One of the biggest barriers to equal educational opportunity disproportionately affects low-income and minority students, lasts throughout childhood, and causes more than 13 million missed school days annually. Yet this barrier—asthma—can be relatively easily controlled.
Children as young as pre-school age who are missing numerous school days, whether they are excused absences or not, have been shown to have lower academic achievement and higher dropout rates compared to their healthier peers. While many school districts may focus their efforts on reducing truancy for unexcused absences, they are not targeting a substantial subset of children who are missing school due to chronic illnesses, such as asthma, which is the most common chronic illness in childhood.
However, for approximately $1,800 per asthmatic child, an in-home asthma remediation intervention can help children and their families better manage asthma and increase symptom-free days. The program includes a behavioral education component that assists with maintaining a healthier environment in the home and remediation of the home to remove asthma triggers.
Approximately 24% of Philadelphia children under 18 are diagnosed with asthma, which greatly impacts school attendance, parents’ ability to work, and visits to the doctor and emergency room for flare-ups. While there isn’t a cure, symptoms and asthmatic attacks can be minimized and quality of life improved with appropriate action. As part of an existing home remediation intervention in Philadelphia, trained personnel visit families to conduct two or more activities with an environmental focus. At the most basic level, they help to identify asthma triggers such as dust and pet dander and educate the family on simple solutions such as regularly washing linens. In some homes additional steps are taken, such as asbestos or mold removal.
Despite the seemingly large up-front costs, the Center for Health Advancement Win-Win Project found that if the program was provided to 75% of the 52,896 low-income asthmatic children in Philadelphia, there are long-term health benefits for child beneficiaries and financial returns to the local and state government that offset the initial costs. By removing asthma irritants from homes, the Win-Win Model showed a positive impact on children’s health, number of missed school days and their academic achievement. There would be approximately 1,200,000 more symptom-free days (an average of 29 days per child) and 12,000 fewer emergency department visits annually over 10 years. This equated to approximately 324,000 additional days of school they would have otherwise missed, which is an average of 9.6 days per child. While these findings show the impact on average across Philadelphia, neighborhoods with higher child asthma rates would benefit even more greatly from the intervention.
So why aren’t all local governments implementing this intervention if it positively impacts health and education? Perhaps because the up-front costs are intimidating. The cost of $1,800 per family sounds like a lot. However, when you consider the long-term benefits of an in-home remediation program implemented by the local government, the upfront costs seem relatively small. Additionally, the program is a win-win for multiple sectors, which when realized can help to promote cross-sector collaboration and encourage cost-sharing for interventions like these. Estimates from the Center for Health Advancement Win-Win Project show that a single investment an in-home remediation program in Philadelphia would return $4.00 to local and state government for every dollar spent over a 10-year period. Perpetual investment over a 50-year period would return $4.14 for every dollar invested. In Philadelphia, the savings are primarily from fewer missed school days and fewer emergency department visits.
Modeling out the long-term benefits of health-fostering programs and policies, such as this asthma home remediation program in Philadelphia, clearly demonstrates the substantial returns on investment for programs like these and the long-term positive impacts to public health and other sectors, such as education, crime and others.
The Win-Win project is a long-term initiative of the Center for Health Advancement at the Fielding School of Public Health, UCLA. It provides good science that drives real-world policy change by showing the health impact to populations and value to governments of policies, systems, and programmatic innovations. The project provides a standardized, unbiased economic analysis of interventions to help public-health officials make informed policy decisions and engage in cross-sectoral collaboration.