The voices of Urban Institute's researchers and staff
April 16, 2014

How being poor in DC makes kids’ asthma worse

April 16, 2014

In the United States, more than 7 million children suffer from asthma. But in spite of the chronic and sometimes life-threatening nature of the disease, most of these kids lead active, healthy lives.

That’s not the case for some low-income families in Washington, DC. Asthma’s a big problem for the relatively small city, where the proportion of children suffering from the condition is one of the greatest in the nation.

Fortunately, DC is also home to IMPACT DC, an emergency department-based intervention that has helped reduce the number of emergency room visits from low-income children with asthma. But despite the program’s effectiveness, lots of DC kids and caregivers are still struggling to manage the disease.

So, how can we help everyone breathe a little easier? Urban Institute researchers, led by Marla McDaniel, teamed up with IMPACT DC to interview 33 players involved in asthma treatment—from parents to primary care physicians to IMPACT DC’s educators—to figure out why it’s so hard to treat asthma among DC’s poorest kids. In their own words, here are five potential factors.

Limited time

Low-income caregivers are often forced to balance parenting duties with inflexible jobs and non-standard working hours. Though children’s medical needs come first, it’s sometimes at the expense of the job that helps pay for the treatment.

“…I had to quit jobs before because she had an asthma attack three days in a row… They won’t let me take time off, so I quit.” - Caregiver

For educators and health care professionals, limited time with patients and caregivers makes it difficult to address all concerns and answer all questions. “…Time is a huge factor... In most primary care visits, you have 15 minutes to cover the entire health of the child… the amount of time physicians have for health education is almost none...” - Asthma educator

Lack of management

Who’s in charge of managing a child’s asthma treatment? For children with multiple caregivers, there’s often no one person ensuring that the child sticks to the treatment plan.

“[Having] multiple caregivers is a strong indicator of poor adherence, for obvious reasons. Usually only one caregiver comes [to] the visit, and frequently it’s the caregiver with the most time on their hands...  But it’s not necessarily the one with the most power in the family dynamic...” - Asthma educator

Sometimes, the responsibility is left up to the child.

“When I am at work then she call[s] me. 'Mommy, it’s time for medicine,’ and I say, ‘OK, go do your thing.’ She turns it on and uses it… She knows what she[‘s] doing… But my son, I can’t trust him with nothing! He’s only four.” - Caregiver

Difficulty accessing care

In DC, the best doctors and specialists are often out of reach for those with low-incomes—located in the less transit-oriented suburbs and Northwest.

“[For low-income families in poor neighborhoods,] getting to the doctor is harder. Once you get to the doctor, you wait longer, so you’re less likely to go… And you lose an entire day of work.  And these are the families who also tend to have the least flexible work schedules.” - Asthma educator

“Unhealthy” housing

Cheaper, older apartments—where many low-income DC families live—can host a number of asthma triggers.

“We don’t have a thermostat to control the heat in the basement apartment.  It gets so hot in there and we have to keep the windows open all the time.” - Caregiver

“We had to move because there was something in the carpets [that was triggering asthma attacks]…” - Caregiver

Lack of adequate health coverage

Most doctors agree that Medicaid and other insurers could do a better job covering routine care for low-income patients, which could go a long way in preventing attacks and hospital visits.

“…Not all of the payers are allowing kids to have two inhalers at the same time. We have one for home, one for at school, and they don’t pay for both…” - Primary care physician

“One of the things [Medicaid] could do better is managing claims and hiring educators to look at claims to see who is filling what prescriptions and when and how often. They could then work with those families when they see prescriptions are not being filled.” - Primary care physician

“It’s much more cost-effective for insurance to keep [a] child out of the ER. There’s a lot of benefit for the insurance.” - Primary care physician

Photo from Shutterstock.

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As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.

Comments

When you are living in a cheaper older low-income apartment. you have no control over the heat''it gets so hot in my apartment. My Comed bills is higher than my rent'I have to run my A/C year around. And watch my son nose bleed and miss school. WHO REALLY CARE ABOUT ASTHMATIC CHILDREN