It is a reasonable expectation that children will live a longer life than their parent. But some would challenge that based on today’s lifestyle, children will actually have a shorter life expectancy than that of their parent (No time to wait: the healthy kids strategy., 2013). One of the major health conditions impacting children today is asthma. Asthma is a chronic lung disease that can make it difficult for a person to breathe. Individuals who suffer from asthma have a sensitive airway, that depending on that person’s triggers, can tighten up and narrow the airway, making it difficult to breathe (Supporting Ontario children and students with medical conditions., 2017). In Canada, 12 people are diagnosed with asthma every hour. It is the third most common chronic disease in our country and those who are mostly affected are children (Asthma Canada, n.d.). In Ontario, one in four children will be affected by asthma as seen in the infographic below (OASIS: Asthma Infographic, 2014).
There are many different factors that can impact someone’s health. These circumstances are influenced by the distribution of resources and power on an international, national and local level (Social determinants of health., 2018). These factors are referred to as the social determinants of health and can include things such as:
· Aboriginal status
· Disability
· Early life
· Education
· Employment and working conditions
· Food insecurity
· Health services
· Gender and gender identity
· Housing
· Income and income distribution
· Race
· Sexual orientation
· Social exclusion
· Unemployment and job security
(Social determinants of health., 2018)
These social determinants can have an impact on our health but also can impact other determinants. When these determinants impact each other, it can affect a person’s health on many different levels. Galea (2015) explained that a multilevel approach to population health is based on the understanding that exposures at many levels of organization, work together to produce health outcomes. Exposures at different levels can be both up and downstream and can be impacted by determinants of health that range from social, political, geographical or biological to name a few. Galea (2015) suggest that a multilevel approach teaches us to examine how social relationships can produce health behaviours that can then result in disease. For this blog post, I am going to apply the social ecological model of health to asthma in school-aged children.
Social Ecological Model
Health promotion is more than simply educating people about being healthy. It requires effort to change organizational behaviour, as well as understanding social norms and looking at physical, social and environmental factors of a community to influence health. There is a need for policies that support health. The Social Ecological Model (SEM) helps us to understand that to create a healthier outcome for the individual, it is necessary to act across multiple levels of the model at the same time. This approach will likely be more successful over time than any single intervention would be. When looking at the SEM, I will be using the adapted model below where there are five levels to the framework: individual, interpersonal, community, organizational and policy/enabling environment. I will be exploring the levels of influence with regards to asthma in school aged children.
The first level of this framework looks at the individual influences on health. Although the exact cause of asthma is not known, biological risk can increase the chances of developing asthma. Biological risks for asthma can include genetics, atopy, low birth weight or prematurity-especially if a ventilator was used (Smith, 2018). Inherited genes from parents can predispose a child to asthma. If a parent has asthma, that child is three to six times more likely to develop asthma than a child without the same genetic predisposition (Asthma Risk Factors., 2018). Atopy, which means that an individual is genetically prone to developing eczema, rhinitis, conjunctivitis and asthma can cause increased sensitivity to allergens (Asthma Risk Factors., 2018). Allergens are a common trigger for asthma attacks.
In the second level of the SEM model, we look at family, friends and social networks. In a study conducted by Chen, Chim, Strunk & Miller (2007), they looked at the association of social environments at different levels such as family, peers and neighbourhood and related it to asthma outcomes in youth. It showed that lack of family support and greater neighbourhood problems were related to increased asthma symptoms and poorer pulmonary functions. These findings suggest the possibility, that among youths with asthma, the family and the neighborhood they live in play an important role in asthma outcomes (Chen, Chim, Strunk, & Miller, 2007). After spending several weeks learning about the determinants of health and how and inequity of those determinants can negatively impact one’s health, these findings were not surprising. In adolescence, there is an importance placed on peer acceptance and “fitting in”. When a child or youth has a health condition that separates them from their peers, it is easy to make the links to how this may impact their health. For youths with asthma, this may mean not taking medication when needed, engaging in physical activity that triggers asthmatic episodes to fit in socially with peers (Smith, 2018).
The next 3 levels- Community, Organization and Policy- of the SEM, come together when we look at the progress Ontario has made since 2015. This is with regards to asthma education and awareness within our community and areas that still require growth. In 2012, Ryan Gibbons, a 12-year-old boy in Ontario, died while at school because he was not permitted to carry his inhaler with him. School policy at the time enforced that medication needed to be in a secure area such as the office. This tragic death triggered change in Ontario (Ontario law passes to let asthmatic kids carry inhalers in school., 2015). Ryan’s Law was created in 2015 and mandates that schools allow a student with asthma to carry their inhaler with the permission of their parent, guardian or physician. It also requires schools to develop ways to reduce exposure to asthma triggers and that each student with asthma requires an individual action plan to manage attacks should they occur (Bill 20, Ryan's Law (Ensuring Asthma Friendly Schools), 2015., 2015).
School boards, public health, local physicians and families, have come together to create awareness and education around asthma. In Niagara, we have Public Health Nurses linked to every elementary and secondary school in our region. They provide education and consultation to school staff, parents and students around asthma prevention, medication administration and modifications that can help reduce triggers for students (School Health Services, n.d.). According to Nuss et.al., (2016), school nurses played an integral role in making schools more asthma friendly. Their presence in providing face to face education and support in schools increased awareness and adherence to policy among staff. In the Niagara Region, our School Boards still can do more to support students with asthma. Incorporating institutional policies and regulations, such as setting limits on bus idling, is a simple step to improve air quality for students at school (Nuss, et al., 2016). Many schools in Ontario are without air conditioning. The temperatures in warmer months can see classrooms with high levels of heat and humidity which is having a negative impact on learning and teaching conditions, as well as school safety. Poor Indoor air quality is contributing to mould and moisture which can trigger asthma attacks and present other health concerns for students and staff (Poor IAQ a concern in elementary schools, 2016).
CONCLUSION
As a public health nurse working with children, I can see how using a multilevel approach to a chronic condition like asthma, can benefit and create positive change for a specific population like school aged children. When all levels come together, positive change like Ryan’s Law, can turn a tragic event into something that will benefit and protect children in the years to come. There is more change that needs to happen but when using a lens that looks at all levels it is easier to see how we can work together to create change.
Annotated Bibliography can be found here.
References
Asthma Risk Factors. (2018). Retrieved from WebMD: https://www.webmd.com/asthma/guide/asthma-risk-factors#1
Bill 20, Ryan's Law (Ensuring Asthma Friendly Schools), 2015. (2015). Retrieved from Legislative Assembly of Ontario: https://www.ola.org/en/legislative-business/bills/parliament-41/session-1/bill-20
Chen, E., Chim, L. S., Strunk, R. C., & Miller, G. E. (2007). The Role of the Social Environment in Children and Adolescents with Asthma. American Journal of Respiratory and Critical Care Medicine, 176(7), 644-649. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994239/
Nuss, H. J., Hester, L. L., Perry, M. A., Stewart-Briley, C., Reagon, V. M., & Collins, P. (2016, March). Applying the Social Ecological Model to Creating Asthma-Friendly Schools in Louisiana. Journal of School Health., 86(3), 225-232. Retrieved from https://stacks.cdc.gov/view/cdc/38068
OASIS: Asthma in Canada (Infographic). (2014). Retrieved from SickKids: http://lab.research.sickkids.ca/oasis/oasis-statistics/
Ontario law passes to let asthmatic kids carry inhalers in school. (2015, April 15). Retrieved from CBC News: https://www.cbc.ca/news/canada/toronto/ontario-law-passes-to-let-asthmatic-kids-carry-inhalers-in-school-1.3055534
Poor IAQ a concern in elementary schools. (2016, September 15). Retrieved from REMI Network: https://www.reminetwork.com/articles/poor-iaq-a-concern-in-elementary-schools/
Public Health Approach to Addictions. (n.d.). Retrieved from Your recovery solutions.: https://www.yourrecoverysolutions.com/projects1.html
School Health Services. (n.d.). Retrieved from Niagara Region: https://www.niagararegion.ca/health/schools/school-health-services.aspx
Smith, Y. (2018, August 23). Causes of Asthma. Retrieved from News Medical Life Sciences: https://www.news-medical.net/health/Causes-of-Asthma.aspx
Social determinants of health. (2018). Retrieved from The World Health Organization: https://www.who.int/social_determinants/sdh_definition/en/
Social determinants of health. (2018). Retrieved from Canadian Mental Health Association: https://ontario.cmha.ca/provincial-policy/social-determinants/
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