Targeting Improvements in Asthma Morbidity in Chicago: Legislative Activities

Chicago continues to be “asthma ground zero” due to its disproportionately high rates of asthma-related hospitalization and mortality. Prevalence rates for asthma for persons in Chicago are higher for whites and African Americans than the national average. However, this increased prevalence does not explain that the Chicago asthma hospitalization rate for African Americans is nearly double that of the nation as a whole.

In the mid 1990s, with the help of The Otho S.A. Sprague Memorial Institute, a number of community-and medical center-based collaborative efforts were launched with the aim of reducing asthma morbidity in Chicago. This multifaceted approach involved healthcare providers, public health agencies, academic medical centers, and community advocates. This review summarizes the many asthma intervention strategies, initiatives and programs that were initiated during the last decade, and highlights some of the successful programs.

Recent asthma interventions in Chicago can be considered in eight major activity domains: policy and advocacy, work addressing disparities, education, surveillance, research, quality improvement, consortium development, and community initiatives. While it is useful to classify these efforts for reporting, many of the activities overlapped categories due to their multifaceted design.

Policy and Advocacy Initiatives Many of the community-based advocacy and policy projects related to asthma have been accomplished by joint efforts of the Chicago Asthma Consortium (CAC) and the American Lung Association of Metropolitan Chicago (ALAMC).

Legislative activity included the following efforts: (1) allowed students to carry inhalers in schools, (2) improved private insurance coverage for inhalers, (3) advanced tobacco control and clean air policy, (4) reduced youth access to tobacco, and (5) developed targeted tax funding for asthma and lung disease research with an optional “check box” on the Illinois state income tax form.

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One of the early major successes of the CAC was to catalyze a change in Chicago Public School policy to allow children better access to their (P-agonist inhalers while in school. That success catalyzed a new state inhaler law that requires all schools to allow children to carry and use life-saving asthma medications. This legislation was later expanded to allow children to carry inhalers to recreational camps. To address restrictions imposed by private insurers on the number of inhalers an individual with asthma may receive in a month, the ALAMC and American Lung Association of Illinois worked together with partners to get a law passed through the Illinois Legislature disallowing restrictions on “medically necessary” inhalers.

Asthma and Air Pollution

Tobacco Control and Clean Air

The ALAMC, CAC, and many other partners, including local health departments, have been working on a multifaceted effort to support communities that desire to go smoke free. After a 16-year struggle, the Illinois General Assembly passed legislation that grants the right to strengthen indoor air laws to all Illinois communities. Previously only 21 communities could strengthen their clean indoor air laws, There are currently campaigns in many communities to make all public workplaces smoke-free. The Smoke-Free Chicago campaign led to a clean indoor ordinance for Chicago in 2005.

The Clean Diesel Campaign focuses on reducing diesel emissions in Illinois through the Clean School Bus program and the No-Idling Initiative. With funding from the Illinois Environmental Protection Agency, the ALAMC has assisted school districts in the Chicago area retrofit > 90 school buses with pollution-control technology, improving air quality in neighborhoods with high asthma prevalence. The No-Idling Initiative advocates public policy to reduce unnecessary idling of diesel vehicles throughout the state. The Clean Power Campaign successfully lobbied the Chicago City Council for an ordinance to limit emissions from two antiquated coal-fired power plants that have been linked to increased asthma emergency department (ED) visits.

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Perhaps the next article will be useful for you: “Occupational Asthma and Work – Exacerbated Asthma“.

City-Wide Asthma Action Plan

In 2004, the ALAMC formed an Advisory Council to create and implement an Asthma Action Plan for Chicago. The council is comprised of leaders from key local coalitions, education, businesses, insurers, and health-care professionals from > 20 organizations and agencies. On World Asthma Day 2004, the council publicly proposed five key recommendations to improve the status of asthma in Chicago: (1) to broaden community awareness of asthma symptoms and control, (2) to improve indoor and outdoor air quality, (3) to improve access to quality care in the community setting, (4) to enhance coordination of asthma care services and epidemiology, and (5) to address asthma health disparities. An updated plan released on World Asthma Day 2005 called for a uniform hospital/emergency care discharge policy based on recommendations from National Asthma Education and Prevention Program Expert Panel Report 2 guidelines. The 2006 plan called for air-quality improvements, specifically achieved through accelerated retrofitting of diesel vehicles and passage of legislation further restricting smoking in all public and work places, including restaurants and bars. The most recent World Asthma Day 2007 proposed improved training of physical education teachers and coaches about recognition and management of asthma. Each of these declarations was done with professional and community representation, usually with persons with asthma or their caregivers. They were major media events covered by print, radio, and television.