With asthma rates climbing in the state’s cities, New Haven has an “army of one” hitting the streets — with cleaning supplies, advice, and some observations about who’s best prepared to protect their children.
That self-described army is Ashika Brinkley (pictured). The Caribbean native has put down roots in New Haven and targeted asthma as project director for the Health Department’s Asthma Initiative.
One in ten of the state’s children now suffer from asthma, with the number higher in urban area.
Brinkley, 28, is using her hands-on experience in New Haven to look at the bigger picture in Connecticut. She’s been named a 2009 Health Leadership Fellow with the Connecticut Health Foundation, part of a group looking at how health providers can be more effective.
In both roles, she’s been looking at how asthma is hitting poor families especially hard, and blacks and Latinos in particular.
She spoke about what she’s learned on the front lines in New Haven about the extent and root causes of asthma here, in a discussion at her small ninth floor office at the city’s Health Department on Union Avenue.
Some people are succumbing to asthma not just because they have less access to care, but because their communities are less prepared to prevent it, Brinkley said. The terms she used are “health beliefs” and “cultural competencies.”
“On the surface,” she said,” someone may seem to have the same access to care. But when their child has to translate for them, when there aren’t things in place that are tailored to that individual that affects how comfortable they are with the health system, that affects patient behavior and patient belief.
“For example, in graduate school [at the Yale School of Public Health], my thesis focused on breast cancer disparities in African-American women, specifically adherence and follow-up regarding mammography. We found it didn’t matter what the socio-economic level was of those women — they had a lot of beliefs about how they were perceived by the health care system, and just cultural beliefs about losing their hair, or how their mate would respond to them if they had a cancer diagnosis, for example. Sometimes the level of cultural competency [of providers] is not conducive to those little things being addressed to make the patient’s experience optimal.”
The discussion lent itself to a question about Brinkley’s own cultural background. Her slightly lilting accent placed her somewhere in the Caribbean, but it didn’t sound Jamaican or Trinidadian.
In fact, she’s from the eastern Caribbean island of St. Lucia, and came to the U.S. several years ago. After graduating from Yale, she stayed in New Haven and began her current job in August 2006.
During the conversation, Brinkley looked through data from the 2008 surveillance report on Asthma in Connecticut.
It shows that between 2000 and 2006, the asthma rate in the state increased from 7.8 to 9.3 percent of residents. That’s almost a percentage point higher than the U.S. average.
Meanwhile, 10.5 percent of the state’s children (86,000 kids) currently have asthma, which is defined as “a chronic disease of the respiratory system that is characterized by reversible obstruction of the airways and airway hyper-responsiveness to a variety of stimuli.” So, many individuals who have asthma at some point in their lives are able to reverse it or outgrow it.
Latinos have the highest rate, followed by African-Americans and whites, although Brinkley said in her program she sees more black families. She’s not sure why. The data show that the poorest families have the highest incidence of asthma.
The hospitalization rate for asthma is three times higher for residents of the state’s five largest cities, including New Haven, than for the state as a whole. The key to preventing visits to the Emergency Department or an in-patient hospital floor is learning how to manage it. “Asthma can kill you,” she said, “so it should be a high priority.”
She said almost all the clients she sees are either black or Hispanic, and low income, uninsured or under-insured. She added that there’s a genetic component to asthma but environmental factors are critical. “Environmental control is a very big piece of asthma — roaches, mice, having a draft in the window that lets cold air in. All of those things are asthma triggers.
“I think a low-income person has less control over their home environment. It’s easy for me to take up my carpet when I own my home. It’s not so easy to tell a landlord, ‘Pull up my carpet because my child has asthma.’ When you can’t control those things, or can only afford medication for the home and not for school, and a child is missing that dose, those are problems.”
Brinkley’s program has two components. The first is access to nebulizers, asthma pumps and spacers (which, as any parent of an asthmatic child knows, helps to deliver the right amount of medication and send it into the lungs where it eases breathing). The program also sometimes provides air conditioners and air purifiers to families who can’t afford to buy them.
Cleanliness is obviously important, but Brinkley said, “People go crazy with bleach and ammonia trying to keep the house clean and dust-free. They’re very well-meaning, but all those things produce fumes that irritate the lung lining. So we give hypo-allergenic cleaning supplies, dust mite powder for rugs, and mattress and pillow covers.”
The second component is education. “We go out and do health fairs, we do talks at PTAs, schools, whenever we get a request. And by ‘we’ I mean me — I’m an army of one.”
Has she seen any results in past five years that the program’s been operating?
“Most people report having some improvement,” she said, “whether it’s under better control at school, or a reduction in emergency room visits. I think people are most pleased with the fact they have more control over their home environment, more control over what their child is exposed to and how they’re managing in general.”
By way of illustration, Brinkley mentions a woman who has three children with asthma. She was referred by the kids’ pediatrician to the Asthma Initiative, and she came in to pick up supplies and learn more about how to manage her children’s ailment.
“Later on,” Brinkley said, “I was giving a presentation elsewhere. She was in the audience, and she asked me to speak to the PTA at her children’s school where she’s the president, so I did that.”
The audience included many Latino parents. “She’s come back to the office a few times more,” Brinkley concluded. “She reported that her kids have not been back to the emergency room, and she felt the parents really benefited [from the talk] ‚so she was able to extend the benefit to other parents at her school.’ Some have also gotten involved in the program.
That’s a healthy multiplier effect.