essentials for healthy homes practitioners
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ESSENTIALS FOR HEALTHY HOMES PRACTITIONERS
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LEARNING OBJECTIVES
Describe four housing conditions and their associated health problems.
Identify three populations at higher risk for housing related disease and injury.
Identify three types of codes used to enforce remediation of housing-related hazards.
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LINK BETWEEN HOUSING & HEALTH
“The connection between
health and the dwelling of the population is
one of the most important
that exists”.Florence Nightingale
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WHY DO WE CARE?
Housing impact on health:Physical, chemical, biological exposuresPsychological
Young children spend about 70% of the time in their home.
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WHY DO WE CARE?
Annual costs for environmentally attributable childhood diseases in the U.S: $54.9 billion.
$43.9 Billion from Lead Poisoning$ 9.2 Billion from Neurobehavioral Disorders$ 2.0 Billion from Asthma$ 0.3 Billion from Childhood Cancer
Additional costs (e.g., lost days of school/work).Asthma contributes 3% of total health care costs.
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HOW SIGNIFICANT IS THE PROBLEM?American Housing Survey
Occupied Housing Units
Severe Physical Problems
Moderate Physical Problems Total
2007 1.8 million 4.0 million 5.8 million
2009 1.9 million 3.9 million 5.8 million
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MASLOW’S HIERARCHY OF NEED
Self-Actualization
Ego
Belonging
Safety and Security
Physiological Needs
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The strength of a nation derives from the integrity
of the home.Confucius
Home is the place where, when you have to go there, They have to take you in.
Robert Frost
One of our deepest needs is to be at home.
Timothy Radcliffe
He is happiest, be he king or peasant, who finds peace in
his home. Johann Wolfgang von Goethe
It may be frail; its roof may shake; the wind may blow through it; the storms may enter; the rain
may enter – but the King of England cannot enter; all his
forces dare not cross the threshold of the ruined tenement.
William Pitt
Where thou art, that is
home. Emily Dickinson
Home is
where the
heart is.Pliny
There’s no place like home.Dorothy, Wizard of Oz
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INSTITUTE OF MEDICINE (2000)
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INSTITUTE OF MEDICINE (2004)
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CHILDHOOD ASTHMACurrent prevalence, 2010 BRFSS data
Source: CDC, Environmental Public Health Tracking (www.cdc.gov/ephtracking)
5.9%-6.6%>6.6%-8.3%>8.3%-9.2%>9.2%-10.9%>10.9%-18.0%No data
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ADULT ASTHMACurrent prevalence, 2010 BRFSS data
Source: CDC, Environmental Public Health Tracking (www.cdc.gov/ephtracking)
6.0%-7.8%>7.8%-8.6%>8.6%-9.4%>9.4%-9.9%>9.9%-11.1%
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ADULT ASTHMA
Current asthma prevalence among adults varies across states, ranging from:
5.3% to 9.5% in 20016.3% to 11.1% in 2009
Prevalence increased significantly from 2001-2009 in 22 states and the District of Columbia.
Current prevalence over timePage 1.7
Current asthma prevalence among adults -Behavioral
Risk Factor Surveillance System, United States, 2001,
2005, and 2009
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EXERCISE #1
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HOLISTIC APPROACHIntegrated approach that considers:
People living in the home
The structure
Potential health hazards
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Why a Holistic Approach?
Moisture/water intrusion
Mold
Asthma exacerbation
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Moisture/water intrusion
Structural damage
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Structural damage
Pests
Deteriorated lead paint/lead poisoning
Fire
Injuries
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Pests
Pesticides
Asthma & allergy exacerbation
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PesticidesPage 1.9
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DIFFERENT APPROACHES
HEALTH• Primary
Prevention• Secondary
Prevention• Epidemiolog
ic Triangle
HOUSING• Well
constructed• Well
maintained• Comfortabl
e• Affordable• Healthy
ENVIRONMENTALHEALTH
LeadRadon
Allergens/asthma Combustion productsUnintentional Injuries
Insects & RodentsMold & Moisture
Pesticides Asbestos
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HEALTHY HOMES PRINCIPLES
1. Keep it DRY
2. Keep it CLEAN
3. Keep it PEST-FREE
4. Keep it VENTILATED
5. Keep it SAFE
6. Keep it CONTAMINANT-FREE
7. Keep it MAINTAINED
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WHAT IS HEALTHY HOUSING?
• Designed,• Constructed,• Maintained, and• Rehabilitated
Healthy Housing
is:
in a manner that is conducive to good occupant
health.
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AMERICAN HOUSING SURVEY
Conducted:•Every two years since the 1980s•Periodically for 46 Metropolitan Statistical Areas (MSA)•Consistent set of homes•Phone survey since 1997
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EXERCISE #2
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AHS NATIONAL (2009)
Demographics
• 119 million homes• 32% rental • 65% single-family
detached homes• 63% built pre-1980• 31% basement
Exterior Problems
• 18.6% exterior physical problems
• 4.2% missing roofing material
• 9.8% exterior water leakage
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AHS NATIONAL (2009)
Interior Problems
•7.9% interior water leakage•4.8% open cracks or holes•3.4% pipes leaked•5.5% mice•9.1% blown fuses or breakers
Safety Devices
•5.6% no working smoke alarm•55% more than two-year old fire extinguisher•64% no carbon monoxide alarm
Heating
•64% warm air furnace•1.0% room heater without flue•0.9% stove as main heating equipment•8.6% uncomfortably cold
(Note: Safety devices information was not available before 2007)
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YOUR COMMUNITY
Healthy Homes Profiles
• Comparison to similarly situated housing
Interior-Exterior Relationships
• Likely to be interior problems if exterior problem is present.
More Detailed Snapshot
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NO PLACE LIKE HOME!Resident Overall Opinion of Structure, American Housing Survey – National 2009
Worst BestType of resident 1 2-4 5-7 8 9 10
All 0.5% 1.9% 22.8% 27.4% 16.0% 27.6%
Renters 0.9% 3.8% 32.8% 27.2% 11.9% 19.6%
Below Poverty 1.5% 4.1% 28.0% 23.2% 10.9% 27.1%
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REAL WORLD IS COMPLEX▪ Current knowledge▪ Economic factors▪ Social and cultural▪ Political and legal factors▪ “Do No Harm”
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WILL THINGS CHANGE?
Homes With “No Smoking” Rule•43% in 1992-1993•72% in 2003•82% in 2009-2010
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HEALTHY HOMES INTERVENTIONS
2008 Expert Panel Convened by CDC and NCHHCategories
EffectiveNeeds More Field EvaluationNeeds Formative ResearchNo Evidence or Ineffective
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HEALTHY HOMES INTERVENTIONS
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HEALTHY HOMES INTERVENTIONS
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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.
Click icon to add picturePage 1.14
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CODES BENEFITING HEALTHY HOMES
Health / Sanitation CodesHousing / Property Maintenance CodesLandlord-Tenant LawsProduct StandardsHazard Management Laws
Housing v. Building v. Zoning Codes
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Does this violate the
IPMC?
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KEY PROVISIONS OF CODES
Structural IntegrityWeatherproofMaintenanceCracks & HolesLoose or Rotting MaterialsDampness & DeteriorationPeeling Paint
Ventilation / WindowsInfestationSanitation & TrashCleanability Clothes DryerSpace Heater
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MODEL CODES FOR HOUSINGModel Codes for Housing
Building Construction Internat’l Building CodeResidential Construction Internat’l Residential CodeRehab Internat’l Existing Building CodeElectrical ICC Electrical CodeFire Internat’l Fire Code and
National Fire Protection AssociationVentilation Internat’l Mechanical CodePlumbing Internat’l Plumbing CodeSewage Internat’l Private Sewage Disposal CodeALL BUILDINGS Internat’l Property Maintenance Code
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INT’L PROPERTY MAINTENANCE CODE
Adopted in:More than 550 communities Two states – New York & VirginiaSeveral states including Georgia & Oklahoma recommend it as a model for locals codes
ApplicabilityExisting BuildingsRental and Owner Occupied HomesLocal Variations
Code Official Enforces
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LANDLORD-TENANT LAWS
Rights and Responsibilities• Certificate of Occupancy• Duty to Pay Rent• Withholding Rent to Make Repairs• RetaliationCommon Requirements
Eviction and Enforcement
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FEDERAL HEALTH PRIORITIESHealthy People 2020 Objectives
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blood lead levels in children
pesticide exposures
indoor allergen levels
homes with operating radon mitigation system
new single family homes with radon-reducing features
lead-based paint or related hazards in homes
units with moderate or severe physical problems
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GREEN BUILDING PRIORITIES
NCHH Comparison – February 2009Major National Programs
Green CommunitiesLeadership in Energy and Environmental Design for Homes (LEED for Homes)National Green Building StandardEnergy Star with Indoor Air Package
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NATIONAL HEALTHY HOMES TRAINING CENTER & NETWORK
Brings together public health and housing practitioners Forum for exchanging information on new research and best practices.
Funded through a contract with the U.S. Department of Housing & Urban Development , and with support from the U.S. Environmental Protection
Agency and the U.S. Centers for Disease Control & Prevention
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PURPOSE OF THE COURSE
Training on housing related health hazardsCross training of practitioners. Exchange of practical guidance about healthy housingMechanism for introduction of new research findingsOpportunity for networking, collaboration and partnerships.
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COURSE OUTLINE
OverviewStart with
PeopleHouse as a System
Keep It:• Dry• Clean• Pest-
Free• Ventila
ted• Safe• Conta
minant-Free
• Maintained
Making It Work
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KEY MESSAGESLink between housing and health
Vulnerable groups
Basic public health and housing principles
Holistic approach
Codes and regulations
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LEARNING OBJECTIVES
Describe four housing conditions and their associated health problems.
Identify three populations at higher risk for housing related disease and injury.
Identify three types of codes used to enforce remediation of housing-related hazards.
Page 1.19
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