1. The Health Benefits of Affordable Green Housing
David E. Jacobs, PhD, CIH
National Center for Healthy Housing
Green Affordable Housing Forum:
Protecting the Most Vulnerable While
Expanding Washington’s Green Economy
March 2009

2. 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

3. 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,

5. 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

6. 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

7. Is Housing a Shared Commons? Is Housing Part of the Infrastructure?

8. Cuyahoga River ca. 1960

9. Medical Care Costs and Housing Improvement

10. US Policies & Blood Lead 1971-2004 Blood Lead Levels (µ/dL)
Air & Ind Workplace Standards (1978)
Lead in Plumbing banned (1986)
Title X Housing & Community Development Act (1992)
Lead-based Paint Poisoning Prevention Act (1971)
Federally Assisted Housing Rule 1999 18 2 4 6 8 10 12 14 16
Residential Lead Paint Ban (1978)
Lead Contamination Control Act (1988)
Virtual Elimination of Lead in Gasoline
McKinney Act
Public Housing Abatement (1989)
Housing Lead Dust & Soil Std Published (1999 & 2001)
Renovation/Painting Rule Published (2008)
Private Housing Lead Paint Grants (1991)
‘74
Phase-out gasoline & lead soldered cans (1973)
Blood Lead Levels (µ/dL)
Ban on lead solder
in food cans (1995)
Const Work Stds (96)
Lead Disclosure Rule (1996)
Housing units with lead paint reduced by 40% since 1990
2.7 %
2.2 %
1.6 %
1.2 %
‘72
‘76
‘78
‘80
‘82
‘84
‘86
‘88
‘90
‘92
‘94
‘96
‘98
‘00
‘02
‘04
Year

12. Power of Housing & Health Surveillance Data: Dust Lead and Windows

13. Benefits of Window Replacement
Lead Dust Accumulation
Energy Savings: Heating and Cooling
Housing Value
Other?

16. 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

17. Data Needed for Cost Benefit Analysis of Green Healthy Housing
Housing Conditions that Impair Health (1)
Housing Improvements that Advance Health (2)

18. Housing Conditions That Affect Health (1)
Categories:
Sufficient Scientific Evidence
Some Scientific Evidence
Insufficient Evidence
World Health Organization (WHO)

19. 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
In 2004 IOM published comprehensive review of the literature “Damp Indoor Spaces and Health”.
Did not find Sufficient Evidence of a Causal Relationship for any health outcome.
Found sufficient evidence of association for:
Upper respiratory tract symptoms
Asthma symptoms in sensitized persons
Hypersensitivity pneumonitis in susceptible persons
Wheeze
Cough
Limited or Suggestive Evidence of association for:
Lower respiratory illness in healthy children
Dyspnea
Asthma Development

20. Some Evidence (WHO, 2005) PHYSICAL FACTORS: CHEMICAL 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

21. Housing Changes Scientifically Shown to Improve Health (2)

22. 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

23. Green Communities Minnesota Case Study

24. Green Rehab Elements at Viking Terrace

25. Viking Terrace Results

26. Viking Terrace Results

27. Viking Terrace Results

28. Viking Terrace Results

29. Viking Terrace Results

30. Viking Terrace Results

31. Housing Improves Asthma

33. 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)

34. Aerial Imagery

35. Making Low-Income Housing Rehab Green and Healthy – Wheeler Terrace, DC

36. 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)
NCHH: Project manager; scientific evaluation of health and housing data
CPDC: Developer; oversees renovation of WT with green and health features
Wiencek: architectural design and planning
Tenant Association: Resident liaison, provide input on project design and implementation, help with allergen sampling.
Nat’l Capital Asthma Coalition: Healthy Homes education to families
GreenHOME: Case study of project to document lessons learned.
DC DOH: develop referral system; public health services to residents.

37. 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

38. 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

39. Conclusions

40. 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!!

41. Contact Information
David Jacobs, PhD, CIH Research Director National Center for Healthy Housing