Through RAMP’s work with clinicians, community and health advocates, local asthma coalitions, and other stakeholders, RAMP has developed policy priorities that reflect the need to comprehensively address clinical and environmental dimensions of asthma. Priority areas include clinical care, outdoor air quality, housing, and schools. RAMP’s priorities for influencing and shaping local, regional, and state level policies in each area are outlined below.
Access to appropriate clinical care is vital to addressing the problem of asthma. Poorly controlled asthma can lead to increased incidence of attacks, more frequent visits to emergency departments, lost school and work days, and at its worst, uncontrolled asthma can lead to death. Assuring quality, culturally appropriate care is a necessary step to help those with asthma lead healthy and productive lives. Priorities include:
- Promoting implementation of the NHLBI guidelines on the management of asthma.
- Promoting access to quality health care and culturally competent care that includes support for self-management of asthma.
- Promoting home visitation approaches that address both clinical management and environmental prevention of asthma.
- Implementing new opportunities within health care reform, including preventive services, the “health home” model, and health impact bonds.
Outdoor Air Quality and Land Use Planning
The vast majority of Californians (almost 80%) live in areas that fail to meet the state’s health-based air quality standards. The problem affects low-income communities and communities of color disproportionately because these groups tend to live in areas where air pollution is worst. Outdoor air pollution has been linked to both the development of asthma and exacerbation of existing asthma.
Reducing exposure to outdoor air pollution isn’t simply a matter of making cars and diesel trucks run cleaner. Land use and transportation planning decisions – like housing built next to high traffic roadways, or industrial facilities placed near schools – also have a tremendous impact on the health and well-being of our communities. RAMP’s priorities include:
- Reducing exposure to diesel emissions, particulate matter, ozone, nitrogen dioxide, sulfur dioxide, and other pollutants, especially in communities disproportionately affected by asthma and environmental injustices.
- Incorporating a health perspective into land-use decision making, ensuring a buffer between sources of pollution and sensitive sites (e.g. housing and schools).
- Supporting climate change policies that maximize health benefits.
- Working with partners to create transformational changes to the state’s freight system of ports, rail yards, warehousing facilities, and truck routes to reduce the disproportionate burden of air pollution on low-income communities and communities of color.
Californians spend nearly 90% of their time during the week indoors, and much of that time is in the home where many environmental asthma triggers exist. Tobacco smoke, consumer products like cleaning supplies, pesticides, and scented “air fresheners,” mold, cockroaches and rodents, and dust mites have been linked to asthma and asthma exacerbation. Many of these triggers can be linked to substandard housing conditions that leave renters dependent on landlords to properly limit exposure to unhealthy conditions. Priorities include:
- Supporting tenants’ rights to healthy indoor air quality.
- Establishing more health protective housing, health and safety codes.
- Improving local jurisdictions’ ability to enforce housing, health, and safety codes.
RAMP has joined housing stakeholders from across the state to address statewide healthy housing issues through the California Healthy Housing Coalition. The coalition focuses on addressing substandard housing conditions, ensuring that green building is not just energy efficient, but also healthy, and establishing evidence-based indicators of healthy housing.
One in five Californians spend a part of their day in a school. During their time at school, students, teachers, and staff can be exposed to numerous asthma triggers, affecting their ability to learn, teach, and be productive. Common problems encountered at schools include inadequate ventilation, moisture and mold, emissions from furnishings, cleaning products, and teaching supplies, dust, and pesticides. Priorities include:
- Promoting asthma management and support systems.
- Encouraging cleaning and maintenance practices that improve indoor air quality.
- Limiting sources of air pollution near school campuses.
- Establishing healthy building standards and equitable funding for school construction and modernization.
School-based health centers also serve an important role in helping children breathe easier. Research shows that SBHC users are less likely to visit the ER or to be hospitalized for asthma. In addition to providing quality clinical care and education, there is an opportunity for school-based health centers to also be leaders in managing the environmental factors that make asthma worse. As such, an additional priority is:
- Increasing the capacity of school-based health center staff to engage in environmental asthma interventions.
For a more comprehensive understanding for creating a healthy school for those suffering or at risk for asthma, RAMP, in collaboration with Community Action to Fight Asthma, developed a school policy framework (web and PDF).