A Better St. Louis. Powered by Journalism.
  • Twitter
  • Facebook
  • Print
  • Email

Treating asthma as a serious public health problem

In Health

8:05 am on Thu, 02.23.12

The American Lung Association is trying to mobilize groups nationwide to fight plans by the Obama administration to consolidate some asthma programs and reduce funding for them. St. Louis has one of the nation's highest rates of asthma. The local cost of treating the illness increases when parents of children with asthma turn to costly emergency rooms for treatment.

Under Obama's proposed budget, the Centers for Disease Control and Prevention would fold the National Asthma Control Program into an umbrella organization focusing not only on asthma but on reducing other environmental health hazards, such as air pollution, lead poisoning, second-hand smoke and radon.

The Lung Association's CEO, Charles D. Connor, says the group will appeal to health partners to start a "nationwide campaign" to save the asthma program. The association also noted that that it had persuaded Congress to reject similar changes the administration sought to make last year.

While the CDC said it would continue to fund evidence-based asthma-control programs, but would put less focus on surveillance and more attention on training health professionals and educating the public about managing asthma. The new approach would reduce to 19 the number of asthma grants made nationwide in the next fiscal year, which begins Sept. 1, down from 65 each during the previous two fiscal years. The CDC's environmental health budget of $139.9 million would be reduced by $7.3 million in the coming fiscal year. The agency added that some cuts would be offset by cutting duplicate  services.

Dr. William Kincaid
Robert Joiner | St. Louis Beacon file photo
Dr. William Kincaid

Impact on the St. Louis region

Among those watching these developments and what they mean to the region is Dr. William Kincaid, head of the St. Louis Regional Asthma Consortium. Kincaid has been a medical practitioner, a public health official, a medical director of a managed care plan and, more recently, a volunteer with many nonprofit health groups. His preference, like the CDC's policy shift, leans toward more training and public education.

"The issue is not more money," he says. "The issue is using the money already in the system more effectively."

The asthma consortium has worked with the Lung Association, the CDC, state health officials and health officials in St. Louis and St. Louis County.

As for the controversy between the Lung Association and CDC, Kincaid says, both sides have merit. On the one hand, he says, the Lung Association's reaction is an example of "special interests rallying the troops to change federal funding priorities." On the other, he says the CDC has done an "excellent job" in asthma treatment and prevention, based in part on work by local groups such as the consortium. The CDC also has funded Missouri's asthma control and prevention program, he says.

What's missing, he says, is a balance between the medical and public-health approaches to the problem, including more initiatives to educate providers and the public about asthma and how to control it.  The consortium's efforts have included encouraging doctors to develop patient-specific asthma action plans.

"These plans," he says, "are really standing orders to be used by parents or a school nurse to manage acute attacks."

This approach and early use of medications can prevent the need to "send the child to an ER or to call parents to take time off work to take care of the child (through) an urgent care visit."

St. Louis ranks sixth in the nation in asthma, with Richmond, Va., having the highest rate. The most recent data by the Missouri Department of Health and Senior Services show that 21 black children under age 15 died from asthma between 2000 and 2007.  During that same period, the agency reported that eight white children in the same age group died of the illness. 

For a three-year period, from 2005 to 2007, the agency reported that asthma-related mortality for blacks in Missouri was 2.5 for every 100,000 people. For whites, it was 0.9 for every 100,000 people. This means the rate for blacks was 2.8 times higher than for whites, according to a DHSS report, Putting Excellent Asthma Care Within Reach (2010-2014).

The data also showed the disease generated many emergency room visits and hospitalizations among young black children across the state. In 2009, for example, Department of Health officials reported 29,600 ER visits and 8,200 hospitalizations relating to asthma. The cost of asthma-related ER visits exceeded $37.5 million in 2009. Overall hospital charges for asthma treatment exceeded $96 million.

Data from 2007 showed that seven of every 1,000 white children between the ages of 1 and 4 visited ERs for asthma, compared to 45.8 of every 1,000 black children. In addition, white children in the 1-4 age group were hospitalized for asthma at a rate of 27.1 for every 10,000, compared to a rate of 83.1 for every 10,000 black children.

Asthma as a public-health problem

Kincaid says a missing ingredient is education. "Many asthmatics do not receive good outpatient medical care," he says. Only 10 percent of those going to an ER for an asthma attack visit a doctor in the next three months. In addition, the condition is often under-treated because patients may not fill prescriptions for controller inhalers because of the cost of the medication. Unlike rescue inhalers, which bring immediate relief, controller inhalers require months to reduce symptoms and control chronic lung inflammation that triggers acute attacks.

Kincaid says public-health officials, locally and around the state, have worked to understand the issues surrounding asthma as a public-health problem.

The changes in funding proposed by the federal government "raise important policy questions," he says, adding that the current system largely treats asthma under a medical model.

With few exceptions, he says the medical models and public-health models function independently, "moving through the community on parallel tracks, not operating as one. This is a huge mistake. Poor policies are leading to higher costs and poor outcomes."

But he sees hope in a new federal initiative called Innovation Challenge grants. The government is setting aside $1 billion for projects that produce creative ways to deliver medical care and save money. Kincaid said the local asthma consortium and four other groups have applied for a grant.

The program seeks to address asthma and other problems through systemic approaches, involving medical care, behavioral health, education, empowerment and epidemiology, Kincaid says.

His hope is that through an innovation grant, public-health officials can form a partnership with hospitals, physicians and Medicaid managed care plans.

"This would unite those groups that have a stake in asthma to develop a statewide program based on best practices from the medical and public health worlds," he says.

The goal would be to "redirect money currently spent at the high-cost end of the asthma problem -- on hospitals and emergency rooms -- to educational and environmental interventions in neighborhoods and among individuals at high risk." He concedes the long odds of winning one of the grants, which the federal government will announce as early as next month and as late as the fall.

"The odds are long that the application will be successful," Kincaid says. "But these kinds of paradigm shifts are needed if we are going to improve patient outcomes and lower costs."

No Comments

Join The Beacon

When you register with the Beacon, you can save your searches as news alerts, rsvp for events, manage your donations and receive news and updates from the Beacon team.

Register Now

Already a Member

Getting around the new site

Take a look at our tutorials to help you get the hang of the new site.

Most Discussed Articles By Beacon Members

Conference of American nuns will mull response to Vatican charges

In Nation

7:55 am on Fri, 08.03.12

Meeting in St. Louis next week, the Leadership Conference of Women Religious will have its first opportunity as an assembled group to consider what to do after the Vatican issued a mandate for change this spring. It calls on the conference to reorganize and more strictly observe church teachings.

The 'free' Zoo

In Commentary

7:51 am on Tue, 05.22.12

When a family of four goes to the St. Louis Zoo, they can be forgiven for not knowing it will cost them $60, $72 if they park. If they can't pay, the alternative is to tell the kids they can't do what kids do at the zoo.

Featured Articles

House sends Boeing incentive bill to Nixon

In Economy

12:55 pm on Fri, 12.06.13

The Missouri House easily passed legislation aimed at attracting production of the 777x, a move that wraps up a legislative special session that saw little suspense and few surprises. The bill now goes to Gov. Jay Nixon, who has strongly supported the legislation.

Gandhi inspired Mandela on South Africa's 'Long Road to Freedom'

In World

10:10 am on Fri, 12.06.13

Nelson Mandela, who died Thursday at the age of 95, was a towering moral figure of the 20th century -- along with Mahatma Gandhi. It was no coincidence that Gandhi and Mandela, whose paths never crossed directly, both embarked on their campaigns against discrimination in South Africa. It was when Mandela won election as South Africa’s first black president that Gandhi's influence became apparent.

Featured Articles

Regina Carter brings jazz and therapy to Children's Hospital

6:36 am on Mon, 12.09.13

One night, the violinist is taking bows before a standing ovation at Jazz at the Bistro. The next afternoon, some of her audience may have trouble standing, but the kids in the playroom at Children's Hospital were no less appreciative. “Jazz is medicine personified," according to a doctor who brings in the jazz musicians.

Encore: Dead before death

In Performing Arts

12:58 am on Fri, 12.06.13

For years , the author was certain he would never come to appreciate The Grateful Dead, let alone be a Deadhead. But little by little, he's come around. He talks about his conversion and relates a real evolution: by a musician who went on to play with the Schwag, a Dead cover band.

Featured Articles

Schlichter honored with St. Louis Award

In Region

4:57 pm on Tue, 12.03.13

The attorney has founded Arch Grants, which brings together nonprofit philanthropy and commercially viable opportunitiesto fund new business startups, and Mentor St. Louis, which finds adult mentors for elementary students in the St. Louis Public School System. He was the driving force behind the state's historic tax credit program.

BioGenerator sets open house to celebrate new digs for entrepreneurs-in-residence

In InnovationSTL

12:29 pm on Tue, 11.12.13

BioSTL's BioGenerator organization is on the move as its entrepreneurs-in-residence find a new home in 4,300 square feet of office and conference space in an old automobile factory. The blossoming program, which helps BioGenerator's portfolio companies to get off the ground, continues to pay dividends within the growing biotech community.

Ambassadors aim to soften rough landing for St. Louis immigrants

In InnovationSTL

6:34 am on Fri, 11.08.13

The St. Louis Mosaic Project is set to hold an orientation for its new ambassadors -- dozens of foreign and native-born volunteers who aim to help make the community a more welcoming place for those from other nations. Participants will be expected to do everything from visiting local restaurants serving international cuisine to having dinner with an immigrant to the area.

Recent Articles

More Articles

Innovation and entrepreneurial activity are on the rise in St. Louis, especially in bioscience, technology and alternative energy. The Beacon's InnovationSTL section focuses on the people who are part of this wave, what they're doing and how this is shaping our future. To many St. Louisans, this wave is not yet visible. InnovationSTL aims to change that. We welcome you to share your knowledge, learn more about this vibrant trend and discuss its impact.

Featured Articles

Regina Carter brings jazz and therapy to Children's Hospital

6:36 am on Mon, 12.09.13

One night, the violinist is taking bows before a standing ovation at Jazz at the Bistro. The next afternoon, some of her audience may have trouble standing, but the kids in the playroom at Children's Hospital were no less appreciative. “Jazz is medicine personified," according to a doctor who brings in the jazz musicians.

Featured Articles

Featured Events:

Upcoming Events

View Full Calendar

More About The Beacon Home