October 14 2015

The recent wildfires throughout the state of California have been devastating.  To date, five people have died from the wildfires and more than 285,000 acres have been destroyed.  The Rough Fire, spreading along Fresno’s eastern edge, has destroyed 141,000 acres and is the 16th largest wildfire in state history.  Unfortunately, residents of the San Joaquin Valley will have to cope with more than just these consequences. Deteriorating air quality will exacerbate health problems for children and adults with respiratory conditions, specifically asthma. The San Joaquin Valley Air Pollution Control District has issued red and purple “air alerts,” signifying the poorest levels of air quality.

In the San Joaquin Valley, 642,000 residents have been diagnosed with asthma, including 184,000 children.

The high rate of asthma in the region, exacerbated by a years-long drought and the recent wildfires, has put tremendous strain on local healthcare systems.  Clinics and hospitals report an increase in the number of patients in their urgent care centers and emergency rooms complaining of upper respiratory system problems and headaches. According to California Breathing, 23 percent of children and 18 percent of adults suffer from lifetime asthma in San Joaquin County, significantly higher than the state average of 13 percent and 12.5 percent for children and adults, respectively. The California Department of Public Health reported that the annual costs of asthma hospitalizations in the San Joaquin Valley exceed $150 million.

The asthma crisis in the Valley is caused by a confluence of factors, including poor environmental conditions, lack of asthma education, and dilapidated housing stock. Collectively, we can make significant improvements on all of these fronts in order to better manage asthma and prevent unnecessary asthma emergencies.

California is a national leader when it comes to greening the environment. Establishing the cap-and-trade system, aggressively curbing greenhouse gas emissions, and boosting renewable energy sources will contribute to better air quality, which will improve acute asthma emergencies over time. While this is one great step forward, it is not enough. Addressing the outdoor environment is only one part of the solution.

A comprehensive and preventative solution must address the notion that substandard living and housing conditions intensify asthma’s impact in the region.  The fact that children spend between 70-90% of their time indoors provides valuable context to the asthma problem, but doubly sheds light on a tremendous opportunity for positive change. Improving indoor air quality and reducing environmental triggers inside of homes must be part of the solution.

Empirical studies indicate that proven strategies and programs exist that can significantly improve a number of important asthma outcomes, including improved asthma control and quality of life; reduced utilization of in-patient and emergency room services; increased school attendance; and improved labor productivity. For example, the Centers for Disease Control and Prevention’s Community Preventive Services Task Force used empirical evidence to identify in-home asthma management programs as an effective tool for preventing asthma emergencies for children and adolescents with uncontrolled asthma. These in-home asthma management programs use a holistic approach that: 1) provides treatment plans and educational information to promote asthma management and 2) offers home remediation services to identify and remove in-home asthmatic triggers that are not covered by our public or private healthcare insurers.

Within the San Joaquin Valley there are a number of organizations and initiatives that have embraced this preventative philosophy. Among these is the Central California Asthma Collaborative, a nonprofit organization that offers comprehensive in-home asthma management programs to families affected by asthma, as well as support to local schools to create asthma safe environments. Thanks to funding from The California Endowment, Central California Asthma Collaborative, in collaboration with Collective Health and Social Finance, is implementing a demonstration project to improve health outcomes and reduce unnecessary utilization of emergency services in Fresno, CA. The objective of the demonstration project, known as AIM4Fresno, is to rigorously measure the impact of the program and develop a scale-up strategy to serve the thousands of other children in the Valley suffering from uncontrolled asthma.

The reality is that organizations like the Central California Asthma Collaborative cannot move the needle on the asthma crisis alone. Support from all the players in the healthcare system is needed, including health systems; Medi-Cal managed care organizations and private health insurers; and city, county, and state-level government. Better management and prevention of asthma will not only improve health outcomes, it will also save us—the taxpayers—money. According to the American Lung Association, the direct medical cost of asthma nationwide is approximately $51 billion annually. When accounting for indirect costs, such as lost productivity, the total cost of asthma increases to $56 billion. There are proven, low-cost ways we can reduce the health and cost burden of asthma. We need to take action, and take action now.

This blog was co-authored by: 

Kevin Hamilton, Central California Asthma Collaborative

Rick Brush, Collective Health

Nirav Shah, Social Finance

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