Southwest Alaska: Improving the Respiratory Health of Alaska Native Children

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Southwest Alaska: Improving the Respiratory Health of Alaska Native Children

As a nonprofit tribal health organization that serves Alaska Native and American Indian people, the Alaska Native Tribal Health Consortium (ANTHC) is Alaska’s second-largest health employer. ANTHC provides numerous programs involving health services, education, advocacy, and research. Most recently, ANTHC’s air quality and respiratory health project conducted air quality interventions that reduced the incidence of breathing-related illnesses, to which children are particularly vulnerable. The project focused on improving air quality in individual residences in Southwest Alaska. In recognition of this work, ANTHC received the 2015 HUD Secretary’s Healthy Homes Award for Cross Program Coordination among Health, Environment, and Housing. ANTHC’s work involved uniting community residents, tribal housing authorities, regional health corporations, and environmental specialists in a partnership that has measurably improved the home environment and health of many Alaska Native families.

You Are What You Breathe

In Southwest Alaska, where average high temperatures are at or below freezing for six months of the year, Alaska Natives often keep their homes warm by sealing them up tightly, blocking ventilation systems with clothing or other household items. The sealed houses create closed areas that concentrate contaminants from cooking and heating with a wood stove, as well as retain visible and invisible pollutants released from materials brought in from outside. The poor home ventilation can lead to asthma, pneumonia, and respiratory syncytial virus and other infections, as well as headaches, eye and throat irritation, worsened allergies, heart disease, and cancer. ANTHC’s award-winning project assessed, remediated, and monitored indoor air quality and its effect on children’s health. Funded by a HUD 2013 Healthy Homes Technical Studies grant, the project built upon work done under a grant from the Commission for Environmental Cooperation in 2011–2012.

Project coordinators selected two regions of Southwest Alaska with rates of child respiratory illness that were among the highest ever documented worldwide. After gaining tribal approval for the project, the project team contacted local pediatricians to identify children who had been treated at a clinic four or more times or who had been hospitalized at least once in the previous 12 months for breathing-related illnesses. The team and the regional health corporation explained the project to the identified families and asked if they wanted to participate. In the end, 63 households in 8 communities agreed to participate in the project.

Cleaning the Air

The project team suggested appropriate home modifications based on the type and amount of pollutants in each home. The modifications often included installing carbon monoxide detectors and improving ventilation systems, by far the most common issue encountered in participants’ homes, according to AJ Salkoski, senior program manager at ANTHC. Each family selected the desired modifications, which local tribal housing authorities completed. In addition, the project replaced 19 leaking wood-burning stoves with new stoves certified by the U.S. Environmental Protection Agency, and 15 diesel-burning heaters were replaced with low-emission, efficient heaters. The team also instructed families on ways to maintain healthy air quality that were tailored to their cultural practices and needs. Educational sessions emphasized the need to keep air ventilation systems functioning, replace cooking stove vents, and open windows whenever possible. Residents were also encouraged to adopt everyday habits that would improve their indoor air quality, such as storing toxic products outside living areas, removing shoes before entering the house, and smoking tobacco products outside. Additional educational support came from a regional health specialist who visited residents needing ongoing medical treatment.

Preliminary results of air monitoring show that the project dramatically improved indoor air quality: decreases of 21 percent in particulates, 26 percent in carbon dioxide, and 68 percent in volatile organic compounds. In questionnaires completed by participants, families reported a 50 percent reduction in clinic visits for children and 27 percent fewer school days missed. Compared to seven hospitalizations for respiratory conditions during the two weeks before the home improvements, no hospitalizations were recorded in the two weeks following the modifications. A forthcoming edition of Indoor Air will include an article presenting the project’s process and results.

In addition to improving residents’ health and enhancing coordination among health and housing providers in Alaska, another program objective was to share effective measures to improve indoor air quality with other indigenous communities in the United States, Canada, and Mexico. ANTHC staff have routinely participated in conference calls, made several visits to other communities, and produced three webcasts for North American viewers.

Next Steps for ANTHC

The next iteration of the air quality and respiratory health project will include investigating measures to extend the program’s reach to more Alaska Native communities while keeping costs low. The project’s education component, which has improved the indoor air quality practices of numerous families in Southwest Alaska, has already expanded. To continue building on this success, ANTHC recently initiated an environmental health hospital consultation project. Instead of going into homes one by one, ANTHC provides information at the Alaska Native Medical Center to families with children who have breathing-related illnesses. Families whose homes need significant improvements are referred to their local housing authorities, which make the home modifications and provide additional educational materials for maintaining air quality in the homes.