Noteworthy Asthma Strategies from our Partners at Indian Health Service: Interview with Celeste Davis, Director, Division of Environmental Health Services / Emergency Management Coordinator, U.S. DHHS /Indian Health Service-Portland Area

THHN: From your perspective with Indian Health Service, what is a good starting point for tribes planning environmental health work?

Celeste Davis:   “A fundamental question tribes can ask is: what programs do we consider part of our public health authority? Which programs are responsible for public health matters as part of their official mandate? This question can be a launching pad for all kinds of public health conversations. Is it just the clinic? Some tribes may see the public health authority also including air quality and environmental programs, but perhaps not housing. Broadening public health infrastructure will help a tribe build partnerships for environmental health work.”

How might tribal air or housing staff partner with their clinic to target healthy home activities?

“There are targeted opportunities when a case-by-case referral process is in place at the clinic. An example of this would be when a new case of asthma is seen, the health care provider can say, let’s refer this patient for environmental health services. The referral could be to trained air staff for a home health assessment, or even for green cleaning supplies handed out by the clinic to the patient’s family.

Other referral partners could be pharmacists, or public health nurses. There are many ways a case-by-case referral approach can look to target healthy home activities.”

What is key to making a referral process work?

“To make any referral process work the clinician has to buy-in. How do you get buy-in? Sometimes education works alone, but the next step is making an internal policy at the clinic.”

Without a formal referral program, or access to health data, is there any way an air quality or housing person can reach asthma patients who most need a home assessment?

“I would suggest they use self-identified (homeowner) data. They could reach out via survey or questionnaire to the public if they had the resources to respond to each individual. It may not be clinically confirmed data, but this type of data is used quite often in public health.”

Related to housing programs, we’ve heard of the concept of health-based prioritization. In theory, this would mean that the kids who need it most (ie with uncontrolled asthma) have repair work done to their house first or before a house where there are no patients with asthma. Yet in our research we haven’t found any formal method for doing this. What are your thoughts?

“If the Housing Authority does not have discrete criteria for prioritizing where they commit resources for existing housing rehabilitation and repairs, they risk being viewed as biased. Using health conditions of occupants as part of the criteria helps the Housing Authority as well as the health of the community.”