Regional Asthma Management and Prevention Program
RAMP’s mission is to reduce the burden of asthma with a focus on health equity. Emphasizing both prevention and management, we build capacity, create linkages, and mobilize networks to advocate for policy and systems changes targeting the root causes of asthma disparities.
Advance Comprehensive Policies on Housing Quality, Affordability and Tenant Protections
RAMP advocates for safe and healthy housing for all Californians through: leadership of the California Healthy Housing Coalition, development of policies to promote a comprehensive approach to healthy housing, and partnerships with affordable housing developers to reduce pest infestations without the use of harmful pesticides. RAMP also works to advance a comprehensive approach to housing instability with health equity as a unifying concept.
Advocate for the Inclusion of Prevention-Oriented Asthma Services in Medi-Cal Coverage and Support Asthma Home Visiting Services
RAMP advocates for the inclusion of asthma home visiting services for Medi-Cal beneficiaries with poorly controlled asthma, and supports asthma home visiting programs through technical assistance. RAMP leads the California Asthma Financing Workgroup, which brings together stakeholders advocating for this shared goal. RAMP also convenes Community Health Workers and others providing asthma education to vulnerable communities in diverse settings for ongoing capacity-building workshops.
Increasing Public Health Engagement in Climate Change
RAMP partnered with other Pubic Health Institute leaders to develop a framework aimed at encouraging public health professionals to incorporate climate change into their existing work. RAMP also supported local projects demonstrating ways to connect climate change and public health.
Lead Community Action to Fight Asthma (CAFA)
Community Action to Fight Asthma (CAFA) is California’s only network dedicated to professionals working on asthma. CAFA provides opportunities for asthma coalitions and other stakeholders to benefit from peer learning and to create a unified voice on state level policy change.
Racial and Ethnic Approaches to Community Health
From 2007-2012, RAMP was designated a Center of Excellence in the Elimination of Disparities under a grant from the U.S. Centers for Disease Control’s REACH-US Program (Racial and Ethnic Approaches to Community Health). The project focused on a comprehensive approach to reduce asthma disparities among African-Americans and Latinos in the San Francisco Bay Area.
Shape Policies to Reduce Air Pollution in Inequitably Burdened Communities
RAMP focuses on the inequitable impact of air pollution on low-income communities and communities of color. RAMP addresses diesel pollution from the freight transportation sector, including ports, railyards, freeways and distribution centers. RAMP is currently conducting an assessment of the air quality and public health impacts of automating the freight sector. RAMP also advocates for policies that address cumulative impacts, meaning the combined impact of pollution from multiple sources.
Support Schools and School-based Health Centers in a Comprehensive Approach to Asthma Management
RAMP brings together school stakeholders to share lessons learned and document best practices. RAMP supports school-based health centers across the country in reducing environmental asthma triggers. RAMP has developed tools, conducted trainings, and currently leads learning collaboratives.
Here's How We're Making a Difference
Advancing Health Equity Through Healthy Housing Policies
In 2015, PHI's Regional Asthma Management & Prevention program (RAMP) played an important role in advocating for two new healthy housing policies passed in California—SB 328 and SB 655—that will reduce exposure to asthma triggers, particularly in low-income communities and communities of color.
In recognition of this work and ongoing efforts in this area, RAMP received the 2016 Housing and Urban Development Secretary’s Award for Healthy Homes on behalf of the California Healthy Housing Coalition. The award recognizes excellence in healthy housing innovation and achievement.
RAMP continued its successful work with California Healthy Housing Coalition partners to improve housing quality. Closing a loophole in California legislation RAMP worked to get signed (SB 328-Hueso), RAMP co-sponsored and the governor signed AB 2362 (Chu) to ensure tenants are notified of pesticide use, including those living in condominiums and townhomes.
In 2016, RAMP also co-sponsored a bill in California that gives tenants new rights when they discover dangerous mold, which is linked to asthma and other respiratory diseases. Now listed as a condition of substandard housing, tenants can hold landlords accountable if the problem is not fixed. Until the bill passed, tenants had few options if their residence had mold. With the new legislation, renters can now for the first time report mold problems to the city, which can then demand repairs and fine landlords who don't comply.
Advocating to Fund At-Home Services for Californians with Asthma
Asthma prevention starts at home—saving money and improving health. That’s why PHI’s Regional Asthma Management & Prevention program championed California policies to support reimbursement for asthma home visiting services, and developed a toolkit, "Leading the Way to Better Breathing: Managed Care Organizations and Asthma Home Visiting Services in California.” RAMP’s efforts buoyed a 2019 $15 million budget appropriation that will help some of the nearly two million child and adult Medi-Cal beneficiaries with asthma receive more prevention-based services and support. Learn more.
Boosting National Leadership Capacity to Act on Asthma
To share the best practices and learnings from California Healthy Housing Coalition model with other states, PHI's Regional Asthma Management and Prevention (RAMP) developed a “National Healthy Housing Learning Community” focused on state–level approaches to healthy housing. This network meets every other month to share experience on coalition building, policy development, and political strategies for healthy housing.
Participants are from Colorado, Nebraska, Montana, Minnesota, Georgia, Rhode Island, Michigan, Mississippi, New Mexico, Louisiana, Ohio, Georgia, and several regional offices of HUD and EPA. Based on member feedback, RAMP also added the National Center for Healthy Housing to provide updates on potential impacts from federal policy changes.
Ensuring Strong Health Measures in the California Sustainable Freight Action Plan
In response the Governor Brown’s 2015 executive order on reducing emissions from the freight sector, the California Air Resources Board and several other state agencies collaborated to develop the California Sustainable Freight Action Plan, released in July 2016. The Plan outlines a wide range of strategies that, in the long term, can transform the freight system.
As part of the California Cleaner Freight Coalition, PHI's Regional Asthma Management and Prevention program (RAMP) joined partners from across the state to advocate for strong, protective health measures in the Plan. In the months ahead, RAMP intends to help shape its implementation to continue their commitment to healthy, clean air for all.
Finding Innovative Ways to Sustainably Finance Asthma Management and Prevention
Regional Asthma Management and Prevention (RAMP) is leading the way in advocating for sustainable financing for asthma services in California, working to build significant momentum with asthma advocates across the state.
Through a multi-faceted approach, RAMP advanced the incorporation of evidence-based prevention activities in health care policies and practices—for example, working to increase the understanding of the Department of Health Care Services (DHCS) staff on effective asthma interventions that improve health outcomes and reduce utilization, which will impact 1.1 million Medi-Cal beneficiaries diagnosed with asthma. They've also trained 100 asthma advocates and policymakers on best practices and opportunities to influence state policy. And some of RAMP’s advocacy efforts are reflected in California's policies, such as the Health Homes Program development, the 1115 waiver language, a draft State Plan Amendment invoking the Preventive Services Rule, and the selection of asthma quality metrics for Medi-Cal Managed Care Organizations.
To learn more about RAMP's efforts to help secure sustainable financing for asthma education and home environmental trigger remediation programs in California, read the full report: A Path Forward: Sustainable Financing for Asthma Education and Home Environmental Trigger Remediation in California.
Improve Healthy Living Opportunities for Children by Advancing Policy and Systems Change
With support from the WK Kellogg Foundation, RAMP worked to reduce health inequities among vulnerable children. The project included three objectives: 1) Advance advocacy efforts to increase access to services aimed at preventing/reducing asthma and other housing illness and share such efforts as a model; 2) Advance policies aimed at protecting vulnerable children from environmental asthma triggers int heir homes and share policies as a model; 3) Increase the number of school-based health centers around the country engaged in interventions aimed at reducing environmental asthma triggers. As a result, RAMP produced "Sustainable Financing for Asthma Education and Home Environmental Trigger Remediation: Lessons Learned from the Field," provided funds and technical assistance to four school-based health centers in New Mexico, each of which conducted a small-scale environmental asthma intervention, and worked with the California Healthy Housing Coalition developed a series of narrated presentations to support landlords and affordable housing developers in making the switch to Integrated Pest Management.
Improving Air Quality Across California
Climate change worsens air quality, yet many climate strategies reduce other air pollutants as well. In California, PHI has assessed the health impact of proposed cap and trade regulations and been an active voice for health equity in the implementation of California’s Global Warming Solutions Act.
PHI’s Regional Asthma Management and Prevention program helped pass California diesel emissions regulations that are projected to prevent 150,000 cases of asthma, 12,000 cases of acute bronchitis and 9,400 premature deaths over 15 years.
Mobilizing School-Based Health Centers in Managing Children's Asthma
PHI's Regional Asthma Management and Prevention (RAMP) program is working to strengthen the capacity of school-based health centers (SBHCs) in the environmental management of asthma. In 2017, RAMP built the capacity of over 450 SBHC staff through trainings in 6 states and through national webinars, equipping them to improve asthma management and prevention for up to 2 million children.
The program also developed the Asthma Environmental Interventions Guide for School-Based Health Centers and disseminated it to over 3,000 people; supported 18 SBHCs in the implementation of asthma environmental interventions; and developed and disseminated 10 case studies to show what works.
Partnering with Community Health Workers to Better Manage and Prevent Asthma in California
RAMP is committed to increasing access to culturally-competent quality clinical care, and has long been committed to building the field of Community Health Workers (CHWs), who are often very successful in improving health outcomes and reducing healthcare utilization. Supporting CHWs also reflects the program's social justice focus, in that—as so many CHWs are members of the communities they serve—RAMP is building the capacity and workforce of community members.
In 2015-2016, RAMP convened Bay Area CHWs to help enhance their asthma management and prevention capacities, who in turn support over 900 families every year. In 2017, RAMP continued to host regular capacity-building workshops for CHWs across the Bay Area. Regular participants include CHWs and other asthma educators who work with vulnerable populations.
In 2017, RAMP also advocated strongly for a California bill authorizing Medi-Cal reimbursement for CHWs and others to provide asthma education and in-home environmental assessments—a bill that passed through every legislative vote with bi-partisan near-unanimous support.