The Health Benefits of Affordable Green Housing
David E. Jacobs, PhD, CIHNational Center for Healthy Housing
Green Affordable Housing Forum:Protecting the Most Vulnerable While
Expanding Washington’s Green EconomyMarch 2009
Outline Health and Housing Connection Examples of Health and Monetary
Benefits of Improved Housing and Health Data Needs for Assessing Health
Outcomes in Green Development Preliminary Results of Health Studies of
Green Housing Wheeler Terrace in Washington DC
Florence Nightingale
“The connection between health and the dwelling of the population is one of the most important that exists.”
Cited in Lowry, S, BMJ, 1991, 303, 838-840
Health in the Late 19th Century Challenge of Tuberculosis Seemed
Insurmountable Lessons for Public Health Officials, Architects
and Planners: Better Ventilation, Reduce Crowding, Improve Housing Sanitation (Plumbing)
With Improved Living Conditions & Medical Interventions, Disease Rates Declined
Re-establish the Housing/Health Collaboration
Green Developers, Builders, Others Weatherization Professionals Public & Environmental Health Housing Professionals Banks & Other Financial Institutions Government Rehab Professionals Many others
Is Housing a Shared Commons?Is Housing Part of the
Infrastructure?
Cuyahoga River ca. 1960
Medical Care Costs and Housing Improvement
‘76 ‘80 ‘82 ‘84 ‘86 ‘88 ‘90 ‘92 ‘94 ‘96 ‘98
Year
‘72
Blo
od
Le
ad L
eve
ls (µ
/dL
)
18
2
4
6
8
10
12
14
16
0
‘00
US Policies & Blood Lead 1971-2004
‘74
Phase-out
gasoline & lead
soldered cans (1973)
Lead-based Paint Poisoning Prevention Act (1971)
‘78
Residential Lead Paint Ban (1978)
Title X Housing & Community
Development Act (1992)
Housing units with lead paint reduced by
40% since 1990
Lead Contamination Control Act (1988)
Virtual Elimination of Lead in Gasoline
McKinney Act Public Housing
Abatement (1989) Ban on lead solder in food cans (1995) Const Work Stds (96)
2.7 %
2.2 %
Lead in Plumbing banned (1986)
‘02
1.6 %
‘04
1.2 %
Air & Ind Workplace Standards
(1978)
Housing Lead Dust &
Soil Std Published (1999 & 2001)
Lead Disclosure
Rule (1996)
Private Housing
Lead Paint Grants (1991)
Federally Assisted Housing Rule 1999
Renovation/Painting
Rule Published
(2008)
Power of Housing & Health Surveillance Data:
Dust Lead and Windows
Benefits of Window Replacement
Lead Dust Accumulation Energy Savings: Heating and Cooling Housing Value Other?
Window Replacement Costs and Benefits
$0
$5,000
$10,000
$15,000
$20,000
$25,000
Upgrade Cost
Market Value
Health Benefit
Health Benefit
Other Value
Energy Value
Cleanup & Clearance Window Replacement
Total Net Benefits of Lead Safe Window Replacement
Pre-1940 Housing—$5,092 x 11 million units with single pane
lead contaminated windows = $56 billion Pre-1960 Housing
—$1, 092 x 11 million units with single pane lead contaminated windows = $11 billion
Total = $67 billion
Data Needed for Cost Benefit Analysis of Green Healthy Housing
Housing Conditions that Impair Health (1) Housing Improvements that Advance Health
(2)
Housing Conditions That Affect Health (1)
Categories:
• Sufficient Scientific Evidence
• Some Scientific Evidence
• InsufficientEvidence
World Health Organization (WHO)
Sufficient Evidence (WHO, 2005)
PHYSICAL FACTORS:— Heat and related
temperatures and winter excess mortality
— Cold indoor temperatures and winter excess mortality
— Energy efficiency of housing and health
— Radon exposure in dwellings and cancer
— Neighborhood and building noise and related health effects
SOCIAL FACTORS:— Multifamily housing, high-
rise housing, housing quality and mental health
CHEMICAL FACTORS:— ETS exposure in
dwellings and respiratory and allergic effects
— Lead-related health effects
BIOLOGICAL FACTORS:— Humidity and mold in
dwellings and related health effects
— Hygrothermal conditions and house dust mite exposure
Some Evidence (WHO, 2005)
PHYSICAL FACTORS:— Ventilation in the dwelling and
respiratory and allergic effects
CHEMICAL FACTORS:— VOCs and respiratory,
cardiovascular and allergic effects
BIOLOGICAL FACTORS:— Cockroaches and rodents in
dwellings and respiratory and allergic effects
— Cats, dogs and mites in dwellings and respiratory and allergic effects
— Pets and mites and respiratory, allergic or asthmatic effects
BUILDING FACTORS:— Sanitation and hygiene
conditions and related physical health effects
SOCIAL FACTORS:— Social conditions of housing
and fear/fear of crime— Poverty and social exclusion
and related health effects— Crowding and related health
effects— Social factors/social climate
and mental health
Housing ChangesScientifically Shown to Improve Health
(2)
Proven Healthy Housing Improvements
Asthma Interventions Integrated Pest Management Moisture Intrusion Reduction Radon Mitigation Lead Hazard Control Smoke & CO Alarms Pre-Set Hot Water Temperature
Green Communities Minnesota Case Study
Green Rehab Elements at Viking Terrace
Viking Terrace Results
Child's Health Compared to When In Old Home
29%
14%
57%
Better Now Worse Now About the Same
Viking Terrace ResultsAdult's Health
Compared to When in Old Home
37%
11%
52%
Better Now Worse Now About the Same
Viking Terrace Results
Comfort in Apartment Compared to Old Home
73%
10%
17%
More Comfortable Less Comfortable About the Same
Viking Terrace ResultsEase of Cleaning
Compared to Old Home
63%10%
27%
Easier Harder About the Same
Viking Terrace Results
Amount of Time Children in Household Play Outside Compared to Old Home
64%9%
27%
Play Outside More Play Outside Less About the Same
Viking Terrace ResultsSafety of Building
Compared to Old Home
41%
7%
52%
Safer Less Safe About the Same
Housing Improves Asthma
Breathe Easy Homes:Health Outcomes With $ Benefits
Change in No. of Asthma Symptom Days:—4.8 days for each two week period
(p<0.004) Change in Caretaker Quality of Life:
—80% improvement (p<0.002) Reduced Visits to Urgent Care:
—40% reduction (p<0.001)
Aerial Imagery
Making Low-Income Housing Rehab Green and Healthy – Wheeler Terrace,
DC
Partners• National Center for Healthy Housing
• Community Preservation and Development Corporation
• Wiencek + Associates Architects + Planners, PC
• Wheeler Terrace Tenant Association
• GreenHOME
• DC Department of Health
• HUD (Healthy Homes grant)
Wheeler Terrace Green Healthy Housing Redevelopment
Health outcomes measured using validated instrument from Centers for Disease Control and Prevention—Asthma—Injuries—Mental Health—Cardiovascular
Allergen levels
Project Approach Examples of Healthy Homes Interventions – 113 housing
units
— Upgrade HVAC system: Fresh air
— Integrated Pest Management
— Low-VOC carpets
— New ducted range hoods
— Bathroom exhaust fans
— Moisture Control
— Energy Efficiency
Conclusions
A National Conversation High Costs of Health Care/Health
Insurance Mortgage & Affordable Housing Crisis Economic Recovery Green Investment in Housing Improves
Health and Reduces Health Care Costs An Unprecedented Convergence!!
Contact Information
David Jacobs, PhD, CIH
Research Director
National Center for Healthy Housing
202-607-0938
djacobs @nchh.org
www.nchh.org