Over four million children in the United States have asthma but it doesn’t affect them all the same. Often, it depends on where they live.
Social determinants of health — factors like where one works, lives, and plays — are finally getting the attention they deserve. It’s becoming clear that much of a person’s health depends on social determinants, not the doctor’s office.
For kids with asthma, the physical environment is especially important. Some of the most common allergen triggers are pests, mold, and dust, which are all routinely found at home and at school. Keeping these kids healthy depends on creating and maintaining healthy built environments.
But housing inequities are all too common. The Boston Globe recently spotlighted new research showing racial disparities in the quality of Boston housing. The asthma triggers mentioned above were more common in low-income, minority neighborhoods and there were more submitted inspection requests from those neighborhoods than from affluent ones.
This new research complements previous studies that show the impact of historical housing policies on the quality of current housing and health. Redlining, banning multiunit housing, and other policies limited the quantity and quality of housing available to minority families. The consequences are still felt today as those neighborhoods tend to be more run down.
Another inequity is the cost of home-based asthma prevention. Families are often told run the air conditioning instead of opening the windows, to buy dust mite covers for beds and pillows, to vacuum every day, to fix any leaks or mold issues; the list goes on. For low-income families, complying can be quite challenging.
However, the evidence is clear that improving a child’s living environment really does improve his health and is actually cost-effective in the long run.
To do so while also addressing inequity will require community partnership.
The Community Asthma Initiative through Boston Children’s Hospital is a great example. For kids with asthma who have had emergency department (ED) or inpatient visits, the program conducts in-home repairs or improvements geared towards the child’s specific asthma triggers. Children see a significant reduction in asthma-related hospitalizations and ED visits and missed school days. What’s more, the program costs are fully recovered within a few years.
The Community Asthma Prevention Program Plus, through Children’s Hospital of Philadelphia, is similar. When the program completed comprehensive repairs for the first cohort of families, the parents reported a significant reduction of asthma triggers in the home and asthma-related ED visits and hospital stays.
But community partnership isn’t enough. We also need policy change.
Housing codes should be revisited. Routine pest and mold inspections — and mitigation — should be required and landlords should be obligated to fix structural issues quickly. Inspection processes should also be reviewed. When tenants submit complaints, are there enough inspectors to address them quickly? How does the city hold landlords accountable to make necessary improvements? Tenants should feel safe to submit complaints and assured that the underlying structural issues will be addressed.
Lastly, and simply put, homeownership must be attainable. Tenants have far less authority over their living spaces than homeowners do. But if homeownership is an impossible dream — given the market or historically discriminatory policies — families who rent will continue to be beholden to their landlords for the health of their homes.
So much of a child’s health depends on where she lives, plays, and learns. Expanding the conversation about childhood asthma beyond the doctor’s office is critical. The goal is to keep kids out of the hospital and on the playground. Getting there starts at home.