georgia healthy homes - georgia department of public health...health challenges in georgia. a...
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GeorgiaHealthyHomes
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HealthyHomesandLeadPoisoningPreventionProgram
GeorgiaDepartmentofPublicHealthEnvironmentalHealthSection
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ExecutiveSummary
Theconnectionbetweenhousingandhealthiswellestablished.Numeroushousing‐relatedhealthissues,includingasthmaandrespiratoryillnesses,leadpoisoning,andinjuries,remainmajorpublichealthchallengesinGeorgia.Ahealthyhomesapproachiseffectiveinreducinghousing‐relatedhealthhazards.Thisapproachisorganizedaroundthe“SevenPrinciplesofHealthyHomes,”whichare:
Keepit:
1. Dry2. Clean3. Safe4. Ventilated5. Pest‐Free6. Contaminant‐Free7. MaintainedRecognizinganeedforamoreintegratedapproachtoimprovinghousing‐relatedhealthoutcomes,theGeorgiaDepartmentofPublicHealth(DPH)embarkedonastatewidehealthyhomesstrategicplanningprocessinthefallof2012.DPHrecruitedkeystakeholderstoparticipateasmembersoftheHealthyHomesStrategicPlanningAdvisoryWorkgroup(theAdvisoryWorkgroup).TheAdvisoryWorkgrouprepresentedcollaborationbetweenadiversegroupofindividualsrepresentinglocal,stateandfederalhealthprograms,socialserviceagencies,housingagencies,realtors,non‐profitsandadvocacyorganizations,andmanyothers.Throughthestrategicplanningprocess,theAdvisoryWorkgroupmembersidentifiedsevenelementsthatdescribetheircollectivestatewidevisionforhealthyhomes.Thesesevenvisionelementsandassociatedkeystrategiesinclude:VisionElement1:ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders
1. Implementandlaunchapublicrelationsstrategy.2. DesignanorganizationalstructuretoadvancethehealthyhomesinitiativeinGeorgia.3. Developahealthyhomescertificationor“sealofapproval.”
VisionElement2:Coordinated,appropriate,andeffectivemarketingandeducation1. Developanddisseminatequality,targetededucationalmaterials.2. Identifylegislativechampionstosupportongoingeducationwithlegislators.3. Developastrategicmarketingandeducationplanwithclearpriorities.4. Launchapublicawarenessandeducationcampaign.5. Identifyfunderstosupporteducationalandpromotionalmaterials.
VisionElement3:Effectivepoliciesandstrongenforcement
1. Educateandmotivatethelegislaturetopassstronglaws.
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2. Identifyanddraftneededlegislativeauthoritiesforhealthyhomes.3. Developpersuasive,data‐drivenarguments.4. Convene,convince,andmotivatethepublicandstakeholderstoengageindialoguewith
theirlegislators.5. Implementstatewidecodeenforcementthatisstandardized,effective,andincorporates
healthyhomesprinciples.VisionElement4:Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation.
1. ImplementmandatedreportingofhealthyhomesdatatotheGeorgiaDepartmentofPublicHealth,includinghospitalemergencyroomvisitsduetopoisonings,fallsburns,andasthma.
2. Coordinatethecollectionandmanagementofhealthyhomesdatatoeducateandinformpolicymakersandfunders.
3. Developcomprehensivedatatrackingandsurveillancenetworks.VisionElement5:Diverseresourcesandrevenuegeneratingmechanisms.
1. Communicatethereturnoninvestmentforhealthyhomesactivitieswithpolicymakers,funders,andotherstakeholders.
2. Implementrevenuegeneratingrequirementsforcontractorsandpropertyowners.3. Collaboratewithinsuranceproviderstomandatehealthyhomesassessmentsand
interventionsforspecifichealthcareclaims.4. Conducteffectiveresearchtogarnerfundingsupportforhealthyhomes.5. Ensureefficientuseofresourcesbyestablishingandstrengtheningpartnerships.
VisionElement6:Standardizedprocessesandconsistentimplementation.
1. Identifycommonbenefitsandclearrolesforallstakeholderstosupportcollaborativeparticipation.
2. Establishpropertrainingstandards,qualitycontrol,andcertificationprocesses.3. Conductcross‐trainingofagenciesandorganizationsstatewidetoensureconsistent
approachestoidentificationandremediationofhazards.4. Engagehomevisitingagenciesinintegratinghealthyhomesstandardsintotheirprotocols.
VisionElement7:Healthier,SaferHomesforGenerations.
‐ Thisvisionelementrepresentstheculminatingoutcomethatwouldresultiftheothersixelementsofthevisionwererealized.
Georgiahasanumberofexistingassetstosupportthesestatewidehealthyhomesefforts.Buildingandmaintainingextensivepartnershipsacrossadiverserangeofstakeholderswillbenecessaryforsuccessfulimplementationofthesekeystrategies.Asaresultofthestrategicplanningprocess,AdvisoryWorkgroupmembersagreedtosustaintheircollectiverelationshipandprovidecontinueddirectionandleadershipfortheactivitiesidentifiedinthisstrategicplan.TheirleadershipandcommitmentwillassureGeorgia’sabilitytorespondcollectivelyandindividuallytoanybudgetaryandpoliticalchangesahead.
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IntroductionTheGeorgiaDepartmentofPublicHealth’sHealthyHomesandLeadPoisoningPreventionProgram(GHHLPPP)(formallyknownastheGeorgiaChildhoodLeadPoisoningPreventionProgram)hasbeeninoperationsince1992underfundingreceivedfromtheCentersofDiseaseControlandPreventionintheformofcooperativeagreement.Sincethen,GHHLPPPhassuccessfullyworkedtogetGeorgia’shighriskchildrentestedforleadpoisoningwhilealsoidentifyingthosewhoareleadpoisonedandrequiringcasemanagementandenvironmentalfollowup.
ThekeyaimsofGHHLPPPareto:
TransitionintoacomprehensiveHealthyHomesProgramwhilecontinuingtomonitorchildrenforleadexposureandprovidecasemanagementandenvironmentalinvestigationsforleadpoisonedchildren;
Developandimplementastrategicplanforthestatetoreduceoreliminatehousing‐relatedhealthhazardsandtopromotehousingthatishealthy,safe,affordable,andaccessible;
Buildaconsortiumofstrategicpartnerstoaddressunsafeand/orunhealthyhousingconditionscausedbyhousing‐basedhazardsbyleveragingresourcesandseekingsustainabilityinfunding;
Assurethatfollowupcareandinterventionsareprovidedforvulnerablepopulationswhoareidentifiedwithhousing‐relatedhealthissues;
ExpandtheGHHLPPPsurveillancesystemtoincludenotonlybloodleadlevels,butalsoenvironmentaltestsresultsandselectedhealthyhomesvariables;
ConsolidateexistingrelatedDepartmentofPublicHealth(DPH)programsintoacomprehensiveHealthyHomesandLeadPoisoningPreventionProgram;
WorkwithhousingagenciestoenforcehazardreductionininspectedhousingthroughexistingHUDhazardreductionprograms,healthyhomeslocalprograms,andhousingcodeenforcementmechanisms;
EngageourEnvironmentalJusticeandFaithBasedPartnerstoeducatethecommunityconcerningthedangersofhousing‐basedhazards,includingleadpoisoning,andidentifyingvulnerablepopulationsthatmaysufferthemostfromthesehealththreateningsourcesofexposure;
ContributetoDPH’smissionofresponsiblehealthplanningandimprovedhealthoutcomesfortheresidentsofGeorgia;
ExpandGHHLPPPbyaddingstafftraininginhealthyhomesconceptsandimplementinginterventionsandreferralsinresponsetothedetectionofhousing‐basedhealthhazards;
Reducetheoverallcostofexpensivemedicalresponsestoinjuriesandtheexasperationofhealthconditionssuchasasthmabyapplyingprimarypreventionprinciplestoreducehousing‐basedhazardstoreduceexposurepriortoneedingmedicalinterventions;
Employindicatorbasedevaluationtechniquestoevaluateeveryaspectoftheprogramtoincreaseefficiencyandimplementresponsiblehealthcareplanningandutilizationofresources;and
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ContinuetotrainandcredentialexistingEnvironmentalHealthBranchandlocalenvironmentalhealthspecialistsinleadinspectiontechniquesaswellasHealthyHomesPractitionerprinciples.
Recognizinganeedforamoreintegratedapproachtoimprovinghousing‐relatedhealthoutcomes,GHHLPPPassembledaGeorgiaHealthyHomesAdvisoryCommitteewiththemissiontodevelopastrategicplantodirectandfocushealthyhomesinitiativesfortheStateofGeorgia.WhatfollowsisacomprehensivehealthyhomesstrategicplantobeimplementedbyGHHLPPPwithintheprogram’skeyaimsinconjunctionwithkeypartneragenciesandorganizations.
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WhyDoHealthyHomesMatter?Theconnectionbetweenhousingandhealthiswellestablished.TheU.S.DepartmentofHousingandUrbanDevelopment(HUD)andtheNationalCenterforHealthyHousing(NCHH)havesummarizedalargebodyofscientificresearchdemonstratingthatnumeroushousing‐relatedhazardsposeathreattohumanhealth(HUD,2011;NCHH,2009).ThesehazardsarefrequentlygroupedintofourmajorcategoriesbasedontheAmericanPublicHealthAssociations“BasicPrinciplesofHealthfulHousing”publishedin1938:
PhysiologicalRequirements:Anumberofindoorchemicalcontaminants,includinglead,environmentaltobaccosmoke,carbonmonoxide(CO),radon,volatileorganiccompounds(VOC),asbestos,andpesticides,poseseriousthreatstohumanhealth.
PsychologicalRequirements:Poorlightinghasbeenlinkedwithdepressionandmooddisorders,suchasseasonalaffectivedisorder.Adequatelightingisimportantinallowingpeopletoseeunsanitaryconditionsandtopreventinjury,thuscontributingtoahealthierandsaferenvironment.Noisecancausehearingimpairment,sleepdisturbance,negativecardiovascularandpsycho‐physiologiceffects,psychiatricsymptoms,andpoorfetaldevelopmentandcanalsoreduceattentiontotasksandimpedespeechcommunication.
ProtectionAgainstInfection:Inadequatedesignandmaintenanceofhousingcanresultinconditionsthatfacilitatethegrowthofmoldandbacteriaaswellasinfestationofrats,mice,andotherpests.
ProtectionAgainstUnintentionalInjuries:Inadequateanddeferredmaintenanceofhomes,inadequatedesignofnewhomes,andlackofimportantsafetydevicescanresultinpreventableinjuries,illness,anddeathinthehome.
Thissectionhighlightsthreehousing‐relatedhealthissuesthatwillrequireacoordinated,housing‐basedapproachasakeystrategy:asthmaandrespiratoryhealth,childhoodleadexposure,andunintentionalinjuries.
Asthmaandrespiratoryhealth:Asthmaisachronicdiseaseinwhichtheairwaysofthelungsbecomeinflamedornarrowed,resultingindisruptionstonormalbreathingpatternsandsignificanthealthconsequences.Asthmadisproportionatelyimpactslow‐incomefamiliesandpeopleofcolorlivinginsubstandardhousingbecauseofthepresenceofpests,mold,environmentaltobaccosmoke,andotherasthmatriggers.Mold,pests,andotherallergenscantriggerasthma,whichistheleadingcauseofschoolandworkabsences,emergencydepartmentvisits,andhospitalizationsintheUnitedStates(AmericanLungAssociation,2011).Asthmaresultsinannualcostsof$20.7billiontothenation(AmericanLungAssociation,2011).Exposuretomoldanddampnesswithinhomescontributestoanestimated21%ofallasthmacasesintheUnitedStates(Mudarri&Fisk,2007).Inaddition,dampnesscanleadtoinsomnia,allergies,headache,cough,andotherrespiratoryhealthissues(Eggleston,etal.,2005;Kercsmar,etal.,2006).Chronicobstructivepulmonarydisease(COPD)isthefourth‐leadingcauseofdeathintheUnitedStates(CDC,2010).COPDmaybeexacerbatedbyenvironmentalexposures,includingtobaccosmokeandairpollutants.ThehighestCOPDhospitalizationratesareseenamongolderadults.
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Childhoodleadexposure:Housingconditionsassociatedwithincreasedriskofleadpoisoningincludechipping,peeling,andflakingpaintontheexteriorandinteriorofahome;leadpaintonfriction‐impactsurfacessuchaswindows,doors,stairs,andrailings;waterleaks,moistureproblems;andrenovationofoldhouseswithoutproperuseoflead‐safeworkpracticesandclean‐up.Childhoodleadexposureremainsacriticalpublichealthissue.Childrenareexposedtoleadintheirhomesfromdeterioratingleadpaintandthecontaminateddustandsoilitgenerates,leadinwaterfromleadedsupplylinesorplumbing,andothersources.Theconnectionsbetweenleadexposureandnegativehealthimpactsincludeneurologicaldamage,decreasedIQ,increasedbloodpressure,anemia,gastrointestinalissues,stuntedgrowth,seizures,coma,and–atveryhighlevels–death(Gould,2009;Fewtrell,Pruss‐Ustan,Landrigan,&Ayuso‐Mateos,2004).Evenlowlevelsofleadexposurecanhavealastingimpactonachild’sIQ,likelihoodofhavingalearningdisability,andeducationalattainment(Chandramouli,Steer,Ellis,&Emond,2009;Miranda,Kim,Galeano,Paul,Hull,&Morgan,2007;Miranda,Maxson,&Kim,2010).Nosafebloodleadlevelinchildrenhasbeenidentified,emphasizingtheimportanceofprimaryprevention,“astrategythatemphasizesthepreventionofleadexposure,ratherthanaresponsetoexposureafterithastakenplace(AdvisoryCommitteeonChildhoodLeadPoisoningPrevention,2012).”TheCDCreferencevalueforchildhoodleadexposureprovidesawaytocompareanindividualchild’sbloodleadleveltoapopulationofchildrenthesameage(AdvisoryCommitteeonChildhoodLeadPoisoningPrevention,2012).Thecurrentreferencevalueis5microgramsofleadperdeciliterofblood(μg/dL)andwillshiftwithpopulationbloodleadlevels.Morethan535,000U.S.childrenages1‐5haveBLLsgreaterthan5μg/dL(MMWR,2013).
Unintentionalinjuries:Inadequateanddeferredmaintenanceofhomes,inadequatedesignofnewhomes,andlackofimportantsafetydevicescanresultinpreventableinjuries,illness,anddeathinthehome(HUD,2011).Theleadingcausesofdeathinthehomearefalls,drowning,fires,poisoning,suffocation,choking,andguns.Fallsaloneaccountforoverhalfofallunintentionalhomeinjurydeaths.Veryyoungchildrenandadultsoverage70arethemostlikelytobehurtathome.Poorlydesignedhomescanalsoprovideanunsafeorunsuitableenvironmentforolderadultsandpeoplewithadisability.Becauseoffalls,manyeldersexperiencedevastatingconsequencessuchasbrokenbonesandheadinjuries.Eachyear,approximately18,000injurydeathsand12millionnon‐fatalinjuriesoccurnationallywithinhomes(Runyan,etal.,2005a;Runyan,etal.,2005b).Fallsaccountforoverhalfofallunintentionalinjurydeathswithinthehome(Runyan,etal.,2005b);fires,drowning,poisoning,suffocation,choking,andgunsareotherleadingcausesofdeathinthehome.
UsingaHealthyHomesApproach
Asubstantialevidencebaseofeffectiveinterventionsexiststoaddressthesehousing‐relatedhealthhazardsthroughahealthyhomesapproach(U.S.DepartmentofHousingandUrbanDevelopment,2011;NationalCenterforHealthyHousing,2009).A“healthyhome”isahomedesigned,constructed,maintained,orrehabilitatedinamannerthatsupportsthehealthofresidents.Thehealthyhomesapproachsystematicallyandholisticallyidentifiesandaddresseshealthandsafetyhazardsinthehomeenvironment.Applyingahealthyhomesapproachismoreefficientthansingleissue‐focusedprogramsbecauseitpromotescost‐efficienthousinginterventionsthataddress
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multiple,interrelatedhealthhazards.Thehealthyhomesapproachisorganizedaroundthe“SevenPrinciplesofHealthyHomes,”whichare:
Keepit:
Dry Clean Safe Ventilated Pest‐Free Contaminant‐Free Maintained
Thehealthyhomesapproachusesthreeinterrelatedstrategiestoaddressenvironmentalhazardsinthehome(HUD,2011).Thesestrategiesinclude:(1)Changesinstructuralconditionsandbuildingpractices;(2)modificationofresidentandpropertyowners’behaviors;and(3)developmentorrevisionofpolicies,legislation,andservicesystemstoenablehealthyhousingpractices(HUD,2011).Extensiveevidenceexiststosupporttheimplementationofspecifichealthyhomesinterventions,suchas(NCHH,2009):
Multi‐faceted,tailoredasthmainterventions Integratedpestmanagement Moistureintrusionelimination Radonairmitigationthroughactivesub‐slabdepressurization Smokingbans Leadhazardcontrol Installationofworkingsmokealarms Pre‐setsafetemperaturehotwaterheaters
Thisevidence‐baseprovidesthefoundationfortheidentifiedpriorityactionstrategiesoutlinedinthisplan.
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HousingandHealthinGeorgia–AnOverviewofExistingConditionsToday,mostAmericansspendnearly90%oftheirtimeindoors,andmostlyathome(EPA,2013).Formany,ahomeisconsideredaplaceofsafetyandcomfort,howevertherearepotentialhazardsthatcancauseillnessorinjury.In2009,theU.S.SurgeonGeneralrecognizedthepublichealthimpactsofhousingandissuedanationwideCalltoActiontopromotehealthinhomes.Thissectiongivesanoverviewaboutcurrenttrendsindemographics,housingquality,indoorairquality,asthma,injury,leadpoisoning,andemergencypreparedness.Thissectionalsohighlightscurrentprogramcapacityandactivities.DemographicsGeorgiaishometoadiversepopulationwithavarietyofcultures.Accordingtothe2011U.S.CensusEstimate,thestate’sestimatedpopulationfor2011was9.8million.Ofthistotal,46%ofpeoplearenon‐whiteorHispanicand16%ofindividualslivebelowpovertylevel.InGeorgia,32%percentofhouseholdshaveoneormorechild,19%ofhouseholdshaveoneormoreelderlyresidents,and15%offamiliesarebelowthepovertylevel.Renterscompriseapproximately35%ofresidents,and56%ofrentersand28%ofhomeownerspay35%ormoreoftheirincomeforhousing.IndoorAirQualityIndoorairqualityislinkedwithmanyhealtheffectsincludingasthma,lungcancer,chronicobstructivepulmonarydisease,andotherdiseases.Poorindoorairqualitycannotonlyaffecthealthofadultsandchildren,butalsoachild’sabilitytolearn.InGeorgia,indoorairqualityissuesincludecarbonmonoxidepoisoning,householdchemicalexposure,airbornemoldspores,radongases,volatileorganiccompounds,particulatematter,allergensandenvironmentaltobaccosmoke.BasedonJanuarytoOctober,2012statewideinquiries,themajorityofcallstotheHealthyHomesProgramwererelatedtohealthconcernsfromexposuretomoldormildew.Additionally,86%ofthosecallerswererenters.
ThemostcommonhouseholdpestsinGeorgiaincludeants,cockroaches,fleas,spiders,flies,wasps,rats,bats,mice,and,increasingly,bedbugs(UniversityofGeorgia’sCollegeofAgriculturalandEntomologicalSciences,2013).Pestscarrydisease,exacerbateasthma,andcreateanuisancewheninsideahome.Theprevalenceofpesticideuseinresponsetothesepestspecieshasraisedsignificantconcernoverthepotentialhealtheffectsassociatedwithbothacuteandchronicexposuretothesechemicals(http://portal.hud.gov/hudportal/documents/huddoc?id=DOC_12484.pdf). The GeorgiaDepartmentofPublicHealth
promotesIntegratedPestManagementandsaferalternativestohouseholdchemicalstoassisthouseholdswithreducingpestsandchemicalgasesinsidethehome.CommercialpestcontrolandpesticideapplicationisoverseenbytheGeorgiaDepartmentofAgricultureandtheGeorgiaEnvironmentalProtectionDivision. TobaccosmokeistheleadingcauseoflungcancerintheU.S.(CDC,2013).Eachyear,approximately150,000peoplediefromlungcancerintheU.S.,andlungcanceristhecauseofone
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ofeverysixcancerdeaths.InGeorgia,environmentaltobaccosmokehasbeenbannedinmanypublicbuildingsinGeorgiaundertheGeorgiaSmokefreeAirAct(2005),andordinancesexistwhichrestrictsmokingnearpublicentrances.Asthesecondleadingcauseoflungcancer,radonisanotherhealthyhomesconcerninGeorgia.TheU.S.EnvironmentalProtectionAgencyidentifiedmostofnorthGeorgiaasmoderatetohighpotentialforexposuretoradoninhomes.Overthelast25years,therewere1,632homesinGeorgiawithashort‐termradonlevel≥4pCi/L.Whencombinedwithsmokingregularly,aperson’sriskforlungcancerincreasesexponentially.Maintaininggoodindoorairqualitywithproperventilationisessentialforreducingasthmaandotherrespiratorydiseases.Approximately230,000(9%)childrenages0‐17yearsand570,000(8%)adultshaveasthmainGeorgia(2010GeorgiaBRFSS).Asthmaisthesecondleadinghealthproblemamongschool‐agedchildren.Inthepastyear,38%ofchildreninGeorgiawithasthmahadanasthmaattackinthepastyear,and14%ofchildrenwithasthmahadtovisitanemergencyroomorurgentcare(2010GeorgiaProgramandDataSummaryonAsthma).Itisestimatedthathospitalizationchargesrelatedtoasthmatotaledmorethan$132millionandERchargesrelatedtoasthmatotaledover$63millioninGeorgia(2010GeorgiaProgramandDataSummaryonAsthma).InGeorgia,amongchildrenwithasthma,hospitalizationratesarehighestforthoseagesfourandunder(2010GeorgiaProgramandDataSummaryonAsthma).
GEORGIA US
Lifetimeasthmaamongadults 11.5% 13.5%
Lifetimeasthmaamongchildren 14.5% 12.6%(38states)
AsthmaEDvisitrateper10,000residents 54.5 55.4
Asthmahospitalizationrateper10,000residents 11.6 14.4
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LeadExposureGeorgiahasnearly300yearsofhousinghistory,andmanyofGeorgia’shistorichomescontainlead‐basedpaint.ThroughoutGeorgia,39%ofhomesarepre‐1978and8%arepre‐1950.Withinatwoyearperiod(2010‐2012)GHHLPPPidentified206homeswithconfirmedinteriororexteriorleadhazardsthataredirectlylinkedtopoisonedchildren.Riskindicatorsestablishinghousingashighriskincludelocationinanurbanarea,highnumbersofrentalhousing,andnumbersofMedicaidchildrenasanindicationofsocioeconomicstatus.Riskindicatorswereoriginallyusedtoidentifychildhoodleadpoisoningriskbutcanbeappliedtohealthyhomesriskfactorsaswellduetobuildingconditionandhousingdisparities.
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Fig.1.(above)Mapofhigh‐riskhousingcounties,2010.In2011,therewere120,797childrenlessthan6yearsoldtestedforleadpoisoning(GeorgiaDepartmentofPublicHealth,2011).Ofthesechildren,5,361werefoundtohaveabloodleadlevelof5microgramsperdeciliter(mcg/dL)orgreater,and778werefoundtohaveabloodleadlevelof10microgramsperdeciliter(mcg/dL)orgreater.Amongthecasesofleadpoisoning,70%aremanagedcarechildren(GeorgiaDepartmentofPublicHealth,2011).GHHLPPPidentifiedseveralcountiesthroughoutthestatethatposeahigh‐riskforleadpoisoningbasedonleadscreeningdataincluding:
Bibb Fulton Carroll Gwinnett Chatham Hall Cobb Laurens Crisp Muscogee DeKalb Richmond Dougherty Whitfield
Fig.2.Mapofhigh‐riskcountiesidentifiedbybloodleadscreeningdata,2010
InjuriesInjuriesinGeorgiacauseanaverageof4,750deathsperyear.Fall‐relatedinjuriesaretheleadingcauseofhospitalizationsinGeorgia.Poisoningandfallsarethe3rdand4thleadingcauseofinjurydeathinGeorgiaforallages,respectively.Themajorityoffiresoccurinresidentialhomes.Injury‐relatedhospitalizationscostnearly$668millioninhospitalchargesperyear(GAVitalStatisticsData&GeorgiaInjuryPreventionStrategicPlan:2010‐2015).
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GHHLPPPcollectsandmanagesinformationonbloodleadtestingthroughtheGeorgiaDepartmentofPublicHealth’sStateElectronicNotifiableDiseaseSurveillanceSystem(SENDSS.)ThissystemservesasadatasharingsystemthatprovidesthecapacityforlaboratoriestoreportresultsofbloodleadtestingandforGHHLPPPtoconductcasemanagementonleadpoisonedchildren.GHHLPPPworkswithGeorgia’sMedicaidProgram,overseenbytheGeorgiaDepartmentofCommunityHealth,toensurethatchildrenatthehighestriskofleadpoisoningarescreenedandreceivetheappropriateattention,andadvisestheMedicaidProgramabouttestingandfollow‐upofMedicaidchildrenforleadexposure.GHHLPPPalsoworkswiththeHeadStartprogramsthroughoutthestatetoensurethatallHeadStartchildrenaretestedforleadwhichisafederalCentersforMedicare&MedicaidServicesrequirement,andoverseescasemanagementandfollow‐upforleadelevatedchildrenintheMaternalChildHealthProgram(MCH).
Since2011,GHHLPPPhasexpandeditschildhoodleadpoisoningpreventionservicestoincludeprovidinginformationaboutotherpotentialhazardsaroundthehome.AspartoftheexpandedleadprogramincorporatingCDC’sHealthyHomesinitiativeinGeorgia,GHHLPPPoffersinformationaboutotherhouseholdhazardssuchasindoorairqualityandunintentionalinjuries.
In2012,theprogramconductedahealthyhomesneedsassessmenttodetermineenvironmentalhealtheducationmaterialsneeds,andhasdevelopedseveralhealtheducationmaterialsfordistributiontothegeneralpublic.Theprogramhastrainedtwenty‐onelocalEnvironmentalHealthSpecialiststhroughoutGeorgiaashealthyhomespractitioners.SeveralbrochuresonvarioushealthyhomestopicshavebeenmadeavailabletoeverypublichealthdistrictinGeorgia.
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cHealth(DPH12.DPHpartntegicplanninalthyHomesoryWorkgroglocal,statearofitsandadvembersisprberswereto:reviewofmaopedbytheAplanningpreprocess,anisoryWorkgr
theAdvisoryhildhoodLeapresentedsuentedmodelrasitworksulatedtheirventforhealthreflectedontupsthenworing,anddeveesanovervie
giaHealthy
Planning
H)embarkedneredwiththgprocess.DPStrategicPla
ouprepresenandfederalhvocacyorganrovidedinAp:(1)participaterials;(2)pAdvisoryWoocessresonandkeepingDroupmembe
yWorkgroupadPoisoningummaryinfolinitiativesatoimplemenvisionsforhehyhomes.Atthesynthesizrkedtoidentelopedactionwofthestra
HomesStra
gProcess
donastatewheNationalCPHrecruitedanningAdvisntedcollaborhealthprogranizations,anppendixA.Thpateinthestrprovideleadeorkgroup;andateamongdiPHappriseders.
p.ThefirstmPreventionWormationonhandstrategientacomprehealthyhomesthesecondmzedpracticaltifyprioritysnplansforthategicplannin
ategicPlanni
widehealthyCenterforHedkeystakehosoryWorkgrationbetweeams,socialsendmanyotheherolesandrategicplannershipforthed(3)adviseiversesectordofactivities
meetingwashWeekandChhealthandhsfromacroshensivehealtsinGeorgiaameeting,heldlvisionstatestrategiesforhefirstyearngprocess.
ingProcess
homesstrateealthyHousiolderstooup(theenadiverseerviceagencers.AcompleresponsibiliningprocesseimplementDPHbyensurs,sharinganandprogram
heldinOctobhildHealthhousingsstheUnitedthyhomesanddevelopedinDecembementidentifrachievingtofplan
16
egicng
ies,eteties
tationuringndms
ber
edaerfiedthe
17
Meetingevaluationssuggestthattheplanningprocesswashighlysuccessfulandwell‐receivedbyparticipants.OfthosewhorespondedtotheOctober2012meetingevaluation,100%ofparticipantsfelttheirinputwas“verymuch”consideredandincorporatedatthemeeting.Eighty‐threepercentofparticipantsfeltthepracticalvisionstatementdeveloped“verymuch”resonatedwiththeirorganization,and17%feltthatit“somewhat”resonatedwiththeirorganization.Fifty‐sevenpercentofparticipantsanticipatestaying“highlyinvolved”and43%anticipatestaying“somewhatinvolved”intheimplementationoftheplan.
57%ofAdvisoryWorkgroup
membersplantostayhighly
involvedintheimplementationofthestrategic
plan
18
VisionforHealthyHomesinGeorgiaTheAdvisoryWorkgroupmembersidentifiedsevenelementsthatdescribeacollectivestatewidevisionforhealthyhomesinresponsetothequestion,“WhatdowewanttoseeinplaceinGeorgiain3‐5yearsasaresultofcollaborationamonghealth,housing,andeducationprograms?”ThepracticalvisionstatementresultingfromthisexerciseisdetailedinAppendixB.Theresultingsevenvisionelementsareasfollows:
1. Comprehensivestrategiestosupportdiverseandengagedstakeholders2. Coordinated,appropriate,andeffectivemarketingandeducation3. Effectivepoliciesandstrongenforcement4. Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation5. Diverseresourcesandrevenuegeneratingmechanisms6. Standardizedprocessesandconsistentimplementation7. Healthier,saferhomesforgenerations
Aftergeneratingtheircollectivevision,theAdvisoryWorkgroupmembersidentifiedkeyobstaclestoachievingit.ObstaclestotheVisionAnumberofimportantobstaclessurfaced,includinglimitedknowledgeandmisinformationabouthealthyhousingamongdecision‐makers,andasaresult,alackofprioritizationofhealthyhomes.AdvisoryWorkgroupmembersalsoidentifiedun‐mobilizedresourcesasanobstacletoacollaborative,statewidehealthyhomesapproach.ThecurrentundevelopedlegalauthoritytosupporthealthyhomesinGeorgiaisanotherbarrier.Finally,theAdvisoryWorkgrouppinpointedlanguageandculturalbarriers,competingpriorities,andpoliticaloppositionasimportantobstaclestoaddress.AssetsandOpportunitiestoSupporttheVisionDespitetheseexistingbarriers,AdvisoryWorkgroupmembersidentifiedanumberofexistingassetsthatwillsupportGeorgiainitsstatewidehealthyhomesefforts.Georgiahasstrongexpertiseinkeyhealthyhomescontentareasandsignificantresearchanddatacapacity.ThelocalpresenceoftheCentersforDiseaseControlandPreventionandregionalofficesoftheEnvironmentalProtectionAgencyandDepartmentofHousingandUrbanDevelopmentbringcapacity,historicalknowledge,
Key Obstacles: Un‐mobilizedandunidentified
resources Politicalopposition Cutstoexistingfundingstreams Competingpriorities Languageandculturalbarriers Undevelopedauthority Limitedknowledgeand
misinformation Inconsistentdataandreporting Unidentifiedstakeholders Limitedoutreachtounder‐
representedgroups
andcrediWorkgrothisstratagenciesmembersensuresu
ibilitytotheupmembersegicplanproandorganizas’existingconuccessfulimp
GeorgiaDepsfeltthattheovidesexcitinations.Finallnnectionswiplementation
partmentofPenewstatewngopportunly,thestatewiththerealenofthestrat
PublicHealthidenetworkitiesforstrowillbeabletestatesector,egicplan.
h’shealthyhoofpartnersbngercollabooleverageA,contractors
omeswork.AbroughttogeorationamonAdvisoryWor,andlocalco
Advisoryethertodevengstateandlrkgroupommunitiest
19
elopocal
to
20
KeyStrategiesandActionPlansTakingintoaccounttheexistingassets,strengths,andobstaclesforachievinghealthierhomesinGeorgia,theAdvisoryWorkgroupdevelopedspecificstrategiestoadvanceeachelementofthestate’svisionforhealthyhomes.TheAdvisoryWorkgroupdeterminedthattheseventhvisionelement‐Healthier,saferhomesforgenerations–representstheculminatingoutcomethatwouldresultiftheothersixelementsofthevisionwererealized.Therefore,theAdvisoryWorkgroupdidnotidentifyspecificstrategiesorconductactionplanningforthisvisionelement.Thekeystrategiesinclude:VisionElement1:ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders
1. Implementandlaunchapublicrelationsstrategy.2. DesignanorganizationalstructuretoadvancethehealthyhomesinitiativeinGeorgia.3. Developahealthyhomescertificationor“sealofapproval.”
VisionElement2:Coordinated,appropriate,andeffectivemarketingandeducation.1. Developanddisseminatequality,targetededucationalmaterials.2. Identifylegislativechampionstosupportongoingeducationwithlegislators.3. Developastrategicmarketingandeducationplanwithclearpriorities.4. Launchapublicawarenessandeducationcampaign.5. Identifyfunderstosupporteducationalandpromotionalmaterials.
VisionElement3:Effectivepoliciesandstrongenforcement.
1. Educateandmotivatethelegislaturetopassstronglaws.2. Identifyanddraftneededlegislativeauthoritiesforhealthyhomes.3. Developpersuasive,data‐drivenarguments.4. Convene,convince,andmotivatethepublicandstakeholderstoengageindialoguewith
theirlegislators.5. Implementstatewidecodeenforcementthatisstandardized,effective,andincorporates
healthyhomesprinciples.VisionElement4:Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation.
1. ImplementmandatedreportingofhealthyhomesdatatotheGeorgiaDepartmentofPublicHealth,includinghospitalemergencyroomvisitsduetopoisonings,fallsburns,andasthma.
2. Coordinatethecollectionandmanagementofhealthyhomesdatatoeducateandinformpolicymakersandfunders.
3. Developcomprehensivedatatrackingandsurveillancenetworks.VisionElement5:Diverseresourcesandrevenuegeneratingmechanisms.
1. Communicatethereturnoninvestmentforhealthyhomesactivitieswithpolicymakers,funders,andotherstakeholders.
2. Implementrevenuegeneratingrequirementsforcontractorsandpropertyowners.3. Collaboratewithinsuranceproviderstomandatehealthyhomesassessmentsand
interventionsforspecifichealthcareclaims.
21
4. Conducteffectiveresearchtogarnerfundingsupportforhealthyhomes.5. Ensureefficientuseofresourcesbyestablishingandstrengtheningpartnerships.
VisionElement6:Standardizedprocessesandconsistentimplementation.
1. Identifycommonbenefitsandclearrolesforallstakeholderstosupportcollaborativeparticipation.
2. Establishpropertrainingstandards,qualitycontrol,andcertificationprocesses.3. Conductcross‐trainingofagenciesandorganizationsstatewidetoensureconsistent
approachestoidentificationandremediationofhazards.4. Engagehomevisitingagenciesinintegratinghealthyhomesstandardsintotheirprotocols.
StrategiesandActionPlanTables:ThefollowingpagesincludethespecificactivitiesandsuccessindicatorstohelpmovetowardGeorgia’svisionforhealthyhomes.Thetablesincluderecommendedfirst‐yearactivities,theleadorganizationandpartnerswhoareresponsibleforimplementation,andindicatorsofsuccessfulimplementation.
22
VisionElement1:ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders
KeyStrategies:
1. EngageandRecruitkeyhealthyhomesstakeholdersthroughoutGeorgia.2. DesignanorganizationalstructuretoadvancethehealthyhomesinitiativeinGeorgia.3. Developahealthyhomescertificationor“sealofapproval.”First‐YearActivities Lead
Organization(s)Partners
(Includingbutnotlimitedto)
SuccessIndicators
DevelopasustainablehealthyhomescoalitionledbytheGeorgiaDepartmentofPublicHealth(DPH).Thecoalitionshould:o Identifyaclearpurposeandconsistentmessage;
o Setclearlydefinedrolesandresponsibilities;
o Seekoutkeystakeholderswhoarenotyetrepresented;
o Identifyatimeframeforongoingmeetings;
o Seekresourcestosustainthecoalition.
EstablishastandardizeddefinitionofhealthyhomesforthestateofGeorgiaandidentifythekeyprocessesrequiredtomakeahomehealthy.
Initiatethedevelopmentofacomprehensivepublicrelationsstrategy.
Identifystatewideandlocalspokespeopletosupporthealthyhomes.
Proactivelyincludeunder‐representedgroups,includingruralandenvironmentaljusticecommunities.
Examineopportunitiesforengagingpropertyownersandcontractorsthroughacertificationor“sealofapproval”process.
GeorgiaDepartmentofPublicHealth(HealthyHomesandLeadPoisoningPreventionProgram)
MembersoftheGeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroup
Traditionallyun‐orunder‐representedcommunities,trades,andsectors.
Thereisanestablishedcoalitionthatissuccessfulinimplementingitsstrategies
Astatewidehealthyhomesprogramiswell‐establishedandwellknown
Acomprehensivepublicrelationsstrategyisinplaceandisactivelybeingimplemented.
Stakeholdershaveacommonunderstandingofhealthyhomes.
23
VisionElement2:Coordinated,appropriate,andeffectivemarketingandeducation.KeyStrategies:1. Developanddisseminatequality,targetededucationalmaterials.2. Identifylegislativechampionstosupportongoingeducationwithlegislators.3. Developastrategicmarketingandeducationplanwithclearpriorities.4. Launchapublicawarenessandeducationcampaign.5. Identifyfunderstosupporteducationalandpromotionalmaterials.
First‐YearActivities LeadOrganization(s)
Partners(Includingbutnotlimitedto)
SuccessIndicators
Initiatedevelopmentofamarketingandeducationstrategicplan.
Usefocusgroupstodevelopeffectivemessagesforkeytargetaudiencessuchasfamilies,homeowners,renters,schoolsandchildcares,andapartmentassociations.
Developtargetededucationalandmarketingmaterials(e.g.pamphlets,slidedeck,pressreleases,etc.)forkeyaudiences.
Inventoryexisting,qualityeducationalmaterialsanddevelopaneasilyaccessiblelistofresources.
Developaneasytonavigate,multi‐lingualwebsiteforthepublicandkeystakeholders(keyhealthyhomesissues,whattodo,etc.)
Continuetoprovidehealthyhomestrainingstatewide.
Developaqualitycontrolprocessforhealthyhomestrainingtoassurequalityeducation.
Identifycommunitychampions. Lookforpartnerswithinterestinfundingmarketingandeducation(e.g.HomeDepot,Lowes).
Hosteducationalforums. EngageGeorgiaPublicBroadcastingtoeducatethepublic.
GeorgiaDepartmentofPublicHealth(HealthyHomesandLeadPoisoningPreventionProgram)
GeorgiaDepartmentofEarlyCareandLearning
Federalpartnersandregionaloffices:CentersforDiseaseControlandPrevention,EnvironmentalProtectionAgency,andHousingandUrbanDevelopment
Healthdistricts Maternalandchildhealthhomevisitors
ChildrenFirstProgram
BabiesCan'tWait
Anti‐smokingcoalition
Housingauthorities
GeorgiaAssociationonYoungChildren
Corporations Foundations Stateagencies VoicesforGeorgia’sChildren
FamiliesFirst FamilyConnectionPartnership
Resourceandreferralagencies
SafeKidsGeorgia
HeadStart
Marketingandeducationstrategicplanisinplace
Georgiaispassingsuccessfullegislationtosupporthealthyhomes
Standardizedmessagingandmaterialsareinplace
Corporationsprovidesignificantfundingtosupportconsumereducationefforts
Legislativechampionsareinplace
Pre‐postsurveydemonstratesincreasedawarenessinpublic
24
VisionElement3:Effectivepoliciesandstrongenforcement.KeyStrategies:
1. Educateandmotivatethelegislaturetopassstronglaws.2. Identifyanddraftneededlegislativeauthoritiesforhealthyhomes.3. Developpersuasive,data‐drivenarguments.4. Convene,convince,andmotivatethepublicandstakeholderstoengageindialoguewith
theirlegislators.5. Implementstatewidecodeenforcementthatisstandardized,effective,andincorporates
healthyhomesprinciples.First‐YearActivities Lead
Organization(s)Partners
(Includingbutnotlimitedto)
SuccessIndicators
IdentifyexistingGeorgiahealthyhomesrequirements,andidentifygapsordeficienciesintheseexistingrequirements.
Researchandaddressexistingbarrierstohealthyhomespolicydevelopmentandadoption.
Determinepolicystrategiestostrengthenexistinghealthyhomesrequirementsandaddressexistingpolicygapsanddeficiencies.
Identify,contact,andengageacomprehensivelistofstakeholderstosupportstatewidepolicypriorities.
Initiateconversationswithlegislativechampionstoidentifykeybarrierstohealthyhomespolicydevelopmentandadoption.
Hostalegislativedaytoencouragedialogueamongthepublicandpolicy‐makers.
Developaclearplanforenforcementofexistingrequirements.
Initiativethedevelopmentofstandardized,statewidecodeenforcement.
GeorgiaDepartmentofPublicHealth(HealthyHomesandLeadPoisoningPreventionProgram)
MembersoftheGeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroup
Aclear,definedstrategyforstrengtheninghealthyhomespolicyisinplaceandactivelybeingimplemented.
Meetingsandcontactsbetweenkeystakeholdersandlegislatorsaretrackedasameasureofdialoguewithpolicy‐makers.
Existingrequirementsarefullyenforced.
Statewidecodeenforcementisinplace.
25
VisionElement4:Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation.KeyStrategies:1. ImplementmandatedreportingofhealthyhomesdatatotheGeorgiaDepartmentofPublic
Health,includinghospitalemergencyroomvisitsduetopoisonings,fallsburns,andasthma.2. Coordinatethecollectionandmanagementofhealthyhomesdatatoeducateandinformpolicy
makersandfunders.3. Developcomprehensivedatatrackingandsurveillancenetworks.
First‐YearActivities LeadOrganization(s)
Partners(Includingbutnotlimitedto)
SuccessIndicators
Establisheffectiveandefficientprotocolsforreportingrequiredhealthinformation.
Inventoryexistingdataandsurveillancesystemsandinitiateaplanfordevelopingacomprehensivetrackingandsurveillancenetwork.
ExpandtheGHHLPPPsurveillancesystemtoincludenotonlybloodleadlevels,butalsoenvironmentaltestresultsandselectedhealthyhomesvariables.
GeorgiaDepartmentofPublicHealth(HealthyHomesandLeadPoisoningPreventionProgram)OHIPGeorgiaDepartmentofPublicHealth
CDC Surveillancesystemhasbeenassessedandissueshavebeenaddressed
Successfulcollectionofsurveillancedata
ComprehensiveHHsurveillancesystemisinplacewithintheGHHLPPPPProgramandbeingutilized.
26
VisionElement5:Diverseresourcesandrevenuegeneratingmechanisms.KeyStrategies:1. Communicatethereturnoninvestmentforhealthyhomesactivitieswithpolicymakers,
funders,andotherstakeholders.2. Implementrevenuegeneratingrequirementsforcontractorsandpropertyowners.3. Collaboratewithinsuranceproviderstomandatehealthyhomesassessmentsand
interventionsforspecifichealthcareclaims.4. Conducteffectiveresearchtogarnerfundingsupportforhealthyhomes.5. Ensureefficientuseofresourcesbyestablishingandstrengtheningpartnerships.
First‐YearActivities LeadOrganization(s)
Partners(Includingbutnotlimitedto)
SuccessIndicators
Instituteahealthyhomescomprehensivedatabaseusingastandardizedtooltoenablereturnoninvestmentcalculations.
Identifyopportunitiestouseresourcesmoreefficientlyamongagenciesandorganizationsinvolvedinstrategicpartnerships.
Approachmedicalinsuranceproviderstobegindialogueregardingreimbursementforhealthyhomesassessmentsandinterventions.
Partnerwithlocalcollegesanduniversitiestoresearchimplementablerevenuegeneratingstrategies.
Identifyincentivesthatcouldbeusedtosupportpropertyownersinremediatinghazards.
Launchcoordinatedtrainingforcontractorsandpropertyowners.
Postasearchableonlinelistingofallfederal,state,andlocalfundedhealthyhomesinitiatives.
Createafee‐for‐servicehomevisitingprogramwithaslidingscalepaymentstructure.
GeorgiaDepartmentofPublicHealth(HealthyHomesandLeadPoisoningPreventionProgram)
NationalHealthyHomesTrainingCenterandNetworkPartners
Healthinsurers CentersforDiseaseControlandPrevention
Localcollegesanduniversities
MembersoftheGeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroup
Comprehensivedatabaseisinplace
Georgiahascalculatedandcommunicatedthereturnoninvestmentforhealthyhomes
Increasedtrainingofprofessionalsandpropertyownersinhealthyhomesprinciples
Dialoguewithinsuranceprovidersresultsinreimbursementmechanisms.
Newrevenuegeneratingstrategiesareidentifiedandimplemented
27
VisionElement6:Standardizedprocessesandconsistentimplementation.KeyStrategies:
1. Identifycommonbenefitsandclearrolesforallstakeholderstosupportcollaborativeparticipation
2. Establishpropertrainingstandards,qualitycontrol,andcertificationprocesses.3. Conductcross‐trainingofagenciesandorganizationsstatewidetoensureconsistent
approachestoidentificationandremediationofhazards.4. Engagehomevisitingagenciesinintegratinghealthyhomesstandardsintotheir
protocols.First‐YearActivities Lead
Organization(s)Partners
(Includingbutnotlimitedto)
SuccessIndicators
FinishtheGeorgiaHealthyHomesStrategicPlantoprovideaframeworkforcollaborationandimplementation.
Alignhealthyhomesconsiderationsacrossallentitiesandorganizations.
Begintodevelopqualitycontrolprocesses.
Initiatetheidentificationofcommonbenefitsandclearrolesforstakeholders.
Identifyachampionfromeachorganizationandagencyinvolvedincoordinatedhealthyhomeseffortsacrossthestate.
Gainparticipationandbuy‐infromkeystakeholders.
Establishaone‐stoplocationforapplicationintakeandeducation.
Encourageandincentivizeinformationsharingamongpartners.
Begindialoguewithhomevisitingagencies.
GeorgiaDepartmentofPublicHealthandregionalhealthorganizations
MembersoftheGeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroup
Federalagencies
Homevisitingagencies
Strategicplaninplaceandinoperation
Onechampionfromeachorganization/agencyisinvolved
Partnersrecognizecommonbenefitsandbuy‐intostatewideefforts
Homevisitingagenciesfullyintegratehealthyhomesstandardsintotheirprotocols.
28
SustainabilityPlanThe2012FederalBudgetcutCDCfundsforlead/healthyhomesby94%.SeveralmonthsintotheprocessCDCofficiallynotifiedGHHLPPPthattherewouldbenofundingbeyondthefirstyear.Asaresult,thisplanwasdevelopedwithanassumptionthatthefutureGHHLPPProleinpromotingandimplementingtheplanmaybeverylimited.However,Georgiahasanextensivebaseofpeople,programs,andorganizationsthatcancontributetohealthyhomesandcommunities,withmultipleexistingcommunityassetsandresourcesidentified.Asofthiswriting,manyprojectsarebeingconsideredforreducingprogramcostsand/orgeneratingfunds.Theseconceptsarebeingevaluatedfortheireffectiveness,cost‐benefitcapacity,barriersandsustainability.Theyincludebutarenotlimitedtoconceptswithstaffreductionandreassignment,resourcereallocation,alternativeactivities,reductionandgenerationoflowercostservices.CareManagementOrganizationsarebeingutilizedtoassistGHHLPPPwithpatientcasemanagementandMedicaidreimbursementforhomeinspectionsofelevatedbloodleadchildren.Additionally,grantfundingopportunitieswillbeexploredandappliedforwhendeemedappropriateforthisprogram’smission.Toachievethevisionelements,strategies,andactionstepsdeveloped,extensivepartnershipswillbenecessaryforsuccessfulimplementation.TheHealthyHomesAdvisoryCommitteerepresentsabroadlistofkeystakeholdersselectedfortheirexpertise,specificfocusandcommondirection.Theseconsistoflocal,stateandfederalgovernmentalhealthandhousing‐relatedagencies,privateindustry,andnon‐governmentaleducationandadvocacyorganizations.AdvisoryCommitteemembershavecommonorganizationalgoalsandhaveindicatedacommitmenttoworktogethertogainsupportforcommonobjectivesandimplementtheplan.Asaresultofthestrategicplanningprocess,membersagreedtosustainthisrelationshipandservetoprovidecontinueddirectionforGHHLPPPactivitiesidentifiedinthisstrategicplan.
29
ReferencesAdvisoryCommitteeonChildhoodLeadPoisoningPrevention.(2012).LowLevelLeadExposureHarmsChildren:ARenewedCallforPrimaryPrevention.Availableat:http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf.AmericanLungAssociation.(2011).CharlesD.ConnorAppropriationsTestimony(DepartmentofHealthandHumanServices‐SummaryofPrograms)totheU.S.HouseofRepresentatives,SubcommitteeonLabor,HealthandHumanServicesandEducation.RetrievedAugust14,2012,fromhttp://www.lung.org/get‐involved/advocate/advocacy‐documents/connor‐appropriations‐testimony.pdfChandramouli,K.,Steer,C.,Ellis,M.,&Emond,A.(2009).Effectsofearlychildhoodleadexposureonacademicperformanceandbehaviourofschoolagechildren.ArchivesofDiseaseinChildhood,94(11),844‐848.Eggleston,P.,Butz,A.,Rand,C.,Curtin‐Brosnan,J.,Kanchanaraksa,S.,Swartz,L.,etal.(2005).Homeenvironmentalinterventionininner‐cityasthma:Arandomizedcontrolledtrial.AnnalsofAllergy,Asthma,andImmunology,95(6),496‐497.Fewtrell,L.,Pruss‐Ustan,A.,Landrigan,P.,&Ayuso‐Mateos,J.(2004).Estimatingtheglobalburdenofdiseaseofmildmentalretardationandcardiovasculardiseasesfromenvironmentalleadexposure.EnvironmentalResearch,94,120‐133.Gould,E.(2009).Childhoodleadpoisoning:conservativeestimatesofthesocialandeconomicbenefitsofleadhazardcontrol.EnvironmentalHealthPerspectives,117(7),1162‐1167.Kercsmar,C.M.,Dearborn,D.G.,Schluchter,M.,Xue,L.,Kirchner,H.L.,Sobolewski,J.,etal.(2006).Reductioninasthmamorbidityinchildrenasaresultofhomeremediationaimedatmoisturesources.EnvironmentalHealthPerspectives,114(10),1574‐1580.Miranda,M.,Kim,D.,Galeano,M.,Paul,C.,Hull,A.,&Morgan,S.(2007).Therelationshipbetweenearlychildhoodbloodleadlevelsandperformanceonend‐of‐gradetests.EnvironmentalHealthPerspectives,115(8),1242‐1247.Miranda,M.,Maxson,P.,&Kim,D.(2010).Earlychildhoodleadexposureandexceptionalitydesignationsforstudents.InternationalJournalofChildHealthandHumanDevelopment,3(1),77‐84.Mudarri,D.,&Fisk,W.(2007).Publichealthandeconomicimpactofdampnessandmold.IndoorAir,17,226‐35.NationalCenterforHealthyHousing.(2009).HousingInterventionsandHealth:AReviewoftheEvidence.Columbia,MD:NationalCenterforHealthyHousing.Portier,C.(2012).TheLatestScienceonLead'sImpactsonChildren'sDevelopmentandPublicHealth.TestimonybeforetheCommitteeonEnvironmentandPublicWorks,UnitedStatesSenate.Availableat:http://epw.senate.gov/public/index.cfm?FuseAction=Files.View&FileStore_id=c7b84ff9‐468a‐4d92‐8adc‐c84aee2e6ff1.
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Runyan,C.,Casteel,C.,Perkis,D.,Black,C.,Marshall,S.,Johnson,R.,etal.(2005a).UnintentionalinjuriesinthehomeintheUnitedStatesParkI:Mortality.AmericanJournalofPreventiveMedicine,28,73‐79.Runyan,C.,Perkis,D.,Marshall,S.,Johnson,R.,Coyne‐Beasley,T.,Waller,A.,etal.(2005b).UnintentionalinjuriesinthehomeintheUnitedStatesPartII:Morbidity.AmericanJournalofPreventiveMedicine,28,80‐87.U.S.CentersforDiseaseControlandPrevention(2010).ChronicObstructivePulmonaryDisease.RetrievedOctober11,2012fromhttp://www.cdc.gov/Features/COPD/index.html.U.S.DepartmentofHousingandUrbanDevelopment.(2011).TheHealthyHomesProgramGuidanceManual.Washington,DC:U.S.DepartmentofHousingandUrbanDevelopment.U.S.EnvironmentalProtectionAgency.(2003).EPAAssessmentofRisksfromRadoninHomes.Washington,DC:U.S.EnvironmentalProtectionAgency.
31
AppendixA–AdvisoryWorkgroupMembersJohnArmour,CityofAtlantaDept.ofPlanningandCommunityDevelopment
SandraBell,GeorgiaCommunityActionAss.(GCAA)Weatherization
KaronBush,WestCentralHealthDistrict,GDPHJuliaCampbell,GDPHHealthyHomesProgramEileenCarrol,HUDSimoneCharles,GeorgiaSouthernUniversityRyanCira,DekalbCountyBoardofHealthMindyCrean,GEPDLead‐BasedPaintProgramToriEndres,WestCentralHealthDistrict,GDPHFoziaEskew,GA.ChapterofAmericanAcademyofPediatricsKimGrier,GDHSDivisionofAgingServicesMargaretGunter,NorthCentralHealthDistrict,GDPHJaniceHacker,Georgia,BrightFromtheStartStephanieHall,GDPHAsthmaProgramCorbyHanna,TheCenterforWorkingFamilies‐LeadSafeAtlantaDebJunkin,GeorgiaRealtorsAssociationChristyKuriatnyk,GDPH,HealthyHomesProgramTomLaubenthal,TheEnvironmentalInstituteBeverlyLosman,SafeKidsGeorgiaFrancescaLopez,GDPHAsthmaProgramBonnieMaurras,LeadnologyTodayMeganPopielarczyk,SafeKidsGeorgiaKennethRay,GDPHTobaccoUsePreventionPennyRound,GAApartmentOwnersAssociation
32
SteedRobison,GeorgiaDept.ofCommunityAffairs(DCA)‐HousingSanjeebSapkota,CDCJanSimmons,GEPDLead‐BasedPaintProgramJonnetteSimmons,HUDGwenSmith,GDPHLeadHazardControlProgramForrestStaley,GDPHLeadHazardControlProgramChrisStevens,StateFireMarshall’sOfficeYuSun,GDPHHealthyHomesProgramShawnTaylor,ColumbusHDVectorControlTracyTeague,GDPH,HealthyHomesProgramLaniiThomas,CityofAtlanta,Dept.ofPlanning&CommunityDevelopmentPamelaTurner,UGAJeremyWeir,PrivateLeadInspectorLizWilde,USEPAMelindaFordWilliams,GeorgiaDept.ofCommunityHealthStateMedicaidProgram
33
AppendixB–PracticalVisionStatement
GeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroupPracticalVision
WhatdowewanttoseeinplaceinGeorgiain3‐5yearsasaresultofcollaborationamonghealth,housing,andeducationprograms?
Healthier,SaferHomesforGenerations
Makehealthyhomesprinciplessecondnaturetoall. Decreasepoorhealthoutcomesandinjuries. Makeallhomessafeandhealthy. Ensurethatallchildrenarefreefromleadandhousing‐relatedhealthissues.
ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders
Developanorganizationalchartthatclarifiestherolesandresponsibilitiesofthediverseorganizationsinvolved.
Establishfunctioningmulti‐sectorcollaborationswithchampions(e.g.,anassociation).
Encouragecollaborationamonghealth,housing,andeducationsectorstoscreenfor,followupon,andeliminateleadpoisoning.
Createafee‐for‐servicehomevisitingprogramwithaslidingscalepaymentstructure.
Establishabroadercoalition. Proactivelyincludeunder‐representedgroups,includingruralandenvironmentaljusticecommunities.
Ensurecommunityengagementtofosternewprogramsandactivities. Identifychampionsatlocallevel. Coordinateaccesstomaterialsandeducationalresources.
Coordinated,Appropriate,andEffectiveMarketingandEducation
Marketandeffectivelycommunicatethebenefitsandsavingsofthehealthyhomesapproachforresidents,contractors,andlegislators.
Developacomprehensiveeducationcampaign. Hosteducationalforums. Increaseawarenessamongfamilies/consumersandagencyofficials. Provideaccesstoresourcestoassistwithhousingimprovements.
EffectivePoliciesandStrongEnforcement
Conducteffectivepolicyanalysis,planning,andmonitoring. Reviewandstrengthenexistinglegislation. Establisheffectivepolicies. Implementstatewidecodeenforcementthatisstandardized,effective,andincorporateshealthyhomesprinciples.
Developaclearplanforenforcement.
Comprehensive,Accurate,andTimelyDataTracking,Surveillance,andEvaluation
Establishdataprocessesandmonitoroutcomes. Developcomprehensivedatatrackingandsurveillancenetworks. Identifyandremediategapsindatasystemprocesses. Collaboratewithinternalandexternalpartnerstoshareappropriatedataasneeded.
Establisheffectiveandefficientprotocolsforreportingrequiredhealthinformation.
34
GeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroupPracticalVision
WhatdowewanttoseeinplaceinGeorgiain3‐5yearsasaresultofcollaborationamonghealth,housing,andeducationprograms?
DiverseResourcesandRevenueGeneratingMechanisms
Provideincentivesforpropertyownersandotherstakeholders. Leveragefundswiththeprivatesector. Developclear“sellingpoints”togeneratefundingsupport. Providelow‐costhomemodificationopportunities. Establishpublic/privatepartnershipstosupportaffordablehousing.
StandardizedProcessesandConsistentImplementation
Establishaone‐stoplocationforapplicationintakeandeducation. Developstandardizedlanguageandacommondefinitionforahealthyhome.
Conductstandardizedcomprehensivehomeassessments. Cross‐trainstakeholdersontechniquestoachievehealthyhomes. Trainallprogramsworkingwithyoungchildrenontheeffectsofleadandotherhealthyhomesissues.
Developawebportaltoassiststakeholdersinsharingresourcesandinformation.
Encourageandincentivizeinformationsharingamongpartners. Developacentralwebresourceforbothinternalandexternalstakeholders.