of the first states in the nation to have an Office of Health Equity, whose mission is to promote equitable social, economic, and environmental conditions to achieve optimal health, mental health, and well-being for all.
At the legislative level, AB 391 is moving forward to adopt a statewide opportunity for Medi-Cal to cover trained community health workers to provide prescribed in-home asthma assessments for Medi-Cal children with asthma, which could identify potential environmental triggers for asthma while also reducing emergency room visits and state Medicaid costs. We are proud to join our partners RAMP and Children Now in advancing this effort. This is what smart policy for health equity looks like.
As advocates, we can help children and families by continuing to link conditions like asthma to their social and environmental causes and to promote health care solutions that address them. Let’s continue to work together so that children of color in underserved communities do not have to grow up dealing with asthma as a part of everyday life, but instead have the opportunity to grow and thrive in a healthy community and state.