An in-depth report reveals asthma’s unrelenting toll on Black, Hispanic and Indigenous communities in the United States in terms of disease rates, emergency department visits and deaths.
The report from the Asthma and Allergy Foundation of America (AAFA) finds all three groups far more likely to have asthma than white Americans. In fact, Hispanics of Puerto Rican descent are twice as likely as white Americans to have asthma.
When it comes to fatalities, the numbers in AAFA’s “Asthma Disparities in America” report are stark. Black Americans are about three times more likely to die from asthma than Hispanic or white individuals. What’s more, Black women currently have the highest fatality rate at nearly four times (23.5 deaths per million) that for white males (5.9 deaths per million). Similarly, asthma deaths among Puerto Ricans are three times higher than within the broader Hispanic and white populations.
The report covers 15 years of data from government agencies and population studies. AAFA points out that while there have been some improvements overall in asthma rates and health care interventions, racial and ethnic disparities are persistent and alarming. “The U.S. is falling far short in eliminating the problem for Black and Hispanic Americans who experience the most stunning differences,” AAFA says.
Importantly, the 264-page report investigates the causes of the disparities in asthma management and offers 69 strategies to effect lasting change.
“Insufficient funding and lack of political will” are the main barriers to fixing systemic failures and improving asthma care for minority populations, says Sanaz Eftekhari, co-author of the report and vice president of research at AAFA. “The disparities are preventable,” she tells Allergic Living. “We know what to do, we just need to get it done.”
Among the almost 25 million Americans with asthma, Puerto Ricans have the highest rate of asthma at 14.9 per cent, followed by Black Americans (10.6 per cent), American Indian and Alaska Natives (10.4 per cent*), white Americans (7.6 percent) and non-Puerto Rican Hispanics (6 per cent).
The report notes that emergency department (ED) visits are indicative of poor asthma control, and that Black patients visit the ED nearly five times as often as white patients.
AAFA cites social and structural health determinants – including poverty, housing quality, access to health care and higher education, along with systemic racism (e.g. in hiring or housing policies) – as major causes of asthma disparities. The report also finds behaviors play roles, such as not using asthma medications regularly, and beliefs, such as distrust of the medical system.
Strategies For Change
With this report, AAFA says it is creating a roadmap for change – to tear down asthma barriers and improve health. It sets out a comprehensive list of 69 strategies spanning a variety of spheres, such as education, access to health care, economic stability, and proper housing. Some of these key strategies for asthma include:
- Implementing policies to improve and expand insurance coverage for underserved communities. Also improving specialist care coverage and increasing diversity in the specialty health-care workforce.
- For economic stability, public policy improvements on minimum wage and through tax measures.
- In health care, measures to bridge communication gaps and offering culturally appropriate asthma action plans.
- In research, significantly increasing participation of Black, Hispanic, and Indigenous Americans in clinical trials.
- Addressing cultural stigmas about research among minority populations and building trust in medical establishment.
- Increasing racial and ethnic diversity among those studying asthma.
- Facilitating collaboration between federal, state and local agencies and non-governmental organizations to aid in promoting effective policies/programs to reduce asthma disparities.
- Reducing financial barriers to filling prescriptions, and expanding pharmacy access by providing a three-month supply of asthma medicines.
- Home programs that include curtailing exposure to triggers in the home by providing trigger-abatement products and referrals to resources such as mold removal, pest management, and legal/housing assistance.
- Appointing diverse patients to advisory councils, task forces and project committees. Plus, fairly compensating patient and family advisors for advisory roles.
Finding Lasting Change
While the asthma issues in Black, Hispanic and Indigenous communities are longstanding, the report’s authors are “cautiously optimistic” about the potential for meaningful change. Report co-author Eftekhari stresses an important point about asthma being a very controllable disease – when there are the right precautions, protocols and medication.
“The thing about asthma is that nobody has to die from it, and that’s the unfortunate truth that we don’t talk about enough,” she says. With 10 people dying from asthma every day in the United States, the fact that most of these deaths are preventable has “an extra sting to it,” says Eftekhari.
So how does this roadmap become an instrument for concrete change? Apart from the partnerships with individuals such as medical researchers and healthcare providers, Eftekhari notes that AAFA needs the engagement of community leaders and organizations to help with the groundwork.
Above all, she calls on policymakers at the federal, state and local levels because, “it’s going to take that long-term structural change in social [and] economic policies to move this forward.” She also notes that the current Black Lives Matter social movement against racial injustice could “give this the kick that it needs.”
See the full report: Asthma Disparities in America: A Roadmap to Reducing Burden on Racial and Ethnic Minorities: aafa.org/asthmadisparities
*AAFA notes that asthma data on American Indian and Alaska Native populations are limited, but it is known that Indigenous Americans face a disproportionate burden of the disease.
Listen to Allergic Living’s “Talking Food Allergies” podcast series on racial disparities in food allergy here. Featuring leading experts and community advocates.