Photo of a white man and a black manAsthma is one of the most common chronic diseases in the United States. It can be managed effectively when patients and families work together with their doctor on creating an Asthma Action Plan and receive asthma education on managing the disease.

However, many patients, especially those among certain racial and ethnic groups living in underserved or urban communities, experience major barriers to asthma control. These barriers include:

  • low household income
  • exposure to environmental allergens and irritants including air pollution
  • substandard housing
  • exposure to pests
  • mold or cigarette smoking
  • high levels of stress due to community violence

These communities are also impacted by access to care issues, such as:

  • lack of adequate health insurance coverage
  • overwhelmed local clinics
  • a shortage of healthcare providers skilled in understanding different cultures, including language barriers
  • low health literacy

How do these social determinants of health play out in the real world? Here are two case studies that illustrate the impact of social and economic factors on asthma health:

George’s story

George is a 30-year-old Caucasian male with asthma that was diagnosed at age 5. George grew up in a home in the suburbs with his parents and two siblings. His household income growing up was about $125,000 a year. George went to a high school where over 90% of the students went on to college, including himself. He graduated with a bachelor’s degree and got a marketing and got a job out of college working on social media marketing. He started his career making about $65,000 a year and that has gone up over the past 8 years to $110,000. When he was 25, George married a teacher. Their household income is about $180,000 a year and they purchased their first home in the suburbs when he was 28.

Throughout his entire life, he has always had health insurance and never had issues filling his medications. The area he lives in has low-moderate pollution. His home is less than 10 years old. Both he and his spouse have cars and they live within three miles of four grocery stores, several gyms, a hospital, and his doctors. In his free time, he likes to go for runs in his neighborhood; he also goes to the gym three days a week.

George’s asthma is well controlled, and he normally only needs his inhaler 1-2 times a month or when sick. He has never been admitted to the hospital for his asthma, though he did have to visit the emergency department once, when he was 9 years old. He is on a daily medication for his asthma and he has an inhaler to use as needed.

Tony’s story

Tony is a 30-year-old African American male with asthma that was diagnosed at age 5. Tony grew up in an apartment in a big urban city with his parents and two siblings. His household income growing up was about $40,000 a year. Tony went to a high school where about 20% of students went on to college, and another 30% dropped out before graduation. He graduated high school but was unable to afford to go to college. He has never been unemployed but has had several low-paying jobs. He currently works in an automotive shop doing car maintenance and makes about $35,000 a year.

Tony got married at 26 and his spouse works as a grocery store clerk – their household income is $48,000 a year. Living in the city, they rent a 1-bedroom apartment in a building that is 40 years old. Tony’s current job does not offer health insurance, but his spouse’s does; however they cannot afford to put him on the family plan. He has had health insurance off and on throughout his life and when he does, he sees a doctor and gets his meds filled.

The area Tony lives in has high pollution. Tony and his spouse do not have cars and they rely on public transit to get to and from work, get food, and access health care. There are no major grocery stores within 5 miles and the nearest corner store with food is about 4 blocks from his apartment. In his free time, Tony likes to play basketball, but there have been issues with crime in his neighborhood, so he only does so during the day and on his days off from work.

Tony’s asthma is not well controlled. He wakes up coughing several nights a week and has had to go to the emergency department three times in the past 12 months due to his asthma. He has been admitted to the hospital due to asthma flares a total of four times, most recently 2 years ago. He cannot afford any maintenance medication to treat his asthma.

The challenge of health disparities

George and Tony are the same age and they were both diagnosed with asthma as children. However, as their stories reveal, there are a variety of social and environmental factors that influenced their health.

George had a good education growing up and was able to go to college and get a good paying job, afford a house in a safe neighborhood, in a community with low-moderate pollution, with access to activities to promote his health. He also has never been without health insurance and has always been able to afford his asthma medications.

Conversely, Tony’s education was disadvantaged, and he couldn’t afford any post-high school tuition. He has worked steadily, but his income is low and his apartment is older, which may contain environmental asthma triggers such as mold and cockroaches. Living in the city, there is high pollution due to car and truck traffic. His neighborhood is not always safe, leading to fewer opportunities for outdoor exercise. Since Tony doesn’t own a car, he is limited to where he can go for food, get healthcare or look for employment. He has had sporadic healthcare due to no insurance and can’t afford his asthma treatment.

While family history is a significant risk factor for asthma, we cannot discount social and environmental factors that may be influencing these two young men with asthma.

Allergy & Asthma Network’s commitment to impact health disparities

We have existing resources to help patients better understand asthma and COVID-19, access treatment and advocate to raise awareness of the impact of health disparities on Americans with asthma. Here are some of them:

Allergy & Asthma Network is actively working to address asthma disparities among African Americans, Native Americans and Hispanic/Latino populations. In the upcoming weeks, we’ll be announcing new and expanding programs to make a greater impact on people impacted by health disparities.

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