www.nchh.org david jacobs, phd, cih, research director national center for healthy housing (mark...
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www.nchh.org
David Jacobs, PhD, CIH, Research DirectorNATIONAL CENTER FOR HEALTHY HOUSING
(Mark James, Jay Wilson, Peter Levavi, Susan Aceti, Carol Kawecki, Emily Ahonen, Sherry L. Dixon, Samuel Dorevitch, Jill Breysse, Janet Smith, Anne Evens, Doborah
Dobrez, Marjie Isaacson, Colin Murphy, Lorraine Conroy, Jonathan Wilson.)
Going Green in Low Income Housing: Perspectives from Developers and Researchers
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www.nchh.orgOutline
Health Investments in Housing – A Framework
Studies of Green Housing & Health Outcomes
Conclusions
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Cuyahoga River ca. 1960
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Is Housing a Shared Commons?
Is Housing Part of the Infrastructure?
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Housing Market Price & Health
Why are Health Investments in Housing Unlike Other Home Improvements?
Cost of NOT Making Homes Healthy
Cost Shifting
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Green Communities Criteria
▪ Integrated Design Process
▪ Location and Neighborhood Fabric
▪ Site
▪ Water Conservation
▪ Energy Conservation
▪ Materials and Resources
▪ Healthy Living Environment
▪ Operations and Management
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www.nchh.orgHealth Criteria
▪ ASHRAE 62.2
▪ Kitchen and bath exhaust ventilation
▪ No carpet in kitchens/baths
▪ Low VOC paints/adhesives
▪ Integrated Pest Management
▪ Radon testing & mitigation
▪ Moisture & mold mitigation
▪ Low/no formaldehyde wood composite products
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Viking TerraceWorthington, MN
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www.nchh.orgMethods
Administered standardized health interview at rehab and one year later
Administered standardized visual assessment
Air sampling
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www.nchh.orgResults
Ability to clean (n=22)*
Comfortable (n=24)*
Safe home (n=14)*
Safe neighborhood (n=12)*
Children play outside (n=7)
0% 20% 40% 60% 80% 100%
86%
88%
86%
83%
86%
14%
12%
14%
17%
14%Worse Better
*p<0.05
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www.nchh.orgChildren
Increased
• Excellent or very good general health increased from 53% to 65%
Decreased
• Non-asthma respiratory problems (38%→23%)
No change
• Asthma
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www.nchh.orgAdults
Increased• Excellent or
very good general health increased from 33% to 62%*
Decreased• Non-asthma
respiratory decreased from 32% to 9%*
• Asthma decreased from 17% to 13%
*p≤0.05
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www.nchh.orgMoisture
Fewer people reported that their newly renovated
homes had:• Mildew or musty odor (29% to
4%)*• Evidence of water or dampness
due to broken pipes, leaks, heavy rain, or flooding (39% to 18%)
• A need for either a dehumidifier (24% to 3%)* or a humidifier (17% to 7%)
*p<0.05
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www.nchh.orgPests
Following the intervention,
fewer people reported:• Problems with cockroaches (25%
to 13%)• Use of insecticides:• By residents (19% to 0%)• By exterminators or maintenance personnel (53% to 7%)*
• Problems with mice or rats(25% to 0%)*
*p<0.05
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www.nchh.orgContaminants
▪ Year-long average CO2 = 982 ppm
▪ All VOCs below ATSDR minimum risk levels
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www.nchh.orgEnergy & Water
46%
Reduction in total energy
use
39%
Estimated reduction
in CO2 emissions
from power plants
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Moving Into Green Healthy Housing: The Yield (Chicago, IL)
J Public Health Manag Pract. 2014 Jan 7
David E. Jacobs, PhD, CIHa,b Emily Ahonen, PhDa Sherry L. Dixon, PhDb
Samuel Dorevitch, MDa Jill Breysse, MHS, CIHb Janet Smith, PhD,a Anne Evens, PhD,a,c Doborah Dobrez, PhDa Marjie Isaacson, PhDc Colin Murphy, MSa Lorraine Conroy, PhD,a
Peter Levavid
a University of Illinois at Chicago, 2121 W Taylor St., MC 922, Chicago, IL 60612b National Center for Healthy Housing, Columbia, MDc Center for Neighborhood Technology Energy, Chicago, ILd Brinshore Michaels Development, Northbrook, IL
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www.nchh.orgMethods
▪ Compared:▪ Health status of
public housing residents before and after a move from old poor-quality public housing into new green healthy housing
▪ These residents to a control group that did not move
Data Sources• Self-reported health by
interview• Building visual assessments• 24-hour air samples• Medicaid records• 325 housing units in 3
Chicago housing developments
• 803 individuals • 203,232 diagnoses• Air quality in 45 non-smoking
apartments
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www.nchh.orgGeneral Health
Adults
Children
1 1.5 2 2.5 3 3.5
3.1
2.3
2.8
2.1
3.0
2.4 Study Previous Study Current
Control Current
Mean Score (1=excellent to 5=poor)
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Mental Health (Adults)
everything was an ef-fort
hopeless
nervous
restless or fidgety
sad
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
3.9
4.4
3.7
3.5
3.7
4.3
4.7
4.2
4.1
4.3
4.2
4.4
3.8
3.8
3.9Study Pre-viousStudy Current
Mean score (1=all the time to 5=none of the time)
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Asthma
prescription inhaler to stop attack
prescription medication to prevent attack
difficulty staying asleep
asthma symptoms
1 1.5 2 2.5 3 3.5 4 4.5
2.4
2.6
2.2
3.0
3.1
4.1
2.4
2.3
3.2
3.3
2.4
1.9
2.1
2.6
1.7
1.4
Study ChildrenControl ChildrenStudy AdultsControl Adults
Mean Score (1=not at any time to 5=every day, all
the time)
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Statistically Significant Physical Health Improvements
General Health
Asthma (measured by lost school/work days, disturbed sleep and symptoms)
Hay fever
Headaches
Sinusitis
Angina
Respiratory allergy
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www.nchh.orgMedicaid Expenditures
0 1 2$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$1,135 $1,020 $1,226
$799 $785
$5,612 $5,768$5,475
$5,199
$6,536
Control Adults Study Adults Control ChildrenStudy Children
Time interval
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www.nchh.orgMedicaid Data
1.Adult medicaid expenditures did not vary between time intervals or between study and control groups
2.At Interval 2, Child medicaid expenditures were marginally significantly higher for the study gp ($1226) than control ($785) (p=0.053) but trend not consistent across other time intervals
3.Overall conclusion: Some time intervals showed Medicaid savings and other showed costs, but none of the trends reached statistical significance.
4.Medicaid data were difficult to interpret-trends seen in self-reported health may not have been observable due to “secular trends in program administration, eligibility, and rising cost of medical care in general . . .“
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www.nchh.orgAir Contaminants
ContaminantNew
Development 1
New Developmen
t 2
Control Group
CO2 (ppm) 777 839 635
CO (ppm) 0.43 0.44 0.31
PM2.5 (ug/m3) 23 26 17
Formaldehyde (ug/m3)
26 28 22
VOCs (ppm as hexane equiv)
64 93 47
(24 hour samples, geometric means, n=45 units)
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Wheeler Terrace: From Battered…
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…to Bright…
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Kitchen - Before
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Kitchen Renovation - After
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Bathroom - Before
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Bathroom - After
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Healthy and Green Rehab Elements
Integrated Pest Management
No carpet in wet areas
New local exhaust fans in kitchens and baths vented to outdoors
Low-VOCs paints and carpet in bedrooms
Non-PVC floor tiles
Waterproofing/damp-proofing
Plumbing repairs
Fire extinguishers in unit
Asbestos Abatement
Improved insulation
Energy Star appliances and fixtures
Energy efficient lighting
Upgraded infrastructure
Door/window repair and replacement
Site improvements to improve walkability
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Adult & Child Health Changes
Health Endpoints Adult
Pre Post
General Health Status• Very good or excellent• Good• Fair or poor
31%35%32%
41%30%30%
Injury 14% 4%
Health Endpoints Child
Pre Post
General Health Status• Very good or excellent• Good• Fair or poor
58%31%9.5%
61%39%0%
Injury 3% 0%
# ER Visits due to Asthma 14 0
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Specific Housing Condition Changes
Home easy to clean (p=0.102)
Comfortable home temp. (p<0.001)
Water/dampness (p<0.001)
Mildew odor/musty smell (p<0.001)
Dehumidifier use (p=0.157)
Humidifier use (p=0.014)
Cockroaches (p=0.003)
Resident insecticide use (p=0.007)
Professional insecticide use (p=0.083)
Mice/rats (p=0.002)
Smoke inside home (p=0.102)
Clean ≥ once a week (p=0.157)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
96%
91%
16%
0%
0%
13%
8%
8%
52%
12%
80%
100%
80%
43%
80%
61%
8%
38%
56%
44%
78%
64%
96%
91%
Baseline1-Yr Post
Percent of Units with Condition
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WATTS to Well-BeingChicago, NYC, Boston
Compared:
▪ Health status of residents before and after energy upgrades
▪ N= 248 households
▪ Chicago, NYC, Boston
▪ Buildings with one to more than 3 units
Data Sources
• Self-reported health by interview
• Air sampling
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www.nchh.orgResults
Worsened• Days with
problems sleeping*
• Frequency of symptoms*
Improved• Mean general health score
decreased from 3.07 to 2.78*• Improvements in:
• Sinusitis (5%)*• Hypertension (14%)*• Overweight (11%)*• Use of asthma medication during
asthma attacks (20%)
*p<0.05
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Child general health (G/VG/E)
Adult general health (G/VG/E)*
Adult difficulty walking
Adult problem prevents work*
Child walk/run/play problem
Adult injury
Child injury
Adult asthma
Child asthma
0% 20% 40% 60% 80% 100%
93%
59%
12%
15%
5%
15%
7%
11%
16%
100%
67%
12%
11%
0%
4%
0%
15%
24%
1 YR PostBaseline
Percentage of People*p<0.05
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www.nchh.orgEnergy & Water Results
16%•Energy cost savings
54%•Water cost savings
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MIGHHTY, Highline, DC Green, Watts to Well-Being, and GREAT Studies
▪ These projects were funded by the U.S. Department of Housing and Urban Development, Office of Healthy Homes and Lead Hazard Control. The work that provided the data for part of this presentation was supported by “Recovery Act or American Recovery and Reinvestment Act (ARRA)” funding under an award with the U.S. Department of Housing and Urban Development. The substance and findings of the work are dedicated to the public. The authors are solely responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not necessarily reflect the views of the Government.
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www.nchh.orgConclusions
▪ Using modern green & healthy housing principles in low-income housing
produces substantial self reported health and housing quality
benefits
▪ All low-income housing construction
and rehab should include green healthy housing requirements
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NATIONAL CENTER
FOR HEALTHY HOUSINGwww.nchh.org
@nchh
Facebook.com/Healthy Housing
www.nchh.org/Resources/Blog.aspx
David Jacobs, PhD, CIH, Research [email protected]
g