By Bruce Bender, PhD

Certain groups of children with asthma experience particularly severe health disparities. African-American and Hispanic children develop asthma more frequently and with greater severity than white children.

Asthma prevalence among Native American children, including American Indian, Alaska Native and Native Hawaiian children, has been under-recognized for decades and equal or exceed those of most other minority groups. Only recently has the need for greater understanding about health disparities of Native American children with asthma become a priority.

How big is the problem?

Because many Native American children live in rural areas, often in remote locations on large reservations in the West, national surveys that document disease frequency have in the past underestimated how many reservation children have asthma.

We know 16 percent of African-American children and 13 percent of Hispanic children have asthma at some time in their life, in contrast to about 7 percent of white children.

Recent surveys of Native American children show wide variations in asthma prevalence, with rates as high as 27 percent among some groups. These children are hospitalized and die from asthma more often than almost any other group.

What are the challenges?

Native American children living on reservations face many barriers that may undermine their health. These include poor air quality – both indoor and outdoor – and lack of access to quality healthcare.

Air Quality Barriers

Indoor Outdoor  Healthcare Barriers
  • Heat and cook stoves
  • Commercial tobacco smoke
  • Ceremonial smoke
  • Mold
  • Dust
  • Coal-fired plants
  • Diesel exhaust
  • Oil and gas extraction or mining
  • Desert dust storms
  • Wildfires
  • Poor access to healthcare
  • Lack of asthma specialists
  • Lack of culturally competent providers
  • Financial constraints
  • Preference for traditional healers
  • Lack of community understanding



What can be done to improve their health?

Native American children need greater access to quality healthcare, provided by healthcare professionals who are knowledgeable about both evidence-based treatments and the culture of their patients. In some cases, providers trained in Western medicine must work cooperatively with traditional healers to fully engage patients.

More research is needed to increase understanding of factors that cause asthma in Native American communities, as well as to find more effective ways to offer healthcare services to children.

Bruce Bender, PhD, is head of the Division of Pediatric Behavioral Health and co-director of the Center for Health Promotion at National Jewish Health in Denver, Colorado.

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