Reviews the environmental triggers of asthma and disparities in the incidence of the disease. Looks at the advocacy work of local coalitions of the Community Action to Fight Asthma initiative and policy outcomes of their efforts

Mary Kreger

English

IssueLab

An Initiative of:A P R I L 2 0 0 7What is CAFA?In 2002, The California Endowment launched the Community Actionto Fight Asthma (CAFA) Initiative. The goal of the initiative is toempower communities to reduce the environmental risk factors forchildren’s asthma. The Endowment funds the statewide networkthat works to influence and change policy at state and local levelsand reduce the disparities in asthma prevalence. CAFA is comprisedof 12 local coalitions (consisting of community members, teachers,parents, environmental advocates and health care advocates fromall areas of the state) and technical assistance partners. CAFA useseducational and programmatic activities to advocate for improvementsin policies related to housing, outdoor air and schools.Asthma in CaliforniaCalifornians are disproportionately likely to suffer from asthma. Thenational asthma prevalence rate is about 12 percent for children under18 and about 9 percent for adults2. In California, 14 percent of childrenaged 1-11 and 19 percent of children aged 12-17 have the disease.However, the disparities are larger within California. Some areas of theCentral Valley have a 16 percent asthma rate and anAfrican-Americanchild is one-third more likely to have asthma than a White child.Improving Environments forChildren with Asthma1 Health of California’s Adults, Adolescents, and Children: Findings from CHIS 2003 and CHIS 2001 (June 2006).2 Centers for Disease Control and Prevention. National Health Interview Survey and National Center for HealthStatistics data. http://www.cdc.gov/asthma/slides/prevalence06.ppt#305,4,Adult and Child AsthmaPrevalence United States, 1997-2004, retrieved April 2, 2007.California AsthmaPrevalence Rates byAge and Ethnicity1GROUP AGES 1-11 AGES 12-17Overall Total 14% 19%Black 21% 27%American Indian/ 15% 32%Alaskan NativeAsian 11% 15%Latino 13% 16%White 14% 19%I S S U E B R I E FImproving Environments for Children with Asthma23 Allergy and Asthma Foundation of America, 1998.4 California Department of Health Services. Guidelines for the Management of Asthma in California Schools: A comprehensive resource for school health and other personnel to addressasthma in the school setting, April 2004.5 American Lung Association http://www.cleanairchoice.org/outdoor/AsthmaFreeway.aspAsthmaEnvironmental TriggersHOUSINGTobacco smoke, Allergens, Mold,Cleaning products and pesticides,Pests, Pets, Dust, PaintsOUTDOOR AIR QUALITYDiesel exhaust from transportationvehicles and ports, Agricultural crop dustingand/or use of pesticides, OzoneSCHOOLSOld or inappropriately used ventilationsystems, Carpets or couches,Animals in classroomsThis problem is not just one of health or equality. Economically,asthma takes a considerable toll. The disease costs California about$1.3 billion per year, with Medi-Cal paying about 45 percent of thecost of care for children3. Additionally, asthma is the leading causeof school absences among all chronic conditions. The CaliforniaDepartment of Health Services estimates that in 2001, schools lostalmost $41 million from preventable absences due to asthma fromchildren ages 12 to 17 alone4. Childhood asthma can financiallyhurt individual families as well – parents who must stay home totake care of ill children are at risk for lost wages or jobs.Environmental Triggers of AsthmaThese disparities and costs can be reduced through asthmaprevention and by limiting the impact of environmental triggers.Asthma episodes are influenced by environmental and social factors(left). Indoor exposures have become increasingly important aschildren spend more time indoors and as buildings are moreinsulated to increase energy efficiency. Low-quality housing alsoincreases indoor exposure risks.Outdoor air can trigger asthma episodes, especially among thoseliving near freeways, ports, power plants or refineries.5 Additionalfactors, such as the increase in childhood obesity, decreasedopportunities for physical activity and reduced exposure tomicrobes in early life, are also considered potential antecedentsto asthma.Outcomes of CAFAThe CAFA Initiative targeted specific issues in the childhoodasthma problem and its work yielded significant results:• Creation of a cohesive statewide network of local coalitions;• Clarification of the coalitions’ focus on environmental triggerscaused by outdoor air quality, schools and housing;• Expansion of local coalitions’ activities and skills to includehigher-level policy, advocacy and communication work;2003-2004n=402004-2005n=38• Very• Somewhat• A Little• Not At AllIncreasing Policymaker AwarenessOne of CAFA’s goals is to raise awareness ofasthma’s environmental triggers among peoplewho can make real change. Policymakerswere interviewed in 2003-2004 and againin 2004-2005 about their familiarity withasthma’s triggers in homes, schools andoutdoor air. In the second survey, policymakerswere noticeably more likely to report that theywere either “somewhat” or “very familiar”with those triggers than they were one yearearlier, especially regarding outdoor air.Policymakers specifically credited coalitionsfor their increased knowledge.• Increase in credibility and external influence, which allowedcoalitions to teach community members to advocate for themselves;• Increase in policymakers’ knowledge of environmental triggersof asthma (right);These outcomes are all admirable on their own, but the mostsignificant result has been the CAFA coalitions’ ability to shift thefocus of the childhood asthma discussion from traditional medicaltreatment to community-based, preventative solutions. This is amajor development in the efforts to reduce the impact of asthmaon school-aged children, their families and their communities.Sustainable FundingGenerally, more developed Coalitions (defined as having moreexperienced leadership and more infrastructure) applied for andreceived larger amounts of outside funding than did newer and/or less developed Coalitions. There were, however, some exceptions.Factors such as specific experience in grantsmanship, availabletechnical assistance, contacts with funding agencies and theavailability of funding had a substantial impact on the success ofgrant applications. For example, one of the less developed Coalitionsreceived substantial grant support from a large, local, community-committed health plan by having the foresight to include aninfluential member of the plan on the Coalition’s advisory board.ConclusionsAs part of the CAFA Initiative, local coalitions made remarkableprogress in three years. The coalitions learned critical lessons abouteducating and providing communities with tools for advocacy,finding and working with strategic allies, communicating withpolicymakers and understanding the local, regional and statewidepolicy processes. Local coalitions continue to be instrumental inraising awareness of the relationship between asthma andenvironmental triggers in outdoor air, schools and homes,as well as addressing the health disparities, social andeconomic costs associated with asthma.The Community Action to Fight Asthma (CAFA) Initiative 350%40%30%20%10%0%60%50%40%30%20%10%0%2003-2004n=402004-2005n=38• Very• Somewhat• A Little• Not At AllPolicymakers said they want to continue towork on environmental issues. They are eagerfor more data from the coalitions on topicssuch as the prevalence and trends of asthmain their communities, economic impacts andcosts to society and individuals, asthma’srelationship to other chronic illnesses andasthma’s relationship to urban planning issues.Policymaker Familiarity with AirQuality Issues Related to AsthmaPERCENTOFRESPONDENTSPERCENTOFRESPONDENTSINDOOR AIR QUALITY IN SCHOOLSDIESEL EMISSIONSImproving Environments for Children with Asthma4CAFA Coalitions’ Local, Regional and StatePolicy Activities and AccomplishmentsOutdoor Air Quality• Advocacy against 710 freeway expansion near schools(in Long Beach and Los Angeles);• Notification of communities regarding oil refinery “flare”releases (in the Bay Area);• Expanding the use of air quality flags to notify communitiesof bad air days (in the Central Valley);• Los Angeles and Long Beach port pollution control;• Replacement of diesel buses;• Fine port terminals when trucks idle for excessive periods of time;• Remove the exemption for agricultural sources of pollution fromthe Clean Air Act;• Penalize those responsible for pesticide poisonings and requiredevelopment of protocols for responding to pesticide drift;• California Air Resources Board (CARB) diesel software upgraderuling (affected 60,000 trucks across the state); and• CARB regulation to reduce diesel truck idling and to reduceautomakers greenhouse gas emissions from vehicles.Schools• Prohibit building schools next to freeways;• Use green construction in new schools; and• Ensure that students have access to their asthma medications whilein school.Other• Asthma treatment care requires health plans to provide spacersand peak flow meters;• Ensure that health plans cover outpatient prescription drugbenefits, and• Bill to allow self-administration of auto-injectable epinephrine.CPA/ Issue Brief: Improving EnvironmentsTCE 0208-07Prepared by:Mary Kreger, Dr. PH., M.P.H.Institute for Health Policy StudiesUniversity of California, San Francisco3333 California Street, Suite 265San Francisco, CA 94118415.502.4544Funded by:1000 North Alameda StreetLos Angeles, CA 90012800.449.4149www.calendow.orgFor more informationabout CAFA visit:www.calasthma.org

Improving Environments for Children with Asthma

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Improving Environments for Children with Asthma

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