1. The impact of housing quality on health
Office of Lead Hazard Control and Healthy Homes
U.S. Department of Housing and Urban Development

3. Strategic Framework
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?
What is the OLHCHH?
The Office of Lead Hazard Control and Healthy Homes (OLHCHH) is an office within the Department of Housing and Urban Development (HUD) that protects children, families and vulnerable populations from environmental health and safety hazards in housing.
The Office was established in 1991 as the Office of Lead-Based Paint Abatement and Poisoning Prevention.
The Office began its Healthy Homes Initiative in FY 1999.
The Office currently has 4 divisions, plus front office staff:
Programs Division
Grants Services Division
Policy and Standards Division
Program and Regulatory Support Division

4. HUD’s Mission and Strategic Goals
Strategic Framework
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?
HUD’s Mission and Strategic Goals
Mission
To create strong, sustainable, inclusive communities and quality affordable homes for all.
Strategic Goals
Strengthen the Nation’s housing market
Provide quality affordable rental homes
Use Housing as a Platform to Improve Quality of Life
Build Inclusive and Sustainable Communities
Transform the way HUD does business
(HUD, 2014, Strategic Plan )

5. OLHCHH’s Mission, Vision, and Goals
Strategic Framework
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?
OLHCHH’s Mission, Vision, and Goals
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.
Vision
To guide the nation to a future where homes are both affordable, accessible and designed, constructed, rehabilitated, and maintained in a manner that supports the health and safety of occupants.
Goals
Building a National Framework
Creating Healthy Housing through Key Research
Mainstreaming the Healthy Homes Approach
Enabling Communities to Create and Sustain Healthy Homes
(OLHCHH, 2009, Healthy Homes Strategic Plan)

6. Strategic Framework
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?
Strategy for Action
OLHCHH was the primary author of the federal document, Advancing Healthy Housing: A Strategy for Action (“Strategy for Action”), which outlines goals and priorities in healthy housing for the next three to five years.
The Strategy for Action was developed by the federal Healthy Homes Work Group, an inter-agency body whose purpose is to coordinate and advance healthy housing issues at the federal level using collective expertise.
7 agencies helped develop the Strategy for Action:
Dept. of Agriculture
Dept. of Commerce
Dept. of Energy
Dept. of Health and Human Services
Dept. of Housing and Urban Development
Dept. of Labor
Environmental Protection Agency
(Federal Healthy Homes Working Group, 2013, Strategy for Action)

7. Strategic Framework
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?
Strategy for Action
Vision
To substantially reduce the number of American homes with residential health and safety hazards
Goals
Establish Healthy Homes Recommendations
Encourage Adoption of Healthy Homes Recommendations
Create and Support Training and Workforce Development to Address Health Hazards in Housing
Educate the Public about Healthy Homes
Support Research that Informs and Advances Healthy Housing in a Cost-Effective Manner
(Federal Healthy Homes Working Group, 2013, Strategy for Action)

8. What is Unhealthy Housing?
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?
What is Unhealthy Housing?
Hazards
Health Effects
Economic Impacts
Lead
Lead poisoning, which causes
Health problems
Hyperactivity
Reduced IQ
Behavioral Problems
Learning Disabilities
Costs to the Individual
School absenteeism
Academic failure
Learning difficulties
Lack of employment
Life-long health problems
Socialization problems
Criminal record
Reduces life-time earnings
Pests CO
Mold
VOCs
Noise
Asthma
Housing Problems
Radiation
Asbestos
Cancer
Costs to Society
Healthcare
Hospitalization
Joblessness
Special education
Juvenile and criminal justice
Deteriorated housing
Less affordable housing
Entry by Intruder
Falls
Electrical hazards
Fire
Flames etc.
Collision & entrapment
Explosions
Ergonomics
Unintentional Injuries
Numerous Health Hazards
Other Health Impacts
(Based on: OLHCHH, 2014, Healthy Homes Rating System Operating Guidance; Loyola University 2015)

9. 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?
Housing Problems
These are some examples of housing problems surveyed in the American Housing Survey:
Signs of rats
Signs of mice
Signs of cockroaches
Holes in floors
Open cracks or holes (interior)
Broken plaster or peeling paint (interior)
No electrical wiring
Exposed wiring
Room without electric outlets
Flush toilet breakdowns
Heating problems
Electric fuses or breakers blown
Water supply stoppage
Water leaks
Exterior building condition problems
Sewage disposal breakdowns
(HUD Office of Policy Development and Research & Census, 2013, American Housing Survey)

10. These are the EHS hazards examined by the Healthy Homes Rating System:
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?
Hazards
These are the EHS hazards examined by the Healthy Homes Rating System:
Damp & Mold Growth
Cold
Heat
Asbestos and man-made fibers
Biocides
Carbon Monoxide, et al.
Lead
Radiation
Uncombusted fuel
Volatile organic compounds
Crowding and Space
Entry by Intruders
Lighting
Noise
Domestic Hygiene, etc.
Food Safety
Personal Hygiene
Water Supply
Falls in baths etc.
Falls on the level
Falls on stairs etc.
Falls from windows, etc.
Electrical hazards
Fire hazards
Hot surfaces etc.
Collision/ Entrapment
Ergonomics
Explosions
Structural collapse
(OLHCHH, 2014, Healthy Homes Rating System Operating Guidance)

11. 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?
Health Impacts
EHS hazards trigger, worsen, or cause a wide range of health effects. Here are some of the most prevalent housing-related health impacts:
Asthma & allergies
Cancer
Lead poisoning
Unintentional injuries
Death
Depression
Anxiety
Cardiovascular conditions
Arthritis
Respiratory conditions
Genitourinary disease
Unconsciousness
Cognitive impairment
Headaches
Mental disorders
Gastrointestinal illness
Skin infections
Neurological problems
Mental retardation
Behavioral problems
(OLHCHH, 2014, Healthy Homes Rating System Operating Guidance)

12. l Multiple Impacts Legend
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?
Multiple Impacts
Housing problems cause a ripple effect of impacts.
Here is an example of how a single housing problem can lead to multiple health effects and economic impacts:
Academic failure
Life-long health problems
Lack of employment
Legend l
Housing problem
Hazard
Health effect
Costs to the Individual
Costs to Society
Asthma
Allergies
Criminal history
Socialization problems
Damp and mold growth
Burns
Physical injuries
School absenteeism
Electric shock
Electrical hazards
Water leaks
Structural collapse
Learning difficulties
Learning disabilities
Lead
Juvenile and criminal justice
Hyperactivity
Special education
Behavioral problems
Reduced IQ
Health Problems
Hospitalization
Joblessness
Healthcare
(Created by OLHCHH for Educational purposes only)

13. Housing Quality and Health: Asthma & Allergies
Strategic Framework
Why Does Our Work Matter?
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Housing Quality and Health: Asthma & Allergies
Related Hazards1
Extent of the Problem2
Economic Impact3
Domestic hygiene, pests, and refuse
~24 million homes
have elevated levels of four or more allergens that have been associated with symptoms of allergic asthma among residents.
Asthma affects million
U.S. adults and million U.S. children.
$3.5 billion per year for asthma due to dampness and mold in the home.
Carbon monoxide and fuel combustion products
Damp & mold growth
VOCs
Noise4
1. OLHCHH, 2014, Healthy Homes Rating System Operating Guidance
2. The number of homes was calculated by multiplying 18% (Salo et al., 2008) by 133 million (HUD & Census, 2013, American Housing Survey); CDC, 2012
3. Mudarri & Fisk, 2007
4. Children under combined exposure to traffic related noise and air pollution have been found to have higher relative risks of chronic bronchitis, asthma and skin allergies than can be explained by air pollution alone.

14. Housing Quality and Health: Lead Poisoning
Strategic Framework
Why Does Our Work Matter?
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Housing Quality and Health: Lead Poisoning
Related Hazards1
Extent of the Problem2
Economic Impact3
Lead hazards, from
Chipping, peeling, flaking, chalking paint in houses built before 1978
Lead contaminated soil
Lead containing household items or products
23.2 million homes have at least one lead-based paint hazard.
Lead poisoning
affects
535,000 U.S. children ages 1-5.
$5.9 billion per year in medical costs and
$50.9 billion per year in lost productivity due to cognitive impairment.
1. OLHCHH, 2014, Healthy Homes Rating System Operating Guidance
2. Dewalt et al. 2015; Jacobs et al. 2002
3. Trasande & Lui, 2011

15. Housing Quality and Health: Unintentional Injuries
Strategic Framework
Why Does Our Work Matter?
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Housing Quality and Health: Unintentional Injuries
Related Hazards1
Extent of the Problem2
Economic Impact3
Entry by Intruder
Falls
Electrical hazards
Fire
Flames, hot surfaces, etc.
Collision & entrapment
Explosions
Ergonomics
18,000 deaths related to injuries occur annually in U.S. homes.
12 million nonfatal injuries
occur annually in U.S. homes.
> $200 billion annually in direct and indirect costs, with
$90 billion due to falls alone.
1. OLHCHH, 2014, Healthy Homes Rating System Operating Guidance
2. Mack & Liller, 2012
3. Zaloshnja et al., 2005

16. Burden of Housing Costs
Strategic Framework
Why Does Our Work Matter?
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Burden of Housing Costs
No one, of any economic class, should have to choose between a home that is affordable and one that is healthy for his or her loved ones.
However, according to the American Housing Survey, more people chose their current house for “financial reasons” than for any other reason (quality of construction, neighborhood, layout, design, etc.).
Affordability
Housing Quality
(HUD & Census, 2013, American Housing Survey)

17. Housing Costs as a Percent of Income
Strategic Framework
Why Does Our Work Matter?
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Housing Costs as a Percent of Income
Rent or Mortgage
Utility
Costs
Both owners and renters spend a high percent of their income on housing costs.*
Costs of
Unhealthy
Housing
Maintenance
Costs (for Owners)
All occupied units
Owner-occupied
Renter-occupied
Median monthly housing cost1
$891
$929
$850
Median monthly housing cost as a % of income
23%
19%
33%
The costs of living in unhealthy housing are a piece of the housing cost puzzle.
* Housing costs include rent or mortgage payments, utility costs, property insurance, etc.
(HUD & Census, 2013, American Housing Survey)

18. Housing Costs as a Percent of Income
Strategic Framework
Why Does Our Work Matter?
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Housing Costs as a Percent of Income
Low-income households are more likely to spend 50% or more of their income on housing costs.
(HUD & Census, 2013, American Housing Survey)

19. Disparate Impact of Unhealthy Housing
Strategic Framework
Why Does Our Work Matter?
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Disparate Impact of Unhealthy Housing
Low-income Americans are particularly vulnerable to unhealthy housing.
(HUD & Census, 2013, American Housing Survey)

20. Just What the Doctor Ordered
Healthy Homes

21. Lead Based Paint Hazard Control: Before and After
Strategic Framework
Why Does Our Work Matter?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
What Does OLHCHH Do Now?
Lead Based Paint Hazard Control: Before and After

22. Lead Based Paint Hazard Control: Before and After
Strategic Framework
Why Does Our Work Matter?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
What Does OLHCHH Do Now?
Lead Based Paint Hazard Control: Before and After

23. Return on Healthy Homes Investments
Strategic Framework
What Does OLHCHH Do Now?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
Why Does Our Work Matter?
Return on Healthy Homes Investments
Inputs
Return on Investment (ROI)
Outcomes
For every $1 spent on asthma reduction programs1
…there is a return of between $5.30 and $14.00.
Reduced healthcare costs
Increased school attendance
Increased employment attendance
Increased lifetime earnings
Fewer hospitalizations
Fewer ED visits
Fewer paramedic runs
For every $1 spent on lead hazard control programs2
…there is a return of between $17 and $221.
For every $1 spent on radon mitigation programs3
…there is a return of $4.95.
1. Nurmagambetov et al., 2011
2. Gould, 2009
3. Healthy Housing Solutions, 2014

24. Strategic Framework
Why Does Our Work Matter?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
What Does OLHCHH Do Now?
What Does OLHCHH Do?
OLHCHH provides and monitors funding to states and local governments to produce lead-safe and healthy low-income privately-owned housing units
Grants for Producing Lead-Safe and Healthy Housing Units
OLHCHH provides and monitors funding to grantees to research methods, costs, and health benefits of making homes safe and healthy
Technical Studies Grants (a.k.a. Research Grants)
OLHCHH enforces the Lead-Based Paint Disclosure Rule and works with HUD program offices on compliance with the Lead Safe Housing Rule
Enforcement
OLHCHH develops and promotes development of healthy homes guidance and green building performance criteria
Guidance and Performance Criteria
OLHCHH provides education and resource materials to homeowners, tenants, and stakeholders on how to make homes safe and healthy
Outreach
Tech Studies - 39 active lead and healthy homes technical studies grantees in 17 states
Amount of current funding awarded: > $20 million
The studies address such key issues as:
Cost effectiveness of home asthma interventions
Potential health benefits of green construction/rehab
Integrated Pest Management (IPM) approaches to controlling bedbugs and cockroaches in low income multifamily housing
The impact of energy upgrades on indoor environmental quality

25. Strategic Framework
Why Does Our Work Matter?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
What Does OLHCHH Do Now?
What Does OLHCHH Do?
A technical manual for lead hazard evaluation and control in federally-assisted housing; cited by EPA in its lead rules as a “documented methodology.”
HUD Guidelines for Evaluation & Control of LBP Hazards
Provides practical guidance for successfully developing and implementing local healthy homes programs.
The Healthy Homes Guidance Manual
A risk assessment system that identifies the likelihood and impact on resident health of housing-related health hazards
The Healthy Homes Rating System
Works with FEMA, EPA, HHS, OSHA, other offices within HUD, nonfederal partners and disaster recovery workers to integrate healthy homes principles into disaster recovery and rebuilding of flooded housing
Disaster Recovery
OLHCHH provides assistance to FBOs, NGOs, tenants, homeowners, consumers and stakeholders on how to make homes safe, healthy, green and energy efficient
Technical Assistance

26. Cross-Cutting Initiatives
Strategic Framework
Why Does Our Work Matter?
What More Can We Do?
What is Unhealthy Housing?
What is the Extent of the Problem?
What Does OLHCHH Do Now?
Cross-Cutting Initiatives
Reimbursements for Home-Based Asthma Assessments
OLHCHH is partnering with other agencies, practitioners, and insurance payers to expand Medicaid services and private insurance to cover healthcare financing housing-based asthma services.
OLHCHH has conducted 8 local asthma summits to promote insurance reimbursements for asthma home assessments and interventions.
OLHCHH chairs the Steering Committee of the Federal Action Plan to Reduce Asthma Disparities

27. Strategic Framework
Why Does Our Work Matter?
What is Unhealthy Housing?
What is the Extent of the Problem?
What Does OLHCHH Do Now?
What More Can We Do?
What’s Next?
Increase our involvement in Green Building science and the integration into HUD programs
Create a bridge between housing & health agencies
Improve our evidence-based platform
Coalition building
Assist grantees & stakeholders in identifying potential philanthropic partners
Share data and identify “gaps” in our data and information
Reduce hospital utilization
Create Healthier Indoor Environments for Child Care
Your Ideas??

28. Thank You! Edward Thomas, Healthy Homes Representative
HUD’s Office of Lead Hazard Control and Healthy Homes ,