Testimony prepared by: Tyra Bryant-Stephens, MD Medical Director, Community Asthma Prevention Program The Children s Hospital of Philadelphia

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1 Testimony prepared by: Tyra Bryant-Stephens, MD Medical Director, Community Asthma Prevention The Children s Hospital of Philadelphia Regarding: Public Hearing on Resolution : Authorizing the Committee on the Environment to conduct public hearings to investigate the relationship between poor Indoor Environmental Quality and high incidences of childhood asthma. Council of the City of Philadelphia Committee on the Environment Philadelphia City Hall, Room 400 Philadelphia, PA Friday, April 29, :00 a.m.

2 Good morning. My name is Tyra Bryant-Stephens, MD, and I am an attending physician at The Children s Hospital of Philadelphia and the founder and Medical Director of The Children s Hospital of Philadelphia s Community Asthma Prevention (CAPP) a program that I began due to the high rates of pediatric asthma we saw in our communities. Before I begin my statement, I would like to thank Councilwoman Blondell Reynolds Brown and the Philadelphia City Council s Committee on the Environment for holding this hearing on the important issue of indoor air quality and its impact on asthma in children. Also, thank you for allowing me to represent CHOP and provide testimony today. Asthma is the most common chronic childhood disease and the number one reason for children to miss school. In fact, in a study conducted at CHOP, we found that nearly 25 percent of children in West and North Philadelphia have the diagnosis of asthma. Children with uncontrolled asthma have nighttime symptoms which interfere with their ability to attend school and to learn when they do attend. As the Medical Director of the Community Asthma Prevention (CAPP) at The Children's Hospital of Philadelphia, over the past 18 years I have seen the detrimental effect of poor indoor air quality on asthma control for children. The Community Asthma Prevention at CHOP provides: (1) free asthma education classes in familiar environments, such as schools, churches, daycare centers and community centers throughout the city 183 class series have been conducted in Philadelphia, reaching approximately 2,700 participants; (2) asthma resources for professionals, students and school personnel; and (3) home visits in West, Southwest, and North Philadelphia to address the home environment of children with asthma. CAPP s expert staff has conducted over 15,000 home visits for more than 3,000 families to assess general living areas and children s bedrooms, teach parents how to make simple environmental interventions (remove carpet, use roach bait and mice bait), use an allergen-proof mattress cover, and then provide supplies to facilitate interventions such as vinyl flooring and pillow/mattress covers. The families are then responsible for making the home improvements which will reduce asthma triggers, and improve their child s breathing and general health all of which can reduce hospitalizations and emergency room visits. Children should be safe where they live, learn, play, sleep and worship. However, poor housing conditions cause these children to be exposed to excess moisture, mold, rodents, roaches and dust from holes in walls - all which are triggers for asthma. Please see attached maps and photos in Appendix A. Most recently, CAPP has initiated the West Philadelphia Asthma Care Collaborative to formulate a comprehensive plan to reduce disparities in asthma outcomes. As part of our fact finding, we have actually mapped hospitalizations, emergency visits and Licenses and Inspections (L&I) violations.

3 As you can see, there is a great overlap of L&I violations and asthma morbidity. This is further confirmation that poor housing is detrimental to the health of all children in Philadelphia, and particularly to those children with asthma. This also supports the need to improve housing, block by block, until we have adequate housing for all of the children in Philadelphia. In terms of remediation, schools must not be forgotten because during the week, school-aged children spend the majority of their time in that environment. Unfortunately, in Philadelphia, due to the age of the buildings and in many cases inadequate funding, our children are exposed to the same triggers that we find in inadequate housing including mice, mold and cockroaches. Our partners at the School District of Philadelphia s Office of Environmental Management Services have done due diligence in identifying school buildings that need capital improvement, but they unfortunately don't have the funding in their budget to implement the changes. It is important for children s health that each school s indoor air quality meets the standard of a green, healthy building and I hope that the Council would support funding to accomplish this. I d like to conclude by telling you a story that I shared with President Obama about a year ago, when I had the honor of representing my patients and CHOP in a small roundtable discussion on climate change and public health with the President and the U.S. Surgeon General, Vivek Murthy. In the year after Hurricane Irene, a young boy came to CHOP s emergency department six times and was admitted multiple times, due to asthma attacks. He was referred to the Community Asthma Prevention and when our staff-member visited the home, she saw mold growing on the wall due to moisture in the home. She was able to connect the mom with additional resources, resulting in the family moving out of the house. During the year after their move, the boy visited the emergency room only once, with no hospitalizations required. In this case, we were able to connect the family with adequate housing, but unfortunately our staff cannot reach every child in Philadelphia with a diagnosis of asthma and therefore we need system wide changes to create asthma friendly environments. All levels of government need to work together to ensure that Philadelphia s children attend school in safe buildings and live in safe housing, which will result in the reduction of asthma triggers, emergency room visits, hospitalizations, and even deaths, due to asthma and also in increased school performance and attendance. Thank you again for the opportunity to testify.

4 The Children s Hospital of Philadelphia Tyra Bryant-Stephens, M.D. Appendix A.

5 WePACC Intervention Mapping Overlap of High and Low Densities of L&I Violations & Pediatric Hospitalizations due to Asthma Low # of pts w/ a Hospitalization, Low # L&I Violations Low # of pts w/ a Hospitalization, High # L&I Violations High # of pts w/ a Hospitalization, Low # L&I Violations High # of pts w/ a Hospitalization, High # L&I Violations *High density of hospitalizations are tracts with at least 30 patients with a hospitalization

6 WePACC Intervention Mapping Overlap of High and Low Densities of L&I Violations & Pediatric ED Visits due to Asthma Low # of pts w/ a ED Visit, Low # L&I Violations Low # of pts w/ a ED Visit, High # L&I Violations High # of pts w/ a ED Visit, Low # L&I Violations High # of pts w/ a ED Visit, High # L&I Violations

7 Community Asthma Prevention Children s Hospital of No mattress or pillow cover

8 Shades replace blinds Mattress and pillow covers Carpet replaced with stick on tiles Community Asthma Prevention Children s Hospital of Philadelphia

9 No mattress or pillow cover Clutter of clothes, no storage Community Asthma Prevention Children s Hospital of

10 Mattress and pillow cover given. Storage bins for clothes Community Asthma Prevention Children s Hospital of Philadelphia

11 Extensive water damage with mold No mattress or pllow covers Community Asthma Prevention Children s Hospital of Philadelphia

12 First step of mold removal. Supplies given. Family provided labor Community Asthma Prevention Children s Hospital of Philadelphia

13 No dry wall, mold damage. Air entering room from outside Community Asthma Prevention Children s Hospital of Philadelphia

14 First step in wall repair. Supplies given to repair wall. Family provided labor Community Asthma Prevention Children s Hospital of Philadelphia

B.R.E.A.T.H.E. Bringing Reduction and Education of Asthma Triggers to the Home Environment

B.R.E.A.T.H.E. Bringing Reduction and Education of Asthma Triggers to the Home Environment A collaborative project of HDHHS and the EPA Bureau of Community and Children s Environmental Health Acknowledgements