A Plan to Reduce Asthma Disparities
Asthma disparities are still persistent among Black and Hispanic Americans, according to a new report from the Asthma and Allergy Foundation of America.
The report, “Asthma Disparities in America: A Roadmap to Reducing Burden on Racial and Ethnic Minorities,” is a follow up to AAFA’s 2005 “Ethnic Disparities in the Burden and Treatment of Asthma” report and looked at serious gaps in asthma rates, care and outcomes.
This year’s review shows small improvements in quality of health care overall. It also found that asthma disparities are beginning to shrink between some racial groups. But this country is still isn’t making inroads into eliminating the problem for Black and Hispanic Americans who are disproportionately burdened by asthma.
With this factor in mind, AAFA’s report provides specific strategies to improve asthma health for Americans most at risk while dismantling systems that fuel harmful disparities.
“The significance of the timing of this report is not lost on us as the struggles of the world around us closely mirror our findings and objectives. The COVID-19 pandemic continues to surge and expose what we’ve found when it comes to asthma: Populations of color are disproportionately impacted,” said Kenneth Mendez, AAFA’s CEO and president. “Racial injustice is being met with a powerful global reawakening that is calling for change. Racism and discrimination touch almost every facet of our lives, including health, and it comes as no surprise sharp inequities continue in the community we serve affected by asthma.”
Key findings of the report include:
- Black and Hispanic Americans still have the highest rates of asthma. We are 1.5 times more likely to have the disease than white Americans.
- Black patients are five times more likely to be treated for asthma in hospital emergency rooms compared to white patients, something that has remained unchanged since 2005.
- Black Americans remain three times more likely to die from asthma than white Americans.
- More Black women die from asthma than any other group.
In addition to these findings, the report also highlights the fact that health disparities not only impact affected groups but also limit the overall quality of health care for the entire population, leading to costs that tax the health care system. It is estimated that, from 2019 to 2038, the total cost of uncontrolled asthma could exceed $963 billion in direct and indirect costs. Asthma is also the leading chronic disease among children and a top reason for missed school days.
“The findings in our ‘Asthma Disparities in America’ report aren’t surprising. Causes of disparities in asthma have been documented for decades, and effective interventions have been successfully implemented in various populations,” said Sanaz Eftekhari, vice president of research at AAFA. “Despite this, disparities persist. Why? It boils down to two reasons: insufficient funding and lack of political will.”
In fact, racial and ethnic disparities in asthma are caused by a set complex factors:
- Structural determinants, such as systemic racism, segregation and discriminatory policies
- Social determinants, such as socioeconomic status, education, neighborhood and physical environment, employment, social support networks and access to health care
- Biological determinants,such as genetics and family health history
- Behavioral determinants, such as tobacco use and adherence to treatments
But asthma disparities, the report found, are driven less by genetics and individual behaviors and more by social determinants and structural inequities.
“Asthma Disparities in America” goes beyond chronicling the problem to providing details of specific strategies to spark change. It also serves as an action plan for like-minded individuals, organizations and other stakeholders dedicated to ending the racial and ethnic imbalances causing the most harm to people of color with asthma.
“It’s important we not only describe these egregious inequities but fully shift the focus toward finally eliminating them once and for all,” said Melanie Carver, AAFA’s chief mission officer. “That’s why we’ve created a roadmap within our report of direct action items aimed at tearing down barriers creating the heaviest burden on Black, Hispanic and Indigenous Americans living with asthma. This report is also a call to action to fix systemic failures and improve asthma care overall.”
Experts have recognized differences in asthma for decades. Now, however, the focus has shifted from describing the problem to finding solutions. Though no single solution to the problem of asthma disparities exists, strategies to address it in communities of color include:
- Improve coverage of asthma guidelines-based care and treatments by expanding specialist care coverage, lowering copays, expanding eligibility criteria, and removing prior authorization barriers
- Encourage state and local health departments to adopt comprehensive community asthma programs
- Combat environmental injustice and reduce exposure to pollution by strengthening clean air policies, reducing transportation-related emissions, restricting zoning of polluting sources and transitioning to a clean energy economy
- Educate nurses, health educators and community health workers to provide asthma care and patient education based on asthma guidelines
- Increase participation of Black, Hispanic and Indigenous Americans in clinical trials
- Conduct further research studies and tests among racially and ethnically diverse populations to discover successful strategies that show increased patient adherence to proven asthma management strategies and medicines.
It’ll take all partners—patients, families, health care professionals, researchers, pharmaceutical companies, educators, schools, community leaders, government agencies, health care systems, employers, national and local associations, advocates, policymakers and legislators, and the media—to affect change.
“Achieving equity in asthma is completely possible,” Eftekhari said, “if all stakeholders agree to prioritize this work and invest the resources needed to make real change.”