A health system-initiated intervention to remediate homes of children with asthma

Asthma is the most common pediatric chronic condition, affecting 5.1 million children in the United States. Although effective clinical management of asthma is readily available and increasingly precise, racial and ethnic disparities in asthma prevalence and clinical outcomes persist. Black and Hispanic children living in low-income urban areas experience higher rates of asthma morbidity and death. In fact, Centers for Disease Control and Prevention data from 2020 reveals a nearly 10-fold difference in asthma death rates comparing non-Hispanic Black children to non-Hispanic white children. These disparities are multifactorial, but likely at least partially attributable to housing stock inadequacy in low-income neighborhoods. Philadelphia is among the oldest large cities in the United States, with the median home built in 1925. At the same time, 37% of children in Philadelphia live below the poverty level, including 42% of Black and 49% of Hispanic children. This concentration of poverty is the result of exclusionary housing policies of the 20th Century that created racially segregated neighborhoods and denied homeownership (a vital component of multigenerational wealth building in the United States) to racial and ethnic minorities. Aging housing stock and high poverty rates have, in turn, created substantial economic barriers to maintaining older homes. The structural problems of inadequately maintained homes are associated with allergens that can cause and exacerbate asthma. Mold growth is facilitated by plumbing leaks or leaking roofs, cockroaches and mice may enter the home through cracks in the foundation, and dust mite levels may be elevated by inadequate ventilation.