#dwasthma #epa.gov #shegoesgreen
xv EPA
United States
Environmental Protection
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iii i ii mi [minium 11 illinium limn
How Technology Can Bridge the Gap
Reducing Asthma's Toll on
a Vulnerable Population
Better Data Means Better Health
m & / \ \
Ronnie's Story: A Son's Mysterious Illness
Disparities in Asthma Treatment:
A Matter of Life and Death
Asthma and Obesity: Access to
Healthy Foods
Introduction to Asthma Disparities ebook // Robin Strongin
Asthma, Disparities and the Environment // Lisa P. Jackson
Government Leaders Convene to Discuss the Launch of an Interagency Effort // Elliot Patton
The Racial Politics of Asthma // Dominique Browning
Reducing Asthma's Toll on a Vulnerable Population // Barbara Kaplan
Chandra's Story: Losing a Son to Asthma // Chandra Baldwin-Woods
Better Data Means Better Health // Kathy Lim Ko, MD
Ronnie's Story: A Son's Mysterious illness // Ronni and Lamar TyLer
How Technology Can Bridge the Gap // Ivor Horn, MD, MPH and Kenneth Eisner
Disparities in Asthma Treatment: A Matter of Life and Death // Elena Berger
Asthma arid Obesity: Access to Healthy Foods // Marian Kerr
Children and Asthma: Dangers in the Home // Andre Blackman

I am pleased	to l
Disruptive	Women
the topic of racial
asthma	disparities.
This is the second installation in a series inspired by the
Disruptive Women in Health Care blog and Environmental Pro-
tection Agency's partnership to examine issues of health and
the environment. The topic of this ebook was inspired by the
Asthma Disparities Working group, which is co-chaired by the
Environmental Protection Agency (EPA), Health and Human
Services (HHS) and the U.S. Department of Housing and Urban
Development (HUD), and which recently released an action plan
that outlines the measures that must be taken in order to re-
duce the drastic disparities in asthma care for racial and ethnic
minorities. The most shocking and summarizing statistic with
regards to these disparities is that Black and Puerto Rican American children are twice as
likely as Caucasian children to be hospitalized by an asthma attack, and four times as likely to
die from the condition. I attended the event that marked the official launch of the action plan,
and upon hearing the heads of these three government agencies give passionate addresses
about the ways that asthma has touched their lives I was certain this would be an ideal topic
for a Disruptive Women in Health Care ebook.
There could not be a more fitting topic for the second iteration of the Disruptive Women
in Health Care Blog's partnership with the EPA, and I am sure that the stories contained in this
series of blog posts will open your eyes to the dire necessity of reducing the disparities that
have become so prevalent in asthma care in this country. I am grateful to EPA Administrator
Jackson for her leadership on this, her partnering with Disruptive Women, and for sharing her
personal story as you will see in her post.
Being diagnosed with asthma is a monumental moment in any child's life: asthma is a
condition that can put lifelong limitations on an individual's lifestyle and choice of activities,
and place an enormous burden of care and stress on their entire family. With proper care, it
is a condition that can be controlled quite effectively, but as you will learn, there exists an un-
acceptable level of disparity in accessing that care. In this series of blog posts, our Disruptive
Women will delve deep into this issue from both a personal and professional standpoint. It is
our hope that this information will contribute to the efforts of the Asthma Disparities Work-
ing Group, and that together we can reach a solution.
President & CEO of
AmpLify PubLic Affairs, LLC
Creator and Founder of
Disruptive Women in
Health Care
Robin Strongin
Elena Berger
Joy Burwell
Hope Ditto
Elliot Patton
Kevin Reid
David Lee
Chandra Baldwin-Woods
Elena Berger
Andre Blackman
Dominique Browning
Kenneth Eisner
Ivor Horn, MD, MPH
Barbara Kaplan
Marian Kerr
Kathy Lim Ko, MD
Elliot Patton
Lamar Tyler
Ronni Tyler
Andre Blackman
The personal nature of these posts is paramount
to the goal of this project, and it is important to
note that the authors were free to write about
any topic - without restriction or guidance from
the EPA or the Disruptive Women in Health Care.

Asthma,	Disp
and the Environment
By EPA Administrator Lisa P. Jackson
The statistics are alarming: Nearly 26 million
Americans suffer from asthma.
One in 10 American children battles this re -
spiratory illness, making it one of the most com-
mon childhood chronic diseases.
Safeguarding the air we breathe and pre-
venting illnesses like asthma is one of my most
important jobs as Administrator of the U.S. Envi-
ronmental Protection Agency. This issue is vety
_ close to my heart. Both of my sons have struggled
with asthma. I know what it's like to stay awake at
night, worrying that the lightest sound of a cough may be a sign of something
more serious. Before I am an environmentalist, I am a mother, and my family's
experiences have given my fight for clean air an added urgency.
One of the challenges we must address is that asthma disproportionately
affects children growing up in low-income and minority families. Among chil-
dren with asthma, black children are twice as likely to be hospitalized, and four
times as likely to die due to asthma. Hispanic children also face a higher risk
of asthma.
Although these statistics can be discouraging, there is cause for optimism.
The EPA has been hard at work to cut air pollution and decrease asthma and
other unhealthy impacts on American families.
In the last three years, we have worked on measures to reduce health
threats from cars on the road and power plants. We've encouraged greener,
cleaner schools that will reduce risks to our children's health. In 2010 alone,
Clean Air Act pollution prevention standards helped prevent more than 1.7 mil-
lion incidences of asthma attacks. In addition, EPA recently finalized Mercury
and Air Toxics Standards which will further reduce air pollution and help pre -
vent even more asthma attacks.
Still, we have a long way to go.
That's why I'm proud EPA is working with the U.S. Department of Health
and Human Services and U.S. Department of Housing and Urban Development
on The Coordinated Action Plan to Reduce Racial and Ethnic Asthma Dispari-
ties. Launched earlier this year, this action plan enables federal agencies and
our partners to work more comprehensively on tackling a major health threat,
so that we can protect all Americans, no matter what community they call home.
At EPA and across the federal government, we are working to enhance our
efforts so that millions of American children - in every community - can benefit
from the simple fact of being able to breathe a little easier.
Administrator of the
United States Environmental Protection Agency

li jw' r

The President's Task Force meets on Environmental Health Risks and Safety Risks to Children Launch of the Coordinated Federal Action Plan to Reduce Racial and Ethnic
Asthma Disparities at the Boys & Girls Club's Town Hall Education Arts Recreation Center Campus on May 31,2012.

Close to 26 million Americans suffer from asthma, including 1 out of every 10 children, and asthma costs our
economy about $56 billion per year.
Associate at
Amplify Public Affairs, LLC
'It was easy to sense the excitement that each and every speaker
and panelist felt at the notion of beginning to chip away at this
problem which has had such a widespread impact not only on
our nation's physical health, but on its economic health as well,"
The condition affects racial and ethnic
minorities at a dramatically disproportion-
ate rate; African American and Puerto Rican
children under the age of 17 are twice as
likely as their Caucasian counterparts to be
affected by this respiratory condition. Asth-
ma rates are also correlated with income,
with lower income individuals having a
significantly higher chance of affliction. In
addition to increased prevalence of asthma
in minority populations, minority individ-
uals with asthma are much more likely to
have a serious asthma-related health event;
black asthmatic children are twice as likely
as white children to be hospitalized and
four times more likely to die as a result of
their condition.
In an event that marked the beginning
of a push to end the suffering of these un-
derserved populations, government leaders
met yesterday at the Boys and Girls Club of
Greater Washington for the official release
of the Coordinated Federal Action Plan to
Reduce Racial and Ethnic Asthma Dispar-
ities. White House Council on Environ-
mental Quality (CEQ) Chair Nancy Sutley,
Environmental Protection Agency (EPA)
Administrator Lisa P. Jackson, Secretary of
the U.S. Department of Housing and Urban
Development (HUD) Shaun Donovan, and
Secretary of the U.S. Department of Health
and Human Services (HHS) Kathleen Sebe-
lius discussed the significance of the action
plan, and a 10 member panel delved deeper
into the details of the coordinated effort to
The President's Task Force meets on Environmental Health Risks and Safety Risks to Children Launch of the Coor-
dinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities at the Boys & Girls Club 's Town Hall
Education Arts Recreation Center Campus on May 31, 2012.
reduce racial and ethnic asthma disparities.
The message that EPA Administra-
tor Lisa Jackson wanted to convey to the
crowd gathered in the Boys and Girls Club
gymnasium was that "the Obama adminis-
tration is here for you." As the mother of an
asthmatic son, she has the deepest possible
understanding of the urgency with which
this problem must be addressed, and of the
injustice that occurs when a child is predis-
posed to this burdensome condition simply
because of their income or race. In her
work at the EPA, Jackson is proud to have
overseen the implementation of programs
that led to the prevention of 1.7 million
asthma attacks last year, and to be working
towards enacting Mercury and Air Toxics
Standards (MATS) which will save between
$37 billion and $90 billion in health care
costs each year by increasing the quality
of our air and decreasing the prevalence of
respiratory illness.
While Lisa Jackson has been fighting to
uphold the maxim that "every child should
grow up in a healthy environment with ac-
cess to clean air and water," HUD Secretary
Shaun Donovan has been attacking asthma
through programs such as "Healthy Homes"
which ensure that people's houses are not
negatively impacting their health. The 1 in
5 children who live in poverty in the United
States are much more likely to live in homes

The President's Task Force meets on Environmental Health Risks and Safety Risks to Children Launch of the Coordinated Federal Action Plan to Reduce Racial and Ethnic
Asthma Disparities at the Boys & Girls Club's Town Hall Education Arts Recreation Center Campus on May 31, 2012.
with environmental asthma triggers, and
Secretary Donovan laments the fact that
it is possibly to predict an individual's life
span based on the zip code that they live in.
He invited the audience to "envision a day
where no child has to be sick just based on
where they live or what they look like," and
expressed confidence that this new part-
nership which spans many different areas
of government is the way to move towards
this goal.
Each of the speakers made a point to
emphasize the importance of the interagen-
cy collaborative nature of the action plan,
HHS Secretary Kathleen Sebelius pointed
out that "the best work we do, we do
together." She praised the implementation
of an all of the above strategy which will
be able to approach the reduction of racial
and ethnic predisposition to asthma from
every possible angle. Having experienced
the pains of dealing with asthma firsthand,
when she used to hear her brother gasping
for air in the next room when she was a
young girl, she is determined to reduce the
burden that this condition places on poor
and minority Americans: "This shouldn't
happen in America," she stated resolutely.
The creation of this interagency initiative
is the first step in making her goal, and the
goal of everyone involved, a reality.
Sandra Howard, Senior Environmental
Health Advisor for the Office of the Assis-
tant Secretary of Health at HHS captured
the essence of the event by stating that "I
feel a great deal of relief that we've gotten
this far, but we're really just at the starting
line." Now that the framework is in place,
it was easy to sense the excitement that
each and every speaker and panelist felt at
the notion of beginning to chip away at this
problem which has had such a widespread
impact not only on our nation's physical
health, but on its economic health as well.

In the wake of the tragic shooting of Trayvon Martin in Florida, there's been a lot of talk about the risks to black
children of being shot and by whom. Last week Harry C. Alford, the President and CEO of the National Black Cham-
ber of Commerce, testified against the new Mercury and Air Toxic Standards during a Senate committee hearing.
Co-Founder of
Moms CLean Air Force
Two days later, during another Senate
hearing on the EPA budget, Alabama
Senator Sessions claimed that air pollution
victims are "unidentified and imaginary."
But neither of these gentlemen is talking
about reality.
This is reality: African American
children are far more likely to develop
asthma than get a bullet to their heads.
And asthma incidence is directly linked
to air pollution. One only has to read the
tragically sad story from Chandra Bald-
win-Woo< . Her 16-year-old son, Jovante
suffered an asthma attack and died after
returning home from a football practice.
In 2008, African Americans had a 35%
higher rate of asthma than Caucasians. A
study has found that one-quarter of the
children in New York City's Harlem have
asthma. The following national statistics
are even more jarring:
African American children have a:
260% higher emergency room visit rate
250% higher hospitalization rate
500% higher death rate from asthma
compared with White children.
One reason for the disparity? 68% of
African-Americans (compared to 56% of
Whites) live within 30 miles of a coal-fired
power plant—the distance within which
the maximum ill effects of the emissions
from smokestacks occur.
"Poverty brings far worse health than mercury coming out of a
coal plant or utility plant. Violence, crime. These kids that I see
are far more likely to get a bullet in the head than asthma. And
that's the reality of it." - Harry C. Alford's testiomony during the hearing
Asthma is the most common chronic
disease in childhood—and its incidence is
increasing. In 1980, 3.6% of U.S. children
had it: in 2001, 9%-an astonishing 250%
increase. It afflicts more than 7 million
American children and is the third-leading
cause of hospitalizations among children
under the age of 15.
Just as medical researchers once
uncovered the link between cigarettes and
lung cancer, researchers are now discov-
ering the exact mechanism by which air
pollution is linked to asthma. Kari Nadeau
is a Stanford University School of Medicine
physician, scientist and mother of five
young children—two sets of twins! She
and her colleagues have been following the
evidence on the asthma trail to understand
the cause of the illness. Their research is
pointing to air pollution as the culprit.
Nadeau and her team investigated the
effects of air pollution on children in Fres-
no—one of the top ten most polluted cities
in the country (in fact, six of the ten are in
California.) Their results were published in
the Journal of Allergy and Clinical Immu-
nology: Ambient Air Pollution Impairs
Regulatory T-Cell Function in Asthma.
Nadeau explained her work: "Our
research showed that the effects of air pol-
lution in Fresno are associated with genetic
changes in the immune cells of children.
In other words, the simple act of inhaling
polluted air affects the immune system's
ability to do its job. The increasing numbers
and severity of asthma are directly related
to these genetic changes. These genetic
changes are possibly permanent."
The immune system is Nadeau's
specialty. In an interview on Stanford's
website, she remarks:
"Many people don't understand that
the immune system is connected to so
many other fields in medicine. Parts of the
immune system exist most everywhere in
your body (from head to toe). The immune
system is involved in neurological diseases,
heart disease, obesity, diabetes, autoim-
mune diseases, asthma, and allergies, to
name a few. In the field of immunology, we
need to appreciate all the different areas
of the body because the immune system is
integrated into everything."
Here's the reality: Reducing air pol-
lution is a social justice issue of profound
significance. The National Black Chamber of
Commerce is playing politics with chil-
dren's health. It has received $525,000 from
ExxonMobil-hardly eager to end fossil fuel
pollution-since 1998. But the games should
end. This is something all parents-black or
white-should be furious about.

by Barbara Kaplan
" """"					"	More than 25 million Americans currently
BARBARA KAPLAN	have asthma—including 7 million kids. Even more
Director of	distressing is the fact that asthma rates are on
Asthma Education fortffe American	^ ,.jse Asthma affects le	rac
Lung Association
genders and socioeconomic status. However, it is
far from an "equal opportunity" offender. Asthma
occurs at disproportionately higher rates among some ethnic and racial populations.
African Americans have some of the highest rates of asthma when compared to Cau-
casians and Hispanics as a whole. However, when you take a closer look within the
Latino population, Puerto Ricans have higher rates of disease than any other group.
In October 2011, we released our fourth report as part of our Disparities in
Luna Health Series which takes an in-depth look at specific problems in specific
communities. The report found that three million Hispanics have asthma in the U.S.
For reasons that are not clear, Puerto Ricans are more likely to be diagnosed with
asthma while Mexican Americans have some of the lowest rates of the disease. How-
ever, there is evidence to suggest that Mexican Americans are significantly under-di-
agnosed. Hispanics are the nation's fastest growing ethnic group, and the urgency of
addressing the burden of asthma grows with it.
Did you know that Latinos with asthma are less likely to be prescribed appro-
priate asthma medicines? Or that they are more likely to end up being treated in the
emergency department or hospitalized as a result of uncontrolled asthma? These
are just two of the reasons why Latinos face a greater burden when it comes to
managing their asthma. Our report Luchando por el Aire: The Burden of Asthma on
Hispanics looks at the complex factors that increase asthma's burden on the Latino
The American Lung Association recommends a number of action steps to help
eliminate these disparities. These steps target federal agencies, public and private
funders, health care systems and providers, insurers, advocacy agencies, Hispanic
community leaders and families. To learn more, go to www.lunq.org/Asthma-ln-His-
panics. The report has been a useful catalyst to bring stakeholders together around
the country to explore the problem in the community and incorporate the recom-
mendations. Concerned groups can also reach out to the American Lung Association
in their communit for tools and expertise to take local action.
To learn about the American Lung Association's programs and resources for
managing asthma, visit www.luna.ora/asthma.

An asthma attack turned my world upside just less than two years ago, and it has never been the same since. After returning home from foot-
ball practice on a typical hot, muggy August day, my 16-year-old son Jovante suffered an asthma attack that rendered him unconscious from
anoxic brain injury. Jovante's father and 1 spent the next four days by his side in the hospital praying for his recovery, which was not to be.
I do not have adequate words to
describe the pain of losing a child. It's
something no parent should ever have to
experience. Knowing that we will never
watch Jovante graduate high school, attend
college or experience the joy of starting a
family is a pain we must live with every day.
Jovante idolized Jerome "The Bus" Bet-
tis for his courage to never let asthma stand
in his way on or off the field. With proper
treatment, Jovante's doctor was confident
that he could continue to pursue his pas-
sion for athletics, especially football, which
runs deep in our family. Not only do I play
on a women's full contact football team,
but Jovante's father Ickey was a fullback
for the Cincinnati Bengals. Both Ickey and I
had asthma growing up and fully expected
Jovante would someday grow out of it just
as we thought we had.
When I hear those who undoubtedly
know better—corporate polluters and even
How these people have the
audacity to callously deny
what is common information
among those in the medical
community — air pollution
causes asthma attacks and
cuts short the lives of those
we love most—is beyond me.
politicians in Congress—minimizing the
serious health consequences caused by air
pollution, my heart breaks all over again.
How these people have the audacity to
callously deny what is common information
among those in the medical community—
air pollution causes asthma attacks and
cuts short the lives of those we love most—
is beyond me.
By fighting for air alongside the Amer-
ican Lung Association and Moms Clean Air
Force, we are passionate about building a
future where every child has healthy air to
breathe. Cleaning up power plant pollution,
tailpipe emissions and other air pollution
sources will prevent thousands of asthma
attacks every year while giving other chil-
dren the chance to fulfill their dreams. It is
through this work that the best memories
of our wonderful, loving child live on.
We are also proud of the foundation
and scholarship program we started in our
son's name to help fund the critical work
of Cincinnati Children's Asthma Research
Division in addition to building organ donor
awareness. To learn more about the Jovante
Woods Foundation and the 3.8 to be Great
Scholarship, please visit:
I am truly glad to call you my mom
I really appreciate in hard times the way you make ends meet
I love you with all my heart and you're the bomb
You taught me to work hard and never cheat
In past times, we've had our share of fights
Sometimes I may say your name followed by a swear
But still you've always encouraged me to reach new heights
I'm so sorry my asthma attacks gave you a scare
Without you, I would not be here
When I'm upset, you've always kept calm
With a house filled with six kids you found time to care
This is why I'm glad you are my mom
- JovanTe Woods, 1994-2010

When it comes to understanding asthma in Asian American, Native Hawaiian and Pacific Islanders (AAs
and NHPIs), we hit a road block because we don't have the full breadth of data that we need — and the limited
data we do have paints a concerning picture. Doctors' diagnoses alone tell us that the rate of asthma in NHPI
children is three times higher than that of white children and twice that of black or Native American children.
But a reliable and accurate rate of asthma in NHPI children simply doesn't exist.
President & CEO :'
the Asian & Pacific Islander American
Heatth-Forum (APIAHF)
Similarly, if hospitalizations are any
indication, then AA and NHPI seniors too
suffer disproportionately from asthma
complications. In 2008, AA and NHPI
adults 65 years and over were admitted
into a hospital for asthma at a rate (235.9
per 100,000) higher than the total popu-
lation (234.9 per 100,000) and all other-
race groups, with the exception of blacks
(427.7 per 100,000). And the nation's vital
statistics system tells us that asthma-relat-
ed deaths were 40 percent greater among
Asian Americans in 2008.
NHPIs in particular comprise a higher
percentage of adults with asthma than any
other racial group in the United States. In
2000, Native Hawaiians had almost twice
the rate of asthma for all other races in the
state of Hawaii.
We know that multiple factors influ-
ence our health, from immigration status,
to geography, to limited English proficiency:
not to mention environmental factors such
as where we live and the presence of aller-
gens. Coupled with genetic factors, these
environmental determinants can have a
marked effect on asthma.
What we don't know, for example,
is how exposure to tobacco smoke in AA
and NHPI communities—where smoking
is prevalent—increases the risk for adult
asthma. What we need to know, through
better and more granular research and
data, are the community and individual
level conditions that contribute to these
With the AA and NHPI populations on the rise—and currently the
fastest growing racial groups in the country—the time for a deeper
understanding of these communities has come. We need more
standardized data collection and reporting on race, ethnicity, and
primary language; in health surveys, hospitals, and health care
organizations; and across the local, state, county and federal levels,
staggeringly high rates of asthma for NHPI
children and adults. If we had this informa-
tion, we could improve prevention, screen-
ing and treatment, and avert thousands of
asthma flare-ups, complications and deaths
in AA and NHPI communities.
With the AA and NHPI populations on
the rise—and currently the fastest growing
racial groups in the country—the time for
a deeper understanding of these commu-
nities has come. We need more standard-
ized data collection and reporting on race,
ethnicity, and primary language; in health
surveys, hospitals, and health care organi-
zations; and across the local, state, county
and federal levels.
Public health officials and health ad-
vocates need more robust data to generate
baseline health information on AA and
NHPI communities, and the conditions that
contribute to health disparities. National
research often cites small population size

and lack of reliable statistics as reasons
for the lack of data on these communities.
This is only exacerbated by a dispari-
ty in federal funding to support these
communities—less than 1 percent of
federally funded health grants focus on
AAs and NHPIs.
Recent federal initiatives like the
Affordable Care Act's requirements to
better collect and disaggregate data on
race, ethnicity, sex, primary language, and
disability status will help generate data
across federal health surveys. And thanks
to the work of health care advocates, the
National Health and Nutrition Examination
Survey (NHANES) has already started to
oversample Asian Americans in the 2011-14
data collection.
While these strategies are a great
start, we must also invest in more innova-
tive approaches at the community level to
generate research that is more granular and
specific to the many Asian American sub-
groups and for even smaller populations
like Native Hawaiians and Pacific Islanders.
We must make sure that when data are col-
lected, the numbers are analyzed in ways
that are useful to these communities.
Community-based participatory
research (CBPI is one such approach.
CBPR will not only fill our information
gaps, but will expand on the health
knowledge we already have. CBPR works
through collaboration between community
stakeholders and researchers to generate
research that is representative, useful
and supported. And, because CBPR is
done at the more local and regional level,
researchers can capture data on smaller
populations like NHPIs, traditionally a
difficult group to capture through the
larger national surveys. The collaborative
approach also yields data that can be more
easily disseminated and used in outreach,
education, advocacy and policy efforts
tailored to participating communities.
The stakes are too high in our commu-
nities. When it comes to asthma in partic-
ular, too many of us are ending up in the
hospital or dying. We can no longer ignore
the multi-faceted health needs of AAs and
NHPIs and must make the investments in
data collection and reporting today.
by Ronni and Lamar Tyler
I remember when my son was first diagnosed with asthma. I was a single mom living over 600
miles away from my family and friends. He was in the 2nd or 3rd grade, and it seemed like he
was always getting sick.
The nurse would call me at work and
say, "Please come pick up your son. He has a
low grade fever and he threw up on the play-
ground." Of course any child who throws up
at school has to go home. So, I had to leave
work to pick him up (it took about 30 to 45
minutes to get to his school).
When I picked him up and took him
home he was fine. No fever. No symptoms of
sickness. No more throwing up. I would give
him over the counter medicine for allergies
or colds. But nothing really helped.
This went on for weeks. I had to leave
work to pick up a child that I knew would
not be sick when we got home. I began to get
frustrated. I was frustrated with the nurse.
"Can't he stay? He's not sick and he is
just going to be playing when we get home.
Her hands were tied: she had to follow
school policy. Then I began to get frustrat-
ed with my son. "Is something going on at
school? Are you doing this to get out of going
to class? Is someone bothering you? You
have to stop this."
Finally, the doctor told me that my son
had asthma. Asthma! I never knew any-
one with asthma, and I never would have
guessed his symptoms were caused by
According to the CDC, asthma is the #1
cause for missed school days and accounts
for more than 14 million missed school
days each year. As I reflect on those times, I
think about how blessed I was, and how my
situation could have been worse. You see, I
had a salaried position and an understand-
ing manager. She did not mind me leaving
work early to pick up my son. I could take
my laptop and finish my work from home.
But what about the single mom or parent
who does not have the luxury to leave work
without worrying about decreased pay, or
According to the CDC,
asthma is the #1 cause
for missed school days
and accounts for more
than 14 million missed
school days each year.
even worse, being fired? Can you imagine
being told that if you leave early one more
time you will be fired?
I was also blessed because I had veiy
good health care benefits through my
employer. I was able to take my son to his
primary care physician where he was finally

diagnosed with asthma. But what about the
parent who does not have health insurance?
Will their child have to suffer with this con-
dition until they finally end up in the emer-
gency room? As reported by the Asthma
and Allergy Foundation: Each year, asthma
accounts for more than 10 million outpa-
tient visits and 500,000 hospitalizations.
Yes, we were blessed. It could have been
worse for my son and me. But being blessed
does not keep me from being concerned
about others that are not as fortunate, and
about my community as a whole. Whether
our kids have asthma or not, or whether we
live in an area with the highest pollution
levels or not, we all have the responsibility
to do everything in our power to minimize
the impacts of asthma - on our kid's health,
and on our families' finances. (The annual
cost of asthma is estimated to be about $18
billion per year.)
We can start by joining the fight for ev-
eryone's right to breathe clean air. Because
even though asthma is not always caused by
air pollution, it can certainly be triggered by
it. With this being an election year, it is more
important than ever to show that we are
united as a community and that we will not
support any politician that plans to remove
the air quality standards that force polluters
to take actions that reduce toxic emissions.
Asthma touches my family and yours.
Please join the Moms Clean Air Force and
show that as a community that we are taking
a stand against air pollution.

by Ivor Horn, MD, MPH
and Kenneth Eisner
Associate Professor of Pediatrics at
George Washington University SchooL
ot Medicine and Children's National
Senior Vice President, Business
Development and Marketing at
One Economy
Asthma is the most common chronic pediatric
medical condition in the United States. Its prevalence has
tripled in the last three decades with disadvantaged, ur-
ban, minority children incurring a disproportionate share:
12.8% of African American children are diagnosed with
asthma compared to 7.9% of Whites, and African Amer-
ican children are nearly seven times more likely to die
from asthma than Whites. Additionally, African Americans
use emergency departments more frequently, incurring
higher health care costs.
Implementation of the National Asthma Education and Prevention Program's (NAEPP)
guidelines has contributed to reductions in asthma morbidity and mortality rates. However,
there is still more work to be done. Recendy, the President's Task Force on Environmental
Health Risks and Safely Risks to Children proposed to expand the reach of the NAEPP guide-
lines by using "innovative technologies to reach, engage and educate patients and families in
communities affected by racial and ethnic asthma disparities."
This call to action presents a unique opportunity to create a framework for the devel-
opment, implementation and evaluation of innovative technologies to address asthma as a
chronic health condition. However, to see significant progress in creating technological innova-
tion to address disparities in asthma, we will need to achieve two important steps:
1.	Identify interventions that will work
2.	Incent organizations and companies to develop solutions


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Similar to other major advances (e.g., antibiotics, immunizations) in health care, mobile
health (mHealth] has the potential to transform how patients manage their health and health
care. Unlike previous innovations distributed to patients via the health care system, mHealth
has the potential to disrupt traditional access inequities that have contributed to racial and
ethnic disparities largely due to device ownership and utilization. As early adopters of mobile
technology, underrepresented minorities may be best positioned to benefit from mHealth.
providers and schools. One solution could
be the development of mobile applications
and messaging tools that support the
parents' ability to manage their children's
conditions, provides parents with a mech-
anism to share their child's asthma action
plan and facilitates co-management by other
In addition, children at risk for
asthma health disparities are more likely
to self-manage their asthma at a younger
age than those from more advantaged
backgrounds with greater social supports.
Consequently, mobile technologies designed
to teach children about asthma in a develop-
mentally appropriate way are particularly
important. Creating mobile solutions that
support parents' ability to co-manage their
child's asthma in these situations would be
a useful tool.
However, there are unique needs for
these types of solutions: According to Pew,
minority families are more likely to connect
to the internet via a mobile device and
continue to fall behind in broadband access
at home. Therefore, mobile innovation to
facilitate communication should be able
to share data mobile to mobile that do not
require download to a desktop or laptop
computer. These are just two potential ways
in which innovative technologies can help
reduce asthma disparities.
Here are some stats from Pew Internet and Life:
In 2010, African Americans and Hispanics
were significantly more likely than whites
to own a mobile phone, access the Inter-
net, and send and receive text messages.
The higher cost of smartphones did not
dissuade purchase rates among these
population segments: 49% of African
Americans and Hispanics own smart-
phones, above the national average of
46% and white average of 45%.
Meanwhile, households with less than
$30,000 in income are the fastest growing
population segment, doubling ownership
rates over the past year, and households
with income level between $30,000 and
$50,000 pace the national average.
By 2012, smartphone adoption in minori-
ty and at-risk populations had acceler-
ated, with these devices often replacing
home broadband ownership.
While there are several potential mHealth technology solutions to help patients mea-
sure asthma symptoms, send pertinent information to medical providers, and recognize/
assess asthmatic triggers, their effectiveness among the most at-risk populations is not clear.
Solutions for disadvantaged and at-risk populations must move beyond reminders. They must
work with the community to address challenges universal to asthma patients and unique to
those most affected by disparities.
For example, parents in at-risk, inner-city communities often need to educate multiple
caregivers about their child's asthma management needs. This can include their parenting
partner, other family members such as grandparents who help with childcare needs, day care

Unfortunately, while new mobile
technologies are being developed at
an unprecedented rate, they may not
be reaching the most needy Americans
where they are—in low-income, ethnic
minority communities. American mHealth
application developers, venture capitalists,
and entrenched health care interest groups
"There is a greater demand for
change and, just as important,
there are fewer entrenched
interests to impede the adop-
tion of new approaches."
are missing this large and untapped
need by solely focusing on higher income
consumers at the top-of-the-pyramid.
A 2012 PriceWatershouseCoopers
report captured this sentiment, concluding
that much mHealth growth will take place
outside of the U.S. because, "... there is a
greater demand for change and, just as
important, there are fewer entrenched
interests to impede the adoption of
new approaches." The U.S. has been
frighteningly slow in recognizing the size
of the at-risk market, the unmet demand,
and the positive impact that mHealth
applications could deliver to society.
Incentives should be created to foster the
creation and usage of mHealth applications
that meet the need of these large at-risk pop-
ulations and to spur innovation. Some ideas
that we suggest to accomplish this include:
•"I Establishing public-private	Progress towards
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insurers, application developers,
telecommunications companies, patients,	/ t/UUCl/ ILJ I liC/Ut
academic institutions and non-profits
focused on at-risk communities to address ethnlC ClSt>hfflCl
these issues and suggest solutions.			
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capitalists to support the creation of incuba-
tors to accelerate development specifically	q IjqJ^ course
targeted at addressing issues of health
disparities in at-risk communities, such as
those seen in asthma, obesity, diabetes, and (J J C/C L IL/i I.
other chronic conditions that add extraordi-
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government and health care insurers	•	j
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	 could he that bold
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provision of devices is needed to support
	 willing to take it


For people with chronic illnesses,
the burden of cost can be overwhelming.
One the most pressing issues in health
care disparities is lack of insurance, 17%
of all people in the U.S. don't have health
insurance, not to mention the underinsured.
Joblessness, low incomes, and the cost of
insurance are all cited as reasons, and those
factors have risen every year for the past
four years. They are also factors that affect
minorities the most.
Besides cost, access to health care
facilities can be a tremendous hurdle.
Sometimes it's a matter of proximity:
for those who don't always have reliable
transportation, something as simple as
distance can make treatment a difficult
proposition. And for those who can't always
get time off of work, their own health or
the health of their children is at odds with
the need to put food on the table and a roof
over their heads. These are problems that
many of us will never have to think about;
for those of us who do have to worry about
these issues, they are as much an obstacle as
a lock on the door of the doctor's office.
A predictable thing happens when
asthma patients don't get treatment right
away: eventually, many of them end up
in the emergency room. The economic
ramifications of that are clear - a larger
burden on the government, on hospitals
and on society if the patients are uninsured
- but the human costs are so much more
frightening. By the time asthma is severe
enough to warrant hospitalization, it's
severe enough to kill - and kill quickly
without prior treatment and medication.
There are some solutions to these
issues already in place. It's worth noting that
the Affordable Care Act, recently upheld by
the Supreme Court, will require everyone to
have insurance and provide ways to make
health care more affordable. While this
won't cure the problem of the high cost of
treatment for the poorest Americans, it will
help. There are also programs that seek to
address the problem of simply getting to the
doctor. Mobile clinics, such as Washington,
DC's Washington on Wheels, provide
quality health care services by appointment
primarily to uninsured and underserved
residents. For urgent care, there are some
examples of mobile facilities that make
house calls for emergencies, such as Chicago
Express Doctors, which is far less expensive
than many Chicago urgent care clinics, and
far less than a trip to the ER.
by Elena Berger
Executive Editor of
Disruptive Women in Health Care
Senior Internet Strategist of
AmpLify Pub Lie Affairs, LLC
It is well-documented that asthma
disproportionately affects minority,
urban, and low-income communities,
The reasons are numerous and
complicated - poor urban planning,
pollution and hazardous materials,
lack of data to pinpoint disparities,
genetics, cultural differences, and
beyond - and these issues must be
tackled at the roots,
But what about right now? What
about people who already have
asthma and are beyond the reach of
Access to care must be part of any
discussion about asthma disparities.
We know the numbers. Now we need
to address not only societal reasons
for this health care crisis, but societal
imbalances in how we care for the sick.
Chronic disease is different from
acute illness. It's not something you go
to the doctor for once and get cured; it's
a daily struggle, and often an expensive
one at that. Considering that the people
who develop asthma at the highest
rates are often the people who can least
afford to pay for it, they - and we - are
facing a monumental problem. From
diagnosis to treatment, we are failing
our most vulnerable citizens.

Diagnosing asthma is a separate issue
from non-treatment, though of course
related. If people don't seek treatment for
asthma, they may not even know that they
have asthma. The symptoms are not always
as cut and diy as you might think. Look at
the example that Ronnie Tyler provides in
this ebook. Her son's illness presented more
like a daily stomach bug than anything else.
Even if people with asthma already
know what they have, the process of
diagnosis is still important. Not only does
diagnosis help determine the next steps
that patients must take to get treatment
- treatment that must be tailored to the
individual, since not all asthma cases are
alike - it also has a drastic effect on asthma
data collection. Lack of good data undercuts
our ability to recognize issues among
specific populations, research reasons, and
set a course of action. It is a public health
matter of the utmost importance.
If it's too costly for asthma sufferers
to seek treatment, imagine how difficult it
would be to pay for long-term medication
and follow-up care. Again, there are some
programs that are meant to alleviate these
costs. Medicaid provides prescription drug
coverage for some people who desperately
need it. However, there is controversy over
the fact that while the program meets the
needs of the veiy poorest, there is a cut-off
point that excludes those who are just above
poverty limits considered so low that they
allow an enormous number of people in
need to fall through the safety net.
What if we continue down the path of disparate trends in illness and treatment?
Minorities make up almost 50 percent of the U.S. We're looking at a future in which most of
the population is in poor health. Asthma is just one of the pressing health issues we need to
deal with, but because of its growing prevalence, chronic nature, and sometimes complicated
treatment, it needs specific attention. We're talking about sustaining the health of our
workforce, our economy, and - more important than any statistic can capture - our children.
We must take action to leave the members of the next generation in better health than ours,
not just some of them but ALL of them.
To accomplish this, we need more research to determine what the trends are in asthma
disparities and why some populations are becoming sicker than others. We need to have
programs in place to change these trends at the preventive level. And for those who are
already sick, we must be able to provide quality care across the board.
That's our responsibility,;
not our choice.

by Marian Kerr
Intern at
Amplify Public Affairs
Obesity and asthma have become serious public health issues. Both diseases are
significantly affected by the constructed environment in which we live. Asthma can be triggered
by a variety of factors, from the cleanliness of our homes to access to medication; obesity can
be affected by access to food, or rather, the lack thereof. Recendy, studies have shown a linkage
between the two diseases. Could the association between these diseases allow us to assume that
asthma can also be affected by the availability of healthy food options? Let's investigate.
Millions of American's live in areas
known as "food deserts." The term "food
desert" is used to describe urban and
rural residential communities with little
or no access to healthy food, such as fresh
vegetables and fruits,
meats and daiiy products.
Grocery stores and other
food retailers in these areas
are hard to come by or are
unaffordable. According to
USDA, more than 23 million
Americans, including 6.5
million children, are living
in food deserts. Low-income
African Americans make
up most of the population
affected by this healthy food
Food deserts are
significant because they pose
health concerns for their
affected populations. A lack of affordable
healthy food in an area signifies a large
presence of processed foods and fast food
options, which in turn leads to health risks
such as obesity, as well as diabetes and
other diet-related conditions. Projects such
as the Healthy Food Financing Initiate and
Michelle Obama's Let's Move' campaign
have targeted their efforts to increasing
access to affordable and healthy food
because of these associated health risks.
By addressing the
issues that affect
the overall public
health of minority
communities, such as
the lack of access to
healthy food, we can
positively influence
the trend of asthma
prevalence as well.
The association between obesity and
asthma is significant. One study found
that the risk of asthma tripled for most
obese individuals compared to people
with normal weight. The Journal for Nurse
Practitioners took a look
into the linkage between
asthma and obesity in
children. The authors
noted that obesity is
strongly associated with
breathing disorders
because excessive body
fat can affect lung function
and restrict the movement
of air within the body. The
effect that obesity has
on a person's breathing
patterns can complicate
the diagnosis, treatment,
and course of asthma.
Both asthma
and obesity are more likely to African
Americans, select Hispanic populations,
and low-income households than other
American populations.
By addressing the issues that affect
the overall public health of minority
communities, such as the lack of access to
healthy food, we can positively influence the
trend of asthma prevalence as well.
Recent studies favor the close
association between the two diseases, but
the exact nature of the association is unclear.
For example, the claim that the increase
of obesity has led to asthma prevalence in
America is controversial. In order to learn
more about this linkage, the Department of
Health and Human Services, partnering with
the National Institute of Nursing Research
organization within NIH, has announced a
funding opportunity in regards to this issue.
The purpose of the funding is to gather
more concrete data about the interweaving
patterns of obesity and asthma so we can
better understand and address these public
health issues.
USDA on Food Deserts
Health Problem's and Childhood Obesity
Obesity and Asthma- What's the

by Andre Blackman
Director of Digital Media for
Disruptive Women
in Health Care
Often times we hear about the environmental dangers of smog, pollution and other
outdoor elements that can negatively impact our air quality - in turn, negatively impacting our
health. For children with lungs that are still growing and adapting to their environment, this
can cause illnesses such as asthma and other respiratory ailments to become active. However,
not all hazardous materials that affect respiratory health are outside of the home - often times,
especially for children, the cause for asthma symptoms can stem from the home environment.
This plays a huge role with asthma development in children of color, particularly those who
live in urban/city environments & low-income housing that may have poor building materials.
When we usually think of the places where we live, we understand that they protect
us from inclement weather and other outdoor elements. Unfortunately, factors such as
mold, cockroaches and dust allergens can create a war zone for young people with asthma -
especially those who spend a considerable time inside the home. As mentioned before, young
people of color who may live in urban environments where regular maintenance of airways
and vents, plumbing and building material are not occurring - can be exposed to such hazards.
otherwise known as mildew, can exist all
year long and usually develops in damp
environments. Mold typically spreads by releasing airborne
remnants (spores) in order to attach to other surfaces. It's this
airborne behavior that can cause irritation of the lungs in youth
and cause onset of asthmatic symptoms.
creatures will want to spend time in our
home, whether we want them there or not.
Specifically, roaches and dust mites are main culprits when it
comes to asthma. The fecal matter and debris from their bodies
float through the air and attach to furniture/carpet. When left
unchecked, the build-up can trigger respiratory problems.
often occurs in the home around
young people. The secondhand
smoke impact on lungs (young or old) can be devastating: for
children with asthma this can be even worse. The smoke from
cigarettes or cigars directly impacts the bronchial passages of
young asthma sufferers that are already inflamed - this can cause
additional irritation, increasing the chances of attacks and other
complications of breathing which can trigger respiratory problems.
and chemicals
are often times in
homes in high-traffic areas in the form of
invisible gases such as carbon monoxide,
which can be a hazard. However, indoor
items such as gas stoves and furnaces can
leak carbon monoxide as well as nitrogen
oxides. This is where if s important to
regularly test for the levels of these types of
gases in your home to make sure they are
safe for those with asthma.
We always want to think of our homes as
safe havens, but when considering those
who may be suffering with asthma - espe-
cially the youth - it is imperative to make
sure that it can still be a hospitable place
by keeping the above in mind. Regularly
clean and check for unsafe levels of airborne
chemicals and gases.
EcoLife's Sources of Indoor Air Pollution
CDC Research on Indoor and Outdoor Air Pollution
ERA's List of Asthma Triggers