The Health Benefits of Affordable Green Housing

David E. Jacobs, PhD, CIHNational Center for Healthy Housing

Green Affordable Housing Forum:Protecting the Most Vulnerable While

Expanding Washington’s Green EconomyMarch 2009

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

‘76 ‘80 ‘82 ‘84 ‘86 ‘88 ‘90 ‘92 ‘94 ‘96 ‘98

Year

‘72

Blo

od

Le

ad L

eve

ls (µ

/dL

)

18

2

4

6

8

10

12

14

16

0

‘00

US Policies & Blood Lead 1971-2004

‘74

Phase-out

gasoline & lead

soldered cans (1973)

Lead-based Paint Poisoning Prevention Act (1971)

‘78

Residential Lead Paint Ban (1978)

Title X Housing & Community

Development Act (1992)

Housing units with lead paint reduced by

40% since 1990

Lead Contamination Control Act (1988)

Virtual Elimination of Lead in Gasoline

McKinney Act Public Housing

Abatement (1989) Ban on lead solder in food cans (1995) Const Work Stds (96)

2.7 %

2.2 %

Lead in Plumbing banned (1986)

‘02

1.6 %

‘04

1.2 %

Air & Ind Workplace Standards

(1978)

Housing Lead Dust &

Soil Std Published (1999 & 2001)

Lead Disclosure

Rule (1996)

Private Housing

Lead Paint Grants (1991)

Federally Assisted Housing Rule 1999

Renovation/Painting

Rule Published

(2008)

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

$0

$5,000

$10,000

$15,000

$20,000

$25,000

Upgrade Cost

Market Value

Health Benefit

Health Benefit

Other Value

Energy Value

Cleanup & Clearance Window Replacement

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

• InsufficientEvidence

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, high-

rise 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:— Ventilation in the dwelling and

respiratory and allergic effects

CHEMICAL FACTORS:— VOCs and respiratory,

cardiovascular and allergic effects

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

BUILDING FACTORS:— Sanitation and hygiene

conditions and related physical health effects

SOCIAL FACTORS:— 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

Housing ChangesScientifically 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%

14%

57%

Better Now Worse Now About the Same

Viking Terrace ResultsAdult's Health

Compared to When in Old Home

37%

11%

52%

Better Now Worse Now About the Same

Viking Terrace Results

Comfort in Apartment Compared to Old Home

73%

10%

17%

More Comfortable Less Comfortable About the Same

Viking Terrace ResultsEase of Cleaning

Compared to Old Home

63%10%

27%

Easier Harder About the Same

Viking Terrace Results

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

64%9%

27%

Play Outside More Play Outside Less About the Same

Viking Terrace ResultsSafety of Building

Compared to Old Home

41%

7%

52%

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) Change in Caretaker Quality of Life:

—80% improvement (p<0.002) Reduced Visits to Urgent Care:

—40% reduction (p<0.001)

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