Millions of Americans are struggling to breathe, and it's not just about the air they inhale. Lung health has reached a crisis point, with chronic respiratory diseases affecting over 35 million people in the US. COPD alone is projected to cost a staggering $60.5 billion annually by 2029, and lung cancer remains the leading cause of cancer deaths, impacting 1 in 18 Americans. But here's where it gets even more alarming: 13% of lung cancer diagnoses occur in individuals who have never smoked, highlighting the complex and multifaceted nature of this issue.
This crisis isn't evenly distributed. And this is the part most people miss: According to the American Lung Association’s State of the Air 2025 report, nearly half of the US population lives in areas with poor air quality, and people of color, who make up 41% of the population, bear a disproportionate burden, representing over 50% of those exposed to the worst air quality. Wildfire smoke, rising ozone levels, and fine particulate matter are exacerbating these disparities, undoing decades of progress in clean air initiatives and leaving vulnerable communities further behind.
So, what can we do about it? AstraZeneca took a bold step by convening a powerful dialogue on lung health during Aspen Ideas: Health 2025, bringing together diverse voices to tackle this urgent public health challenge. The session, Breathing New Life: Addressing Lung Health in America, highlighted the interconnected risks of asthma, COPD, and lung cancer, emphasizing the need for an integrated, equitable approach to prevention, early detection, and care. The conversation marked a turning point: lung health could no longer be addressed in isolation but required collaboration across sectors.
At the 2025 Lung Health Roundtable, the focus shifted to state-level solutions. With states holding significant responsibility for Medicaid policy, community health infrastructure, and digital health regulation, the panel asked: What will it take to break down silos and achieve equity, technological advancement, and policy alignment at the state level?
Mohit Manrao, President of the AstraZeneca Foundation, set the tone: “We cannot solve lung health challenges in silos. The states that succeed will be the ones that integrate policy, digital infrastructure, and equity from the ground up.” This call to action was guided by AstraZeneca’s broader US Health Equity Ambition, centered on science, delivery, community, and people.
Early Detection: The Lifesaving Power of Screening
Laura Kate Bender from the American Lung Association highlighted the stark reality: “We know screening saves lives, but low awareness, stigma, and other barriers keep screening rates low.” States can play a pivotal role by funding mobile units and partnering with community organizations to reach rural areas and reduce barriers. Kentucky, for instance, serves as a model for state investment and collaboration.
Dr. Eric Flenaugh pointed out that lung cancer screening is still in its infancy, with evolving criteria and limited integration into routine protocols. Most diagnoses come from incidental findings, and follow-up remains a challenge. “We have to think outside the box,” he urged, calling for more inclusive research and interdisciplinary coordination.
But here’s the controversial part: While screening is critical, the financial burden on states and families is immense when diagnoses are delayed. Every year screening is postponed, the strain on Medicaid programs and vulnerable families grows. Is enough being done to prioritize early detection?
Equity and Underserved Populations: Meeting Patients Where They Are
Dr. Christina Harris from Cedar-Sinai delivered a powerful statement: “If you want to change outcomes, you have to change the rules. If we don’t meet patients where they are, they won’t come—no matter how advanced our technology is.” Expanding insurance access and ensuring continuous coverage are essential, as lack of coverage reduces preventive screenings and worsens outcomes. With federal Medicaid changes on the horizon, states must invest in outreach, education, and trusted provider networks serving hard-to-reach communities.
Jonathan Dayton emphasized the importance of changing patient perspectives: “Even when screening sites are available, patients often don’t show up. Without good data, we don’t understand why.” Community partnerships are key to building trust and overcoming skepticism.
But here’s where it gets controversial: Federally Qualified Health Centers (FQHCs), vital for building trust, face precarious funding due to potential federal budget cuts. Are we doing enough to protect these critical programs, or are we risking further inequities?
As a researcher with the LA Fire Health Study, I’ve witnessed how inequities widen in the aftermath of disasters. In Altadena, CA, a diverse community vulnerable to wildfires, indoor air quality worsened in over 1,000 homes, even miles from burn zones. Families unable to relocate or remediate remain exposed long after the flames are gone. This highlights policy gaps: communities need dedicated funding for air quality monitoring, remediation, and lung cancer screenings as part of disaster recovery.
Digital Health and Data: Promise and Perils
The digital health discussion underscored that technology is not a magic bullet. AI-assisted CT scans can reduce variability in interpretation, but without standardized state guidelines, innovation remains inaccessible to many. Dr. David M. Mannino warned: “We’ll end up with a patchwork system where only some benefit.”
Dr. Flenaugh added: “We can’t let the hype around AI obscure equity. If technology doesn’t reach safety-net clinics and Medicaid systems, it reinforces silos instead of breaking them.” Panelists agreed that technology must complement, not replace, trust. “Parachuting in answers won’t work—we need long-term relationships,” one noted.
From Evidence to Action: Calls to States
Key opportunities for state action emerged: promote screenings, support respiratory health initiatives, fund trusted outreach, invest in interoperable digital infrastructure, protect climate-vulnerable communities, and sustain community partnerships.
AstraZeneca’s commitment to health equity is evident through its support for rural lung cancer screening, digital health pilots, broader clinical trial representation, and expanded community partnerships.
Conclusion: Breaking Silos, Building Trust
The 2025 Lung Health Roundtable concluded with a shared recognition: the fight for lung health equity requires state-level action. As a researcher, I’ve seen how national insights mirror local realities. Communities like Altadena, with their diversity and resilience, are also among the most vulnerable. Breaking silos allows us to invest in building trust, staying proximal to the problem, and aligning inclusive systems.
The call to states is urgent and clear:
- Lead with equity as the compass.
- Use digital tools as the bridge.
- Ground policy in evidence and accountability.
- Invest early and consistently in trusted networks.
But here’s the ultimate question: Are we willing to prioritize lung health equity with the urgency it deserves, or will we continue to let millions suffer? The cost of delay is measured not just in billions of dollars, but in the health and survival of millions of Americans. What’s your take? Share your thoughts in the comments—let’s spark a conversation that drives change.
