The voices of Urban Institute's researchers and staff
October 14, 2013

Asthma in D.C. is a problem of poverty

October 14, 2013

I am an asthma mom—both of my kids developed asthma when they were babies, so the challenges of asthma management have been part of my life for more than 20 years. My daughter, now 16, has severe asthma—the kind that can land kids in hospitals if it is not well-controlled; my son was also severely ill when he was an adolescent.

Managing asthma effectively requires following daily medication regimes and paying attention to a host of environmental triggers. I am intimately familiar with inhalers, nebulizers, nasal sprays, the various pills, and the side effects of steroids and albuterol—not to mention juggling work, sick children, and frequent doctor’s appointments.

But one thing I have never experienced is a terrifying trip to the ER with a child who is barely breathing, something that poor families in D.C. and other cities experience all too often. As the article in yesterday’s Washington Post makes clear, poverty is the main reason that poor children end up hospitalized for asthma.

The Post piece grew out of a project we are collaborating on with Children’s National Medical Center’s (CNMC) Asthma Clinic, a unique effort to provide education and support to every family that comes to the ER because of asthma. Through this program, IMPACT DC asthma educators work with families to teach them about asthma, how to take medication, and what they need to do to help their child stay healthy.

But even this state-of-the-art program does not always work to keep kids out of the ER. As the article states, a major reason is poverty. Language and literacy problems mean that low-income patients require more time and ongoing support than the well-educated and affluent (like me), but the inequalities of the medical system mean that they usually get less time and less access to specialists.

Most of the asthma specialists like the ones my kids see are located in either Northwest D.C. or the suburbs, not in the communities east of the Anacostia River where most of the poor, mostly African-American children who come to CNMC’s ER live.  While D.C. provides health insurance for nearly all children, not all providers accept Medicaid or State Children's Health Insurance Program (SCHIP). The community providers who see poor children do not have the time it takes to really educate their patients about asthma or to ensure they truly understand how and when to take their medications. Finally, poor children are more likely to be exposed to the environmental triggers that can exacerbate asthma—caregivers who smoke and apartments that have problems with mold, roaches, and mice.

The persistence of unequal outcomes for poor, minority children with asthma is an ongoing frustration for pediatricians. As Dr. Stephen Teach, the director of IMPACT DC put it, it is an issue of “health equity.”

Doctors have known for years how to manage asthma and keep kids out of the ER—my kids are living proof. But even with all of this knowledge and cutting-edge programs, the system continues to fail poor children. Policymakers should care about asthma—mostly because of the burden this most common of childhood chronic diseases imposes on families, but also because all those trips to the ER continue to drive up medical costs for all of us.

Illustration by Daniel Wolfe/The Urban Institute.

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Comments

Anecdotally,we see a marked reduction in asthma symptoms among children whose families use a voucher and mobility counseling to secure housing in a healthier community. Pediatricians could recommend a move to better housing in a higher opportunitu area gor families with a voucher in addition to the usual medical management of asthma.