1. Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities President’s Task Force on Environmental Health Risks and Safety Risks to Children CWRU Asthma Care Pilot Summit September 21, 2012 Peter J. Ashley, DrPH Office of Healthy Homes and Lead Hazard Control US Department of Housing and Urban Development

2. Asthma Disparities Action Plan Received a High Level Launch (May 31, 2012) 2

4. To Review Today –Background and context of plan –Especially relevance aspects for today’s meeting –Plan implementation

5. President’s Task Force on Environmental Health Risks and Safety Risks to Children TF Mission: – Identify priority issues of environmental health and safety risks to children that could best be addressed through interagency efforts – Recommend and implement interagency actions – Communicate to federal, state, and local decision makers information to protect children from risks

6. President’s Task Force on Environmental Health Risks and Safety Risks to Children Organization: Cabinet level, inter-agency task force co-chaired by the EPA Administrator and DHHS Secretary Senior Steering Committee provides support 14 Executive Branch departments/agencies represented Priority Areas: Asthma Disparities Settings where children live, learn, and play - near term focus on “ healthy homes”

7. Why Asthma Disparities? 7 Minority children have a greater asthma burden than white children

8. President’s Task Force on Environmental Health Risks and Safety Risks to Children Asthma Disparities Working Group: Co-chaired by EPA, HHS/NHLBI, HUD: – 28 member workgroup representing 21 offices Gathered input from federal programs, NGOs and foundations, leading researchers, physician champions, thought leaders Writing Team used an iterative, consensus-based process

9. The focus of the plan is on: “preventable factors that contribute to disparities in the burden of asthma”, including: Barriers to the implementation of guidelines-based asthma care – Medical care factors – Physical and psychosocial environmental factors Lack of local capacity to deliver community-based, integrated, comprehensive asthma care Gaps in capacity to identify and reach children most at risk Focus of the Action Plan 9

10. The Action Plan promotes improved compliance with NAEPP’s evidence-based guidelines which establishes that effective asthma care must be comprehensive and include four key components:  Pharmacologic treatment  Education to improve self-management skills of the patient and their family  Reduction of environmental exposures that worsen asthma  Monitoring the level of asthma control with a patient’s management plan adjusted accordingly National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma 10

11. Get the right asthma care to children, at all points of care All components of NAEPP guidelines – based care (asthma medications, self-management education, environmental interventions, and monitoring) need to be incorporated in clinical, home, school/day care settings. Reduce barriers to guidelines-based care:  Cover all guidelines-based asthma services and reduce out-of-pocket expenses  Update and disseminate federal guidance to health care purchasers and planners on key clinical activities for guidelines-based care Coordinating Federal Action on Asthma Disparities 11

12. President’s Task Force on Environmental Health Risks and Safety Risks to Children Coordinating Federal Action on Asthma Disparities Promote NAEPP Guidelines-based care Support public-private partnerships Build community capacity for sustainable and comprehensive care systems Target effective public health practice and interventions MCAN/GWU report on Changing pO2licy NAEPP Guidelines Implementation Panel Report Advance policy initiatives Foster research on environmental influences in asthma, prevention, systems-approach interventions, and comparative effectiveness research in the context of reducing disparities Execute collaborative research agenda

13. Taking Action: Four Key Strategies 13

14. Get the right asthma care to children, at all points of care In health care settings, coordinate existing federal programs in underserved communities  Train primary care providers to practice NAEPP guidelines-based care (e.g. HRSA knowledge management portals, National Health Service Corps sites)  Promote comprehensive asthma care through state Medicaid and CHIP demonstration projects  Expand dissemination of quality improvement models in primary care Coordinating Federal Action on Asthma Disparities 14

15. Get the right asthma care to children, at all points of care In school and child care settings (including Head Start), implement asthma care services and reduce environmental exposures  Promote use of asthma action plans  Provide training and technical assistance for policies and programs on asthma care and reducing environmental exposures  Disseminate demonstration projects for school-based asthma case management Coordinating Federal Action on Asthma Disparities 15

16. Get community support for asthma care: build capacity Local capacity needs to be built to integrate asthma care with existing community resources to support and reinforce clinical care and patient self-management. Promote cross-sector partnerships among federally-supported, community based programs targeting children with high asthma burden  Promote data-sharing mechanisms between health care and supporting entities (e.g. hospitals, pharmacies, schools, health care providers, social services)  Encourage coordination with other health, health disparity and housing programs (e.g. link asthma programs with community health worker/promotoras, healthy homes, tobacco control, weatherization, radon and lead reduction, diabetes and obesity programs) Coordinating Federal Action on Asthma Disparities 16

17. Get community support for asthma care: build capacity Systems approaches are the most promising way to address the multi-factorial causes of asthma disparities. Models and rigorous evaluations are needed for dissemination. Develop and evaluate model Asthma Empowerment Partnerships that equip families and communities to overcome barriers to asthma management by:  Identifying children most in need of comprehensive, integrated care  Promoting quality asthma care in a medical home  Providing asthma self-management education and linking to medical home  Coordinating home visits to reduce environmental allergens and irritants and reinforce patient skills  Coordinating with school health staff and services  Promoting data sharing and linkages across all systems  Fostering community wide efforts to reduce environmental exposures Coordinating Federal Action on Asthma Disparities 17

18. Get asthma care and support to the right children A greater impact on reducing asthma disparities will depend on best use of modern tools to target those children most in need, engage them, and track their progress. Harmonize data, metrics, definitions and outcome indicators Explore emerging technologies to enhance identification of target populations and tracking risk factors for poor asthma outcomes (e.g. health GIS, GIS medication delivery devices, internet and mobile phone communication, spatial epidemiology and hot-spot analysis) Explore adding socio-economic and contextual factors (e.g., school nurse and attendance records, housing authority data, community resources ) to spatial analyses. Coordinating Federal Action on Asthma Disparities 18

19. Senior Leadership across government is focused on reducing health disparities:  Affordable Care Act  Healthy People 2020  HHS Action Plan to Reduce Racial and Ethnic Disparities  National Stakeholder Strategy for Achieving Health Equity  The National Prevention Strategy  EPA Plan EJ 2014 The Asthma Disparities Action Plan will contribute a specific blueprint for reducing asthma disparities in children. This could be a model for addressing disparities in chronic diseases. Executive endorsement and directives to make this action plan a priority are critical to support our momentum and accomplish our objectives. Moving into Action 19

20. Health Equity for Children Who Have Asthma Right Asthma Care With Right Support To the Right Children