Urban Wire In Washington, DC, is childhood asthma part of a poverty trap?
Zachary J. McDade
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When I was a kid in Boulder, Colorado, one of my soccer teammates had asthma, but, like a lot of kids with that condition, it didn’t slow him down. Although asthma affects nearly 1 in 10 children, it is a well-understood and highly treatable disease.

It’s therefore concerning that so many low-income kids—often black or Latino—in Washington, DC, suffer regular, negative consequences of asthma (among the highest rates in the nation). I suspect that’s because it’s yet another example of the pernicious cycle of poverty. In fact, research shows that children from low-income families have far less control over asthma and higher morbidity from the disease than their higher-income peers.


Evidence is mounting that poverty is a vicious cycle that produces other negative outcomes, which in turn deepen poverty. For example, children born into poverty are much likelier to be poor adults, and so their kids are likelier to be poor. The rise of long-term unemployment has plunged many families into poverty, and being in poverty increases your chances of being unemployed for a long time. Austerity measures like sequestration cuts to unemployment insurance and food stamps all compromise family finances and deepen the cycle.

Is the same thing playing out with asthma in DC? A qualitative study by my Urban Institute colleagues sheds some light on the problem.

Poverty puts up barriers to treating asthma

For DC’s large low-income population, it’s clear that where you live matters for getting effective asthma treatment. Families in many communities have poor access to transportation to the doctor. They also have fewer available doctors. And many low-income, especially single, parents cannot take time away from work during doctors’ business hours.

What’s more, much low-income housing comes with a host of asthma triggers, whether it’s proximity to pollution or other toxins in the neighborhood or, as many interviewees reported, exposure to dust, mold, or other negative conditions within the home.

Asthma can also get in the way of a child’s education because these problems get compounded at school. Low-income kids tend to need even more vigilant asthma monitoring and treatment at school, for which most schools are simply not equipped. And when low-income families either don’t have the resources to get a second school inhaler or the bandwidth to ensure that kids carry one every day, asthma problems can compound at school.

But asthma can also lead to greater poverty

Poverty can worsen asthma, but worse asthma, in turn, can deepen a family’s poverty.

Many parents reported that, in order to care for their children’s asthma, they had to take time off from work. But many low-income parents don’t have paid time off or flexible schedules, so they were fired for taking too much time or quit preemptively because they knew they would get fired anyway.

So, for many families, there is a direct tradeoff between treating a child’s asthma and being employed. If they choose treating the asthma, they can lose their income, making it even harder to get good medical care, move into a healthy home and neighborhood, and afford the necessary medication and equipment to treat asthma.

A byproduct is that those families often end up getting expensive, publicly funded treatment in the hospital’s emergency department.

Can we break the cycle?

To be clear, these stories are anecdotal and do not constitute a statistically sweeping claim. But they add to the growing mountain of evidence that poverty is a trap with a clear conclusion: if we spend money now to break people out of the trap, then they’ll be healthier, more productive and self-sufficient, and in less need of support later.

It’s an investment: spend some now, save more later.

There are some obvious ways to break a poverty-asthma trap. We can more vigorously enforce housing quality regulations and mandate that employees with documented asthma needs be exempted to care for their children. We could also incentivize clinics to maintain non-standard hours and work with organizations like ImpactDC – an emergency department intervention program - to build better asthma-treatment routines into low-income neighborhoods and schools.

Image: Standing outside her home on East Street in downtown Raleigh, N.C., Lonnette Williams, right, talks Wednesday, Oct. 5, 2005, about living in Raleigh's South Park neighborhood. Children living in low-income areas like South Park, which has particularly poor quality air, are at greater risk of asthma problems. (AP Photo/Karen Tam)

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The Urban Institute podcast, Evidence in Action, inspires changemakers to lead with evidence and act with equity. Cohosted by Urban President Sarah Rosen Wartell and Executive Vice President Kimberlyn Leary, every episode features in-depth discussions with experts and leaders on topics ranging from how to advance equity, to designing innovative solutions that achieve community impact, to what it means to practice evidence-based leadership.


Research Areas Health and health care Greater DC
Tags Poverty Racial and ethnic disparities Children's health and development Maternal, child, and reproductive health Public health
Policy Centers Center on Labor, Human Services, and Population
Cities Washington-Arlington-Alexandria, DC-VA-MD-WV