More than 6 million U.S. children are afflicted by asthma. Asthma is the third leading cause of hospitalizations and emergency room visits among children under age 15 and accounts for as many as 15 million lost school days per year.
Asthma also disproportionately strikes African American children. According to federal health statistics, more than 14 percent of African American children suffer from asthma, compared to 8 percent of whites, and African American children are more likely to experience complications.
But what is striking about childhood asthma – despite its prevalence – is that it is both manageable and treatable. While 60 percent of children with asthma will experience at least one attack per year, many of these attacks are preventable. Families can, for example, work to eliminate common “triggers,” including cigarette smoke and exposure to air pollution.
Far too many families, however, lack access to the resources they need to manage their children’s asthma effectively. For example, more than 1.1 million children with asthma lack health insurance, which means they also lack access to routine care.
In 2005, while rates of childhood asthma morbidity and disparities were rapidly increasing, the Merck Foundation decided to tackle the challenge of childhood asthma, using a strategy based on public-private partnerships and evidence-based research.
After a strategic planning process that incorporated expert opinions and stakeholder feedback, the Foundation established the Merck Childhood Asthma Network, Inc. (MCAN), which became the only independent 501(c)(3) nonprofit organization focused solely on the burden and associated morbidity of childhood asthma.
From 2005 to 2015, the Foundation committed $41.1 million to help achieve MCAN’s goals of improving access to quality asthma care for children; increasing public knowledge; promoting “asthma-friendly” schools and communities and “asthma-safe” home environments; and reducing disparities in childhood asthma outcomes.
Evidence-based interventions have helped reduce childhood asthma in cities across the country, including New Orleans and Philadelphia.
During its first five years, MCAN funded the implementation and evaluation of five evidence-based interventions in diverse community settings. For example, in Philadelphia, four distinct neighborhoods with high rates of asthma-related emergency room visits were targeted through a community-based approach that included schools, nonprofit organizations, and primary care providers. Trained and supervised lay-person care coordinators built trust with local residents; provided individualized asthma education and removed asthma triggers and allergens in families’ homes; and coordinated care plans with primary care providers and schools.
MCAN realized early on that in order to achieve sustainable change in health care settings, federal and state level advocacy for evidence-based quality care had to be a priority as well. In partnership with the National Institutes of Health (NIH) and a private family foundation, MCAN assisted children and their families in New Orleans after Hurricane Katrina in 2005 through a combined, “hybrid” intervention of care management and mitigation of triggers of asthma symptoms in the home. In particular, the project focused on the effects of mold and other allergens in New Orleans, where as many as 24 percent of minority children suffer from asthma.
From 2010 to 2015, MCAN leveraged what it learned in its early years and expanded to support interventions at four different program sites that facilitated coordination of care and were grounded in a single evidence-based intervention. For example, MCAN supported Federally Qualified Health Centers in implementing the evidence-based “hybrid” intervention proven effective in New Orleans.
Throughout the project, collaboration among community stakeholders was critical, allowing program sites to connect families in need with services and resources outside their expertise. MCAN’s contribution with the ongoing support of Merck Foundation ranged from funding initiatives to providing expert consultation and calls to action.
MCAN Executive Director Dr. Floyd Malveaux teaches Rhonda, Jermid and Jabeaux Brown of New Orleans to use a peak flow meter.
The impacts of these interventions were unmistakable. The 805 children enrolled in the second-phase care coordination programs sponsored by MCAN missed an average of 11 days of school in the year prior to the program and reported limited activities due to asthma on about six days in the month prior to enrollment. A year into the program, children reported missing an average of four days of school over the last year and had limited activities on fewer than two days in the previous month. Emergency room visits among children at MCAN-funded sites also dropped by 30 percent. These numbers suggest major implications in addressing not only America’s childhood asthma problem, but also improving educational outcomes and contributing to the economic stability of impacted families.
Greater focus on federal policy initiatives also led to the commissioning of a report, Changing pO2licy: The Elements for Improving Childhood Asthma Outcomes and the formation of the Childhood Asthma Leadership Coalition (CALC). MCAN was also invited by the U.S. Environmental Protection Agency to co-sponsor AsthmaCommunityNetwork.org and worked with the President’s Task Force on Environmental Health Risks and Safety Risks to Children in 2012 to develop and launch its Federal Action Plan to Reduce Asthma Disparities. Finally, MCAN co-sponsored a workshop with the National Institutes of Health (NIH) and others to identify standardized outcomes to be used in future NIH-sponsored clinical trials.
MCAN’s success in identifying barriers and implementing effective asthma programs has valuable implications for the management of other diseases, especially other chronic conditions. The MCAN experience is a testament to The Merck Foundation’s commitment to improving healthcare quality and capacity, and to using innovative philanthropic solutions to address significant public health problems. MCAN demonstrates that well-designed initiatives supported by the private sector can have a positive impact on the quality of life of individuals, families and communities through evidence-based action.
Floyd J. Malveaux, MD, PhD is executive vice president and executive director of the Merck Childhood Asthma Network, Inc. (MCAN). He is a nationally recognized expert on asthma and allergic diseases and is emeritus dean of the College of Medicine, and professor of microbiology and medicine at Howard University.
Julie Kennedy Lesch, MPA, is the programs manager of the Merck Childhood Asthma Network, Inc. (MCAN), where she plays an active leadership role in the organization, operation, management, and evaluation of all MCAN projects and initiatives to improve the quality of life for children with asthma. –
Merck Childhood Asthma Network, Inc. (MCAN)