Fostering Child Well-Being and Healthy Homes

Fostering Child Well-Being and Healthy Homes

General Deputy Assistant Secretary for Policy Development and Research Matt Ammon (left) moderates a discussion on child well-being and healthy homes featuring panelists Felicia Rabito, Margaret Reid, Clifford Mitchell, and Randy Jepperson at the July 2016 PD&R Quarterly Update.

Poor-quality, unhealthy housing poses both short- and long-term risks for resident safety and well-being and results in long-term costs to both individuals and society. Although the benefits of a healthy home — one that is dry, clean, ventilated, temperature controlled, safe, and free from pests and contaminants — may be self-evident, implementing healthy homes initiatives remains challenging. Programs administered by local entities often focus on single issues, housing code enforcement is variable and does not cover all rental housing, and funds for home assessments and interventions are often inadequate. Compounding these challenges is a lack of awareness among the public and clinicians of the importance of healthy homes.

HUD’s promotion of the connection between housing and health is therefore an important goal. As HUD Assistant Secretary for Policy Development and Research (PD&R) Katherine O’Regan emphasized in the Winter 2016 issue of Evidence Matters, HUD has endeavored “to expand our ability to integrate health measures into housing work.” On July 26, 2016, PD&R hosted its quarterly update on the health benefits of green and energy-efficient building methods and alleviating health hazards, interventions in existing housing to improve children’s health, and the ways in which partnering and braiding of funds can result in healthier homes for low-income households. This article will explore panel participants’ discussion of the social and monetary costs of unhealthy housing and home-based interventions that can help mitigate household hazards. A subsequent article will address ways to support and sustain healthy homes initiatives at the local level.

The Costs of Unhealthy Housing

Nearly six million occupied housing units in the United States — 5.1 percent of total occupied units — are considered poor quality, contaminated with hazards such as lead, radon, pests, and mold, according to Matt Ammon, general deputy assistant secretary for PD&R and moderator of the session. These home health hazards disproportionately affect minority and low-income households, which often lack funds to address them. Moreover, children, who are often indoors and have higher absorption rates of contaminants than do adults, are especially vulnerable to the effects of household hazards, including asthma, cancer, and lead poisoning — the latter of which causes hyperactivity, reduced IQ, behavioral problems, and learning disabilities. The consequent costs to the individual include missed school days and poor school performance, socialization problems, and hospitalization. The costs to society include increased healthcare spending, lower educational attainment, reduced productivity, and increased risk of delinquency. Public spending on healthy homes, on the other hand, can reap multiple benefits. As Ammon pointed out, for every dollar spent on controlling lead hazards, $17 is returned through such outcomes as improved health, increased lifetime earnings and tax revenues, and reduced criminal activity. Every dollar spent on asthma triggers reduces healthcare costs by an average of $10.

Promoting Home-Based Interventions

Evidence suggests that home-based interventions targeting lead, radon, asthma triggers, injuries, and secondhand smoke improve children’s health and have benefits that last through adulthood, according to Clifford Mitchell, director of the Environmental Health Bureau at Maryland’s Department of Health and Mental Hygiene. One such intervention, developed by Tulane University and funded by HUD, targets cockroaches using insecticidal bait to improve the health of asthmatic children. Felicia Rabito, associate professor of epidemiology at Tulane University, reported that this simple, low-cost, low-toxicity approach is a highly effective alternative to traditional multicomponent interventions.

Organization partnerships, data quality, and the legal and regulatory framework all affect the ability of health authorities to carry out such interventions. Although many public health agencies are hampered by outdated laws and insufficient information on housing conditions, the city of Boston exemplifies how proactive collaboration, good data, and supportive laws can promote effective interventions. For example, since 2001 the Boston Public Health Commission (BPHC) has collected detailed housing information on residents, allowing it to stratify health data according to whether residents live in public housing, assisted housing, or neither.

In 2006, BPHC piloted the Breathe Easy at Home (BEAH) initiative, a web-based referral system that allows clinicians at Boston Medical Center, Boston Children’s Hospital, and other health organizations to request home inspections for asthma patients. BEAH referrals currently stand at 250 per year. BEAH has not only created an environment that reaffirms the importance of inspections, but it has also fostered a strong advocacy community. Lobbying by healthy home advocates resulted in an amended city rental inspection ordinance that requires registration of all private rental units and inspections every five years. Enforcement of the ordinance, which went into effect in 2013, is backed by fines and prosecution. Margaret Reid, director of the Division of Healthy Homes and Community Supports at BPHC, stated that the ordinance is “a very good preventive public health action.”

In addition to the BEAH initiative, BPHC and the Boston Housing Authority (BHA) have maintained an integrated pest management system since 2006 to reduce the incidence of asthma among residents of the city’s public housing. BPHC has also been active in training and supporting community health workers, with an emphasis on asthma home visitor training, and BHA will partner with Boston REACH in 2016 to launch a new Smoke Free Housing campaign.

The next edition of The Edge will delve further into this panel discussion of child well-being and healthy homes. It will focus on new trends in promoting healthy homes that take a holistic approach to home construction and will explore steps that can be taken to support and sustain healthy homes initiatives.