Neighborhood Organization for Pediatric Asthma Management in the Neighborhood Asthma Coalition: Insufficient Appreciation of Seriousness of Disease
One might suspect that the relationships among socioeconomic and psychological factors and morbidity and mortality in the studies noted above are somehow peculiar to how these variables are manifest in the United States. It may not be the case that economic poverty generally exacerbates asthma, but only in the circumstances surrounding economic poverty in this country. In contrast, observations from New Zealand indicate the generality of such relationships between poverty and problems with asthma. There, mortality was two to three times greater in lower socioeconomic groups and about four times as great among Maoris and Pacific Islanders. Canadian pharmacy levitra There also, access to care appears to be a major link between socioeconomic status and asthma care. In New Zealand, primary care is subsidized but not free. Thus, low-income patients have a major barrier to early, nonemergency care that is not shared by more affluent patients. Thus, 48% of patients presenting for emergency asthma care had symptoms which had deteriorated for more than 24 h prior to their seeking care. In Australia, where primary care is free, only 25% reported with such deteriorating asthma.
In the group of asthma deaths in the African American neighborhoods in St. Louis noted above, misunderstanding of the seriousness of the disease was apparent in four of the five decedents’ families. Similarly, Lewis and her colleagues identified problems with recognition of the seriousness of asthma and need for active management of it in low-income, minority groups. They found few cultural problems when transferring an asthma self-management program from middle-class white to middle-class Latino audiences. However, they found substantial problems in seeking to apply the program to lower socioeconomic status Latino audiences. Mild symptoms were often interpreted as normal. As one child said about wheezing, “For me, that’s normal.”^p284^ Consequently, these investigators have reorganized their self-management curriculum to emphasize attention to symptoms and using them as cues for commencing self-management.