Reducing Asthma Disparities

As a primary care pediatrician and leader of the Community Asthma Prevention Program of the Children’s Hospital of Philadelphia, I am very excited about the Coordinated Federal Action Plan the Obama Administration recently announced to reduce asthma disparities. For years there have been a number of disparate efforts from various federal agencies to address asthma disparities; yet the gap in asthma-related emergency room visits, hospitalizations and deaths still exist. Asthma is a disease that is impacted by a host of environmental, health and social factors. Therefore it’s no surprise that efforts made in a singular fashion have not worked in the past. This Coordinated Federal Action Plan represents the coming together of 16 federal agencies to use their collective strengths to collaboratively and systematically reduce, and someday eliminate, asthma disparities.

This plan recognizes the importance of the community’s involvement in efforts to reach disparate populations and the importance of collaboration among healthcare providers, community agencies, and social support systems. The following two strategies resonate with my experience in taking care of children with asthma:

• The standardization of training and certification of Community Health Workers (CHW) and utilization of CHW’s in care of at-risk asthmatics

The Community Health Worker is often the unsung hero in the frontline effort to intervene in the disproportionate burden of asthma on disadvantaged communities. These highly trained lay health educators are effective in working together with families to increase self-management skills and to remove asthma triggers as well as provide care coordination services. CHW’s are often the glue that connects caregivers to the healthcare system, community resources and social support systems and a key driver in community efforts to reduce asthma disparities. Given their important role in working with the most vulnerable populations suffering from the burden asthma places on their lives, standardization of curriculum and certification of CHW’s is a necessary step in providing wrap around asthma care to reduce asthma disparities and asthma costs.

• Promoting collaboration across all systems that serve children with asthma including health care, housing, schools and childcare settings

While disseminating best practices in implementing asthma guidelines is a step in improving overall asthma health outcomes, it is essential that the asthma care plan accompanies the child where they live, learn and play. Strategies toward this goal include: creating communication channels via federal interagency and private partnerships to provide comprehensive services to the people most affected by asthma; sharing data (including asthma care plans) between health care and school/childcare systems; and equipping federally qualified health centers and hospitals who serve disadvantaged populations to implement best practices.

The Coordinated Federal Action Plan provides guidance for approaching asthma disparities in a holistic fashion recognizing that patients live in the “real” world where their housing, health and education are all interconnected. Using all resources available and intervening in an integrated, collaborative manner will give us the greatest chance for finally closing the gap on asthma disparities.

Tyra Bryant-Stephens is Director and Founder of the Community Asthma Prevention Program at the Children’s Hospital of Philadelphia, and Clinical Associate Professor of Pediatrics at the University of Pennsylvania School of Medicine