Chicago must do more to erase racial disparities in childhood asthma

Black children are more than four times as likely to go to the emergency department for asthma symptoms, like trouble breathing, compared to white children. The racial gap has increased by nearly 10% between 2016 and 2021.

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Junie Jackson, 4, who has asthma, plays with an inhaler outside the Environmental Protection Agency’s office in the Loop. Pilsen community residents and leaders delivered a letter to Debra Shore, the regional administrator for the EPA Region 5, on March 23, 2022.

A child with asthma plays with an inhaler outside the Environmental Protection Agency office in the Loop at a March 23 rally by Pilsen residents and leaders who opposed a permit for a local metal shredder because of air quality concerns.

Pat Nabong/Sun-Times

As pediatricians, advocates, and parents, it is concerning to learn that disparities are worsening among Chicago children with asthma.

In Chicago, approximately one out of seven children lives with asthma. The rates are higher among Black and Hispanic/Latino children, with one out of every four children having asthma. With proper treatment and education, children with asthma should be able to do everything that a child without asthma can do, without needing to stay overnight in the hospital or visit an emergency department.

But the reality is that’s not true.

A new report by Respiratory Health Association released in May 2022 showed Black children are more than four times as likely to go to the emergency department for asthma symptoms, like trouble breathing or wheezing, as compared to white children. The fact that Black children have worse outcomes is not new.

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In fact, data from each of the past 10 years show that Black children have the highest rates of emergency department visits in Chicago.What is new, however, is that the gap between Black and white populations has increased by nearly 10% between 2016 and 2021.

There are many reasons that Black and Hispanic/Latino children in Chicago are more likely to have asthma and more likely to visit an emergency department for it. While asthma can run in families, decades of structural racism have had a greater impact. For example, policies have led Black and Hispanic families to be more likely to live in communities near highways and industrial businesses and/or warehouses, meaning greater exposure to pollution for children.

Also, factors such as the home environment, education level, employment status, and health care access all have significant effects on asthma. For example, studies show that Black children are less likely to have regular access to a doctor who can provide care and education for their asthma.

Where do we go from here? There’s no simple answer or quick fix. It takes collaborative and comprehensive solutions that include individual, system, and policy changes. We acknowledge that this is a complex undertaking, but it is a necessary one.All children need access to quality, affordable medical care no matter who they are, what language they speak, what health insurance they have, or where they live.

Central to the solution is providing asthma education to children and their families — not in a lecture, but rather in a forum where the child and their parents or guardians can learn by practice. Children must also be immersed in environments that support their asthma management, including good air quality and lack of allergens and triggers like smoke, animal dander, and dust.

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Finally, networks must be created and connected to support children with asthma as they develop the knowledge, skills, and confidence to care for their asthma on their own. Children move between homes, schools, and activities daily; thus, each setting must have systems in place to support children with asthma. Parents, caregivers, teachers, coaches, and religious leaders have a key role in this process.

Many partners across Chicago and Illinois are dedicated to eliminating racial disparities in asthma. But it’s not work that can be done alone or for free. It is imperative that funds are allocated to this essential work so our children in Illinois can breathe easy.

The state of Illinois recently increased its investment in programs to address childhood asthma by $1 million. To date, Chicago has committed $0 to address asthma disparities, despite a stated commitment to eliminating racial health disparities.

What will it take for our city to act to improve inequities for the thousands of Chicago children with asthma?

Anna Volerman, MD, is an internist and pediatrician. Andrea A. Pappalardo, MD, is an allergist-immunologist, internist, and pediatrician. Ruchi S. Gupta, MD, MPH, is a pediatrician. Erica Salem, MPH, is with the Respiratory Health Association.

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