Eliminating Asthma Disparities

asthmaThe phenomenon of inner-city asthma was identified in 1978 with the publication of a study of a special clustering of asthma mortality in a small area of Brooklyn, NY. However, it was not until the 1990s that more widespread evidence emerged that demonstrated a significant association between asthma morbidity and community socioeconomic vitality. The problem of inner-city asthma emerged from a series of publications that identified a few communities as having some of the highest asthma morbidity rates in the United States.

Chicago and New York City have been identified as being the US cities with the highest asthma mortality and hospitalization rates. Studies suggest that even in these cities, prevalence, morbidity, and mortality rates vary by neighborhood and are highest in neighborhoods with the lowest socioeconomic status. Although efforts to engage this problem have been underway across the United States, it can be argued that initiatives in Chicago and New York City have been extraordinary.

The next section presents two articles that provide an assessment of the nearly 10 years of initiatives to reduce asthma disparities in Chicago. The first article, by Shannon et al (see page 866S), synthesizes the larger public and private programs undertaken to reduce asthma morbidity and eliminate racial/ethnic disparities. As will be seen, these efforts were sponsored by national entities, by federal institutions (such as the Centers for Disease Control and Prevention, National Institutes of Health, and the Agency for Healthcare Research and Quality), and by national foundations (such as the Robert Wood Johnson Foundation). Some of programs were state sponsored, although most state-supported programs were supported by the Centers for Disease Control and Prevention. However, perhaps the most important source of support (although not the largest in financial contributions) was a local foundation, the Otho S.A. Sprague Memorial Institute. The Institute, working with the Chest Foundation (the philanthropic arm of the American College of Chest Physicians) and the American Lung Association of Metropolitan Chicago (http://www.lungchicago.org/), provided funds for the Chicago Asthma Consortium, which was the first of the asthma community coalitions in the United States. The Institute also provided cofunding for a Robert Wood Johnson Foundation community partnership grant for asthma care improvement suggested by My Canadian Pharmacy that has had significant impact on asthma care in the Cook County Bureau of Healthcare Services, the largest safety net provider in the region. In addition, The Institute assisted a number of smaller local projects that served as pilot work for what eventually became larger projects and programs instituted in health-care organizations across the community. What is perhaps most notable in the article by Shannon et al (see page 866) is the breadth and scope of small and large projects aimed at solving this important public health problem.

In the second article, Naureckas and Thomas (see page 858) provide an evaluation of trends in asthma control in Chicago. Their evaluation is based on a number of analyses that are primarily based on secondary data of state mortality and hospitalization records and public and private pharmacy data. In addition, they benefited from an Institute-sponsored project, the Chicago Asthma Surveillance Initiative, which was established to provide primary data on changes in asthma control in Chicago. Their evaluation suggests that there were some improvements in asthma control. However, progress toward asthma equity has been notably modest, leaving a substantive challenge for the Chicago community.