Federal agency actions can provide leadership and direction in reducing environmental risks to protect children who have asthma or are at risk of developing it. Recommendations put forward in this strategy are predicated on the principles that federal action must have:
1. A focus on efforts to better understand and eliminate the disproportionate impact of asthma in minority populations and those living in poverty.
Poor and minority children are much more likely than white, non-Hispanic children to visit an emergency room, to be hospitalized, or to die from asthma, although the rising prevalence of asthma has affected all populations. The reasons for this disparity are not known, although environmental exposures and limited access to quality medical care may all play a role.
The focus on eliminating disparities across racial and ethnic groups has to be considered in all efforts to prevent asthma and its health impact; however, because of the importance of this issue the Task Force has included a specific recommendation in this strategy to examine, understand, and ultimately eliminate disparities.
2. An emphasis on partnerships and community based programs.
A successful effort to reduce childhood asthma will depend in part on the level of success achieved in enlisting all sectors of society in efforts to implement effective programs to prevent and manage the disease. Federal agencies have already forged effective partnerships with many health and professional organizations, corporations, and foundations to conduct training, educate health care providers and the public, and to implement a wide range of prevention activities at the national, state, and local levels.
Expanded partnerships both within government and between government and the private sector are needed. With increasing knowledge about the primary causes of asthma and triggers of asthma attacks, the challenge for the 21st century will be to integrate new research findings into effective environmental, medical and educational programs. Partnerships will be critical to implementing this broad vision of asthma control. In particular, community-based programs should integrate asthma control activities into existing systems such as schools, child care, youth programs, workplaces, primary health, and job training programs.
3. A commitment to setting measurable and consistent goals for childhood asthma under the Healthy People 2010 program.
Health objectives are now being developed for the year 2010 and represent a significant revision of the goals set for the year 2000. These objectives will set the nation’s health agenda for increasing years of healthy life and reducing disparities among the entire American population. Draft objectives currently encompass an expanded set of asthma-related objectives for improved clinical management as well as a series of environmental objectives addressing known asthma triggers such as indoor allergens, secondhand smoke and outdoor air pollution. The goals embodied in the final Healthy People 2010 document will serve as the tools to measure progress towards control of asthma.
4. Investment in evaluation of programs to identify those strategies that are most effective in reducing the burden of asthma so that they may be replicated.
Asthma intervention programs and related activities need to be fully evaluated to determine those techniques which are successful and should be replicated. Evaluation should be incorporated in the planning of all programs and should include:
- identification of desired health outcomes of the program;
- measurement of effectiveness of the intervention activities and processes used to implement them;
- identification of unforseen obstacles;
- assessment of the cost-effectiveness of the program;
- a prediction of long term sustainability of the program.