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Health Equity

Asthma Disparities

In Ohio, the following groups of people have worse asthma outcomes than other residents.

  • Children

  • African Americans

  • Residents of Metropolitan Counties

  • Adult Women

State data shows that asthma-related visits to hospital emergency departments are 4 times higher and asthma-related hospital admissions are 5 times higher among black children than white children.

These differences or disparities are health inequities that must be addressed to reduce the burden of asthma.

Structural racialization is a cause of asthma disparities and explains how systems, structures, organizations, and the design and structure, in general, restrict opportunities and life chances for African Americans due to their racial identity.

Structural racialization creates and perpetuates stereotypes and stigmas that cause disparities in asthma care and management such as:

  • Having longer wait times for assessment, treatment, and referral

  • Having less time with healthcare providers

  • Being less likely to be diagnosed with asthma

  • Being given varying and inconsistent treatment options

  • Receiving a dominant and condescending tone from providers

  • Having different cultural considerations regarding healthcare behaviors and decisions  

Sources:

Hall, W., et al. (2015) Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systemic a review. American Journal of Public Health.

Sabin, J. and Greenwald, A. (2012). The influence of implicit bias on treatment recommendations for 4 common pediatric conditions. American Journal of Public Health. 102, 5. p. 988-995.

Health Equity

The Ohio Department of Health Asthma Program is committed to the elimination of health inequities.

Health Equity is an opportunity for everyone to achieve the same health outcomes. While personal choice has a role in health, we can only make choices available or known to us. Achieving health equity requires removing barriers to care such as poverty and discrimination to improve self-efficacy, the quality of care, and the overall patient experience.

Our Mission

Our mission is to is to intentionally and consistently engage individuals and entities across sectors and disciplines to build capacity and promote health equity to eliminate disparities, improve quality of life, and achieve optimal health outcomes for people with asthma in Ohio. 

Our strategies:

  • Promote inter- and intra-agency collaboration and strategic partnerships to address factors associated with asthma-related disparities

  • Foster opportunities for healthcare providers and stakeholders to learn about health equity, cultural competence, implicit bias, and structural racialization 

  • Enable stakeholder engagement to promote community-level approaches to reducing asthma disparities

Strategies to Improve Health Equity:

  • Adhere to National Asthma Education and Prevention Program (NAEPP) EPR-3 guidelines to provide comprehensive asthma care services at every point of care.

  • Build trust and transparency into patient-centered care to ensure patients feel empowered and take part in their own care.

  • Develop, implement, and regularly review policies, laws, systems, and practices that reduce implicit bias and eliminate inequities.

  • Develop quality improvement and evaluation projects to identify equity concerns in your organization, set goals to address them, and monitor and report your results.

  • Recruit, develop, promote, and retain a diverse and inclusive workforce.

  • Provide culturally competent care education opportunities to every single person in your organization and create safe spaces for employees to reduce their own bias.

  • Develop and foster diverse, inter- and intradisciplinary relationships and partnerships that support and build capacity in communities and self-efficacy in patients and families.

  • Create space and time for self- reflection and self-awareness of staff to reduce their own biases.

Check out our Resource Tool Kit for health equity resources such as the ODH’s Cultural Care Kit or Ohio State University’s Kirwan Institute’s Implicit Bias Training Modules and much more!

Social Determinants of Health

Address Social Determinants

One way to reduce asthma disparities is to address social determinants of health (SDOH) or conditions where people are born, live, work, play, and age that affects their health, functioning, and quality of life outcomes and risks.  

Addressing SDOH can help people with asthma have better opportunities to improve their health and wellness by reducing exposure to triggers, barriers to care, and stressors that can hinder healthy choices and behaviors.

Healthy People 2020 reports that the 5 key social determinants are:

  • Economic Stability

  • Education

  • Social and Community Context

  • Health and Healthcare

  • Neighborhood and Built Environment

Social Determinants Vignette: 

A child with asthma lives in an urban neighborhood with high crime and poverty.  The housing they live in has mold in their only bathroom. The landlord says that it’s Mom’s fault because the unit didn’t have mold when they moved in.  They don’t have a fan in the bathroom to reduce moisture and can’t open the window because they fear someone will try to break in.  The mold continues to grow and the child with asthma in the home keeps going to the emergency room to get treated but eventually gets discharged back home. Mom doesn’t have money to move because she keeps losing her job because she misses too much work to take care of her child with asthma.  Mom is also having trouble getting to and from doctor appointments because she doesn’t have bus fare to get to the hospital, so the child isn’t getting the regular care she needs.  

This is a very common scenario that causes asthma disparities and explains how one problem, creates another, then another.

Strategies to Address Patients’ Social Determinants of Health

  • Seek Medical-Legal Partnerships to refer to patients for help with legal issues related to housing, education, and employment.

  • Educate families about transportation assistance and/or provide vouchers to reduce the cost of traveling to appointments.

  • Provide free parking for patients and families.

  • Provide asthma home assessments to identify environmental issues that contribute to asthma severity.

  • Use community health workers to help provide culturally competent care in the clinical environment and the patient’s home.

  • Provide community resources to address patient needs (food insecurity, utility assistance, education, and employment opportunities). 

  • Ensure regular follow up with patient and family to address health status, review patient goals and needs, and identify barriers to care.