Health Experts Urge Major Policy Reforms To Stem Childhood Asthma Epidemic In The United States

SANTA MONICA, CA - A panel of health experts convened by RAND marked World Asthma Day by recommending a series of far-reaching actions today to improve the lives of the estimated 5 million children in the United States with asthma.

The proposed actions include expanded insurance coverage and benefits for children with asthma, and the creation of "asthma-friendly" communities and policies to:

Quickly diagnose asthma among children and ensure they receive appropriate and ongoing treatment.

Equip health care facilities, schools and social agencies to meet the needs of children with asthma and their families.

Ensure that children are safe from physical, social and environmental risks that exacerbate asthma.
The panel's recommendations appear today in the journal Pediatrics on the eve of World Asthma Day on Tuesday, an international event designed to improve asthma awareness and treatment. Asthma is the most common chronic childhood illness in the United States.

To achieve its objectives, the panel identified 11 specific policy recommendations. Recommendations call for improving asthma care in primary care settings; teaching children with asthma and their families how to better manage the illness; providing coordinated case management to children at high risk for asthma; and developing model health care benefit packages for essential childhood asthma services.

Additional recommendations are designed to strengthen the public health infrastructure. These include a call for development of a national asthma surveillance system to assess the magnitude and nature of the childhood asthma crisis and provide data for new prevention, treatment, and management strategies. The surveillance system would be funded and coordinated by the U.S. Centers for Disease Control and Prevention.

To promote asthma-friendly schools, the panel recommends educating school nurses and other personnel about performance standards of care for asthma, as well as applicable laws, and making school-based services available to all children who attend school as a community benefit.

The Robert Wood Johnson Foundation funded RAND Health to identify and outline future directions for childhood asthma policy in the United States, as part of the Foundation's broader Pediatric Asthma Initiative. RAND engaged an interdisciplinary panel of nationally recognized childhood asthma experts and leaders in a structured process to create a strategy. (A list of the panel members is below.)

The lead author of the report was Marielena Lara, M.D., M.P.H., a researcher at RAND Health and at the Division of General Pediatrics, University of California at Los Angeles. She said: "We need to dramatically improve our approach to dealing with childhood asthma. Although children with asthma can live normal lives when they receive effective treatment, too many children with asthma are suffering unnecessarily, and some are even dying. This report is a call to action to leaders in the public and private sectors to make substantial, coordinated efforts to solve this problem."

Panel member Noreen Clark, Ph.D, dean of the University of Michigan School of Public Health, said: "Many asthma attacks could be avoided - and much suffering prevented and many medical costs saved - if more children received good-quality, ongoing asthma care and if their communities were more asthma-friendly. We have the means to treat and manage this disease, yet we are failing to get the job done."

Dr. Claude L'Enfant, director of the National Heart, Lung and Blood Institute, which administers the National Asthma Education and Prevention Program, said of the panel report: "This thoughtful analysis of the complex public health problem of childhood asthma is a valuable contribution to the body of literature on this disease. We are committed to improving the diagnosis, management and prevention of asthma in children. This blueprint will help us and other government and private agencies improve the outlook for childhood asthma in the U.S."

To implement its plan, the panel envisions significant roles for a wide range of private and public stakeholders at the local, state, and federal levels. Leading national organizations and government agencies would include Congress, the National Asthma Education and Prevention Program, the Department of Health and Human Services, the Centers for Disease Control and Prevention and the Department of Education, as well as state agencies for Medicaid and for the State Children's Health Insurance Program.

Despite significant improvements in medical care for childhood asthma, the human and financial costs of the disease continue to grow. The number of cases increased 160 percent between 1980 and 1994 among U.S. children under age 5, and 74 percent among children ages 5 to 14.

The illness accounts for an estimated 11.8 million school days missed per year nationwide, as well as lost parental workdays. In 1994, the U.S. spent an estimated $10.7 billion on asthma.

Both poor and minority children suffer a greater burden of asthma. African Americans and some Hispanics, particularly Puerto Ricans, suffer the highest asthma rates. Research points to several possible reasons for this, including: less access to quality health care; genetic factors; and higher exposure to environmental factors such as tobacco smoke, dust mites, and cockroaches.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.

The Robert Wood Johnson Foundation is the nation's largest health care philanthropy.

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