Environmental Justice

Conference & Training

Program
Ruth Ann Norton
President & CEO
February 5, 2015
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[1]

Problem/Root Cause
In 2010, 18.7 million adults and 7 million
children had asthmaa 15% rise since
2001. Asthma medical costs are $50.1
Unhealthy
billion/year.
Home
Guidelines-based care calls for 1)
Assessment of disease severity; 2)
Medication; 3) Patient education; and Treatm
Asthma
ent/
4) Environmental control.
tic Child
Inhaler
Evidence base: HHSs Community
Preventive Services Task Force found
Hospit
strong evidence of effectiveness of inal Visit
home environmental interventions in
improving asthma management and
overall quality of life for asthmatics.
ROI : HHSs economic review of published
studies showed a return of $5.3 to $14 for
each $1 invested.
Quick
payback
and All
easily
identifiable
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Green & Healthy
Homes Initiative.
rights

GHHI Solution:
A Model That Benefits Families

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[3]

Solution: Baltimore
PFS Model

Target
setting

Loan
for
service
s

Risk
mitigatio
n

Monetize
d
savings

Loan repayment

Evaluatio
n

Guarantee

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[4]

Policy Implications
SIBs/PFS can lead to sustainable funding for
Healthy Homes
Solving the wrong pocket problem
Investment directed
produced
to improve housing
healthcare

Savings
for

Building the evidence to promote policy change

Rigorous evaluation
Proving model at scale
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Healthy
Homes Initiative.risk
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Eliminates
to government / healthcare
/ education [ 5 ]

Impacts
ROI: HHSs economic
review of published studies
showed a return of $5.3 to
$14 for each $1 invested
in environmental asthma
interventions
MN Dept of Health:
Reducing Environmental
Triggers of Asthma
program produces cost
savings of $1,960 per
patient over 1-yr period
Seattle King County
Healthy Homes II project
found additional benefits
of adding environmental
trigger reduction above
2014 Green & Healthy Homes Initiative. All rights

Baltimore Demonstration
Project1 Impact on asthma:
66-70% reduction in asthmarelated client hospitalizations
28-60% reduction in asthma ER
visits
50% increase in participants
never having to visit the
doctors office due to asthma
episodes
62% increase in participants
reporting asthma-related perfect
attendance for their child (0
school absences due to asthma
episodes)
88%
Peer-reviewed
and published
Environmental
increase
in inparticipants
Justice journal
reporting never having to miss a
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day of work due to their childs
1

Findings: Healthy Homes

Demonstration Project

Mean Change and

200 units completed with 139 respondents
Percent Reduction of Key completing
6 month post intervention health surveys
Outcomes
In the past 6
months (N=139)

Hospitalizations

ER Visits

Physician Visits

Calls to Physicians

Work missed

School/ daycare
missed

Intake
Mean (StdDev)

6 Month
Mean (StdDev)

0.364288
(0.923013)

0.141791
(0.53667)

0.942857
(1.22193)

0.701493
(1.097022)

1.76258
(1.462491)

1.340909
(1.413293)

2
(1.498792)

Pre Post Mean

Change
(StdDev)

One-sided t test

Percent
Reduction

0.238806
(0.824248)

0.0008

65.5%

0.261194
(1.250137)

0.015

27.7%

0.389313
(1.460098)

0.002

22%

1.481203
(1.490381)

0.515152
(1.565296)

0.0002

26%

2.76259
(1.954492)

1.736842
(1.85413)

1.037879
(2.057959)

0.0000

37%

2.372093
(2.008069)

1.787402
(2.091669)

0.647059
(1.998254)

0.0002

27%

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[7]

Data Reduction in Asthma

ER visits
ER visits at 6 Month Assessment

ER Visits at Intake

ER Visits

ER Visits

6%

0 time

6%

1 time

14%

2 times
52%

3 times

13%

80%

2014 Green & Healthy Homes Initiative. All rights

2 times
3 times

16%

64%

4+ times

ER Visits at 12 Month Assessment

ER Visits at 9 Month Assessments

5% 1% 1%

1 time

10%

4+ times

22%

0 time

6% 3%

0
times
1 time
2
times
3
times

4% 1% 3%
6%

0 times
1 time
2 times
3 times
4+ times

86%

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[8]

Data Reduction in Asthma

Hospitalizations
Hospital Admissions at Intake

3% 4% 3%
9%

Hospital Admissions at 6 Month Assessment

Night
in hospital
0 time
1 time

0 time
1 time

2 times

2 times

3 times

3 times

4+ times

4+ times

82%

91%

Hospital Admissions at 9 Month Assessment

3% 1%

5% 1% 2%

0 times
1 time

Hospital Admissions at 12 Month Assessment

3%

0 times
1 time

2 times

2 times

3 times

3 times

4+ times

4+ times

96%

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97%

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[9]

Data Increase in Asthma Action

Plans
Use of Asthma Action Plan at Intake

Use of Asthma Action Plan at 6 Month Assessment

8%

6%
Dont No
know

40%

55%

2014 Green & Healthy Homes Initiative. All rights

Yes

56%

36%

Don't
know

No

Yes

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[ 10 ]

Data Reduction in Missed

School Days
Missed School/Daycare at 6 Month Assessment

Missed School/Daycare at Intake

1 time

1 time
2 times

8% 2%
16%
28%

3 times

12%
7%

Never

Missed School/Daycare at 9 Month Assessment

67%

48%

8%

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Not Applicable

1 day
6%

3 days

10%

4 days
None

More than 5 times

10%

2 days

5 or more days

4 times

Missed School/Daycare at 12 Month Assessment

1 day
7%
6%
4%

3 times

Never

19%

Not Applicable

28%

9%

5%
10%

4 times
More than 5 times

2 times

6%7%
5%

60%

7%
7%

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2 days
3 days
4 days
5 or more days
None

[ 11 ]

Data Reduction in Missed

Work Days
Missed Work Days at Intake

Missed Work Days at 6 Month Assessment

Missed HH work
1 time

1 time
7% 3%

1%5%

2 times
18%

3 times
4 times

30%

11%
6%

More than 5 times

14%
6%

NA

7%

7%
2%
65%

11%

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7%
4%
4%

3 times
4 times
Never

1 time

11%

2 times

5 or more times

Never

Missed Work Days at 12 Month Assessment

1 time
9%

More than 5 times

Not Applicable

14%

25%

3 times
4 times

44%

Never

Missed Work Days at 9 Month Assessment

2 times
16%

64%

9%

2 times
3 times
4 times
5 or more times
Never

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[ 12 ]

Questions?
Ruth Ann Norton
President & CEO
ranorton@ghhi.org
410-534-6447
@RuthAnnNorton
Follow us on Twitter @HealthyHousing
Like us on Facebook @GHHINational

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[ 13 ]