The US Healthy Housing Program

The US Healthy Housing Program

David E. Jacobs, PhD, CIH Chief Scientist, National Center for Healthy Housing Director, Collaborating Center on Health Housing Training & Research, US University of Otago, Wellington New Zealand February 2019

WHO Collaborating Center for Healthy Housing Research & Training, US

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Healthy Homes Principles

Keep It: 1. Dry

2. Clean

3. Ventilated

4. Pest-Free

5. Safe & Accessible

6. Contaminant-Free

7. Maintained

8. Affordable

9. Thermally Controlled

Multiple Impacts

Water leaks

Housing problems cause a ripple effect of impacts.

Here is an example of how a single housing problem – water – can lead to multiple health effects

and economic impacts:

Electrical hazards

Lead

Damp and mold

growth

Structural collapse

Allergies Asthma

Burns

Electric shock

Legend

l Housing problem

l Hazard

l Health effect

l Costs to the Individual

l Costs to Society

Physical injuries

Lack of employment

Learning difficulties

School absenteeism

Academic failure

Strategic Framework

What is the Extent of the Problem?

Why Does Our Work Matter?

What Does OLHCHH Do Now?

What More Can We Do?

What is Unhealthy Housing?

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Learning disabilities

(OLHCHH, 2016)

Hyperactivity

Reduced IQ

Health Problems

Life-long health problems

Socialization problems

Criminal history

Healthcare

Hospitalization Joblessness

Special education

Juvenile and criminal justice

Behavioral problems

Mission, Vision, and Goals

Goals

Building a National Framework

Creating Healthy Housing through Key Research

Mainstreaming the Healthy Homes Approach

Enabling Communities to Create and Sustain

Healthy Homes

Vision

To lead the nation to a future where homes are both affordable and designed, constructed, rehabilitated, and maintained in a manner that supports the health and safety

of occupants.

Mission

To help all Americans, but especially children and other vulnerable populations in low-income households, reach their full potential by making homes safe and healthy.

5 (OLHCHH, 2009, Healthy Homes Strategic Plan)

What is Unhealthy Housing?

What is the Extent of the Problem?

Why Does Our Work Matter?

What Does OLHCHH Do Now?

What More Can We Do?

Strategic Framework

Housing with Severe and

Moderate Deficiencies (US)

6.6%

5.5%

2.8%

3.2%

2.5%

1.5%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

Non-Hispanic Black Hispanic Non-Hispanic White

Per

cen

t

Race/Ethnicity

Inadequate Housing by Race/Ethnicity

moderate

severe

Source: American Housing Survey, 2011

Surgeon General’s Call to Action

A healthy home is sited, designed, built, renovated, and maintained in ways that support the health of residents.

Journal of Public Health Management

Practice, 2015, 21(4), 345–354

The MIGHHTY STUDY: Moving Into Green Healthy Housing: The Yield in health

Statistically Significant Results (p<0.05)

• Housing conditions and self-reported physical and mental health

• Hay fever, headaches, sinusitis, angina, and respiratory allergy.

• Asthma severity (lost school/work days, disturbed sleep, and symptoms)

• Improved sadness, nervousness, restlessness, and child behavior

Breathe Easy Home Health Improvements in Asthma

Health Outcome Change

Symptom-free days/2 weeks 4.8 fewer days/2 weeks (p=0.004)

Urgent Clinical Care Trips (% reduction) 41.2% (p=0.002)

Asthma Triggers in House Dust 2.0 before/0.03 after

Caretaker Quality of Life Score 4.9 before/5.8 after

• Breysse et al. 2015 - improved mental health, falls, and adult general health

• Colton et al. 2014 - improved PM2.5, NO2, and 47% less symptoms);

• Breysse et al. 2011 - improved general health, asthma and respiratory health);

• Takaro et al. 2011 - reduced asthma symptom free days, ER visits, caretaker quality of life and lower asthma triggers);

• Jacobs et al. 2014 - improvements in allergens and adult general health;

• Garland et al. 2016 - decreases in asthma & respiratory symptoms, urgent visits to a healthcare professional for asthma and fewer days of work, school, or daycare missed).

Green Building/Weatherization/Energy Conservation/Building Performance

Summary of 72 US Healthy Housing Studies

• https://www.hud.gov/program_offices/healthy_homes/hhi/hhts

HHTS & LTS Grant Programs Abstracts FY 2006 – 2017 (Link is on the right side of the page)

The principal investigator, award amount, grant number and citations for publications resulting from the studies

Who Should be Involved?

The per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit. The average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit

Healthy Housing &Disaster Recovery

To reduce housing-related health risks, federal, state, and local governmental housing agencies should: • require that new residential construction and substantial

rehabilitation of existing residences financed with public funds after disasters comply fully with Enterprise Green Communities standards or their equivalent and with the minimum requirements set forth in the National Healthy Housing Standard.

• Federal and state funding agencies should tie these requirements to recovery funds, and private funders should consider incentivizing compliance with these standards.

• Additionally, multiple affordable housing options should be considered during redevelopment to ensure that people of all income levels can remain in the community.

Recommendation 12: Ensure Healthy and Affordable Post-Disaster Housing.

The Origin of US Healthy Housing

National Safe and Healthy Housing Coalition

http://www.nchh.org/Policy/National-Safe-and-Healthy-

Housing-Coalition.aspx

Healthy Housing

• Limitations of the Medical & Housing Professions • Treat Only After Getting Sick • Housing Quality by Complaint

• Challenges • Focus & Breadth • Investment & Market Failures

•More Than Another Good Idea

David E Jacobs PhD, CIH

djacobs@nchh.org