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Introduction to the National Workshop To Reduce Asthma Disparities^*

^* From the Otho S. A. Sprague Memorial Institute, Chicago, IL.

Correspondence to: James N. Alexander, BS, JD, Alexander Associates, 2129 Central Park Ave, Evanston, IL 60201-1801; e-mail: Jim{at}AlexanderAssocs.com

Key Words: asthma • epidemiology • health administration

Since 1910, The Otho S. A. Sprague Memorial Institute has pursued the mission outlined by its founder: "... to investigate the causes of disease and the prevention and relief of human suffering in the City of Chicago ... " Throughout its history, the institute has identified and responded to some of the most troublesome health concerns in the community. Asthma was and continues to be one of the most intractable conditions facing Chicagoans. To address this, in 1994 the institute launched a multiyear Chicago Asthma Initiative, focusing the bulk of its annual philanthropic budget on this topic. While that amount is modest in comparison to the largess flowing from the Gates/Buffet treasury, the investment has had significant impact. First, it changed the way the local health community interacted on this topic. Secondly, it created a replicable model for asthma and other conditions. Finally, it demonstrated how a midsized foundation could make a difference.

Funders can no longer rely on traditional forms of grant making. Simply writing a check and reviewing the report may not work when innovation is required. A dozen years ago, asthma disparities were recognized but ineffectively addressed. Too many physicians were indifferent to National Heart, Lung, and Blood Institute best practices. Too many patients were noncompliant, or ignorant about how to manage their disease. All this was evident, even as undiagnosed and untreated asthma drove unacceptably high morbidity and mortality statistics. While many bemoaned the facts, few were taking appropriate action.

It took a proactive approach by the board of The Institute to put the topic on a different trajectory. Convening a diverse group of leaders to discuss the problem was a first step. Formalizing and funding their ongoing network was the more important one. Seeding promising new approaches across a spectrum from bench science to peer education became the hallmark of the initiative. Mapping, monitoring, and sharing data and outcomes through the Chicago Asthma Atlas, the Chicago Asthma Surveillance Initiative, and the Chicago Asthma Consortium and its annual data workshop resulted in improved understanding of what works, who is effective, and where additional interventions are needed. After more than a decade of encouragement, several of these programs have become self-sustaining, while the principal investigators have continued to attract larger grants from government, foundation, and corporate sources. Problem-based learning and patient empowerment were tested and proven as cost-effective techniques to achieve better asthma outcomes. Mobile C.A.R.E. has demonstrated impressive results through its community-based approach. The value of collaboration also has been recognized. The Chicago Asthma Consortium model now has been replicated in dozens of communities across the nation. To maintain and strengthen this national asthma network, the CHEST Foundation convenes them annually. (It also has been adapted by The Otho S. A. Sprague Memorial Institute to address other health issues including childhood obesity through its role as the cofounder of the Consortium to Lower Obesity in Chicago Children, which has emerged as a national model.) While this is encouraging, networking is not enough. It takes sustained focus and increased funding if health outcomes are to be improved and disparities decreased.

Despite the years of investment by the institute, Chicago is not asthma free. Regrettably, too many residents of this community suffer from undiagnosed or poorly managed asthma, and the disparities remain. Still, there is cause for optimism. Best practices are better understood. Chicago now has greater public awareness, proven health education techniques, and a creative and connected infrastructure that can meet the challenges. A diverse leadership cadre willing to address the problem has been identified and trained. They will need more resources to succeed and they deserve them.

While yet another set of National Heart, Lung, and Blood Institute guidelines are being promulgated, private and public funders, health-care providers, and patients must build on the models now tested and proven to ensure broader compliance and more effective interventions. We have more tools in the toolkit. New funders must be conscripted to support the talented scientists, health-care professionals, peer educators, and community agencies that have emerged from this initiative. Donor-advised funds and conversion foundations represent two important targets of philanthropic opportunity. Fundraising is never easy, but the role of The Otho S.A. Sprague Memorial Institute as an enabling funder has enhanced the odds for success.

	Footnotes

 
The author has no conflict of interest to disclose.

Received for publication December 20, 2006. Accepted for publication August 2, 2007.

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