Asthma disparities exist among Indigenous American populations, with American Indian (AI) and Alaska Native (AN) people experiencing poorer health outcomes than other American populations. Factors contributing to these disparities include limited access to healthcare services, language and communication barriers, discrimination, poverty, unhealthy housing conditions, and proximity to high levels of air pollution. Asthma prevalence differs between tribal nations due to varying cultures, traditions, lifestyles, and environmental exposures. AI/AN individuals have a 10.4% asthma prevalence compared to 8.0% in white individuals. The disparity is even greater in children. To address these disparities, efforts should focus on providing culturally competent care, improving data collection, expanding funding for asthma control programs, working with tribal health leaders, and improving air quality regulations.

The Problem is Significant and Solutions are Urgent

American Indian/Alaska Native ADULTS	American Indian/Alaska Native CHILDREN
Higher asthma prevalence than general population in all income levels	30% of 12th graders reporting having lifetime asthma (general population reported 20%)
Nearly twice as likely to experience asthma symptoms every day than other adults with asthma	Just one in four have received a written asthma action plan from their provider
Report more asthma episodes or attacks compared to general population	High school youth with asthma were nearly four times as likely to report having a long-term disability or health problem than youth without asthma
Report waking up more during the night because of asthma related symptoms than other adults with asthma do	Twice as likely to smoke and about 1/3 of high school youth with asthma are exposed to secondhand smoke
More likely to experience poor mental health and emotional issues including stress and depression	Over 1/3 of high school youth with asthma are depressed and one in six has seriously thought about suicide

Existing Asthma Initiatives are Numerous

The National Indian Health Service (IHS) is an agency within the U.S. Department of Health and Human Services that provides healthcare services to American Indian and Alaska Native (AI/AN) populations. IHS aims to raise the physical, mental, social, and spiritual health of AI/AN people to the highest level. Asthma is a significant health concern for AI/AN populations, and IHS implements various initiatives and programs to address this issue:

1. Asthma Management Programs: IHS offers comprehensive asthma management programs that encompass asthma education, prevention, and treatment services. These programs are tailored to meet the unique needs of AI/AN communities and include culturally appropriate approaches to managing asthma.
2. Community Health Workers: IHS utilizes community health workers (CHWs) to provide in-home asthma care, visits, education, and assessments for AI/AN communities. CHWs are often trusted members of the community who can provide culturally competent care, addressing barriers such as language and communication that may hinder access to healthcare services.
3. Environmental Health Services: IHS focuses on environmental health services to identify, address, and mitigate asthma triggers in AI/AN communities. This includes assessing indoor and outdoor air quality, promoting the use of air quality monitors and green cleaning kits, and addressing sources of indoor pollution such as mold, formaldehyde, and tobacco smoke.
4. Data Collection and Monitoring: IHS aims to improve data collection and monitoring efforts to better understand asthma prevalence, severity, and disparities in AI/AN populations. This information is crucial for developing targeted interventions and measuring the effectiveness of asthma management programs.
5. Partnerships and Collaborations: IHS works closely with tribal health leaders, AI/AN patient advisors, and other organizations to develop and implement asthma programs that address the unique needs of AI/AN communities. By fostering strong partnerships, IHS can leverage resources and expertise to enhance asthma care for AI/AN populations.
6. Funding and Support: IHS advocates for increased funding and support for programs that address asthma disparities in AI/AN communities. For instance, IHS seeks expanded funding for the CDC’s National Asthma Control Program to support tribal health organizations in their efforts to improve asthma care.
7. Training and Education: IHS focuses on training healthcare providers to offer culturally competent care, which is essential in addressing asthma disparities in AI/AN populations. This includes education on AI/AN cultures, traditions, and beliefs, as well as guidance on developing and implementing asthma management plans that respect and incorporate these cultural elements.

By implementing these initiatives and programs, the National Indian Health Service aims to reduce the burden of asthma in AI/AN communities and improve health outcomes for individuals living with asthma.

Sources:

National Indian Health Service (IHS) – Asthma: Official website of the IHS that contains detailed information on their programs, services, and initiatives related to asthma in American Indian and Alaska Native populations. https://www.ihs.gov/asthma/

Centers for Disease Control and Prevention (CDC) – National Asthma Control Program: The CDC’s National Asthma Control Program focuses on improving asthma management and reducing disparities among various population groups, including American Indian and Alaska Native communities. https://www.cdc.gov/asthma/nacp.htm

The National Tribal Air Association (NTAA): The NTAA is a member-based organization that works with tribes, the Environmental Protection Agency (EPA), and other partners to advance air quality management and address environmental health issues, such as asthma, in tribal communities. https://www.ntaatribalair.org/

The American Lung Association (ALA) – Asthma in American Indian/Alaska Native Communities: The ALA provides resources on asthma and its impact on American Indian and Alaska Native populations, including factsheets and educational materials for patients, caregivers, and healthcare providers. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/american-indian-alaska-native