Q&A about air quality and asthma with Dr. Loren Robinson at the Pennsylvania Department of Health
Our reporting found an asthma crisis in Pittsburgh. Politicians are starting to notice.
Following the publication of our four-part series
Breathless: Pittsburgh's asthma epidemic and the fight to stop it, we reached out to politicians and lawmakers to hear their thoughts on how we can work together to improve the air.
Dr. Loren Robinson has been the Deputy Secretary of Health Promotion and Disease Prevention at the Pennsylvania Department of Health since 2015.
EHN: What asthma initiatives are underway at the Pennsylvania Department of Health?
Robinson: Most are related to partnerships. The Pennsylvania Asthma Partnership, or PAP, is a multidisciplinary program that spans the state.
We help get families connected with community services and primary care doctors and help community members implement asthma plans in schools or homes. We also offer resources to parents or anyone else interested that educate people about asthma, triggers, and how to avoid triggers.
In Philadelphia County, we also have Community Asthma Prevention, administered through the Children's Hospital of Philadelphia. Community workers go into homes to identify asthma triggers and find ways for families to reduce them.
EHN: Is the Pennsylvania Department of Health working with the Pennsylvania Department of Environmental Protection or the federal Environmental Protection Agency to improve air quality?
Robinson: While we do partner with DEP and EPA, we're not involved in any collaborations to do anything related to air quality or reducing particulate matter. We primarily focus on interventions at the patient or the community level.
EHN: Is there any funding in the 2018 state budget to address asthma?
Robinson: No, there is not. The state of Pennsylvania does not provide funding for asthma initiatives. All funding for asthma education in the state comes through our agreement with the CDC.
EHN: Is the Department of Health doing any work related to the Strategic Asthma Plan for Pennsylvania?
Robinson: Absolutely. We use the Strategic Asthma Plan as a guide for asthma control in Pennsylvania overall. There are four goals in the Strategic Asthma Plan, and we track our progress against those goals.
For goal number one, for example, enhancing asthma surveillance, we use surveys about risk factors, in combination with hospitalization and mortality data. We're also pulling in air quality and Medicare data and survey data asking people to report how many days of work or school they've missed due to asthma. So because we're using many different data sources, we have pretty robust data on asthma surveillance to better understand pockets of asthma. We can focus our education and prevention work there to improve asthma outcomes.
"The state of Pennsylvania does not provide funding for asthma initiatives."
In terms of improving environmental factors—and this goes more to your geographic region in Pittsburgh—we're working within the Pennsylvania Asthma Partnership program to implement asthma-friendly school initiatives in Allegheny County. As a first step, schools will implement and enforce anti-idling measures for school buses, which create a lot of particulate matter, especially in Allegheny County where there are a lot of valleys and it's really hard for it to disperse.
Additionally, we're trainings school nurses about triggers, and also training them to go out and educate their colleagues—which might include teachers, hall monitors and even cafeteria workers—about what an asthma attack looks like. Because it's great if students can get to the school nurse in time, but a lot of asthma attacks happen on the playground or in the hallway. So the more people can recognize symptoms and help students get to an adult who can make sure they get adequate medical care, the better.
We're also working to reduce tobacco use. Having a comprehensive plan for the state also helps with cessation and reduction of asthma.
EHN: Is the Health Department involved with preventing the initial onset of asthma, through measures like reducing air pollution?
Robinson: I'm trained as a pediatrician and internist, so I know that the earlier we address things like asthma in kids, the better chance they have of becoming healthy adults.
We don't have a lot of initiatives aimed at primary prevention of asthma related to air pollution—it's more the DEP and EPA who move those things forward.
I think these anti-idling measures are probably the closest thing to primary prevention we're doing at the Health Department. Anti-idling policies around workplaces, airports, gas stations and rest stops could be really helpful when it comes to reducing the overall amount of emissions in the state.
I don't know that we're in an environment—no pun intended—where those sorts of measures will be espoused at the national level, but at the state level we're open to collaborative partnerships and having conversations about how we can elevate environmental policies aimed at improving public health.
EHN: Our reporting of a recent study of 1,200 Pittsburgh students in low-income neighborhoods found that more than 70 percent of those children live in areas with particulate matter pollution levels above World Health Organization annual average thresholds for safety. Is this a problem the PA DOH is aware of?
"I know they're working to figure out an action plan for particulate matter in Allegheny County, but they have not come to the state health department to ask for any particular support."
Robinson: I actually first became aware of those specifics, in terms of the particulate matter air pollution levels being above WHO thresholds, through your report, which elevated that to our attention.
EHN: Are there any efforts underway to collaborate with/support the Allegheny County Health Department in their efforts to address this problem?
Robinson: We do partner with the Allegheny County Health Department as part of our Pennsylvania Asthma Partnership, but we haven't specifically partnered with them to look at particulate matter in Allegheny County or put anything in place to address that. I know they're working to figure out an action plan for particulate matter in Allegheny County, but they have not come to the state health department to ask for any particular support.
EHN: If they were to come to the state health department with those requests, would support be available?
Robinson: We would definitely be open to looking at it. It would of course depend on their models for change and the particular recommendations they were making and what sort of resources they were seeking. We do have some flexibility in our federal budgets to be able to prioritize and shift as necessary.
I think us doing the work with Allegheny County school was just a first step because we otherwise don't do much around particulate matter pollution, but I do think it would make sense for the Department of Health and the Department of Environmental Protection to sit down and and have a conversation to figure out how we can partner to address this issue.
We do have a lot of health partners throughout the state, and we may be able to help leverage those partnerships to do what we can at the community level to reduce particulate matter.
EHN: A Pittsburgh pediatrician, Dr. Deborah Gentile, has launched a pilot program that uses a simple survey to predict asthma diagnoses in kids. She hopes to see mandatory asthma screenings implemented in all public schools in the county and ultimately throughout the state, similar to vision and hearing screenings, on the premise that kids' ability to breathe is just as critical as their ability to see and hear. What do you think about that idea?
"I do think it would make sense for the Department of Health and the Department of Environmental Protection to sit down and and have a conversation to figure how we can partner to address this issue."
Robinson: We know Dr. Gentile well. She's one of the leaders of the Pennsylvania Asthma Partnership, and probably one of the reasons that we do have such a strong partnership across the state. We would definitely support asthma screenings for children in schools.
Children are probably not screened for enough issues in school, but asthma is one that can be managed well enough to help children live almost symptom-free if the disease is controlled. One challenge is that to have it be mandatory would require legislation, so we kind of get stuck there, but the Department of Health would absolutely be in support of an initiative like that.
EHN: Massachusetts has one of the most comprehensive state asthma plans in the country. Their plan includes initiatives aimed at primary prevention of asthma, like substantially reducing particulate matter pollution throughout the state, and measurable benchmarks aimed at ensuring accountability. A recent mid-course assessment indicated many of their objectives are well underway. PA's asthma plan runs through 2020. When that plan expires, would the PA DOH consider developing an updated asthma plan modeled after Massachusetts?
Robinson: We look at other states to see who has been successful, what has been successful, and what does the evidence show. We want to make sure our updated plans are evidence-based and also include promising practices. I don't say best practices, I say promising practices, because obviously what worked in Massachusetts might not work in Pennsylvania, but it may be worth giving it a shot.
So we're definitely open to not only incorporating some of those strategies, but maybe even having folks from Massachusetts come down and talk to us about what worked and what didn't.
The other part is, it's great Dr. Gentile has been involved with the Pennsylvania Asthma Partnership, but I think pulling her in as a stakeholder and leader as we think about our next steps will help us make sure we're thinking about more interdisciplinary ways of creating this plan. Like bringing in our partners from the Department of Environmental Protection to figure out if there is a way, from a public health perspective, to address things like particulate matter, and to address the issues that children are facing in Allegheny County and across Pennsylvania to better control asthma in kids who have it and to prevent asthma in kids who don't.
EHN: Any other thoughts?
Robinson: Unfortunately I think you could have a job for a really long time writing about these issues. But I think the more you write about it, the more people will know, and if you reach just one person who didn't know these things before reading your article, that's half the battle.
Sometimes you reach the people who have their hands in the right pots and their hearts in the right places, and that can really move something forward, which will help make sure we have a healthier Pennsylvania, and overall a healthier country.
Editor's note: This interview has been edited for length and clarity.
If you're a politician or lawmaker and you'd like to speak with EHN about air quality and asthma, contact Kristina Marusic at kmarusic@ehsciences.org.
