By Dr. Paul Ehrlich
The World Allergy Organization Journal article featured on our Journals page “Asthma Care in Resource-Poor Settings” cites factors including “low accessibility to effective medications, multiple and uncoordinated weak infrastructures of medical services for the management of chronic diseases such as asthma, poor compliance with prescribed therapy, lack of asthma education, and social and cultural factors.” The article encompasses studies in Asia, Africa and Latin American and calls for “better ways to treat asthma in underserved populations, enhancing the access to preventive medications and educational approaches with modern technological methods.”
While I endorse these public health measures, I was also reminded that some of this epidemic is the fault of “progress.” A number of years ago I was invited to Bermuda to look into a sharp spike in the incidence of asthma. A real hardship assignment, let me tell you. However, what we learned was deeply compelling and disturbing. Namely, that a big part of the increase, which affected both affluent and non-affluent people, was attributable to changes in construction on the island. Bermudan architecture had been constructed to take advantage of a great natural resource—the wind. Buildings were ventilated and cooled using shutters and ceiling fans, which also kept indoor air fresh and dust-free. When closed construction and air-conditioning entered the picture, there were many fewer air exchanges, and allergens were trapped. Asthma went up.
The genie is out of the bottle with such improvements. And indeed the preventive medications and better education will become imperative in all these countries as they alter their economies with global industry and agricultural methods. I just hope that when the resources do become available they will do better with compliance than we do, and Canada does, and the UK. We have these resources, but asthma is still frequently uncontrolled, as Dr. Chiaramonte and I are always writing. The price of progress should be measured in public health as well as money.