Management of Indoor Air Quality for Individuals With Asthma (Follow-Up)

Issued Date
September 09, 2024
Agency/Authority
Health, Department of

Objective

To determine the extent of implementation of the six recommendations included in our initial audit report, Management of Indoor Air Quality for Individuals With Asthma (Report 2020-S-59).

About the Program

Asthma is a significant public health problem in the United States. It is one of this country’s most common and costly diseases, which often requires emergency care and hospital admission and is responsible for a high number of missed school and/or workdays. According to the Centers for Disease Control and Prevention (CDC), in 2020, asthma accounted for 94,560 hospitalizations and 986,453 emergency department visits in the United States. In 2021, asthma accounted for 3,517 deaths. In New York, DOH data estimated that more than 1.4 million adults and 315,000 children are living with asthma.

The COVID-19 pandemic had significant impacts on those living with chronic diseases such as asthma. According to the CDC, people with moderate-to-severe or uncontrolled asthma are more likely to be hospitalized from COVID-19. Reducing asthma triggers is one objective of the Department of Health’s (DOH) Healthy Neighborhoods Program (HNP).

The HNP is designed to provide environmental health services to targeted high-risk neighborhoods. These areas sometimes include environmental justice communities and are usually home to at-risk populations, including low-income and minority families, living in homes and neighborhoods with a disproportionate number of residential hazards. The HNP’s goals include reducing hospitalizations due to asthma and limiting exposure to indoor air pollutants that are known asthma triggers. To accomplish these goals, the HNP contracts with Local Health Departments (LHDs) to perform in-home visits and assessments to raise awareness of and help families manage asthma in order to reduce hospitalizations. LHDs visited 17,352 households, consisting of 26,602 individuals, from January 1, 2021 through June 30, 2024. Of the total households visited, 5,139 (29.6%) had at least one individual with asthma.

The objective of our initial audit, issued on August 2, 2022, was to determine if DOH effectively identified poor housing conditions for residents with asthma and worked with LHDs to ensure home visits were prioritized. The audit covered the period from April 2014 to January 2021. We found that while DOH, through its contracts with LHDs, identified poor indoor environmental conditions that impact residents with asthma, it needed to improve its oversight and monitoring of LHDs to ensure that individuals identified with asthma in targeted areas continued to receive appropriate assistance. Among the issues found:

  • LHD-identified target areas were included in DOH-approved contracts, but DOH did not assess whether services were provided in those target areas. Further, DOH could not provide 39 of the 106 LHD reports required by the terms of the contracts. As progress reports provide accountability and enable project monitoring, it is uncertain how effectively DOH monitored the program and determined if LHDs were meeting the goals outlined in their contracts.
  • The LHDs did not sufficiently perform the required 1-year follow-up visits to households where at least one individual was identified as having asthma during the initial home visit, and DOH took no action on the lack of LHD compliance.
  • Separate from the HNP, DOH has a public-facing Asthma Dashboard (Dashboard), which, according to DOH, is updated annually. However, the Dashboard that was publicly available during audit fieldwork was significantly outdated, displaying emergency department visits and hospitalizations information from 2012–2014, deaths information from 2014–2016, and asthma prevalence data as of 2016.
  • DOH had not conducted an overall evaluation of the HNP to determine program effectiveness or performed any evaluations of LHDs as outlined in the contracts.

Key Findings

DOH officials made some progress in addressing the problems we identified in the initial audit report. Of the initial report’s six audit recommendations, four were partially implemented and two were not implemented.

Key Recommendation

DOH officials are requested, but not required, to provide information about any actions planned to address the unresolved issues discussed in this follow-up within 30 days of the report’s issuance.

Nadine Morrell

State Government Accountability Contact Information:
Audit Director
: Nadine Morrell
Phone: (518) 474-3271; Email: [email protected]
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236