Asthma and the Environment: Science and Policy
2:00 pm US Eastern Time
1. Facilitator: Michael Lerner, PhD, President, Commonweal
2. Introduction: Steve Heilig, MPH, Co-Director of CHE, Director of Public Health & Education, San Francisco Medical Society
Asthma is a widespread and growing problem. We have a great panel of speakers who will discuss some of the issues around this growing problem.
3. First Speaker: Anthony J. DeLucia, PhD, Chairman of the Board, American Lung Association (ALA), Professor of Surgery, Department of Surgery, Q-D College of Medicine, East Tennessee State University
Dr. DeLucia was speaking from the annual meeting of the ALA and the American Thoracic Society. The ALA particularly intends to get out front on the type of research that will support stronger preventive policy on indoor air, balancing research and advocacy.
While outdoor air quality plays a big role in lung health, indoor air is also a huge factor. We need to be working towards something like a Lung Week that focuses on the lungs and health and what happens with the lung at different times of the year, both indoor and outdoor. ALA intends to expand its focus to broader societal issues: to partner with other groups, and to build local networks that will leave in place the appropriate communications channels to fight entrenched mentalities to promote care on asthma. We need to keep groups engaged on the local as well as the federal level.
4. Second Speaker: Ann Kelsey, MPH, Regional Asthma Management and Prevention Initiative (RAMP), Public Health Institute
RAMP is working on facilitating those who are concerned about asthma prevention (voluntary health orgs like ALA, public health, managed care, environmental health and environmental justice groups, community based orgs, etc.). Our goal is to have a regional approach where we work together to reduce asthma through clinical management and the reduction of triggers. In recent years, organizations in the San Francisco Bay Area have flourished, with progress in creating greater access to care, enhancing physician education, increased public awareness guidelines and education on health management. It's time to include environmental issues as well.
A statewide initiative funded by the California Endowment called Community Action to Fight Asthma (CAFA) funds 4 regional centers, including RAMP, and 12 local coalitions. We are looking at 3 areas to reduce environmental triggers through change of protocol: 1) Schools: Implement EPA's Tools for Schools, which works with the school to reduce triggers. A new statewide bill in California aims to eliminate pesticides/toxic chemicals in schools. 2) Home: We're doing outreach to help tenants reduce environmental triggers in their home. The problems are behavioral, but more often structural, in the home: we need to create rights for tenants. 3) Outdoors: We are also looking into reducing refinery emissions, and diesel and wood burning practices.
RAMP has begun partnering with environmental health and justice groups in the Bay Area.
5. Third Speaker: Laurie Stillman, Executive Director, New England Asthma Regional Council, The Medical Foundation
In 2000 the Asthma Regional Council launched an initiative to address environmental affects of asthma as it affects children in the region. We're working with state agencies on environment, health, education and housing in 6 New England states.
We meet twice a year to develop policy and action items within 5 areas: 1) Most New England states have adopted a healthy building guidance to help builders of low-income housing. 2) A recent healthy schools policy to addresses issues of indoor air quality. A surveillance committee, facilitated by Polly Hoppin, of the Tellus Institute, is focused on bringing in all northeastern states and pulling together data people who are tracking asthma, and those who are tracking environmental issues to link those two data sets. 3) Betsy Rosenfeld has pulled together BRFS coordinators and we released a report on Adult Asthma in the northeastern states. We're planning on releasing a report on childhood asthma as well. 4) A diesel pollution committee is working on pollution prevention technology for school busses. 5) We are working with the Tellus Institute to examine the potential for promoting environmental investments in home environments through the health care sector. We're trying to bring the health care sector together with researchers to promote ideas of health care and provide intervention.
6. Comments and Questions
Claire L. Barnett, Healthy Schools Network, Inc.: The NY State Dept. of Health has CDC Grants to look at Asthma in young children and has an active statewide asthma reduction program that is based on medical management. Schools are now installing asthma nebulizers with Dept. of Health funds. There is a lot of indoor environment work coming out of federal agencies, and the feds are way ahead of the states and advocates, but they are voluntary programs. The EPA schools work group I chaired last winter recommended that EPA change how it evaluates its IAG programs and look at children's health. It's time for EPA to move beyond the numbers of IAQ committees set up and to look at kid's test scores and attendance and promote more basic prevention techniques rather than more medication.
Diane Estrin, State Coordinating Office Director, Community Action to Fight Asthma: I just spoke with Pesticide Reform counselors who indicated that they felt they should have made their IPM programs mandatory. The voluntary programs are having the same problems that healthy schools are.
Claire L. Barnett: It’s hard to mandate Indoor Air Quality Programs because there aren't any standards for indoor air, even though it's 100 times more polluted. The problem is how to establish the best practices and standard settings. Schools present an interesting problem because they're so densely populated and there's a different vulnerability of the occupants.
Bonnie Holmes-Gen, Assistant Vice President, Government Relations, American Lung Association of California: We're co-sponsoring legislation in California to require controls on particulate matter pollution, which is linked to 340,000 asthma attacks every year. I find this a high priority and would like to see this move up on the agendas of asthma groups and would welcome feedback on this.
Anthony J. DeLucia: The Centers for Disease Control/CDC has shown interest in how communities can get engaged in policy discussions. The tobacco control changes and second hand smoke have shown how to take it to the appropriate decision-makers to build influence. CDC may be interested in Laurie Stillman's point about the need to get the message into the hands of the communities and work on policy and change.
Jacquelyn J. Wilson, MD, Consultant Physician: I am interested in ecology: in schools that can open windows, with trees nearby that can clean up the air.
Anthony J. DeLucia: As there is so much asthma in our cities, this is a controversial issue. Opening the window may not be helpful; more pollutants may come in, ozone and particulate matter.
Polly Hoppin, ScD, Senior Scientist, Tellus Institute: NESCAUM is looking at the relationship between indoor and outdoor air in regards to traffic around schools. They've found that when traffic dies down, while the levels of particulates outside reduces, the levels inside stay up. In terms of research, this is a good opportunity for us. The New England States effort is unique in that the Asthma Regional Council got off ground because it got public feedback on what people wanted to look at. The state legislatures blessed this.
Michael Lerner: How well has asthma done at the national level of coalescing as an issue? Can the whole issue be moved up on the agenda as a more collective strategy? Do we have a sense of how asthma is doing given the solid science and the extraordinary prevalence in terms of organizational and political aspects?
Anthony J. DeLucia: I've seen the most progress in New England and on the West Coast. But ALA should promote national success and engage various agencies, from the local to the cabinet level. ALA should commit to best practices, to show what is being done in research, advocacy, and education. We need to make the case that lung disease is killing great numbers.
Polly Hoppin: There has been an enormous surge on asthma work in the governmental and non-government sectors. Those that have integrated environmental with other aspects of asthma (social issues, medical management) have been very effective. In New England, the focus on environmental factors has also focused on medical management factors.
Carolyn Wysocki, President, Ecological Health Organization, Inc. (ECHO), Member of CT State Asthma Task Force: On a state level, at the Asthma summit we developed a task force, and broke into 4 groups: public education, professional education, environmental work groups and clinical management. As someone who started as an advocate and became a consumer, I learned that we need to have consumers engaged on every level because they do bring in another perspective. We are having a meeting on May 28, which will share the results of the task force plan, get implementation to start, and develop new partnerships.
Nina Moliver, EarthSave Boston; Alliance for Democracy: I am interested in the roles that junk food and dairy play in asthma. Has anyone looked at the relationship between environment and diet or asthma and diet?
Anthony J. DeLucia: We have done some clinical studies at ALA, one on asthma and the flu vaccine -- in which we also looked at soy products, which, in children, seem to stimulate immune system.
Karen Florini, Senior Attorney, Environmental Defense: We recently released a prototype of a Fed Ex truck, which reduces particulate emissions by 90% and increases fuel efficiency by 50%. These should roll out in larger numbers soon. If you were Czar for a day, what single thing would you take on to reduce asthma?
Anthony J. DeLucia: We've had such good progress with outdoor air; it’s time to mount an aggressive initiative on indoor air.
Claire L. Barnett: Senators Jeffords and Clinton, at the US Senate hearing on November 1, 2002, and again this spring have called for indoor air quality standards to be set by EPA. The new opportunities for research on indoor air are great but not nearly enough has been done to promote prevention (elimination of sensitizers and asthma triggers).
Ted Schettler, MD, MPH, Science Director, Science and Environmental Health Network: Are there any single interventions with big affect? Asthma has complex mechanisms and they interact in complex ways. This is one of the reasons we have a hard time deciding on single interventions. We also don't want to forget about the hidden population of occupational asthma. Workers are less in positions of power to do something, as they don't want to lose their jobs.
Polly Hoppin: I think the most important aspect is to improve housing and eliminate poverty. But there's also a huge health disparity issue in asthma. The cycle of returning to hospitals over and over is due to people's housing conditions. Asthma is an issue of poor housing quality and poverty and a lack of access to good primary and prevention care.
Michael Lerner: Is this forum useful for people to strategize and is there something useful that CHE can do to help facilitate further work?
Anthony J. DeLucia: There's a CDC meeting on public health and the environment December 3-5. Equity issues are going to be paramount. I think that the gaps will continue to grow. If this group could look at a plenary session on Asthma, I could get ALA support and we have contacts within CDC.
Michael Lerner: Anyone who is interested in furthering this conversation can contact Frieda Nixdorf, our CHE administrative assistant.
Polly Hoppin: I would be willing to help bring CHE Partners together to continue working on this. I would like to look at where research is taking us and strategize around that and keep each other updated.
Sharyle Patton: The CDC is looking at health tracking of Asthma in Alameda County. Are there other states involved in this? Maybe we could share information about how useful that is in terms of leveraging state regulations.
Polly Hoppin: Four of the 6 New England States have received health-tracking grants and we are looking at how we can collaborate across the states.
Carolyn Wysocki: I am on the tracking task force for public health and that would be helpful.
Theo Colborn, Senior Conservation Scientist and Director, World Wildlife Fund: I think we also need to look at gestational exposure and it's impact on asthma, as well as transgeneration impact on the child before birth. It might be great to set up a panel on this in December.
Neil Gendel, Project Director, Healthy Children Organizing Project, Consumer Action: I'm interested in knowing more about the high performance school concept and better indoor air. We have healthy housing programs, which includes asthma, and is supposed to include all housing across the country.
Anthony J. DeLucia: There’s also a HUD program that deals with universities on this.
Michael Lerner: Thanks to all speakers for a compelling dialog. We look forward to continued discussion.
Our next call, scheduled for June 17, will be on The Precautionary Principle, which is a crosscutting way of thinking about how to establish public policy under conditions of uncertainty.
As of April there are 500 CHE Partners and the CHE Science Website www.healthandenvironment.org is getting stronger every day with many of new fact sheets.
Congratulations to the recipients of the CHE Mini Grants: African-American Breast Cancer Group Birth Defects Research California Indian Basketweavers Association Center for Ethics and Toxics Hispanic Radio Network Institute for Agriculture and Trade Policy Learning Disabilities Association of California of CA Lymphoma Foundation of America New Mexico Environmental Law Center Students for Environmental Awareness in Medicine West Oakland Asthma Coalition
CHE National Conference in San Francisco: There will be a CHE national conference in San Francisco on November 14, 2003. It is conveniently scheduled for the day before the American Public Health Association APHA meeting, November 15 and 16. The APHA has panels on bio-monitoring, body-burden and health affected groups.