Fostering Child Well-Being and Healthy Homes – Part 2

Fostering Child Well-Being and Healthy Homes – Part 2

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.

The federal government has long recognized the connection between housing and health. As HUD Assistant Secretary for Policy Development and Research (PD&R) Katherine O’Regan noted in the Winter 2016 issue of Evidence Matters, part of HUD’s mission from the start has been the promotion of healthy and sanitary housing. To foster awareness of and stimulate research into this crucial area, on July 26, 2016, PD&R hosted its quarterly update on the topic of child well-being and healthy homes. The September 12 edition of The Edge explored panel participants’ discussion of the social and monetary costs of unhealthy housing, and addressed home-based interventions that can help mitigate household hazards. This issue focuses on the panel’s discussion of new trends in promoting healthy homes that take a holistic approach to home construction and steps that can be taken to ensure the sustainability of healthy homes initiatives.

Green Homes and a Holistic Approach

Matt Ammon, General Deputy Assistant Secretary for Policy Development and Research and panel moderator, emphasized how HUD prefers to address housing hazards with a comprehensive strategy rather than tackling each issue individually. Salt Lake City’s Green and Healthy Homes Initiative exemplifies this holistic approach to creating a healthy home environment in energy-efficient homes for low- and moderate-income families. According to Randy Jepperson, housing program manager of Salt Lake County Community Resources and Development, the initiative involves 23 participating agencies and employs a wide range of health-sector resources for interventions, including physicians, nurse managers, and therapeutic and diagnostic services.

Green and Healthy Homes leverages funds from numerous private and public sources, including HUD, to mitigate identified household hazards such as lead, radon, and mold and to construct energy-efficient green homes. Demonstrated results include lower asthma rates and fewer injuries and poisonings, decreased crime in areas around improved homes, lower healthcare expenditures, reductions in energy costs for homeowners, and workforce development. The initiative's goal over the next 3 years is to help 800 families obtain healthy, safe, and energy-efficient homes free of radon gas.

The science behind a home that is both energy efficient and healthy is relatively new, however, and achieving the proper balance between the two can be challenging. Felicia Rabito, associate professor of epidemiology at Tulane University, noted that sealing gaps prevents rodents and other pests from entering the home, but too much airtightness can trap moisture and toxins. Radon can also become concentrated in a house that is too airtight. Adequate ventilation systems are therefore necessary to prevent trapping contaminants and moisture. Clifford Mitchell, director of the Environmental Health Bureau at Maryland’s Department of Health and Mental Hygiene stressed that “we are still at a point where we do not necessarily understand all of [the] relationships” among ventilation systems, airtightness, and health; gathering more data is fundamental to understanding these issues.

Sustaining Healthy Homes

Panel participants cited a number of areas in which steps can be taken to ensure continued promotion of healthy homes. One of these is research funding and support. Rabito stressed the need for more funding to replicate Tulane University’s promising cockroach abatement study and to apply its findings. Mitchell suggested that HUD might collaborate with the Centers for Disease Control and Prevention, the U.S. Environmental Protection Agency, and other agencies to spur healthy-home research.

Another factor that is crucial to sustaining successful intervention strategies is collaboration and coalition building between public housing agencies and medical providers, which, according to Ammon, is a practice that has not been broadly adopted.. An exception to this trend, the Salt Lake City Green and Healthy Homes Initiative found collaboration with the medical community and its access to research to be critical to its success. Jepperson notes, however, that such collaboration did not happen naturally; rather, it proceeded only after concerted efforts to get the various parties to work with one another. Rabito suggested a system that streamlines housing and medical collaboration for “translating what we know [about healthy homes] into practice.”

The restructuring of healthcare finance is a third area that can offer future healthy home benefits. One solution, according to Mitchell, is to reward healthcare providers for achieving long-term health benefits rather than recouping same-year expenditures. Margaret Reid, director of the Division of Healthy Homes and Community Supports at the Boston Public Health Commission (BPHC) concurred with this view, stating that the social determinants of health will only be taken seriously when accountable care organizations bear more of the costs associated with them.

Finally, good data collection is vital to sustaining healthy home initiatives. Jepperson, citing Salt Lake City’s Pay for Success program in lead abatement, emphasized how having measurable outcomes to identify savings can be a “powerful tool” that contributes to program success. On a broader level, Mitchell stressed the need for researchers to be creative and exploit underutilized data sources, such as education and healthcare systems, so that they can better evaluate intervention initiatives.

Challenges and Possibilities

Achieving healthy homes that are free of hazards is crucial to household — especially children’s — well-being. Although HUD provides funds to mitigate hazards, local governments continue to face challenges in achieving this goal. A number of models and initiatives, however, offer templates to housing practitioners for substantially reducing such hazards. By supporting research and building broad coalitions between disparate stakeholders, these goals can be achieved, with healthy homes a reality for all.