Clearing the Air: Addressing Asthma Disparities in Maryland

This morning I had the pleasure of addressing a group of health care professionals at the Asthma and Allergy Foundation’s Clearing the Air: Addressing Asthma Disparities in Maryland conference in Linthicum, Md.

In Baltimore City, over 60,000 adults and nearly 20,000 children have been diagnosed with asthma at some point in their lives. There are considerable disparities in the burden of asthma by age, race, ethnicity, and geography. Young children, African-Americans, those with low income, and urban residents carry a disproportionate burden of asthma in Maryland. Access to quality care is thought to be a significant factor contributing to disparities. Disparate populations may lack insurance, asthma education, or access to quality primary or specialty care providers. These and other barriers to quality care have significant impacts on asthma morbidity and mortality.

One of the key ways that the Health Department is addressing asthma disparities in Baltimore is through Healthy Baltimore 2015, our comprehensive health policy agenda. This agenda aims to explore the root causes that drive health inequities, break down silos between various sectors of our society. To this end we’ve created an interagency task force to examine potential health implications of policy decisions.

To date, the asthma home visiting programs have reached over 500 children and have documented significant reductions in asthma symptoms, roach and mouse infestations, and school absences. Among a sample of 94 clients, 94.7% had a reduction in emergency department visits and 100% had a reduction in hospitalizations after completing three home visits. School-age participants also reported an increased attendance rate.

To address asthma disparities in Baltimore City Schools, we are working with the state to implement the Asthma Friendly School Initiative. More than 30 Baltimore City Schools that are Asthma Friendly. This Initiative requires schools to meet a set of criteria to be considered Asthma Friendly including:

• Identifying and tracking students with asthma;
• Maximizing asthma management through the use of asthma action plans and case management;
• Coordination of asthma management with parents/guardians and health care providers;
• Supportive policies regarding access to asthma medication;
• Proactive maintenance of buildings and school facilities to reduce asthma triggers and improve indoor and outdoor air quality; and
• Asthma education for students and staff

Additionally, the Health Department’s EPA-funded Healthy Environments Healthy Kids program will provide training of and direct services to community-based partners engaged in improving environmental health for children in Baltimore. Through this grant, the BCHD will improve child health outcomes in Baltimore through:

o   inspecting and training for city-based Head Start Programs and child care providers focused on environmental and health hazards in those settings;

o   training of key home visit staff (e.g., community health workers and nurses, Healthy Start staff) on healthy home fundamentals;

o   training for WIC and other community-based partners; and

o   integrating healthy homes and community principals into training and certification programs for licensed child care providers.

BCHD will continue to collaborate with its partners to improve asthma disparities, working toward our goal of turning Baltimore into a city where all residents realize their full health potential.

I’m curious to hear what other public health workers are doing around asthma and schools. What are some of your success stories?