Reflections on the National Healthy Homes Conference
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An image of a child’s hand on a window sill with peeling paint. Attending the National Healthy Homes Conference in Denver was a June treat. The low humidity in the Mile-High City is always a welcome gift to a visitor from the Washington Beltway. The pedestrian-friendly urban center has plenty of activity. And presumably the facility managers of the sparkling, LEED-certified Colorado Convention Center had only the health of their guests as their motive for requiring a three-quarter circuit of the 50-acre facility to find an open entrance—the big blue grizzly bear who endlessly peers into the front windows apparently still hasn’t found the unlocked doors!

The Healthy Homes Conference, hosted by HUD's Office of Healthy Homes and Lead Hazard Control, is a good place to get a broad yet detailed idea of the enormous public health implications of housing as well as the range of people engaged in addressing healthy housing. Federal officials, academic and applied researchers, physicians, and practitioners stepped back from the battle lines to consider both the larger policy picture and the specific technical details, tools, and tactics that are most effective in making home environments safe. The stakes are great, with childhood environmental diseases accounting for nearly 3 percent of all U.S. health care costs:

  • The share of children who currently have asthma reached nearly 1 in 10 for the first time in 2009, up 9 percent just in the past decade.
  • 1.2 million housing units with lead-based paint are occupied by children—and the developmental and behavioral effects of each additional unit of lead in their blood cost an estimated $2,500 for health care, lost productivity, and criminal justice.
  • An estimated 21,000 premature deaths are caused by radon-induced lung cancer each year, yet only 11 percent of homes with radon above Environmental Protection Agency’s (EPA’s) action level have mitigation systems/

“Healthy homes” is an evolving concept. It is being reshaped as progress is made in building science and medical science; as building practices enter a greener, post-McMansion era; and as asthma rates continue shooting upward. The linkage between healthy homes and green building practices continues to strengthen. Although drafty older homes could tolerate an occasional leak in the building envelope, today’s more well-insulated homes require substantially more attention to detailing than many contractors have yet achieved.

Simply adding insulation or sealing up a home to prevent drafts can lead to serious health hazards from poor indoor air quality. It is necessary not only to seal leaks but also to seal them in the right place so that rain doesn’t flow in, moist air doesn’t condense on cold surfaces, and moisture can escape building materials before it triggers mold or pest infestations. And toxins need to be kept out and extracted as they are introduced or generated by occupants. “Build tight and ventilate right” is a common refrain among healthy homes researchers and practitioners. Increasingly, tightly sealed homes are best served by continuous, low-volume introduction of fresh air through small fans or heat-recovery ventilators.

Radon, a gas emitted by various types of rock and entering homes through unsealed basements, accounts for 40 percent of the radiation received by the average adult. The risk of dying from lung cancer reaches 1 in 100 for individuals who spend a lifetime in homes with the EPA’s recommended action level for radon (4.0 picocuries per liter of air). Remarkably, inadequate detailing and controls in homes constructed since Congress passed the Indoor Radon Abatement Act in 1988 means that the total number of families exposed to significant radon risk is greater now than when the act became law!

The health impact of unvented cooking appliances may be surprising to many, yet cooking can be troublesome both for excessive moisture and for the noxious, asthma-causing chemicals it releases. A recent study in Boston assisted housing found that mold is correlated with pests and inadequate ventilation and bears directly on health. In fact, the odds of health problems among the residents more than double if multiple problems are present.

Healthy homes practitioners are sold on the idea of Integrated Pest Management. Rather than setting off pesticide “bombs” in homes to rid them of cockroaches, occupant health is better served by a softer and more thoughtful approach: sealing gaps, removing the food and water the pests need, and applying targeted pesticides for a short time with long-term monitoring. New research shows that reductions in cockroach populations need to be substantial for significant health effects; the allergen produced by a single adult cockroach, if dispersed into the air, is hundreds of times more than needed to sensitize children to asthma or trigger an asthma attack.

As environmental science matures, a Federal Healthy Homes Work Group is bringing together staff from a half-dozen agencies to develop a unified strategy for advancing healthy homes. Collaboration is key to success because of the complexity of healthy homes challenges. The National Healthy Homes Conference, the second of its kind, was a milestone toward further progress in meeting this challenge with appropriate information and effective strategies and tactics. It may not be difficult to recognize the hazards of a blue grizzly and lock it outdoors, but indoor health hazards are more insidious.

Barry Steffen is a social science analyst in HUD’s Office of Policy Development and Research.