By NanaEfua Afoh-Manin MD, MPH, MPA
Why Lung Health, Why Now?
Lung health has reached a critical inflection point. Chronic respiratory diseases affect more than 35 million Americans, and COPD alone is projected to cost the US $60.5 billion annually by 2029.1 Lung cancer remains the leading cause of cancer deaths, with 1 in 18 Americans facing a lifetime diagnosis risk.2 Likewise this threat affects 13% of people diagnosed with lung cancer who have never smoked.3
These burdens are not evenly distributed. According to the American Lung Association’s State of the Air 2025 report, 156 million Americans — nearly half the country — live in counties with poor air quality.6 People of color represent 41% of the US population but make up more than 50% of those living with the nation’s worst air quality.5 Wildfire smoke, rising ozone levels, and fine particulate matter are increasingly driving these inequities, erasing decades of clean air progress and pushing vulnerable communities further behind.
Looking Back, Moving Forward
AstraZeneca convened a powerful dialogue on lung health during Aspen Ideas: Health 2025, bringing together diverse voices to confront one of America’s most urgent public health challenges. The breakfast session, Breathing New Life: Addressing Lung Health in America, explored how disparities in diagnosis, treatment, and access continue to impact vulnerable communities. Experts underscored the shared risks that connect asthma, COPD, and lung cancer—and called for a more integrated, equitable approach to prevention, early detection, and care. The conversation marked a pivotal moment: lung health could no longer be treated in silos, but as a unifying cause demanding collaboration across sectors. (Aspen AZ Roundtable, 2025)
Now, at the 2025 Lung Health Roundtable, the focus sharpened. With state governments carrying much of the responsibility for Medicaid policy, community health infrastructure, and digital health regulation, the panel asked: What will it take to break down silos and deliver equity, technology, and policy alignment at the state level?
As moderator Mohit Manrao, President of the AstraZeneca Foundation and Senior Vice President, Head of US Oncology Business Unit, framed it, “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.”
His call set the tone for a discussion guided by AstraZeneca’s broader US Health Equity Ambition, built around science, delivery, community, and people.
Early Detection: Screening Saves Lives
Laura Kate Bender, Vice President of Nationwide Advocacy and Public Policy at the American Lung Association, noted:
“We know screening saves lives, but low patient and provider awareness, stigma, and other factors keep screening rates low. States can fund [efforts like] mobile units and other programs to reach rural communities, and partner with community organizations to reduce barriers to screening.”
She pointed to Kentucky, a model for state investment and collaboration.1
Dr. Eric Flenaugh, Chief and Director of Pulmonary, Critical Care, and Interventional Pulmonary Medicine at Grady Memorial Hospital/Morehouse School of Medicine, observed:
“Lung cancer screening is still the new kid on the block!”
Criteria are evolving, but screening is not yet part of routine protocols. Most diagnoses still result from incidental findings, and tracking patients for follow-up is a challenge. “We have to begin to think outside of the box,” he added, urging research data to be more inclusive and coordinated across disciplines.
Moderator Manrao tied their points together with a fiscal argument: when patients are diagnosed late, the human cost is devastating, but so is the financial cost to states. Every year screening is delayed, the burden on Medicaid programs and families least able to afford it grows.
Actionable takeaways to improve lung cancer screening: Promote screening to eligible populations, expand mobile/community-based programs, continue to support research to inform guidelines, and standardize state coverage for advanced diagnostics.
Equity and Underserved Populations: Meeting Patients Where They Are
“If you want to change the outcomes – you have to change the rules.” A profound statement asserted by Dr. Christina Harris, Vice President and Chief Health Equity Officer at Cedar-Sinai led this segment. “If we don’t meet patients where they are, they won’t come — no matter how advanced our technology is.”
She emphasized that expanding insurance access to ensure continuous coverage is essential, as lack of coverage reduces the likelihood of preventive screenings and compromises outcomes. As changes to the federal Medicaid program loom, this point is particularly salient. Dr. Harris urged states to invest Medicaid resources in outreach, education, and trusted provider networks serving hard-to-reach communities
This point was echoed by Jonathan Dayton, Executive Director of the Maryland Rural Health Association, who emphasized that changing patient perspectives is key to buy-in:
“Even when screening sites are available, patients often don’t show up. Without good data, we don’t understand the why.” Community partnerships, he stressed, are essential to overcome skepticism and build trust.
Gilmar Flores, Director of Programs and Research at Breathe Southern California, added:
“States have a policy toolbox, but too often budget cuts erode the very programs communities rely on. Without sustained advocacy, community voices are sidelined.”
Federally Qualified Health Centers (FQHCs) remain a cornerstone for building trust and maintaining community presence. Yet with threats of federal budget cuts, their funding remains precarious. Flores noted that foundations are becoming savvier about public–private partnerships, and this should be encouraged at the state level, so strong programs are not lost during turbulent times.
As a researcher with the LA Fire Health Study and Impact Consultant for the Altadena Forward Alliance, I’ve seen inequities widen in the nine months following the Eaton Canyon Wildfire. In Altadena, CA — a racially and economically diverse community vulnerable to urban wildfires — data show how indoor air quality worsened in over 1,000 homes, even miles from burn zones.4 Families unable to relocate or remediate remain exposed long after the flames die out. This evidence points to policy gaps: communities need dedicated funding streams for residential air quality monitoring, remediation and Lung cancer screenings as part of disaster recovery. Investing in localized testing infrastructure is essential to prevent long-term respiratory harm in fire-impacted neighborhoods and their borders.
The panel also drew lessons from Native American communities, where health initiatives succeed only when built on longstanding, trusted networks. Short-term interventions that “parachute in” fail, while culturally grounded partnerships endure.4
Moderator Manrao concluded:
“Equity cannot be an afterthought. If we don’t integrate it into state policies from the start, we hardwire inequities into the system. And that begins with investing in the trusted networks that communities already turn to.”
Actionable takeaways: Fund trusted networks early and consistently — from FQHCs and CHWs to churches and culturally responsive messengers. Protect programs from budget cuts and embed equity metrics in policy evaluation and disaster recovery.
Digital Health and Data: Promise and Perils
The digital health conversation took on the tone that essentially echoed that every technology that glitters isn’t gold – and that the promise of AI technology is less a magic bullet than tools that will naturally enhance and augment the strengths and weaknesses in these organizational systems. It was explained that the vast majority of incidental cancer findings came from trauma cases where several images were lost to follow up; unloading Primary Care doctors with information without guidelines. How can the EMR better provide workflow pathways for them to act on it?
Dr. David M. Mannino III, Chair of Department of Occupational Medicine and Environmental Health at the University of Kentucky Health Systems, emphasized:
“AI-assisted CT scans can reduce variability in interpretation, but without consistent and standardized state guidelines and coverage, we’ll end up with a patchwork system where innovation is only available to some.”
Dr. Flenaugh warned:
“We can’t let the hype around AI obscure equity. EMRs and reimbursement models aren’t aligned to support the patients who need the most. If technology doesn’t reach safety-net clinics and state Medicaid systems, it reinforces silos instead of breaking them.”
Panelists agreed that technology must complement, not replace, trust.
“Parachuting in answers will not be helpful — we need long-term relationships, not extractive ones,” one noted. Moreover, we have collected a lot of data and produced many dashboards, but we have yet to be able to successfully tell the true story of impact.
Actionable takeaways: Invest in state-level interoperable data systems with equity metrics. Extend AI and EMR tools to rural and safety-net providers and embed trusted community partnerships in their design and rollout.
From Evidence to Action: Calls to States
Throughout the roundtable discussion key opportunities for state action emerged. First and foremost, capture the low hanging fruit – the things that are already happening and throw additional resources to support them. Key opportunities for state action emerged:
- Promote screenings to eligible populations.
- Support respiratory health initiatives for chronic respiratory disease.
- Fund trusted outreach through Medicaid and health departments.
- Invest in interoperable digital infrastructure with equity metrics.
- Protect climate-vulnerable communities with monitoring and remediation.
- Sustain community partnerships with shared data, collaboration, and insulation from budget volatility.
Bender reminded the group of the power of storytelling: “Pairing personal stories to advocacy is what moves the needle for policy decisionmakers.”
AstraZeneca’s Commitment
For AstraZeneca, the roundtable is more than a convening. It reflects the company’s US Health Equity Ambition, guiding action through science, delivery, community, and people. Over the past year, AstraZeneca has:
Supported rural lung cancer screening initiatives.
Advanced digital health pilots.
Encourage broader clinical trial representation.
Expanded partnerships with community-based organizations.
As Manrao emphasized in his closing, education drives the uptake in the volume of screening and thinking about the social determinants indices helps identify nontraditional opportunities for intervention. Some that were highlighted included involvement of schools and churches for Asthma education and the success of social media marketing campaigns, such as Truth.org, to get the message to target populations and the importance of CMS and payers to reimburse for education and further help fund novel screening programs.
Conclusion: Breaking Silos, Building Trust
The 2025 Lung Health Roundtable closed on a shared recognition: the fight for lung health equity must move beyond national rhetoric to state-level action. The goal of the roundtable was not simply to discuss solutions, but to begin building them — state by state, community by community. As a research partner with the LA Fire Health Study, I was struck by how the panel’s national insights echo local realities. Communities like Altadena, with their diversity and resilience, are also among the most vulnerable. Breaking silos allows us to make the necessary investment in building trust with communities, staying proximal to the problem, and aligning systems that are effective and inclusive.
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.
And above all, invest early and consistently in trusted networks.
The cost of delay is measured not only in billions of dollars, but in the health and survival of millions of Americans.
References:
- American Lung Association. State of the Air 2025. Chicago, IL: American Lung Association; 2025.
- Kentucky Cancer Consortium. Kentucky Lung Cancer Screening Program Report. Lexington, KY: Kentucky Cancer Consortium; 2024.
- Siegel DA, Fedewa SA, Henley SJ, Pollack LA, Jemal A. Proportion of Never Smokers Among Men and Women With Lung Cancer in 7 US States. JAMA Oncol. 2021;7(2):302–304. doi:10.1001/jamaoncol.2020.6362
- LA Fire Health Study: Data Brief 2 – Indoor Air Quality Post-Fire. Los Angeles, CA; March 5, 2025.
- LA Fire Health Study: Data Brief 3 – Volatile Organic Compounds in Impacted Households. Los Angeles, CA:March 14, 2025.
- Unga 2025 Roundtable Notes (AstraZeneca). Lung Health Roundtable Discussion Guide and Proceedings. New York, NY: September 18, 2025.