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Floyd J. Malveaux, M.D., Ph.D. Headshot

Addressing Childhood Asthma -- and the Millions That Have It

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"Nero fiddled while Rome burned" is a phrase I often use to describe irresponsible behavior in the midst of a crisis.

For many of us who are invested in and committed to the fight against childhood asthma in this country, it's clear that we are in the midst of a public health crisis. A recent report by the Centers for Disease Control and Prevention (CDC) confirmed for many of us what had become obvious -- progress against asthma in the United States has stalled and we are losing ground.

Yet federal asthma budgets are being cut by both the Administration and Congress, and asthma does not appear to be gaining the traction that is needed to address this major public health issue at the federal level.

How bad is the problem?

Approximately 25 million Americans have asthma -- and the numbers are increasing every year without clear explanation. Children have more asthma attacks than adults, and the disease is especially devastating for children and families living in poor, minority and medically underserved communities. Asthma prevalence over the last 10 years has increased most significantly among black children -- 17 percent of all black children in the United States currently have asthma.

We have known for a long time that asthma is the most common chronic disease in children, the primary reason why kids with chronic diseases miss school days and among the top three reasons why children end up in emergency rooms or are admitted into hospitals.

And it goes without saying that the economic consequences are staggering. To be more specific, the CDC report notes that asthma costs in the U.S. increased by six percent (from $53 billion to $56 billion) between 2002 and 2007. While the financial costs are staggering, the human costs and erosion of quality of life are inexcusable -- especially because we know how to help most people with asthma control their symptoms and prevent life-threatening attacks.

So why are we failing?

The CDC report concludes that "persons with asthma need to have access to health care and appropriate medications and use them. They also need to learn self-management skills and practice evidence-based interventions that reduce environmental risk factors." I couldn't agree more, but the statistics are dramatic proof that we are failing to deliver the health care, education and self-management tools needed by many to manage their asthma.

While various health reform and the Affordable Care Act (ACA) begin to address some of the systemic problems -- especially with regards to care access reduction of care disparities and creating incentives to better control chronic conditions -- there are potential land mines that may exacerbate health disparities. For example, how do we ensure that pay-for-performance measures don't inadvertently cause providers to avoid treating high-risk individuals or communities associated with poor health outcomes?

So what can we do now while health reform is being sorted out?

First, we have to recognize that "Rome is burning" and admit that business as usual is not working. We need to move past the silo mentality and work within and across agencies -- public and private -- to find a common voice on the most critical issues.

Just last week, U.S. Surgeon General Regina Benjamin and the National Prevention Council released the nation's first National Prevention Strategy as a critical component of the new health reform law. In that strategy she stressed preventive measures to control chronic conditions and noted that "asthma attacks can be prevented through home visitation programs that assess and modify homes to reduce exposure to asthma triggers and educate individuals on how to improve asthma self-management." I applaud her efforts and it gives hope that we are moving in the right direction on the federal level.

The Federal Initiative to Reduce Childhood Asthma Disparities is another great start to solving some of these issues, but we need to take it a step further. The initiative, which is part of a White House instigated Federal Task Force on Environmental Health Risks and Safety Risks for Children, should be evolved into a public-private partnership to reduce childhood asthma disparities. This should be a partnership with support and involvement from the White House -- similar to their backing of obesity and autism initiatives.

There's also been progress made on the community and research levels. My organization, the Merck Childhood Asthma Network, recently partnered with Alpha Kappa Alpha Sorority, Inc. to launch the National Asthma Prevention and Management Initiative, which aims to ease the burden of childhood asthma on minority communities over the next three years.

We also funded research at George Washington University that identifies challenges and opportunities to make progress on childhood asthma using the tools we already have in place. Specifically, a report released through this research says that ensuring all children with asthma have stable and continuous health insurance, using health information technology to enhance and formalize monitoring of the disease and reducing triggers in homes and communities could make a marked difference for thousands of children.

I believe that we know all we need to know, so we should stop twiddling our thumbs. My personal and professional experience with asthma won't let me sit idly by while children with asthma fall off the radar. It is now more important than ever that we encourage collaboration, and gather the resources and commitments necessary to successfully address this issue.