Décadas de crisis: Adecuación de un marco socio-ecológico para estimar qué elementos estructurales afectan a las tasas de asma en el sur del Bronx / Decades in crisis: adapting a social-ecological framework to assess structural elements impacting asthma rates in the South Bronx

Renan Eduardo Orellana, Ismael Moradeyo, Paul Uzodinma

Resumen


Se han documentado tasas inquietantemente altas de hospitalizaciones relacionadas con el asma en el sur del Bronx durante varias décadas. La crisis se ha caracterizado por la violencia estructural, la inequidad en la salud y la exposición desproporcionada a los daños ambientales, con la carga de la enfermedad del asma mal controlada que recae principalmente en las minorías raciales y étnicas socioeconómicamente vulnerables. Esta revisión adapta el modelo socioecológico (SEM) como un marco basado en la teoría para analizar críticamente las disparidades en la atención y el control del asma en el sur del Bronx. El análisis se basa en consideraciones históricas de la violencia estructural, en particular el legado de los terrenos baldíos, los vertidos tóxicos, la política de trastienda y los arreglos sociales que perpetúan las disparidades en la atención médica y la salud. Este modelo puede guiar el desarrollo de intervenciones de múltiples niveles, incluida la gestión médica sostenible del asma, particularmente en el contexto de la actual crisis de asma en el sur del Bronx y su desastrosa superposición más reciente con el brote de COVID-19 que ha devastado a Nueva York. Ciudad.

Abstract

Disturbingly high rates of asthma-related hospitalizations have been documented in the South Bronx for several decades. The crisis has been typified by structural violence, health inequity, and disproportionate exposure to environmental harms, with the disease burden of poorly controlled asthma falling primarily on socioeconomically vulnerable racial and ethnic minorities. This review adapts the Social-Ecological Model (SEM) as a theory-based framework to critically analyze disparities in asthma care and control in the South Bronx. The analysis is grounded in historical considerations of structural violence, particularly the legacy of brownfields, toxic dumping, backroom politics and social arrangements that perpetuate disparities in medical care and health. This model can guide the development of multi-level interventions, including the sustainable medical management of asthma, particularly in the context of the ongoing asthma crisis in the South Bronx and its more recent disastrous overlap with the COVID-19 outbreak that has devastated New York City.

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