Santana Hudson, a 3-year-old boy from a low-income family in the Midwest, suffers from chronic asthma. The normally active young boy stops like clockwork every four hours to sit down and inhale asthma medication. If a dose is missed, he likely will end up in a trip to the emergency room, which for him, are frequent. Santana lacks a primary care doctor, and like many other children, he is left with one option for treating severe asthma attacks—to call an ambulance.
Asthma impacts roughly one in 12 Americans. It’s so common that its severity is often underestimated. But for some, like Santana, asthma can be so debilitating that it interferes with daily activities and can lead to life-threatening attacks. While asthma affects all ethnic groups and levels of socio-economic status, it disproportionally impacts low-income, minority and inner city populations.
What accounts for this inequality?
The main factor leading to the health disparities in asthma is poverty and the resulting exposure to environmental and lifestyle risks. Exposure to asthma triggers—including cigarettes, allergens, indoor and outdoor air pollution, viral respiratory infections due to crowding, and stress—are greater in poorer neighborhoods.
Further, the cost to care for asthma is a burden for low-income families. Researchers found that the direct cost of asthma can run about $3,259 annually. With other basic needs taking priority, preventive care and medication to treat asthma may not be financially feasible. And for these low-income families, modifications to living areas to reduce the asthma triggers, such as removing carpet and fixing leaks, are often not an option.
While preventative care will help individuals better manage their asthma, to truly improve the health of those who suffer from asthma, healthcare must go beyond traditional methods. To keep individuals and children, like Santana, from returning to the emergency room regularly, the social determinants of health must become an area of focus. For asthma, this means the environmental conditions, including suitable housing, replacing carpets, improving ventilation, and removing household mold.
Boston Children’s Hospital started a program to tackle just that. As part of their Community Asthma Initiative, Boston Children’s Hospital hired bicultural community health workers to provide case management and home visiting services to families frequenting the emergency room for asthma attacks. The community health workers didn’t just coordinate care, they met with landlords, property managers, and the public housing authority on housing code violations such as pests and mold; they provided parents smoking cessation resources; and they even arranged for families to receive allergen-proof bedding encasements and air purification systems. This comprehensive approach provided all of the education and community resources families needed to improve their health. After a year, the program saw significant decreases of asthma-related hospitalizations, emergency room visits, and missed days of school. In fact, there was nearly an 80% reduction in hospitalizations among the children enrolled.
The key to better health for many suffering from asthma isn’t a new breakthrough treatment, and it certainly isn’t constantly calling the ambulance. Instead, it’s understanding what triggers asthma attacks and improving the environmental and social conditions. By connecting families with the resources they need to address the social determinants of health, health disparities in asthma can be reduced, and children like Santana can start to live life freely again.
At Healthify, we are focused on coordinating services with community resources in order to better address the social determinants health. If you’re interested in learning how, please contact us below!