Health Equity in Allergies, Asthma and Immunology

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Health equity in healthcare is essential. It can reduce health disparities and help ALL people get the care they deserve.

Photo composite of a face created with various ethnic and genders.

Allergy & Asthma Network is committed to ending health disparities and advancing health equity. We strive to increase opportunities for people to live the healthiest life possible – no matter who they are, where they live, or how much money they make. We do this through our mission areas of outreach, education, advocacy and research.

Here is a breakdown of the U.S. population by race and ethnicity. This is according to the 2020 U.S. Census:

U.S. Population by Race & Ethnicity (2020)
White and non-Hispanic: 57.8%
Hispanic/Latino: 18.7%
Black or African American: 12.1
Asian American: 5.9%
2+ races: 4.1%
American Indian/Alaska Native: 0.7%
Other race: 0.5%
Hawaiian/Pacific Islander: 0.2%

Let’s examine how racial and ethnic groups face health disparities.

What are health disparities?

Health disparities occur when there are differences in health outcomes between population groups. Healthy People 2030 has defined health disparity as a health difference closely linked with social, economic, and/or environmental disadvantage.

Health disparities affect people who have experienced greater obstacles to health based on:

  • their racial or ethnic group
  • religion
  • gender identity
  • socioeconomic status
  • age
  • mental health
  • cognitive, sensory or physical disability
  • sexual orientation
  • geographic location
  • other characteristics historically linked to discrimination or exclusion

What is health equity?

Health equity is when everyone has an equal opportunity to reach their full health potential. No one should face a disadvantage from achieving this potential. It should not occur due to social position or any other socially defined circumstance.

Achieving health equity involves addressing risk factors apart from genetics and biology. It involves valuing everyone equally. It involves removing systemic biases and inequalities from healthcare. These factors affect the health of individuals and communities.

Health disparities make achieving health equity more difficult. This is why it’s vital to advance health equity. Social determinants of health contribute to both health equity and health disparities.

Path to achieving Health Equity infographic

What are social determinants of health?

The term social determinants of health (SDOH) describes “conditions in the environments where people are born, live, learn, work, play, worship, and age. It affects a wide range of health and quality-of-life outcomes and risks.” These factors involve:

  • annual household income (socioeconomic status)
  • education
  • neighborhoods and physical environments in which people live
  • employment opportunities
  • social support
  • access to healthcare

These factors impact not only a person’s physical health but also mental health. They play into the ability of people to manage chronic conditions.

Why do social determinants of health matter?

Good health doesn’t happen in a bubble. Without a quality education, people are less likely to get steady employment. They may struggle to get an adequate income and access to health insurance. They may not be able to find or afford appropriate housing.

People in some communities may struggle to find or afford fresh, healthy foods. They may live in a “food desert,” which is an area with limited or no access to affordable healthy food, including fresh fruits and vegetables. They may have to travel a long distance to get to a supermarket. This can be a problem for those who may not have a vehicle or lack public transportation.

A nutritious, well-rounded diet helps develop a healthy immune system. (Asthma is primarily an immune system disease.) Healthy eating is especially important for children with still-developing lungs and airways. Also, healthy food helps reduce overall inflammation, the underlying cause of asthma symptoms.

People who lack access to fresh, healthy foods are at risk for weight gain and obesity. Weight gain is a risk factor for asthma. Some communities may have a lot of fast food restaurants or convenience stores. These food outlets sell unhealthy foods and drinks that contribute to weight gain. Yet, it may be cheaper for a family to buy fast food than to afford a more nutritious, balanced meal.

In the end, some people have to choose between food, housing, medical care or medications. Since food and housing are essential, they may forgo medical care or medications.

Another complication? Lack of access to healthcare providers who are multilingual. Or the healthcare providers may not be able to meet a patient’s social and cultural needs. Patients are better able to follow a treatment plan when their healthcare provider speaks in a way that is easy to understand.

How do social determinants of health impact people living with asthma and allergies?

Woman in a telehealth session

Asthma and allergies are conditions that need ongoing care. Without ongoing care, these conditions can become a struggle to keep under control.

Taking medications as prescribed is important in managing both asthma and allergies. Some people may not use medications as directed or may ration them if they can’t afford the cost. This often occurs with controller medications and quick-relief inhalers for asthma. It can also happen with epinephrine for severe allergies.

Some people may live in an area where they are unable to find quality healthcare. They may not live in an area where there is an allergist, asthma specialist or lung doctor. Finances, lack of health insurance or transportation issues may force people to skip or delay medical care.

Access to allergen-safe foods can be a challenge due to cost or lack of options for obtaining groceries.

Urban environments have more air pollution due to vehicle traffic. Both rural and urban areas may have substandard housing. This can cause more exposure to asthma and allergy triggers such as mold, dust mites, mice and cockroaches.

Cultural and language barriers play a role in understanding treatment plans. It could cause confusion in how to correctly use an asthma inhaler, epinephrine device or allergy nasal spray.

What is health literacy?

Health literacy is the ability to find, understand and use health information and services. It can inform health-related decisions. People with poor health literacy may struggle to understand and use health information.

Infographic of Health Literacy from the CDC

How is health literacy linked to health disparities?

People who experience health disparities are more likely to have low health literacy. Low health literacy is more common in older adults and in under-resourced or underserved communities. It also affects people from low-income homes.

How does health literacy impact people with asthma and allergies?

Health literacy is an important part of managing chronic health conditions. These include asthma, allergies, COPD and eczema.

Low health literacy can contribute to poor control of chronic conditions including asthma. Low health literacy can make it challenging to use an asthma inhaler, for example. Improper use can lead to poor control of asthma symptoms.

People with low health literacy may need health information in simple, easy-to-understand language. They may need help navigating the healthcare system. They may need help finding resources and providers.

Factors that add to asthma disparities: access to care, income, environmental allergens, education, language and cultural differnces.

Why is it important to have diversity in research?

It’s essential to include a diverse patient population in research and clinical trials. Researchers are better able to identify issues that affect certain patients or patient groups.

Black, Hispanic/Latino, Asian and Native Americans are often missing in clinical trials. This under-representation makes it difficult for researchers to generalize findings for all populations.

A study published in The Lancet examined racial and ethnic group participation in research between 2000 and 2020. It found that only 43% of studies reported race/ethnicity data. The study also found enrollment of diverse populations was “poor but improving.”

Diversity in research involves participants from all racial and ethnic groups. It involves people who are from low-income homes or live in rural areas without many resources. Inclusion helps researchers gain a fuller understanding of different health experiences. It provides a fuller picture of real-world needs and concerns.

Research participation also provides under-represented groups with greater knowledge and access to treatments.

Some people from racial and ethnic groups may feel reluctant to get involved in research. Black Americans may distrust the healthcare system and medical research due to historical and contemporary injustices. More barriers for a racial or ethnic group may include:

  • lack of transportation
  • lack of knowledge or understanding about participating in a study or clinical trial
  • language and cultural differences
  • whether the research is a paid or volunteer study or clinical trial

Allergy & Asthma Network is working to address these barriers with its Trusted Messengers program.

People of various ethnicities and socioeconomic backgrounds

Children from racial and ethnic minority groups are less likely to take daily asthma controller medication than non-Hispanic white children.

 

Asthma health disparities by race as explained in the text below.

Black family at the park

How is the Black community affected by health inequities?

Approximately 40.1 million Black Americans live in the United States. This represents 12.1% of the total population. They are the second largest minority population in the country.

Black Americans have lower life expectancy than whites. Life expectancy is 66.7 years for Black men and 74.8 for Black women (compared to 73.7 and 79.2 respectively of non-Hispanic whites).

Asthma: Black Americans are three times more likely to die from asthma-related causes than U.S. non-Hispanic whites. Black children had a death rate 7.6 times that of white children and were 4.5 times more likely to be admitted to the hospital for asthma.

Food allergy: Black Americans have a higher prevalence of food allergy (10.6%) across all ages. They are also more likely to report food allergy to multiple foods. Food allergy outcomes are often more severe in the Black community, with higher rates of anaphylaxis and ER visits. Black children received less follow-up care for food allergy than white children.

Eczema: Black Americans face higher rates of eczema, especially among children. Children tend to develop more severe cases of eczema compared to white children. They are also more likely than white children to miss school due to eczema.

COVID-19: Black Americans experienced higher rates of COVID-19 cases and deaths than non-Hispanic whites in age-adjusted data.

How do social determinants of health affect the Black community?

Black Americans experience higher rates of poverty and unemployment than other population groups. They are more likely to live in low-income communities. And they are less likely to seek or afford higher education. These social determinants of health put many at risk for health inequality.

Some statistics about Black Americans that are indicators of social determinants of health:

  • Median household income of Black Americans is $48,297 (compared to $77,999 in non-Hispanic whites).
  • 19.5% of Black households live in poverty (compared to 10% of non-Hispanic white households). Families with lower income spend more on emergency care than higher-income families.
  • 9% are medically uninsured or do not have health coverage (compared to 5.2% of non-Hispanic whites).
  • 19.8% of Black households are food insecure. They are also more likely to live near a food desert.
  • Black Americans are more likely to live near facilities that release air pollution than non-Hispanic whites.
  • Black Americans account for 39.8% of those experiencing homelessness.

Hispanic family looking at a laptop together

How is the Hispanic/Latino community affected by health inequities?

Approximately 62.1 million Hispanic/Latino Americans live in the United States. They are the largest minority population in the country. They represent 18.9% of the total U.S. population. A feature of the Hispanic/Latino population in the U.S. is that it is generally young. One-third of Hispanic/Latinos are under the age of 18 and nearly 60% are millennials or younger. This may play a role in the rates of chronic disease.

Hispanic/Latino Americans have a slightly higher life expectancy than non-Hispanic whites. The life expectancy for men is 74.4 years while for women it is 81 years (compared to 73.7 and 79.2 respectively of non-Hispanic whites).

Asthma: Approximately 2.3 million Hispanic/Latino people in the U.S. report they have asthma. They are twice as likely to visit the emergency department for asthma, as compared to non-Hispanic whites. They are 40% more likely to die from asthma.

In Puerto Rico, a U.S. territory of 3.2 million people, asthma rates are among the highest in the world. Puerto Rican Americans had nearly double the asthma rate compared to the overall Hispanic/Latino population. They are four times more likely to die from asthma than U.S. non-Hispanic whites. Puerto Rican children are more likely to have asthma, as compared to U.S. non-Hispanic white children.

Food allergy: Hispanic/Latino Americans have a high prevalence of food allergy (10.6%) across all ages. They have higher rates of severe food allergy reactions, including anaphylaxis and ER visits. Hispanic children tend to receive less follow-up care for food allergy than white children.

Eczema: Hispanic/Latino Americans have historically not experienced high rates of eczema. However, some recent studies suggest the rates may be higher than previously shown. This may be due to more Hispanic/Latino people having access to doctors and getting an accurate diagnosis. Similar to Black children, Hispanic/Latino children tend to develop more severe cases of eczema compared to white children. They are also more likely than white children to miss school due to eczema.

COVID-19: The COVID-19 pandemic had a significant impact on the Hispanic/Latino community. In 2020, COVID-19 was the leading cause of death among Hispanic/Latino Americans. As a group, they experienced higher rates of COVID-19 cases and deaths than non-Hispanic whites in age-adjusted data.

How do social determinants of health affect the Hispanic/Latino community?

Hispanic/Latino health is often shaped by factors such as:

  • language and cultural barriers
  • lack of access to preventive care
  • lack of health insurance

Some statistics about Hispanic/Latino Americans that show social determinants of health:

  • 71.1% speak of Hispanic/Latino Americans speak a language other than English at home and 28.4% are not fluent in English.
  • Median household income is $55,321 (compared to $77,999 in non-Hispanic whites).
  • 17% of Hispanic/Latino households live in poverty (compared to 10% of non-Hispanic white households). Families with lower income spend more on emergency care than higher-income families.
  • 18.3% are medically uninsured or do not have health coverage (compared to 5.2% of non-Hispanic whites).
  • 16.2% of Hispanic/Latino households are food insecure. They are also more likely to live near a food desert.
  • Hispanic/Latino Americans are more likely than non-Hispanic whites to live near facilities releasing air pollution.
  • Hispanic/Latino Americans account for 22% of those experiencing homelessness.
Asthma rate for Puerto Ricans is 2X higher than the overall Hispanic/Latino population.

 

Indigenous family at the park

How are Indigenous people affected by health inequities?

Approximately 9.7 million Indigenous people (also called Native Americans) live in the United States. They make up 2.9% of the total population. American Indians (AI) and Alaskan Natives (AN) make up Indigenous population groups. The data includes those who are AI/AN alone or in combination.

Indigenous people are often faced with issues that prevent them from receiving quality medical care. These issues include cultural barriers, limited access to medical facilities, and poverty.

Indigenous people have a significantly lower life expectancy than non-Hispanic whites. The life expectancy for men is 61.5 years and for women it is 69.2 years (compared to 73.7 and 79.2 respectively of non-Hispanic whites).

Asthma: Asthma has been under-recognized in Indigenous people for decades. As a result, the data is limited. Recent surveys show wide variations in asthma prevalence. According to CDC, approximately 278,000 AI/AN adults reported they have asthma in 2018. Indigenous children were almost twice as likely to have asthma as non-Hispanic white children.

Food allergy: Specific prevalence is uncertain. A recent study of food allergy prevalence in 50,000+ households combined AI/AN with other populations due to small sample sizes.

Eczema: Some research suggests people with AI/AN backgrounds have low rates of eczema. Other research suggests eczema prevalence in AI/AN could be as high as 13%. What is known is that health data has been limited in AI/AN population groups for decades. Skin conditions have often been “scarcely reported.” Access to care for diagnosis and treatment has also been limited.

COVID-19: Indigenous people experienced significantly higher rates of COVID-19 cases and deaths compared to other racial and ethnic groups.

How do social determinants of health affect Indigenous people?

Indigenous people from AI/AN backgrounds face many health disparities. These can negatively impact health outcomes. Some statistics about Indigenous communities that are indicators of social determinants of health:

  • Median household income is $49,906 (compared to $77,999 in non-Hispanic whites).
  • 20.3% of households live in poverty (compared to 10% of non-Hispanic white households). Families with lower income spend more on emergency care than higher-income families.
  • 14.9% are medically uninsured or do not have health coverage (compared to 5.2% of non-Hispanic whites).
  • Nearly 25% of households are food insecure. They are more likely to live near a food desert.
  • Indigenous people are more likely than non-Hispanic whites to live near facilities that release air pollutants.
  • Indigenous people account for 3.2% of those experiencing homelessness.
  • In the Navajo Nation, 30-40% of residents live in a food desert.

Native Americans:

  • 20% more likely to have asthma
  • Asthma-related deaths 40% higher than non-Hispanic whites

 

Asian family at the park looking up at something interesting.

How are Asian American people affected by health inequities?

Approximately 18.4 million Asian Americans live in the United States. They make up about 7% of the total population. Asian Americans primarily comprise of people whose heritage is from:

  • China
  • India
  • Philippines
  • Vietnam
  • Korea
  • Thailand
  • Japan

The average life expectancy for Asian Americans is 80.7 years. This is higher than all other population groups. The life expectancy for men is 78.4 years and for women it is 82.7 years (compared to 73.7 and 79.2 respectively of non-Hispanic whites).

Asthma: Asian Americans generally have lower rates of asthma than other population groups. Data in some communities may be limited. According to CDC, approximately 572,000 Asian Americans report they have asthma.

Food allergy: Asian Americans have high rates of food allergy at 10.5%. However, they report fewer severe allergic reactions to food.

Eczema: Asian Americans tend to have higher rates of eczema — about 13% — than other population groups. One study found that Asian Americans were seven times more likely to have eczema compared to non-Hispanic whites.

COVID-19: Asian Americans had higher rates of COVID-19 cases, hospitalizations and deaths compared to non-Hispanic whites.

How do social determinants of health affect Asian Americans?

Asian Americans face fewer health disparities overall. The median household income is $93,759 (compared to $77,999 in non-Hispanic whites). Some statistics about Asian Americans that impact health risks and indicate social determinants of health:

  • 9.6% of households live at the poverty level (compared to 10% of non-Hispanic white households).
  • 6.6% of Asian Americans do not have health insurance coverage.
  • 30.9% of Asian Americans are not fluent in English; and 73.5 percent of Asian Americans spoke a language other than English at home.

How does Allergy & Asthma Network address health disparities?

Allergy & Asthma Network is committed to ending racial, ethnic and socioeconomic health disparities. Our goal is to ensure that everyone who lives with asthma and allergies is able to live to their full potential. We do this through outreach, education, advocacy and research.

Health professional and community leader doing outreach for health disparities

Outreach

Allergy & Asthma Network hosts asthma, food allergy and eczema screenings in under-resourced communities. The screenings are part of our Trusted Messengers program.

We focus on building relationships and establishing trust in those communities. We also work with community leaders and health advocates to achieve health equity and improve cultural competency. We do this by expanding healthcare access through digital innovation.

Woman educating community members on health disparities

Education

Allergy & Asthma Network shares news, information, research and patient stories. Our audience is patients, caregivers, and healthcare professionals. Our media platforms include our website, social media, E-newsletters and publications.

Content is medically reviewed and developed to be accessible to all. It is available in English and Spanish. We host webinars on the impact of allergic diseases on under-resourced communities.

Image of various ethnic children lined up in front of the class

Advocacy

Allergy & Asthma Network supports the passage of bills that ensure access to quality healthcare for all. We advocate for innovative treatments and expanded access to safe, affordable medications.

We work to reduce harmful air pollution. We push for a safe environment to live, work and play. We work with federal, state and local government officials to pass legislation.

Our successes include stock albuterol and epinephrine in schools and public places. We also focus on legislation that address health disparities at the systemic level.

Doctor examining ethnic child

Research

Allergy & Asthma Network works to encourage greater participation in research. In 2021-22, we hosted a series of virtual conferences to address this need among Black and Hispanic/Latino Americans. Asthma patients, doctors, faith-based leaders and other stakeholders were among speakers.

By engaging under-represented communities in research, we can close the gap in health disparities. We can also improve health outcomes.

Chart showing how income level and education play a role in asthma, as the article states.

How did the COVID-19 pandemic spotlight health disparities?

Evening photo of buildings representing wealth with a shanty town in front, representing the working class

COVID-19 had a disproportionate impact on racial and ethnic groups in the United States. It shined a light on longstanding healthcare inequalities in the United States.

Black, Hispanic/Latino and Indigenous people have higher rates of COVID-19 cases, hospitalizations and deaths compared to non-Hispanic whites.

The majority of people hospitalized due to COVID-19 also had underlying medical conditions. These conditions include asthma, COPD, hypertension, obesity, diabetes and heart disease. Many of these conditions impact Black, Hispanic/Latino and Native American communities at high rates.

The data paints a broad picture of the challenges facing these under-resourced communities. Social determinants of health clearly play a role. For example, many households had serious financial problems during the pandemic. Many under-resourced groups reported serious financial problems during the pandemic:

  • 72% of Hispanic/Latino Americans
  • 60% of Black Americans
  • 55% of Native Americans
  • 37% of Asian/Pacific Islanders
  • 36% of non-Hispanic whites

People in under-resourced communities also had higher risk of COVID-19 because they were more likely to:

  • work front-line jobs;
  • live in crowded housing conditions;
  • lack paid sick leave.

All these factors proved to have severe consequences for many communities during COVID-19.

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Reviewed by:
Nancy Joseph, DO is an award-winning physician (Top Physician Under 40) double board-certified in general pediatrics and allergy/immunology. She is based in Massachusetts. She is a consultant and medical advisor for Allergy & Asthma Network and staff physician at Amwell Medical Group. Dr. Joseph is a fellow with the American College of Allergy, Asthma & Immunology (ACAAI), and is past Chair of the Allergy, Asthma, and Immunology Section of the National Medical Association (NMA). She has collaborated with the NAACP speaking about COVID-19 and has been featured on NMA Talks as an expert panelist discussing asthma in the African American Community.

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