December 5, 2001

Guiding Principles of ARC’s Asthma Action Plan

Coordination of the efforts of the New England States is necessary for effective response to the asthma epidemic.

In order to protect human health, action should be taken as early as possible, even where the precise benefit of our actions for asthma may be unknown so long as the action is reasonably likely to reduce the impact of asthma on children and families and holds general public health benefit.

When costs are incurred by one sector for benefits generally attributed to another sector, Council members will seek to support an appropriate allocation of funding and recognition across sectors.

Public sector programs will be targeted first in implementing this action plan.

We will maximize the effectiveness and efficiency of government resources by experimenting with interagency policy and programming that is responsive to the needs of children and families with asthma.

We will add to the understanding of Asthma in New England through evaluation of the efficacy and cost effectiveness of our policy and programmatic actions. While this Council does not focus on medical management issues we will coordinate closely with colleagues who do to ensure our actions are integrated and mutually supportive.

In keeping with these guidelines the following 12-point action plan will be pursued:

Surveillance

Action Item 1:     

ARC encourages every NE state to develop and maintain an asthma surveillance program, and to make the data publicly available for purposes of analysis and comparison. ARC further encourages the states, within their surveillance program, to work with ARC to develop comparable and consistent data sources/collection methods on asthma prevalence which can be used to compare the six NE states and generate a regional asthma prevalence rate on a periodic basis. ARC further encourages the development of such common strategies in conjunction with the eventual integration of health status data with indoor and outdoor environmental data. The sub-items below detail the best current pathways for this work based on ARC’s extensive experience working on surveillance with its state and other partners in NE:

Action Item 1(A )   

ARC endorses the development of and continued use of school-based surveillance in all 6 NE states for pediatric asthma tracking. ARC will work with the states and other related entities, including funders, to leverage existing or new funds to provide school nurses with the training, technology and resources to ensure the provision of clinical as well as public health services in the school setting.

Action Item 1(B)   

ARC encourages all NE public health departments to continue working with their state Medicaid colleagues to use Medicaid data as part of their asthma surveillance efforts, where useful and appropriate. ARC will bring together the 6 sate public health and Medicaid agencies for purposes of training on the use of Medicaid data for public health purposes, disseminating effective data-sharing models and exploring opportunities to generate comparable Medicaid data.

Action Item 1(C)   

ARC will work with the 6 NE states to continue the success of its 2003-released regional BRFSS reports by generating agreement for and implementation of a periodic coordinated system of surveillance which can offer both comparable state asthma prevalence rates as well as a NE regional asthma prevalence rate. ARC will further work with the states to develop and implement a commonly-agreed to NE-specific BRFSS environmental health module, to be administered simultaneously with the asthma prevalence module.

Action Item 1(D)   

ARC will continue to work with the NE states to provide support for coordination among the current CDC Environmental Public Health Tracking grantees, to coordinate their work with ARC’s work to encompass the non-grantee states, and to support efforts to ensure that all NE states secure CDC EPHT funding in the future.

Action Item 2:     

The Council will 1) provide a forum for exchanging and strengthening health, economic and environmental data relevant to asthma in the region with a goal of creating more comparable data; 2) work toward developing pilot projects and research programs to answer specific, priority questions by examining health and environmental data.

Outreach and Education

Action Item 3:     

The Council encourages every New England state and each participating regional federal agency to identify an Asthma Coordinator dedicated to advancing this action plan through coordination across agencies and disciplines.

Action Item 4:     

The Council will support states and federal agency coordination across agencies to have education and technical assistance available to assist families in undertaking household management activities that improve indoor air and reduce asthma triggers in their homes.

Action Item 5:     

The Council will support states and federal agency coordination across agencies to have education and technical assistance available to schools in undertaking management activities that improve indoor air and reduce asthma triggers in schools.

Action Item 6:    

The Council will support states and federal agency coordination to have education and technical assistance available to private rental property owners in undertaking management activities that improve indoor air and reduce asthma triggers in their rental units.

Exposure Reduction in Homes and Schools

Action Item 7:   

The Council encourages health care organizations and agencies to collaborate in the identification and implementation of strategies to provide families’ access to environmental interventions designed to reduce the burden of asthma. These agencies should, whenever possible, use outcome data from well established research organizations, public health agencies and other institutions to inform coverage decisions for environmental interventions. Such outcome data should include reasonable evidence of both the clinical and the cost effectiveness of these interventions. These agencies should also seek opportunities to collaborate on demonstration projects and cost effectiveness studies.

Action Item 8:     

The Council will support the creation and dissemination of guidance and training for the design, renovation and maintenance of asthma safe homes. The Council will work to have publicly funded housing agencies and programs use asthma safe guidelines in construction and renovation projects and maintenance and repair programs.

Action Item 8(A)   

ARC encourages state Housing Finance Authorities, or other state agencies that administer federal funds for affordable housing, to adopt healthy housing building and maintenance practices and standards such as those promoted in ARC’s guidances.

Action Item 8(B)   

ARC will work with at least one Municipal Housing Authority in every state to encourage their adoption of healthy housing building and maintenance practices and standards such as those promoted in ARC’s guidances.

Action Item 8(C)   

The Council will support state and local efforts to incorporate reduction of asthma triggers into state and local housing, health and/or building codes and develop and sponsor related training.

Action Item 9:     

The Council encourages all state housing agencies and municipal housing authorities to seek opportunities to designate specific funds and funding mechanisms to be drawn on to make repairs to housing units necessary to maintain the units as asthma safe.

Action Item 9(A)   

When feasible, energy and weatherization programs should integrate a respiratory health component into their assessment and remediation efforts and leverage other housing and energy funds to initiate other repairs.

Action Item 10:   

The Council will support the creation and dissemination of guidance for the design, renovation and maintenance of asthma safe schools. All new public schools construction should be built to meet indoor air performance standards. The granting of public funds for school renovation should be tied to schools conducting indoor air quality assessments and correcting deficiencies.

Action Item 10(A)   

ARC will work with the 6 NE states to develop and implement model bid specs that incorporate SMACNA and other guidelines for occupant protection during school construction and renovation projects.

Action Item 10(B)   

ARC encourages every state to develop school site selection standards that can address conditions that pose environmental health threats, such as toxics and excessive moisture, whenever schools are being constructed, extended and/or replaced.

 

Exposure Reduction in Communities

Action Item 11:   

The Council supports the reduction of diesel school bus emissions through programs such as retrofit of diesel buses with commercially available emissions control technology, the provision of less polluting diesel fuel, improved maintenance practices, and the replacement of diesel school buses with buses using less polluting alternative fuels.

Action Item 12:   

The Council supports the development of targeted programs to substantially reduce diesel school bus idling on school premises and other locations that children frequent.