Children of color in Milwaukee suffer from asthma at alarming rates, but it doesn’t have to be this way

In Milwaukee, a chronic disease is sweeping the city’s children from predominately Black and poor neighborhoods into emergency rooms at alarming rates.

The disease is asthma and doctors say it’s one of the most preventable reasons for pediatric emergency room visits.

Asthma is a chronic respiratory disease caused by hyperactive airways that can be inflamed by anything from allergens to physical exercise to irritants such as extremely cold weather. However, with daily medicine and a rescue inhaler for emergencies, it can be controlled and those with asthma can lead normal lives.

So why do so many of Milwaukee’s asthmatic children from disinvested neighborhoods find themselves in the ER so frequently?

I cover affordable housing at the Milwaukee Journal Sentinel and I am embarking on this project, with support from the 2022 Impact Fund for Reporting on Health Equity and Health Systems, to answer that question. I will be investigating the source, impacts and solutions for these disparities in uncontrolled asthma with our paper’s veteran health reporter, Guy Boulton, and with our photography and data teams.

Here is what we’ve found so far.

Parents in low wage jobs with transportation barriers face a time deficit in trying to take their asthmatic children to preventative doctor visits because few have extended hours. A low rate of health literacy means many children do not take their controller medicine and instead rely on their rescue inhalers, leaving them more vulnerable to severe attacks. A legacy of racial inequity in redlining and concentrated poverty lead many families to rent substandard housing. And systems plagued by inadequacy, such as the city’s department responsible for code enforcement, are often understaffed and underprepared to follow up on dangerous health conditions. 

As a result, some of Milwaukee’s most vulnerable residents suffer uncontrolled asthma at unparalleled rates compared to affluent neighborhoods just a 20-minute drive away.

There are strong connections between poorly controlled asthma and poverty. In the Milwaukee ZIP codes of 53205 and 53206, more than half of children live in poverty and those ZIP codes also feature two of the highest ER rates (per 10,000 children) due to pediatric asthma. Those rates are more than 10 times that of their suburban neighbors in Whitefish Bay.

Substandard housing tends to be concentrated in Milwaukee’s poorest neighborhoods and some of its elements — dust, rot, pests, mold, dirty carpets, clogged HVAC systems, and deteriorating facilities that expose metals and other construction chemicals — are known to exacerbate asthma, begging the question: even if parents do ensure their children take the medications to control their asthma, how can they be healthy if returning to a home full of asthma triggers? 

This project wants to hold the city’s Department of Neighborhood Services, which is responsible for code enforcement, accountable in their role of addressing asthma-exacerbating housing factors.

Preliminary research suggests that long wait times and weak anti-retaliation statutes prevent Milwaukee residents — the poorest of whom often have evictions on their records or other factors that can make finding new housing difficult — from receiving safe and healthy housing.

And although Milwaukee and the state are home to asthma programs, they have failed to reduce asthma in neighborhoods such as 53205. For example, the nonprofit Fight Asthma Milwaukee works on the issue, but their research coordinator said that their biggest challenge is finding resources to do the work, which involves home visits, family education and working with health care providers. 

Among health systems, Children’s Hospital of Wisconsin is one of the few building clinics in low-income areas where residents can access them.

From the personal terror of watching a child suffer through the wheezing, coughing and gasping that accompanies an asthma attack, to the economic burdens weighing down parents forced to leave work and come their child’s aid, asthma exacts an understated human and financial toll in Milwaukee.

And that financial toll isn’t limited to the families who suffer.

In the majority of impoverished neighborhoods, few families have private insurance and instead rely on the state program, BadgerCare Plus, to pay for their health care needs. The cost of every pediatric asthma-related emergency department visit by families on BadgerCare is passed onto taxpayers.

But these problems have solutions.

Some of them involve revamping existing systems, such as Milwaukee’s Department of Neighborhood Services, with infusions of staff and resources needed to increase outreach and enforce building codes.

Others involve looking around the country at initiatives that have proven successful at reducing emergency room visits and the housing conditions that exacerbate asthma.

For example, in Boston, the Children’s Hospital Community Asthma Initiative reduced ED-related asthma visits by 68% in a year and saved $1.46 for every dollar invested. Other projects in Philadelphia, Des Moines and Greensboro, North Carolina also have programs that have successfully reduced high rates of uncontrolled asthma.

Our goal with this project is to help members of Milwaukee’s community access the tools they need to engage in proper preventative care and empower themselves against slumlords while also holding city systems accountable and incentivizing more investment in programs that provide asthma education and home remediation.