Feature

Clearing the air on asthma

It will take determined political action to tackle the problem of childhood asthma, says Steve Mumby

A long hot summer and high levels of air pollution have put asthma back in the news, amid calls for measures to reduce traffic fumes and congestion. The Ashden Trust, in their recent report How vehicle pollution affects our health, has brought together doctors and transport specialists to argue strongly that we need changes in transport policy in the interests of public health. Top of the list of necessary measures would be improvements to public transport and restrictions on car use, heavy vehicles and exhaust emissions.

The proposals come in the wake of mounting concern over the apparently inexorable rise in asthma incidence, especially among children, and the lack of urgency in government and health service responses. But how convincing is the evidence for an increase in asthma? How certain are we that traffic pollution is to blame and what are the chances for effective preventative action?

I became conscious of the issue about a year ago when I began work as a welfare rights worker in an unemployed centre in Kirkby, a deprived area on the outskirts of Liverpool. A co-worker, herself the grandmother of a child with asthma, pointed out to me how many of the children in the area suffered from asthma. Once we started asking about it on a routine basis, we soon found that about half the parents coming through the door had children with the condition. And answering the phone for my partner—a GP in Toxteth—seemed to confirm that asthma was one of the commonest reasons for a night call-out.

A question in the House of Commons, from our local Labour MP George Howarth, brought the reply that childhood asthma had doubled in incidence since 1979. I began to look around for evidence on prevalence and possible causes, without much success. A recent British Medical Journal paper on asthma found limited evidence of rising incidence, and was sceptical of suggested links with traffic pollution and poverty.

Our local health authority, in reply to a further question from George Howarth, said it had no figures on the illness and suggested asking local GPs. Most statistics seem to focus only on hospital admissions and deaths rather than the amount of illness in the community. A number of local studies seem to be underway looking at prevalence of childhood asthma and possible causes, but at present any estimates of the size or cause of the problem—if there is one—seem bound up in debates which stray from being purely academic to becoming intensely political.

I have no quarrel with this. It is often necessary to take preventative action before cast-iron proof of a risk to health can be gathered. Equally, even if one accepts (which I do not) that environmental factors are secondary to behavioural triggers in childhood asthma, it is still reasonable to argue that the former are more open to public action than the latter. But politically it would be a mistake to confine the argument to an alliance between environmentalists and health professionals.

While I support the case for public transport and restrictions on private motor vehicles, I’m conscious that this offers little in the short term for children with asthma, or their parents. It is an important battle, but a very long-term one, to take on the motor industry and the road lobby. We need to develop more immediate and achievable goals alongside the longer term aims.

To be fair, environmentalists have put forward more immediate proposals, such as traffic calming schemes, which can contribute to the solution as well as being part of the longer term process of change. But there is also a range of other options.

Some studies suggest that childhood asthma hits the rich more than the poor. This is not my experience. While any child with asthma suffers, the stress on carers is likely to be greater for families living in poverty. One step is to help families claim Disability Living Allowance for children with asthma. At Kirkby unemployed centre, we have found that carefully written claims stand a good chance of success. GPs reading this may well groan, having been inundated with DLA-related work, but the sums of money involved for families living in poverty can be significant.

An award of the lower rate of care component, worth £12.15, will be matched by another £19.45 in Disabled Child Premium for families on Income Support. In our area the Borough Welfare Rights Forum is planning a take-up campaign for DLA for asthmatic children. Apart from the benefits for the families themselves, the cost to the public purse is one way of putting pressure on government to take the issue seriously.

Asthma—particularly childhood asthma—affects millions of people in the UK, directly or indirectly, and it’s not going to go away. It is not glamorous, nor amenable to a quick fix. Though press coverage and publicity campaigns are welcome, they are not enough. What we need is parents, health workers, environmentalists and community activists coming together in local and national campaigns on the issue. If you’re like me, you’re probably desperately short of time to commit to something like this. But we should.

For further information on claiming DLA for childhood asthma, write to: Steve Mumby, Kirkby Unemployed Centre, Westhead Avenue, Northwood, Kirkby L33 0XN. 051-548 0001.