Baker News March 18, 2019

Policy Challenge Finalist Spotlight: Breathe Easy

by Jose Altamirano

Addressing D.C’s High Asthma Rates Through Home Visits

Emilia Calma (MPP ’20) and Lina Stolyar (MPP ’20) are McCourt School of Public Policy students involved in the Policy Innovation Lab and are finalists in this year’s Georgetown Public Policy Challenge, a interdisciplinary competition that tasks graduate students with developing innovative policy solutions aimed to address local or regional issues in the Washington, D.C. region. Every day this week, we will be publishing a spotlight on each of the five finalists who will be competing in the Policy Challenge final round on Friday, March 22.

Emilia and Lina came up with Breathe Easy, a proposal to address the high, disparate incidence of asthma across Washington, D.C., especially in Wards 7 and 8. To that end, they are proposing a corps of community health workers who would visit families at their homes and provide asthma education, guidance on medication management, and more. Read more about Breathe Easy and what inspired Emilia and Lina’s proposal below:

Describe your proposal in 140 characters or less.
Our proposal addresses DC’s high asthma prevalence and ER utilization rates by implementing home visits by community health workers.

How has your proposal changed between the start of the Challenge to now?
We wanted to take the human-centered design approach of first looking to understand the needs of the community before proposing a solution. Wards 7 and 8 have asthma prevalence rates twice that of Ward 3 and disproportionately large ER utilization rates. To figure out why this was happening, we researched general causes of asthma and then focused on what specific challenges DC parents and children were facing. We didn’t have a solution coming into the process because HCD has taught us that you can only identify a solution once you understand the needs of the community and the gaps that need to be filled.

What is the biggest challenge you face in addressing the problem you seek to solve?
Asthma is an incredibly complicated issue. There are many interrelated causes which makes finding a solution complicated. For example, substandard housing and the stresses associated with poverty can exacerbate asthma symptoms, but one is hard to solve without addressing both. We wanted to come up with a solution that would be impactful and address as many of DC’s identified barriers as possible while still being feasible.

Is there anything new you have learned about crafting policy through participating in the Challenge?
It has reinforced how important it is to understand the people who the policy will affect. We interviewed many people and really tried to get as much information as possible about the typical asthmatic patient and typical asthmatic family. I think this process can sometimes get lost in policy making. Additionally, we think it is important to keep an open mind about possible alternatives and solutions.

What inspired your proposal?
We saw a statistic that said that DC was the third worst ranked state in asthma prevalence (CDC, 2014) and were shocked. When we looked at a map of asthma rates across D.C.’s wards, we were even more taken aback in the difference in rates and ER utilization between locations just a couple miles apart. We are both passionate about health and environmental policy and how those policies interact with health equity needs. As soon as we talked about it, it felt like the right issue to address.

Say your solution is implemented/funded/approved. How would you define success after 5 years?
We would like to see utilization of the community home visits lead to lower utilization of the ER, fewer hospitalizations for asthma, reduced burdens and stress on affected families, lower rates of acute asthma attacks, and more preventative treatment of asthma. We would love to see families be able to feel like they can manage this chronic illness.

How has your involvement in the Policy Innovation Lab impacted the development of your solution?
Because the Policy Innovation Lab focuses on human-centered design thinking, racial equity, and community engagement, I think we had an amazing foundation off of which we could build. The Lab gave us a framework to try to address these policy needs. Additionally, the guidance of Margaret O’Bryon was invaluable in figuring out who to talk in D.C. about what is already happening around asthma care.