Asthma and poverty
- Department of Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, Guy's Campus, 6th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK
- Dr R Rona
If the UK Department of Health's “Independent inquiry into inequalities in health”1 had been carried out in the USA, asthma would probably have occupied a prominent place in the document. In Britain a review of the evidence on inequalities did not mention asthma as a health issue related to poverty. Americans review the association of asthma and poverty on a regular basis in the literature.2-7 Platt-Mills3 suggested that the link between low social class and asthma was a phenomenon restricted to the USA. Is this perception correct and, if so, why should it be? In reviewing the topic it is appropriate to disaggregate several related but separate components. Poverty may contribute to the aetiology, exacerbation, recognition, and management of asthma (box FB1). There is also a historical perspective that needs some consideration. In Britain both coronary heart disease and diabetes mellitus were initially more prevalent among the wealthy, but subsequently became associated with poverty. Studies based on more recent data may therefore show a different association between asthma and poverty than earlier work.
Possible effects of poverty on asthma
Measuring poverty
The nature and intensity of poverty differ between societies. In the USA financial barriers may prevent the poor from obtaining appropriate care and may limit the ability to purchase medication. In Britain financial barriers are less obvious and cultural differences between strata in society may be more relevant. It is important to consider whether we are dealing with structural poverty—that is, characteristics that are essential to being poor—or characteristics that are associated with the poorest groups in a country. Smoking, high indoor and outdoor pollution, obesity, family size, low birth weight and preterm delivery, characteristics of diet and ethnic background which, in varying degrees, have been found to be related to asthma, are also associated with poverty, …
