The northeast United States is the nation’s asthma belt. Massachusetts has one of the highest rates of asthma in the country and Worcester has one of the highest asthma hospitalization rates in Massachusetts. All together, that means Worcester is one of the most difficult cities in the country in which to take a breath.
The state’s perennially high ranking in this unfortunate category, while under the radar as general knowledge, has been catching the attention of health professionals for a long time. But they have not been able to reverse the tide. Massachusetts continues to rank highly, and in some years leads the nation, in asthma cases per capita.
This year, the American Lung Association gave an ‘F’ grade to seven Massachusetts counties as part of its annual “State of the Air” report that assigns letter grades to counties throughout the country based on ozone and particle pollution. The cleanest Massachusetts counties were Berkshire to the west and Suffolk to the east. They received a grade of C.
Worcester County, benefiting from being in the hills, received a D. But the city itself ranks as one of the most asthma-laden in the state. [Editor’s note: See page 96 of the linked report.]
The reasons why are numerous – substandard housing, low awareness of how to combat the affliction, and the general dirt and grime associated with an urban area. Still, there are many cities across the country that fare much better on the asthma scale.
While Worcester fares considerably better than the Boston area, Fall River, New Bedford and Brockton, that fact provides little comfort to local officials who say they are committed to decreasing the city’s asthma numbers.
Worcester’s Commissioner of Health and Human Services, Dr. Matilde Castiel, said the city hopes to cut into its high numbers through an ongoing, aggressive program to track asthma cases and remove or reduce environmental causes.
“Nobody is really looking at the home environment,” Castiel said in an interview with the Sun. Causes can include dust mites, droppings from pests like mice and living with a smoker, she said.
Indeed, carpeting, according to state figures, has been the most significant trigger for asthma sufferers in the state, three times more prevalent than smoking [see page 14 of this report].
“We conduct an evaluation of the home situation, look at the triggers that occur in the house,” she said. “People will go to an emergency room to get treatment and nobody looks at what actually triggers it. This method, having community health workers come to the house, that is a huge piece that is missing in our healthcare system right now.
“If you look at any type of disease, addiction, people can overcome if people are coming to the home to follow up. When we talk about health we talk about the social determinant of health: How do we make the home environment a better place to live?”
The northeast United States as a whole has seen an increase in asthma rates in recent years due to acid rain that comes predominantly from coal burning (which eventually produces sulfuric acid in the atmosphere) in the Midwest, according to Elizabeth Tanefis, director of the Massachusetts Asthma Action Partnership, or MAAP.
She said rates are higher for Hispanics and African Americans because they are disproportionately poorer, have limited access to good healthcare and live in cities with substandard housing that can have carpeting with mildew and pest droppings that aggravate the condition.
“Asthma is one of the leading causes of school absenteeism,” Tanefis said, adding that one in five students in the Boston public schools has an asthma diagnosis. Worcester’s asthma prevalence in the kindergarten through Grade 8 category is in the range of 12 percent, a number that Dr. Castiel said is in line with the state average.
The Worcester effort, funded through a state Prevention and Wellness Trust Fund grant that is three years into its four-year life, could be very enlightening. Six of the grant’s nine statewide community partnerships are charged with addressing pediatric asthma.
“Right now we don’t have evidence that is strong enough about effective prevention strategies,” said Erica Marshall, director of the Asthma Prevention and Control Program at the Massachusetts Department of Public Health.
At the same time, it is known that communities can be proactive by controlling the indoor air quality in their schools and promoting locally the state’s vehicle anti-idling law through signage and enforcement.
“A lot more children have asthma than people realize,” Marshall said.
Part of the asthma puzzle is unknown. MAAP, a collaboration of health centers, hospitals, school nurses and others, is beginning to explore connections between rising asthma rates and greater instances of extreme weather events caused by accelerating climate change.
Periodically, MAAP and DPH collaborate on a report of progress and goals in the fight against asthma in Massachusetts. The most recent document, which targets the years 2015-2020, lists a number of statewide goals for 2020:
- Increase provider knowledge of the home environment and encourage providers to ask patients about their living conditions.
- Increase number of pediatric asthma home visits.
- Promote smoking cessation.
- Encourage healthcare providers to report work-related asthma cases as mandated by law.
The report notes that health insurance plans have varied reimbursement policies for asthma services, medications and devices. “Tiered medication coverage often put controller medications in a higher tier resulting in costly co-pays for persons with asthma,” the report states.
The report also lists asthma as the leading nationwide cause of school absenteeism.
It also stresses the importance of reducing exposure to many of the realities of urban life, including pollutants from fuel combustion, among them gasoline, diesel and coal. It notes that intervention programs that reduce air pollution are associated with a decline in symptoms and a correlation between proximity to traffic and childhood asthma.