Outline

Health and Housing Connection Examples of Health and Monetary Benefits of Improved Housing and Health Data Needs for Assessing Health Outcomes in Green Development Preliminary Results of Health Studies of Green Housing Wheeler Terrace in Washington DC

Florence Nightingale
The connection between health and the dwelling of the population is one of the most important that exists.
Cited in Lowry, S, BMJ, 1991, 303, 838-840

Health in the Late 19th Century

Challenge of Tuberculosis Seemed Insurmountable Lessons for Public Health Officials, Architects and Planners: Better Ventilation, Reduce Crowding, Improve Housing Sanitation (Plumbing) With Improved Living Conditions & Medical Interventions, Disease Rates Declined

Re-establish the Housing/Health Collaboration

Green Developers, Builders, Others Weatherization Professionals Public & Environmental Health Housing Professionals Banks & Other Financial Institutions Government Rehab Professionals Many others

Is Housing a Shared Commons? Is Housing Part of the Infrastructure?

Cuyahoga River ca. 1960

Medical Care Costs and Housing Improvement

US Policies & Blood Lead 1971-2004

Lead-based Paint Poisoning 18 Prevention Act (1971) Air & Ind Workplace Standards (1978) Residential Lead Paint Ban (1978) Lead in Plumbing banned (1986) Lead Contamination Control Act (1988) Virtual Elimination of Lead in Gasoline McKinney Act Public Housing Abatement (1989) Title X Housing & Community Development Act (1992) Federally Assisted Housing Rule 1999

Blood Lead Levels (/dL)

16 14 12 10 8 6 4
Phaseout gasoline & lead soldered cans (1973)

Private Housing Lead Paint Grants (1991) Ban on lead solder in food cans (1995) Const Work Stds (96) Lead Disclosure Rule (1996)

Housing Lead Dust & Soil Std Published (1999 & 2001)

Renovation/ Painting Rule Published (2008)

Housing units with lead paint reduced by 40% since 1990

2.7 % 2.2 % 1.6 % 1.2 %

7 8 80 82 84 86 88 90 92 94 96 98 00 02 04

2
0 72 74 76

Year

Power of Housing & Health Surveillance Data: Dust Lead and Windows

Benefits of Window Replacement

Lead Dust Accumulation Energy Savings: Heating and Cooling Housing Value Other?

Window Replacement Costs and Benefits

$25,000 $20,000 $15,000 $10,000 $5,000 $0 Upgrade Cost Market Value Health Benefit Cleanup & Clearance Window Replacement Health Benefit Other Value Energy Value

Total Net Benefits of Lead Safe Window Replacement

Pre-1940 Housing
$5,092

x 11 million units with single pane lead contaminated windows = $56 billion

Pre-1960 Housing
$1,

092 x 11 million units with single pane lead contaminated windows = $11 billion Total = $67 billion

Data Needed for Cost Benefit Analysis of Green Healthy Housing

Housing Conditions that Impair Health (1) Housing Improvements that Advance Health (2)

Housing Conditions That Affect Health (1)

Categories: Sufficient Scientific Evidence Some Scientific Evidence Insufficient Evidence
World Health Organization (WHO)

Sufficient Evidence (WHO, 2005)

PHYSICAL FACTORS: Heat and related temperatures and winter excess mortality Cold indoor temperatures and winter excess mortality Energy efficiency of housing and health Radon exposure in dwellings and cancer Neighborhood and building noise and related health effects SOCIAL FACTORS: Multifamily housing, highrise housing, housing quality and mental health

CHEMICAL FACTORS: ETS exposure in dwellings and respiratory and allergic effects Lead-related health effects BIOLOGICAL FACTORS: Humidity and mold in dwellings and related health effects Hygrothermal conditions and house dust mite exposure

Some Evidence (WHO, 2005)

PHYSICAL FACTORS:

BUILDING FACTORS:

Ventilation in the dwelling and respiratory and allergic effects VOCs and respiratory, cardiovascular and allergic effects

CHEMICAL FACTORS:

Sanitation and hygiene conditions and related physical health effects Social conditions of housing and fear/fear of crime Poverty and social exclusion and related health effects Crowding and related health effects Social factors/social climate and mental health

SOCIAL FACTORS:

BIOLOGICAL FACTORS:

Cockroaches and rodents in dwellings and respiratory and allergic effects Cats, dogs and mites in dwellings and respiratory and allergic effects Pets and mites and respiratory, allergic or asthmatic effects

Housing Changes Scientifically Shown to Improve Health (2)

Proven Healthy Housing Improvements

Asthma Interventions Integrated Pest Management Moisture Intrusion Reduction Radon Mitigation Lead Hazard Control Smoke & CO Alarms Pre-Set Hot Water Temperature

Green Communities Minnesota Case Study

Green Rehab Elements at Viking Terrace

Viking Terrace Results

Child's Health Compared to When In Old Home

29%

57% 14%

Better Now

Worse Now

About the Same

Viking Terrace Results

Adult's Health Compared to When in Old Home

37% 52%

11%

Better Now

Worse Now

About the Same

Viking Terrace Results

Comfort in Apartment Compared to Old Home

17% 10%

73%

More Comfortable

Less Comfortable

About the Same

Viking Terrace Results

Ease of Cleaning Compared to Old Home

27%

10%

63%

Easier

Harder

About the Same

Viking Terrace Results

Amount of Time Children in Household Play Outside Compared to Old Home

27%

9%

64%

Play Outside More

Play Outside Less

About the Same

Viking Terrace Results

Safety of Building Compared to Old Home

52%

41% 7%

Safer

Less Safe

About the Same

Housing Improves Asthma

Breathe Easy Homes: Health Outcomes With $ Benefits

Change in No. of Asthma Symptom Days:

4.8

days for each two week period (p<0.004) improvement (p<0.002) reduction (p<0.001)

Change in Caretaker Quality of Life:

80%

Reduced Visits to Urgent Care:

40%

Aerial Imagery

Making Low-Income Housing Rehab Green and Healthy Wheeler Terrace, DC

Partners
National Center for Healthy Housing Community Preservation and Development Corporation Wiencek + Associates Architects + Planners, PC Wheeler Terrace Tenant Association GreenHOME DC Department of Health HUD (Healthy Homes grant)

Wheeler Terrace Green Healthy Housing Redevelopment

Health outcomes measured using validated instrument from Centers for Disease Control and Prevention
Asthma

Injuries
Mental

Health Cardiovascular

Allergen levels

Project Approach

Examples of Healthy Homes Interventions 113 housing units

Upgrade HVAC system: Fresh air Integrated Pest Management Low-VOC carpets New ducted range hoods Bathroom exhaust fans

Moisture Control
Energy Efficiency

Conclusions

A National Conversation
High Costs of Health Care/Health Insurance Mortgage & Affordable Housing Crisis Economic Recovery Green Investment in Housing Improves Health and Reduces Health Care Costs An Unprecedented Convergence!!

Contact Information
David Jacobs, PhD, CIH Research Director National Center for Healthy Housing 202-607-0938 djacobs @nchh.org www.nchh.org