Is Louisville, Kentucky, the new face of asthma healthography?

Reposted with permission from the Robert Wood Johnson Foundation Human Capital Blog:


Leaders in Louisville, Kentucky, know first-hand that where you live and work affects your health and well-being. During a special session at the American Public Health Association’s meeting this week in New Orleans, we explorehow the air quality in Louisville neighborhoods impacts the health, economy and overall vibrancy of the community. And we’ll highlight how Louisville is the poster child for tackling tough issues like asthma head-on, top-down and bottom-up, through data and collaboration among individual residents, corporate execs, community organizers and public leaders.

Asthma attacks are sneaky, expensive and debilitating, yet almost entirely preventable.

Asthma is one of the most common and costly chronic diseases in the US, affecting over 8% of the US population. Despite decades of research and the development of effective treatments, rates of morbidity have not declined and healthcare costs reach over $50 billion a year. Asthma also leads to more than 13 million missed days of school and 10 million missed days of work, negatively affecting educational achievement, employee productivity and regional business growth. But the most frustrating part is that a large proportion of these hefty impacts could be avoided with improvements in self-management, community policy and advances in digital healthcare.

Where someone lives, works and plays directly influences their asthma.

Triggers of asthma are well-known –allergens, mold, dust, smoke. Yet it’s difficult to identify an individual’s own environmental triggers, much less regional triggers like traffic and air pollution, that may aggravate asthma across a whole community. Typically, cities and public health departments have to rely on national, year-old asthma hospitalization or prevalence data aggregated at a zip code or county level, so identifying the causes of asthma morbidity in real-time and in real space is a huge challenge.

This is exactly the challenge facing Louisville.

Kentucky has the fourth highest adult asthma prevalence in the US (10.4%). Louisville was named one of the top 20 “Most Challenging” cities to live in with asthma, and the #1 “Spring Allergy Capital” in the US in 2014, contributing to asthma and COPD (chronic obstructive pulmonary disease) being the 3rd and 4th leading causes of hospitalization in Jefferson County.

But unlike most communities facing this kind of burden, leaders in Louisville recognized the tremendous potential of innovative, data-driven collaborations to address these challenges.

In 2012, the City of Louisville partnered with Propeller Health and local funders, including the Owsley Brown Charitable Foundation, Norton Healthcare Foundation and the Foundation for Healthy Kentucky, to determine how an integrated asthma surveillance program could not only improve residents’ daily asthma symptoms, but also inform municipal policy and target community interventions.

Louisville built a map of asthma combining citizen-powered, digital therapeutics and open data — public health data in action.

Local residents received Propeller’s inhaler sensors that tracked the frequency, time and location of inhaler use for 13 months, collecting over 5,400 rescue inhaler use events. These data were then de-identified and combined with over 40 socioeconomic and environmental data layers, and hotspots of high asthma inhaler use were identified.

In this proof-of-concept pilot, we showed that collecting real-time, geographically explicit data on asthma is incredibly valuable for individuals, for their doctors, for local decision-makers and for the community at large.

Now an unprecedented collaboration is about to take place with a single, unified agenda: reduce the burden of asthma.

With generous funding from the Robert Wood Johnson Foundation, and in collaboration with the City of Louisville; Louisville Metro Public Health and Wellness; the Institute for Healthy Air, Water and Soil; the Community Foundation of Louisville; Propeller Health; and local health systems, payers and employers, we are seeking to creating a model of collective action to reduce the burden of respiratory disease in Jefferson County. This program will support existing programs in the county, such as the Mayor’s Healthy Hometown Movement and Healthy Louisville 2020, and contribute to policy-making that will impact thousands of lives in Jefferson County.

Our collective aim? To inspire daily self-management of asthma and COPD, improve residents’ outcomes, reduce healthcare utilization and costs, and, importantly, better understand the environmental and neighborhood drivers of asthma in the community.

We encourage you to join us as we talk about early results, lessons learned, and goals for the future at our APHA special session on Tuesday, November 18th: Technology-Driven Asthma Data Perspectives: Municipal, Clinical, Environmental, and Public Health.  We’ll hear from multiple stakeholders, including the municipal perspective from Ted Smith, PhD, Chief of Civic Innovation for Louisville; the public health perspective from LaQuandra Nesbitt, MD, MPH,  Director of the Louisville Metro Department of Public Health and Wellness; the clinical perspective from David Van Sickle, PhD, co-founder and CEO of Propeller Health; and the environmental perspective from me. I hope you join us!