Can new program tackle the problem of asthma on Native American reservations?

The Navajo Reservation is dry and dusty. The coal-fired power plant further pollutes the air. The winters are cold, and many on the reservation heat their homes with wood- or coal-burning stoves. Asthma rates are high, and kids with asthma are forced to spend a lot of time in clinics and hospitals, missing school as a result.

About one in five Native Americans has asthma. That’s compared to about one in 10 people in the general population. Even after controlling for income and other risk factors, Native Americans are more likely to have asthma than the population as a whole.

Asthma is a serious health problem: People with poorly controlled asthma lose sleep, spend time in clinics and emergency rooms, and are more likely to have a variety of other chronic conditions, including high blood pressure, diabetes and depression.

Asthma is an especially serious condition on reservations: Native Americans with asthma are twice as likely to die from asthma compared to the population as a whole.

Researchers are still trying to understand all the causes of the high rates of asthma among Native Americans, but some potential reasons they’ve posited include poor housing on reservations, dust and other outdoor air pollution (including, on some reservations, fossil fuel projects), indoor air pollutants like wood-burning stoves, and according to some researchers, trauma-induced inflammation.

Past programs seeking to address the high rates of asthma on reservations have encountered challenges such as lack of trust and dispersed communities living across areas as big as small states. 

For example, in 2010, the Washington State Department of Health tried to launch a home-visit program on the Port Gamble S’Klallam Reservation. In other contexts, home visit programs have successfully reduced factors like dust and mold that can trigger asthma attacks, and thus reduced clinic visits and hospitalizations. But on the Port Gamble S’Klallam Reservation, residents were wary of allowing government health workers with clipboards into their homes. After a year during which the program had made almost no headway, the CDC took away funding.

In this void of cancelled government programs, health workers are trying new ways to tackle the issue. On reservations across the US, they’re trying out culturally sensitive programs in schools, sending health workers into homes to reduce asthma triggers there, and cleaning up outdoor air pollution.

My reporting for the 2019 National Fellowship will look at innovative projects that are tackling the problem of asthma among Native Americans, their challenges and successes, and how they would work on a broader scale. A print version will be published in The Nation, and I also plan to produce a radio version.