In many parts of the US, asthma rates continue to increase, resulting in a substantial societal burden of human suffering, lost capacity and productivity, and direct fiscal costs. As with other chronic diseases, far more resources focus on managing asthma in people who have it than on preventing the disease. There remains an urgent need to better understand the root causes of asthma and to develop strategies for reducing the rate of new cases.
A growing body of research documents associations between asthma onset and a range of risk factors, many of which are modifiable, such as exposure to contaminants and allergens in indoor air, maternal health—including stress associated with poverty and racism—as well as obesity, outdoor air pollution, traffic and occupational chemicals. Several studies have demonstrated reduced rates of new onset asthma among recipients of an intervention to address multiple risk factors as compared to a control group. A review of these studies suggests that a more systemic, multi-factorial approach may be effective.
What could a state concerned about asthma prevalence do to reverse rates over time? For which risk factors is the weight of the evidence strong, indicating a known association between exposure and asthma onset? Where there remain uncertainties about the strength of the science, what other considerations might justify action to modify one or more risk factors? What kinds of interventions would align best with an understanding of asthma development as a complex, multi-factorial process?
This call explored these science and policy questions with three people who have been involved in a groundbreaking effort to develop a “roadmap” for the primary prevention of asthma. Polly Hoppin, research professor and program director at the University of Massachusetts, Lowell, and the Lowell Center for Sustainable Production, has designed government and nongovernment initiatives to reduce the burden of asthma via policy and program change for over a decade. She described the steps that led to a decision in Massachusetts to include primary prevention in its state strategic plan and the process she and colleagues are leading to develop the roadmap. CHE’s Science Director Ted Schettler described the heterogeneity of asthma, its multi-factorial nature, and the weight of the evidence associating particular risk factors with asthma onset. Our third speaker is David Kriebel, professor of work environment at the University of Massachusetts, Lowell. Dr. Kriebel commented on the ways in which “systems thinking” can inform strategies for preventing complex multi-factorial diseases like asthma.
Featured Speakers
Dr. Polly Hoppin is a research professor and program director for the Environmental Health Program in the Lowell Center for Sustainable Production. Prior to coming to Lowell, Dr. Hoppin held senior positions in the federal government, both at EPA and the US Department of Health and Human Services in New England, and served as senior advisor to the Secretary’s Science Advisor at DHHS in Washington, DC. Prior to joining the Clinton Administration, she worked in the not-for-profit sector for 15 years. Dr. Hoppin synthesizes research relevant to environmental public health problems and solutions, working closely with private and public sector organizations that are anticipating policy decisions. She has convened and facilitated numerous discussions among stakeholders in the context of these decisions, playing a leadership role in the design of policies, programs and strategic initiatives. Dr. Hoppin has been instrumental in developing and promoting key concepts in environmental health policy, including reducing reliance on pesticides, environmental investments to reduce the burden of asthma and generational goal-setting for sustainability. Current professional activities include serving on the Boards of Directors of the Clean Water Fund and Pesticide Action Network North America.
Dr. Ted Schettler is the science director for the Science and Environmental Health Network (SEHN) as well as for CHE. Dr. Schettler has worked extensively with community groups and nongovernmental organizations throughout the US and internationally, addressing many aspects of human health and the environment. He has served on advisory committees of the US EPA and National Academy of Sciences. He is co-author of Generations at Risk: Reproductive Health and the Environment, which examines reproductive and developmental health effects of exposure to a variety of environmental toxicants. He is also co-author of In Harm's Way: Toxic Threats to Child Development, which discusses the impact of environmental exposures on neurological development in children, and Environmental Threats to Healthy Aging: With a Closer Look at Alzheimer' and Parkinson's Diseases. Dr. Schettler has published numerous articles in the medical literature, and is frequently quoted in the popular press.
Dr. David Kriebel co-directs the Lowell Center for Sustainable Production and serves as a professor and chair of the Department of Work Environment at the University of Massachusetts Lowell. Since 1988, he has been on the faculty at the University of Massachusetts Lowell. Dr. Kriebel’s research focuses on the epidemiology of occupational injuries, cancer and non-malignant respiratory disease. He has published on various aspects of epidemiologic methods, particularly on the use of quantitative exposure data in epidemiology. He has been active in developing dosimetric models to better understand the effects of aerosols on the lungs. He teaches introductory and advanced courses in epidemiology, risk assessment, and research synthesis. Dr. Kriebel has served on several National Academy of Sciences committees on environmental health and has written and lectured on the role of epidemiologic evidence in science policy decision making.
The call was moderated by Elise Miller, MEd, CHE director.