A Guide for Public Health Educators on Asthma and Asthma Exacerbation Burdens in Metro Detroit Child
Detroit has a storied history of attracting automotive and manufacturing industries to base their operations there. This came as a result of multilevel government benefits and exemptions given to businesses to promote economic growth. But at what cost? The cost has been the health of our citizens. Factories have long been spewing toxic waste into our communities with little repercussion or reparation. This has caused an increase in various health issues with asthma being one of the highest.
Asthma is a chronic lung disease that inflames and narrows the airways. Although asthma has no cure, it is usually a manageable disease with medication treatment and avoidance of triggers. Detroit, in particular, experiences the highest asthma burden in Michigan, especially among children. The fundamental cause for this massive disparity in asthma prevalence is due to the presence of heavy industry in Detroit. The metropolitan and surrounding areas of Detroit are currently some of the least ideal areas for asthma patients to reside in due to the amount of environmental pollution from gas and oil refineries. High prevalence of asthma coupled with a lack of access to quality healthcare and further exposure to triggers also and also lead to high asthma exacerbation rates. Once an individual has asthma, pollution can lead to asthma exacerbation.
These problems can have profound downstream effects on the child’s life, affecting academic, social, and behavioral outcomes. Throughout this communication we aim to elucidate the degree to which this burden exists, its implications, and provide some actionable interventions to reduce the burden of asthma and asthma exacerbations.
Individuals under the age of 18 in the tri-county area of Detroit had higher rates of asthma compared to the other counties within Michigan (11.3% vs 9.7%). Looking at the same data, we can see that these higher prevalences and rates translated into higher hospitalization rates across all age groups and socioeconomic levels when comparing Metro Detroit to the rest of the state. Hospitalization rates in Metro Detroit for asthma are three times higher compared to other Michigan counties. Increased hospitalization also directly leads to higher healthcare costs. When we look specifically into racial groups, black individuals living in Metro Detroit are hospitalized for asthma at a rate more than 150 percent that of their white neighbors.
High rates of asthma exacerbations among the youth has deeper implications than just health issues. According to Asthma Institute of Michigan, asthma is the leading chronic condition causing school absenteeism. What's more, children in those pollution-exposed schools scored lower on standardized tests. Air pollution has already been shown to cause cognitive delays in children and an array of adverse pregnancy outcomes, such as early birth and low birth weight, which can also impair a child's brain development down the road. As we can see, asthma leads to greater issues in the future and can be especially harmful to children. Focusing on advocacy efforts to hold source polluters accountable will be essential to reducing the asthma rates in Metro Detroit.
Figure 1: Choropleth map showing the rate of hospitalization secondary to asthma complications per 10,000 individuals in Detroit, Michigan. Source: Michigan Health and Hospital Association Data Driven Detroit. Created September 2012.
Figure 2: Trend analysis for the rate of hospitalization secondary to asthma complications in Detroit vs the overall state of Michigan (per 10,000 individuals) Source: Michigan Inpatient Database, 2008‐2013, MDHHS
Call to Action and Interventions
While the issue seems daunting, there are some key actions that we can take as public health professionals. The first is to reduce the number of exacerbations in prevalent cases through health education. The second is to pursue environmental and health policy change as a primary intervention against incident cases.
The first step towards decreasing asthma exacerbation is to inform children and stakeholders about the various triggers of asthma attacks. Stakeholders include parents/guardians, healthcare providers, and school faculty, staff, & administration. Secondly, we want to encourage individuals to avoid triggers as best as possible. While it may not be possible to avoid all triggers, modifiable risk factors like passive smoke inhalation, diet, exposure to indoor environmental hazards, pets, and pests can more easily be addressed. Lastly, we want to ensure that asthma treatment and medication adherence are well-maintained. The next step is to find and produce education materials to inform stakeholders.
Currently, there are a number of projects that aim to improve environmental conditions in Detroit. The most notable is Community Action to Promote Health Environments (CA-PHE) which is a five-year community based participatory research project funded by the National Institute of Environmental Health Sciences. The aim of the study was to recruit partners and stakeholders to elucidate the problem, create a plan, and then implement that plan. Currently they are in progress of implementing their public health action plan. This action plan contains many important interventions and can be found on their website. Another important resource, the Asthma Initiative of Michigan (AIM), provides a comprehensive guide specifically for children with asthma, families, schools, and health professionals in the optimal management of asthma symptoms. Potential areas in which we can expand the efforts of AIM is in translating the contents of the website into training for educators, parents, and other community stakeholders. Also widely distributing educational materials like Figure 3 can provide easily understandable and actionable information to education administrators. Through these secondary and tertiary interventions we hope to see a decrease in the burden of asthma exacerbations in Detroit Children.
Lastly, the issue of industrial environmental pollution is a health policy issue and must be addressed on a bigger front. In a relatively recent article in Lancet Respiratory Medicine, it mentioned that in 2017, the Detroit Department of Health had to battle the Michigan Department of Environmental Quality against approving a new Marathon petroleum refinery. This exemplifies why it is imperative that we hold both our state and local regulatory bodies accountable. One way to get involved in policy activism is through Detroiters Working for Environmental Justice (DWEJ). DWEJ advocates for clean air policies in Detroit and is one of the partners of CA-PHE. Supporting initiatives such as this are the first step towards reducing environmental hazards. And if we are successful we may finally have an effective primary intervention against asthma in Detroit Children.
Figure 3: A health communication for teachers and administrators regarding the Asthma Friendliness of their schools. Educational pieces like this can be crucial for preventing missed school days in K-12 children and teens.
Credit: Michigan Department of Human & Health Services
Asthma Initiative of Michigan. https://getasthmahelp.org/Default.aspx.
2012‐2014 Michigan Behavioral Risk Factor Surveys, MDHHS
2012 Michigan Health and Hospital Association Data Driven Detroit.
2008‐2013 Michigan Inpatient Database, MDHHS
DeGuire P, Cao B, Wisnieski L, et al. Detroit: The Current Status of the Asthma Burden. In: Vol March 2016.
Nelson R. Plans to reduce the high asthma burden in Detroit. Lancet Respir Med. 2017;5(5):388-389.
Asthma Triggers (Adapted from the Guidelines for the Diagnosis and Management of Asthma, National Asthma Education and Prevention Program of the National Heart, Lung and Blood Institute, Expert Panel Report 3, 2007). Asthma Initiative of Michigan. https://getasthmahelp.org/.