In the fall of 1997, DHHS Secretary Donna Shalala called for an initiative to tackle the growing problem of asthma. Shortly thereafter, the President's Task Force on Environmental Health Risks and Safety Risks to Children, which Secretary Shalala co-chairs with Environmental Protection Agency (EPA) Administrator Carol Browner, began to address the environmental influences on childhood asthma. In April, 1998, the Secretary's Science Advisor (the Deputy Assistant Secretary for Science Policy) convened a DHHS workgroup to help guide a Department- wide initiative on all aspects of asthma, including the environment and asthma in children. The DHHS workgroup developed a draft strategic plan (Action Against Asthma, March 22, 1999) and solicited public comment. The draft plan was revised in response to the comments received, and this final strategy is the result. For the first year of the strategy, DHHS discretionary funding for asthma increased from $157 million in FY 1999 to $183 million in FY 2000.
This strategy is designed to help achieve the national Healthy People goals for asthma. Over the next five years, this strategy will guide the development of budget proposals of DHHS agencies. Annually, budget proposals from each agency will be evaluated to ensure that they address the priority areas identified in this plan. Representatives from DHHS agencies will continue to coordinate and collaborate on key asthma programs. The agencies will assess progress in addressing the priorities of this strategy and contributions to achieving the Healthy People goals. The agencies will also continue to reach out to external constituencies to convey information on DHHS efforts and to receive advice on future directions.
The strategy envisions close coordination between DHHS initiatives and activities led by professional societies, universities, non-governmental and community-based organizations, providers of medical care, businesses, and other federal, state, local and tribal government agencies in pursuit of progress in these areas over the next five years (see Appendix F for a description of asthma programs outside of DHHS). A primary forum for coordination of education and public health programs with these entities is the National Asthma Education and Prevention Program (see Appendix F for a list of member organizations).
Table 1. Healthy People 2010: National Goals for Asthma
Healthy People 2010 is designed to achieve two over-arching goals: 1) to increase quality and years of life, and 2) to eliminate health disparities. Progress toward the goals will be monitored through specific objectives in 28 focus areas. Respiratory diseases, including asthma, are covered in Focus Area #24. The asthma objectives are:
24.1 Reduce asthma deaths
|1998 (baseline)||2010 Target|
|Rate per million|
|a. Children under age 5 years||1.7||1.0|
|b. Children aged 5 to 14 years||3.2||1.0|
|c. Adolescents and adults aged 15 to 34 years||5.9||3.0|
|d. Adults aged 35 to 64 years||17.0||9.0|
|e. Adults aged 65 years and older||87.5||60.0|
|24.2 Reduce hospitalizations for asthma||1998 (baseline)||2010 Target|
|Rate per 10,000|
|a. Children under age 5 years||60.9||25|
|b. Children and adults aged 5 to 64 years||13.8||8|
|c. Adults aged 65 years and older||19.3||10|
|24.3 Reduce hospital emergency department visits for asthma||1995-97 (baseline)||2010 Target|
|Rate per 10,000|
|a. Children under age 5 years||150.0||80|
|b. Children and adults aged 5 to 64 years||71.1||50|
|c. Adults aged 65 years and older||29.5||15|
24.4 Reduce activity limitations among persons with asthma
24.5 (Developmental) Reduce the number of school or work days missed by persons with asthma due to asthma.
24.6 Increase the proportion of persons with asthma who receive formal patient education, including information about community and self-help resources, as an essential part of the management of their condition.
24.7 (Developmental) Increase the proportion of persons with asthma who receive appropriate asthma care according to the NAEPP guidelines.
24.8 (Developmental) Establish in at least 15 States a surveillance system for tracking asthma death, illness, disability, impact of occupational and environmental factors on asthma, access to medical care, and asthma management.
(See Appendix G for additional data and data sources for these objectives.)
As described in the following chapters, the priority areas for investment over the next five years are:
- Determine the causes of asthma and develop interventions to prevent its onset .
- Reduce the burden for people living with asthma.
- Eliminate the disproportionate health burden of asthma in minority populations and those living in poverty.
- Track the disease and assess the effectiveness of asthma programs.
The remainder of this strategic plan expands on these priorities. For each, it provides examples of current and relevant DHHS-supported activity to illustrate the breadth and depth of work underway, as well as the most urgent needs for additional investment. The plan concludes with detailed recommendations for activities to be undertaken in each priority area over the next five years. The recommendations represent the most urgent needs to control asthma and the DHHS' capacity to address those needs.