We are all familiar with the phrase "Nero fiddled while Rome burned" to describe irresponsible behavior in the midst of a crisis. Well, for those who monitor and are interested in the ongoing status of childhood asthma in this country, we are in the midst of a public health crisis. Let us be reminded that this is the most common chronic disease of children.
Recently the Centers for Disease Control and Prevention (CDC) confirmed what for many of us 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 condition at the federal level.
How bad is it?
Approximately 25 million Americans have asthma and the numbers are increasing every year and we don’t know why. 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 number one cause among chronic conditions of missed school days, and it is among the top three reasons why children end up in emergency rooms or are admitted into hospitals. It goes without saying that the economic consequences are staggering. To be more specific, the CDC report notes that asthma costs in the US increased by 6% (from $53 billion to $56 billion) between 2002 and 2007. But for me, while the financial costs are staggering, the human costs and erosion of quality of life are inexcusable because we know how to help most people with asthma control their symptoms and prevent life-threatening asthma 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 agree, but the statistics are dramatic proof that we are failing to deliver the health care, education and self-management/empowerment tools needed by many to manage their asthma.
But, there is hope!
The Affordable Care Act (ACA) begins to address some of the systemic problems, especially with greater access to care, reduction of disparities and incentives to control better chronic conditions. On the other hand, ACA does have potential land mines that may exacerbate health disparities. For example, how do we ensure that the proposed “Accountable Care Organizations” that will be reimbursed to a large extent based on performance (i.e., health outcomes) do not organize in a way to avoid treating individuals with high risk or communities associated with health disparities?
While implementation of the ACA is sorted out in the years ahead we must do what we can now to address the asthma public health problem. First, let’s 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.
To that end and with one caveat, I propose we begin by coalescing around the Federal Initiative to Reduce Childhood Asthma Disparities which is part of a White House instigated Federal Task Force on Environmental Health Risks and Safety Risks for Children. Co-chaired by HHS, EPA, and HUD, several federal departments, agencies, and White House offices are attempting to work together to promote best practices in asthma care to reduce disparities and to develop a coordinated research plan. The work of this Task Force was endorsed in the recently published HHS Action Plan to Reduce Racial and Ethnic Health Disparities. If we are successful in addressing asthma health disparities, all persons with asthma and their families will benefit.
And here’s the caveat, I urge that immediate steps be taken to evolve the Federal Initiative into a Public-Private Partnership to Reduce Childhood Asthma Disparities that will have the full support and involvement of the White House along the same lines as recent efforts to tackle childhood obesity and autism. So, let's stop fiddling. In these challenging times, it is important that we all work together to bring to bear the resources and commitment necessary to be successful. That level of commitment is necessary if the programs and projects that emerge are the products of a true collaboration.
Floyd J. Malveaux
June 9, 2011
Let's Stop Fiddling Around while "Rome Burns"