National Healthy Homes Training Center and Network

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National Healthy Homes Training Center and Network

• Overview

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The Link Between Housing Health
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Maslows Hierarchy of Need

Self-Actualization Ego Belonging Safety and
Security Physiological Needs
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What is Healthy Home?

• A healthy home is a home
• Designed,
• Constructed,
• Maintained, or
• Rehabilitated
• in a manner that supports the health of
  residents.

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Why Do We Care About Healthy Homes?
Young children spend nearly 80-90 of their time
inside.

• Housing affects health
• both directly and
• indirectly
• Physical, chemical, biological exposures
• Psychological

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Known / Suspected Health Effects Associated with
Housing Conditions

• Respiratory infections
• Asthma
• Injuries and burns
• Reactions to extreme cold and extreme heat
• Irritations, allergy, rashes
• Poisonings, asphyxiation
• Neurotoxic exposures
• Cancer
• Death

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Unhealthy Homes

• American Housing Survey for 2005
• 2 million homes have severe problems.
• 4.2 million homes have moderate problems.
• Rating system does not include
• Insects
• Humidity and Condensation
• Lead-Based Paint, Radon, and Asbestos

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Who is Disproportionately Affected?

• Asthma rates are 40-50 higher among children of
  color living in U.S. cities.
• Children from low-income communities and children
  of color are more likely to be lead poisoned that
  their wealthier and Caucasian children.

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Why Do We Care?Costs of Unhealthy Homes

• Annual costs for environmentally attributable
  childhood diseases in the U.S 54.9 billion.8
• 43.9 Billion from Lead Poisoning
• 9.2 Billion from Neurobehavioral Disorders
• 2.0 Billion from Asthma
• 0.3 Billion from Childhood Cancer
• Additional costs from asthma care stem from the
  more than 10 million missed school days a year.
• Asthma contributes to approximately 3 of total
  health care costs. 9

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Categorical Approach

• Allergens/asthma
• Asbestos
• Combustion products
• Lead
• Mold and Moisture
• Insects and Rodents
• Weatherization

• Pesticides
• Radon
• Take Home Hazards Work at Home
• Unintentional Injuries / Fire
• Other

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Holistic Approach

• Integrated approach that considers
• People living in the home
• The structure
• Potential health hazards

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Purpose of National Healthy Homes Training Center

• Bring together public health and housing
  practitioners to promote practical and
  cost-effective methods for making homes
  healthier.
• Serve as a forum for exchanging information on
  new research and best practices.  

Funded by a grant from the U.S. Centers for
Disease Control Prevention, with support from
the U.S. Department of Housing Urban
Development, and the U.S. Environmental
Protection Agency.
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Purpose of the Course

• Provide training for public health and housing
  practitioners in the assessment and treatment of
  housing related health hazards, with a focus on
  practical and cost-effective methods.
• Promote cross training of public health and
  housing practitioners. 
• Create a forum for the exchange of practical
  guidance about healthy housing strategies among
  federal, state, tribal and local agency staff.
• Develop a mechanism for the ongoing introduction
  of new research findings into public health
  training and practice.
• Identify and optimize opportunities for
  networking, collaboration and partnerships.

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Course Outline

• Overview
• Start with People
• Keep It
• Dry
• Clean
• Pest-Free
• Ventilated
• Safe
• Contaminant-Free
• Maintained
• Making It Work

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Components of this Training
HOUSING
HEALTH
Lead Radon Allergens/asthma Combustion
products Unintentional Injuries Insects and
Rodents Mold and Moisture Pesticides
Asbestos Fire
Well constructed Well maintained Comfortable Affor
dable Healthy
Primary Prevention Secondary Prevention Epidemio
logic Triangle
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The Real World is Complex

• Current knowledge
• Economic factors
• What funds are available at government level and
  at family level?
• Social and cultural
• Political and legal factors
• Is the condition reportable?
• Is it mandatory to report?
• Are there guidelines available?
• Do No Harm
• Precautionary principles

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• Until effective standards for the domestic
  environment are devised, it is likely that
  children will continue to be employed as
  biological indicators of substandard housing.
  34

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Model Codes for Housing

• Building Construction Intl Building Code
• Residential Construction Intl Residential
  Code
• Rehab Intl Existing Building Code
• Electrical ICC Electrical Code
• Fire Intl Fire Code and National Fire
  Protection Association
• Ventilation Intl Mechanical Code
• Plumbing Intl Plumbing Code
• Sewage Intl Private Sewage Disposal Code
• All Buildings Intl Property Maintenance Code

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Intl Property Maintenance Code

• Adopted in
• More than 550 communities and
• Three states including New York, Virginia and
  Oklahoma.
• Applicability
• Existing Buildings
• Rental and Owner Occupied Homes
• Local Variations
• Code Official
• Notices and Orders
• Unsafe Structures and Equipment
• Emergency Measures
• Demolition
• Appeals

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IPMC (cont.)

• General Requirements
• Light, Ventilation, and Occupancy
• Plumbing and Fixture
• Mechanical and Electrical
• Fire Safety
• Sanitation?

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Typical Health Codes

• Every building or structure constructed or
  maintained
• In violation of the building provisions of this
  Code, or
• Which is in an unsanitary condition, or
• In an unsafe or dangerous condition, or
• Which in any manner endangers the health or
  safety of any person or persons,
• is hereby declared to be a public nuisance.
• Every building or part thereof which is in an
  unsanitary condition by reason of
• The basement or cellar being covered with
  stagnant water, or
• The presence of sewer gas, or
• Any portion of a building being infected with
  disease or being unfit for human habitation, or
• Any other unsanitary condition,
• is a source of sickness, or which endangers the
  public health, is hereby declared to be a public
  nuisance.

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Landlord-Tenant Laws

• Rights and Responsibilities
• Common Requirements
• Certificate of Occupancy
• Duty to Pay Rent
• Withholding Rent to Make Repairs
• Retaliation
• Eviction and Enforcement

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Federal Agencies

• Environmental Protection Agency (EPA)
• Housing and Urban Development (HUD)
• Centers for Disease Control and Prevention (CDC)
• Consumer Products Safety Commission (CPSC)

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Federal Regulations

• Apply to federally assisted owned housing
• CDBG Community Development Block Grant
• HOME repair funds
• Public housing
• Privately owned tenant project-based housing
• Housing Quality Standards
• Lead
• Lead safety through identification and hazard
  control.
• Requires licensing for service providers.
• Asbestos
• Focused on schools and housing with more than
  four units.
• Requires licensing for service providers.
• Radon

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HUD Housing Quality Stds

• Section 8 Property Must Meet Standards
• Special Rules on Lead-Based Paint
• Inspection Form

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Core Healthy Homes Principles

• Start with People
• Keep It
• Dry
• Clean
• Pest-Free
• Ventilated
• Safe
• Contaminant-Free
• Maintained

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Key Messages

• There is a link between housing and health.
• Certain groups are at greater risk for adverse
  health effects.
• There are basic public health and housing
  principles that can help us understand the link
  between housing and health.
• The Healthy Homes movement is a holistic
  approach to promote health through better
  housing.
• Codes and regulations are tools that can help you
  achieve healthier housing in your community.

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Learning Objectives

• Describe four housing problems and the health
  impacts associated with them.
• Identify three populations that may be at higher
  risk for housing-related disease and injury.
• Identify three important housing systems that
  contribute to a comfortable living space.
• Identify three types of codes that can be used to
  enforce housing-based health threats