Obama Administration on Race and Asthma

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(The Root) — Nearly 26 million Americans are affected by asthma, including 7 million children, and research has shown for decades that poor and minority children bear the greatest burden of the respiratory disease. According to the Department of Health and Human Services, asthma rates for African-American children are at 16 percent — and 16.5 percent for Puerto Rican children, more than double the rate of white children in the United States. The annual economic cost of asthma, including hospital stays and indirect costs such as lost work days, adds up to $56 billion.


This long-standing racial and ethnic disparity is linked to a combination of social and environmental factors, including a greater likelihood of living in communities or attending schools near highways, ports and bus terminals that expose children to air pollution; living in poorly constructed housing with mold and shoddy ventilation; and lacking resources for the preventive medicine needed to manage the disease at home.

Last week the Obama administration announced a new approach to hit each of these trigger areas. The Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities — an interagency effort from HHS, the Environmental Protection Agency, the Department of Housing and Urban Development and the White House Council on Environmental Quality — will focus on asthma management and prevention through reducing barriers to asthma care, building community-based systems for care at the local level and targeting services to the children and families most affected by the disparities.


EPA Administrator Lisa P. Jackson spoke with The Root about why the administration moved to tackle asthma and race, her agency's role in the action plan and why the disease is not a minor nuisance but a major health threat.

The Root: Has anything changed in the frequency of asthma diagnoses, or the research on the disease, that motivated the administration to create this plan around racial disparities?

Lisa P. Jackson: I don't think it's changed as much as it's not changing fast enough. When we look across America, we see the stubborn, disproportionately higher risk for asthma and respiratory illnesses among low-income and minority children and families. That's a disparity that has real impact on everyday quality of life; a huge impact on a family's pocketbook; and, of course, it has the potential to bring serious health effects that in some cases have proven to be fatal. Black children are four times more likely to die via asthma than white children, they're more than twice as likely to have an emergency-department visit and they're twice as likely to be hospitalized. So you can see the human cost as well as the economic cost.

TR: Asthma is often seen as a condition that's easily manageable, yet you call it a major health threat. Why do you think the seriousness of asthma is downplayed?


LPJ: I think people have the impression that the disease is a chronic, treatable illness, and that makes some assumptions. It assumes that families have the wherewithal economically to be able to afford good preventative care and diagnoses early on.

I'm very fortunate. My youngest son has asthma, and we were at the allergist, and the doctors very early on [came] up with strategies to help him manage the disease. But I think that it is a fundamental injustice and a huge economic cost that there are families who don't have that opportunity. And then it turns into a much more concerning thing where you start to see the hospitalization rates and the death rates.


TR: In terms of your jurisdiction at EPA, what environmental interventions are in the plan to reduce asthma rates?

LPJ: The plan talks, in part, about us accelerating our existing prevention efforts. One of the huge triggers for asthma is the quality of the air we breathe. At EPA we're really proud of the mercury and air toxic standards that we promulgated last year, and the cross-state air-pollution rule that we promulgated last year as well. Those standards are designed to deal with toxic pollution in our air, and both of them will have a huge impact on the levels of smog, which is an asthma trigger. They will also have an impact on fine particles — most people call that 'soot" — which can be a huge problem for any people who have any kind of respiratory disease.


While we do this work with respect to outdoor air, indoor environmental conditions can be an important part of the problem as well. Everything from our standards for school siting [deciding where schools are located] and putting out guidance on ways to manage triggers in schools is part of this.

TR: How will the participating federal agencies track progress? What are your benchmarks?


LPJ: As we move forward, we are going to set benchmarks and ways to look at progress. But I think the most important benchmark is first being able to reach communities and being able to ensure that the federal agencies and our partners are working collaborative and comprehensively on this issue. Then we can move toward making sure that we actually see, if not the rates of asthma going down, the costs and the deadly toll of this disease starting to fall.

Cynthia Gordy is The Root's senior political correspondent.

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