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Uncontrolled asthma drives disparities and hurts young lives. It doesn’t have to be this way.

Topics in Health: Lessons From The Field

Uncontrolled asthma drives disparities and hurts young lives. It doesn’t have to be this way.

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Starms Discovery Learning Center is an elementary and middle school located in the 53205 ZIP code, a neighborhood where children
Starms Discovery Learning Center is an elementary and middle school located in the 53205 ZIP code, a neighborhood where children visit the ER for asthma at vastly higher rates than they do in wealthier neighborhoods in Milwaukee.
(Photo by Angela Peterson/Milwaukee Journal Sentinel)

After several years covering disenfranchised communities in Milwaukee, Wisconsin, one common thread emerged: housing. Housing is a pivotal force in shaping life outcomes. A child’s ZIP code is often predictive of education access, safety levels, nutrition and employment opportunities. And it is also predictive of health disparities.

While reporting a story on rental housing, I came across a family struggling to get their landlord to repair an incredibly dilapidated home. Shrouds of black mold decorated the walls of their master bedroom and bathroom. Water dripped from upstairs onto their stove. Lights sporadically flickered on and off. 

In a passing comment, the matriarch of the household mentioned she suffered from asthma. So did her husband. So did all of her children. And because of the condition of the house, she had sent her kids to live elsewhere, and found herself traveling back and forth to the hospital for relief.

It wasn’t the first time asthma had appeared on my radar. A 2021 report from the Asthma and Allergy Foundation of America 2021 Asthma Capitals had declared Milwaukee the fourth-worst asthma capital in the country, and the worst among Midwestern cities. Statewide, emergency departments seemed to be disproportionately filled with asthmatic children from communities of color. With the help of a colleague, veteran health reporter Guy Boulton, I researched asthma rates and discovered the number of children visiting the emergency room for asthma was significantly higher in predominately Black, Hispanic and low-income ZIP codes compared to predominately White and higher-income ZIP codes.

In one of them, 53205, children were visiting the emergency department for asthma at a rate 20 times that of children from the affluent ZIP code of 53217, according to hospital data collected between 2018 and 2020.

The development of asthma is difficult to predict; its causes are genetic and environmental, and it can appear at almost any age. But the racial disparities seen in those ZIP codes, experts told me, is the result of uncontrolled asthma. 

I embarked on my project, “Fighting for Air,” to examine why uncontrolled asthma is so rampant in central Milwaukee and explore potential solutions. My reporting revealed how health systems are often ill-equipped to address the exacerbating factors of poverty and substandard housing, which all combine to create unequal outcomes for those with chronic respiratory disease. It revealed how uncontrolled asthma is often the result of medications either not being used properly — if at all — or medications that are too weak to reduce attacks. It revealed how uncontrolled asthma is prompted by substandard housing environments where triggers can be both frequent and severe. It revealed how many residents with uncontrolled asthma don’t even know their triggers because they have never seen a specialist. And it revealed how the historical racism of America’s medical system has led to mistrust and cynicism in the very communities where health education is needed most.

Those without respiratory diseases often take breathing for granted. But it is important to examine the impact of uncontrolled asthma in kids because of how disruptive the disease can be. It can cause sleep issues, hurting school performance in children. Uncontrolled asthma can lead to attacks so recurrent and serious that parents in low-wage jobs lose pay (and potentially, jobs) by tending to these unpredictable incidents. And the failure to access adequate care for uncontrolled asthma can lead to reduced lung function later in life.

I strived to convey to readers the lessons I learned while reporting for this project. 

The story explains to parents that the best way to avoid an asthma-related trip to the emergency room is by having a child checked out by a specialist after an asthma diagnosis and establishing regular, subsequent visits with a primary doctor. Specialists can determine the severity of asthma by testing lung function, identify specific asthma triggers through allergy testing, teach proper inhaler technique, establish when a spacer is necessary and explain the difference between a controller medication meant to be used daily and a rescue inhaler designated for emergencies. Without a specialist, treatment, as one parent described in our story, often feels like guesswork.

On the housing side, the story emphasized the need for parents to understand their rights as tenants. In Milwaukee, they can make complaints to the city about their housing, but they should not withhold rent without using the city’s rent withholding program. The story also identified a code enforcement loophole common to Milwaukee and many other cities: the fact that code enforcement does not accept mold complaints. As a result, landlords are not required by law to remediate existing mold. However, where cities have made this a requirement, asthma-related hospital visits have decreased.

On the health side, my reporting underscored the importance of having community health workers on hand. These workers can advocate for families in hospitals, explain medical advice in layman’s terms and ensure families’ needs are being met holistically. It also established the need for hospitals to understand how the social forces shaping health, such as housing, poverty and nutrition, can undermine medical advice and well-intentioned plans.

The resources in this story were meant to augment these lessons and help families access the tools they need to prevent uncontrolled asthma in their households. Visualized data indicated which ZIP codes have the highest rates of uncontrolled asthma. One of the articles features answers to frequently asked questions in a comprehensive guide for parents and asthmatic patients. And an interactive graphic identifies house triggers and their remedies. 

But telling the story wasn’t easy, and I often experienced challenges balancing work on my regular housing beat and the work for this project. 

I spent the first half of my day working on the project: reaching out to experts for interviews, writing out question lists in preparation for those interviews, reviewing related scientific research and inventorying what remained to do for the project. During the second half of my day, I dedicated time to my beat reporting. Nearly every day, a scheduled interview for my project would pop up, and those prewritten question lists became essential. Throughout this reporting process, organization was key, and I found tools such as Calendly and OneNote exceptionally helpful to organize my day, document communications and easily schedule interviews across differing availabilities and time zones.

I also experienced challenges specific to this project, such as finding sources. Using the common reporting question “Who else should I speak to for this project?” I came across an advocate who connected us to patients and shared firsthand, insider knowledge on the challenges of treating asthma from a health care standpoint. I searched open-facing databases, such as our city’s code enforcement department, with keywords such as “mold” to find housing situations with asthma exacerbators. And finally, I requested death records from our local medical examiner’s office to identify common patterns I could highlight in the project.

A great guiding light for this project was the use of databases such as Google Scholar to find scientific studies on asthma exacerbators and asthma solutions. Through those, I was able to discover solutions in other cities. One in particular, from Greensboro, North Carolina, perfectly encapsulated all the elements experts had said were necessary to successfully reduce uncontrolled asthma. This discovery, however, presented another challenge as a journalist: reporting in an unfamiliar city without an established relationship with residents. I reached out to local organizations who helped me set up interviews before my arrival, but I was especially grateful for the openness of residents. Showing patented Southern hospitality, they invited me into their homes and enriched my reporting with their stories.

But perhaps the greatest challenge was figuring out how to pull together these contributing factors of a complex, chronic disease and illustrate them in a way that didn’t confuse our readers. Using subheads, data visualizations, graphics and narrative, we did our best to accomplish this.

Since publication, we have received positive feedback from members in and outside of the community impacted. Local officials have expressed a desire to do more to protect tenants from environmental asthma triggers and explore what solutions from other cities could be adopted here. We are developing an information sheet about asthma to hand out at public events.

Even though the project is finished, our work on this issue is not done. We hope to continue raising awareness and bringing solutions to this, and other racially disparate diseases. And we hope readers and reporters across the country are inspired to do the same in their communities.

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