Asthma is increasingly becoming a major public health problem, affecting millions across the world. The American Public Health Association highlights asthma as a leading cause of high childhood mortality and morbidity rates (Holgate & Douglass, 2010). Asthma affects close to 15 million Americans – double the number of reported cases in 1980 and increasing sharply over the past 15 years. It is important to note that a third, 5 million, of the asthma patients in the United States are children. High death and hospitalization rates have turned asthma into a major public health risk, especially over the past 20 years. Each year the American Public Health Association (3) lists nearly 5500 asthma-related deaths, as a case in point. In essence, asthma is a major public health concern that can require the implementation of necessary countermeasures.
The social environment is defined by as connection between an individual and his community. The social environment comprises of the social standing of the person, the daily connections they have, and their interpersonal relationships. To understand the effect of the social environment on the prevalence of asthma, it is important to examine the social environment at three levels. The family which forms the closest social connection of every individual, peers, and the mutual connections. These social connections provide each with companionship and social support, and their social identity (Chen & Schreier, 2008).
Williams, Sternthal and Wright (2009), identified a pattern of race/socio-economic status and an increased prevalence of asthma. The mortality and morbidity rates of asthma are three times higher among non-white children. Poor regions and non-whites living in inner city areas are exposed to a higher asthma risk. The researchers identified a significantly higher hospitalization and morbidity rates among black children when compared with white and Hispanic children. Additionally, Puerto Ricans have an elevated asthma risk as opposed Latinos. This suggests a correlation between the socioeconomic conditions of a household to the asthma prevalence of the region.
Poverty is often associated with an increased incidence of disease in a community. Asthma, in particular, shows a strong correlation to the GNP per capita of a country. Countries with a lower GNP per capita tend to show a higher prevalence of wheezing (a reliable indicator of asthma) (Cruz, Bateman & Bousquet, 2010). According to Holgate and Douglas (2010), asthma symptoms tend to differ depending on the exposure of individuals to allergens including air pollution and the quality of healthcare provided. As a result, even when the prevalence asthma is low in a region the burden might be too high. Suffice it to say that poverty is a major risk factor for the occurrence of asthma symptoms.
On the other hand, the social environment may play a role in the asthma risk due to the failure of the physical features of public environments to explain the variations of childhood asthma around the world. The dissimilar exposure to pathogenic factors in the environment plays a hand in the social patterning of asthma. Williams, Sternthal and Wright (2009), noted that the mental state of a child’s caregiver was a stronger predictor of asthma prevalence and not the physical environment. Children exposed to chronic and acute stress are more likely to experience asthma-related hospitalization, especially when there is a lack of social support. Stress in children can be an indicator of psychological morbidity e.g. depression, and the social context of the child’s life. A neighborhood disadvantage (ND) is resonant with communities with a limited social capital, poor housing, crime, and poverty.
It is important to note that most urban areas in the US are described as having a high level of ND. Studies continuously link the severity of the asthma symptoms in children to violence in their community. Researchers were able to lower successfully the asthma symptoms in children by moving their families to better neighborhoods (Williams, Sternthal & Wright, 2009). The behavior of the children’s caretakers, stress, major life events, smoking, and unwanted thoughts are hypothesized to influence the occurrence of asthma symptoms.
Researchers need to take into account the role of social determinants in the occurrence of asthma among children. The measures required to keep a check on asthma will have to involve the understanding of these social determinants. In developing countries the scarcity of resources prompts the use of measures against the alleviation of the social forces behind asthma to reduce the burden of this major public health problem to the public (Cruz, Bateman & Bousquet, 2010).
Residential environments can be efficiently studied in their role in the prevalence of asthma in the children residing in the neighborhood. Childhood morbidity and mortality as a result of asthma can be significantly reduced by alleviating the poverty levels in the most affected areas. Stress and violence seem also to play a significant role in the prevalence of this public health problem among children living in neighborhoods with a significant neighborhood disadvantage. The ethnic disparity in asthma occurrence can be similarly influenced by policies that seek to improve the quality of housing in poverty-stricken communities. A significant improvement in neighborhood conditions and the exposure of individuals to pathogens is necessary (Chen & Schreier, 2008).
Asthma is a major public health concern that is increasingly prevalent in spite of the medical advances of recent years. The burden of this chronic ailment is a byproduct of increased urbanization, shifts in environmental protection policy, and an aging population in developed countries. It’s hard to trace a direct link between poverty and the prevalence of asthma because of the complex role played by lifestyle and environmental aspects. However, healthcare systems targeted at the demographical and socioeconomic have to take into account the effects of poverty on the prevalence of asthma (Holgate & Douglass, 2010). A major improvement of the economic, social, and political infrastructure in disadvantaged communities is imperative to reduce the significant social disparity in asthma outcomes. The accumulation of social problems linked to poverty and racial segregation appears to be the major contributor to the patterns of asthma distribution. Also, future research should be focused on the interaction between the social and political environment with asthma risk.
References
Chen, E., & Schreier, H. (2008). Does the Social Environment Contribute to Asthma?. Immunology And Allergy Clinics Of North America, 28(3), 649-664. http://dx.doi.org/10.1016/j.iac.2008.03.007
Cruz, A., Bateman, E., & Bousquet, J. (2010). The social determinants of asthma. European Respiratory Journal, 35(2), 239-242. http://dx.doi.org/10.1183/09031936.00070309
Holgate, S., & Douglass, J. (2010). Asthma. Abingdon: HEALTH Press.
Meltzer, E., Blaiss, M., Nathan, R., Doherty, D., Murphy, K., & Stoloff, S. (2011). Asthma burden in the United States: Results of the 2009 Asthma Insight and Management survey. Allergy And Asthma Proceedings. http://dx.doi.org/10.2500/aap.2011.32.3519
Williams, D., Sternthal, M., & Wright, R. (2009). Social Determinants: Taking the Social Context of Asthma Seriously. PEDIATRICS, 123(Supplement), S174-S184. http://dx.doi.org/10.1542/peds.2008-2233h
