In late October 2016, I was invited to participate in a webinar exploring the results of a study I helped recruit patients for a few years ago. While I’d been aware of the scope of this study from the University of Alberta, the results presentation and discussion that followed was eye-opening to many facets of asthma I had not ever contemplated before. Without getting too much into the research (yet), here’s the first in a series of posts on things explored over the 90-minute webinar that changed my perceptions of life with asthma, yet again.
14% of Canadian children and 21% of American children live in poverty.1,2 1 in 30 children in the United States experience homelessness annually2. Certain geographic pockets of course, have higher concentrations of homelessness, but essentially, if distributed equally throughout the United States, in a given classroom in a school, one child would at some point during the year experience homelessness. Now consider that 1 in 14 children—or two children in each class, approximately—in the United States have asthma.4
Low income families experience many factors that may worsen asthma. This research is not new, but the barriers are still present. Many of them are not surprising: difficulty accessing medications, attending medical appointments or education sessions, and missed school days for the child and work days for the parent adding to stress. However, one factor I had not considered prior to this webinar is that of housing: presence of mold and drafts can cause issues for children with asthma and allergies, whereas high-density housing may expose individuals with asthma to cigarette or other smoke from neighbouring families—even if smoking is not allowed inside, smoke exposure in vehicles and doorways is nearly unavoidable. And for children with sensitive airways and especially those with uncontrolled asthma, this can cause increased issues breathing—in the child’s own home.
This is something that before today I had never considered. Research on low-income families and their asthma experience is not new—nor was it the sole focus of this study. But I still had not considered it before: what happens when someone with asthma—focusing on children for this post—finds themselves slipping into homelessness? Or suddenly becomes homeless because of having to flee a dangerous or abusive situation? Rates of childhood homelessness and/or poverty and childhood asthma are only rising.1,4 Asthma does not simply disappear because crisis happens—what happens for children and their families when these two situations co-occur?
For many families, the focus becomes survival. If medication is not affordable or able to be accessed, other options that are less appropriate for the person with asthma may be used simply based on cost. For families living in cars, shelters or on the streets, the uncertainty of living situations can cause even more stress for children—and it is not as if children with asthma do not experience stress-induced asthma symptoms just as adults might. To this end, children living in shelters may be better able to access medical care and support depending on the operations of the shelter and how much staff understand about asthma and can assist the family with navigating medical care and programs and services available to them.
The medical system can be difficult to navigate, no matter where you live. But for parents who are struggling to make ends meet, it can be the difference of working a half day and earning money versus taking a child to the doctor—even if that is free—and missing out on that pay that might be required to keep the bills paid. It is hard for many of us to imagine this situation, but if we know that rates of asthma are higher among children in poverty, and we know just how prevalent poverty is in America: 12% of children in low-income families are believed to experience asthma from a 2013 statistic, compared to 8% of children not experiencing poverty.5
Is your head spinning yet? Mine was—and it still is. How do children and their families navigate life with asthma in these situations? We’ll explore this in my next post.