Healthy Homes

Tuesday, November 13th, 2012

Here is a great article if you are interested in a healthy home.  This goes beyond "green" homes.  It was written by:  David Jacobs, Ph.D., CIH, director of research at the National Center for Healthy Housing and Vision 2020 chair for Indoor Environmental Quality.

By 2020 we will have ended the practice of allowing unhealthy and unsafe building materials to enter commerce and reduced the need to provide medical care to people who have been hurt by exposure to these materials—and the related costs of correcting these conditions by retrofitting housing at great expense. Doctors will no longer be forced to treat patients and then return them to the homes that made them sick in the first place. Our now skyrocketing health care costs will be contained in part due to the establishment of clear health-based, practical housing standards based on rigorous science that protects not only the public, but our most sensitive and at-risk populations, such as children, the elderly, and low-income families. In 2020 our housing financial system will enable health-based investments to be made in much the same way other housing improvements are done. We will have credentialed, well-trained healthy housing practitioners and our National Institutes of Health will have within it a National Institute for Healthy Green Housing, spawning new housing-based interventions that are evidence-based. By 2020 improved health from green healthy housing will be the new normal, reducing costs and needless suffering.


In the most basic sense, houses are shelters, providing protection from weather and potentially hostile environments. But beyond the basics, housing can and should support good health. The connection between housing and health has long been recognized. The public health and housing movements have common roots planted more than a century ago in efforts to address slum housing. The first modern housing laws were established to respond to infectious disease threats to public health such as tuberculosis and typhoid. The provision of indoor plumbing improved sanitation and led to the control of cholera and other waterborne illnesses.

Why are green healthy housing improvements unlike other home improvements? For housing, there is not a consistent perceived “shared commons” for which the public feels a communal benefit and responsibility, unlike other more widely shared elements of physical infrastructure, such as water or outdoor air quality. Housing codes are almost entirely local affairs, unlike health or environmental laws, which typically have national standards of care.

So, why is an integrated approach that eliminates health hazards in housing so difficult? One answer is that the scientific evidence of harm to specific groups has not been assembled adequately, although that is beginning to change, as described below. Another is that we have had no dramatic moment of recognition of the problem to galvanize public action, although the recent mortgage crisis has shown the importance of housing to us all. A third is that responsibility for housing is diffuse, including architects, builders, maintenance personnel, designers, code and building inspectors, occupants, engineers, urban planners, public environmental health professionals, and others. A final answer has to do with economic investment and the inability of housing price to reflect health outcomes.

Despite these obstacles, there are signs that a more integrated approach is emerging in the form of green healthy housing guidelines and that such approaches do in fact improve health.


During the first energy shock in the 1970s, efforts to improve energy conservation in buildings sometimes inadvertently created “sick building syndrome” because not enough attention was given to proper ventilation with fresh air, moisture control, and other factors. Several recent studies conducted by the National Center for Healthy Housing ( and others show that more modern green healthy housing building techniques are associated with large health improvements.

For example, in the Watts to Well-Being study of 248 households in Boston, Chicago, and New York City, we found statistical significant health improvements in adults in general health, sinusitis, hypertension, obesity, and use of asthma medications.

In another study in Seattle, we worked with a local public health department’s community health worker asthma education home visit program, combined with a local housing agency’s weatherization program. The study group received in-home education and “energy plus health” physical interventions on the structure in 34 units, and the control group received only the community health worker asthma education. We found that combining energy plus health structural treatments and the community health worker asthma education program resulted in greater significant reductions in the percentage of children with either not well-controlled or very poorly controlled asthma compared with those families who participated in the asthma education program alone. Specifically:

• For the study group, the percentage of children whose asthma was either not well controlled or very poorly controlled significantly decreased from 100% to 28.8% about a year later.

• The comparison group also showed an improvement from 100% to 51.6%, but the improvement for the study group was significantly greater than that of the comparison group.

• Caregiver quality of life significantly improved.

• For all the following measures, the study group showed a greater improvement than the comparison group, although the improvement did not attain statistical significance, possibly because the sample size was too small:

• frequency of urgent clinical care visits,

• symptom-free days,

• days of limited activity,

• days of rescue medicine use, and

• nights with symptoms.

• The presence of home asthma triggers (visible evidence of mold, water damage, pests, and smoking) also significantly decreased for the study group.

Finally, a major study of “breathe-easy” homes, public housing units occupied by asthmatic children (see chart on page 45), showed that trips to the emergency room were reduced by 41.2%, there were 4.8 fewer days with asthma symptoms for every two-week period, asthma triggers in house dust fell from 2.0 to 0.03, and caretaker quality of life improved.


Two major parts of our economy, health care and housing, are in crisis. I believe this represents an opportunity because the two are linked. A major cause of inability to meet mortgage payments is known to be high health care bills. And high medical costs can be linked to unhealthy housing conditions. One focus of health care reform is prevention, and one form of prevention involves investing in green healthy housing, which will produce major health care savings as shown in many studies, including those reviewed here.

Similarly, weatherization of homes is often cited as the “low-hanging fruit” in reducing greenhouse gas emissions associated with heating and cooling buildings. This is also the subject of a new World Health Organization report on “Health and the Green Economy: Co-Benefits to Health of Climate Change Mitigation (Housing Sector).” We also need better indicators of what green healthy housing looks like and how consumers can recognize it. One major way to accomplish that is to standardize labeling systems for green healthy housing, such as LEED for Homes or Enterprise Green Communities standards. But to do that, we must end the proliferation of green rating systems. Internationally, there are well over 30 such systems. I believe that the best way to standardize these systems is through validation from rigorous scientific studies. But right now, our health research system, principally housed at the National Institutes of Health, does not contain an institute that examines housing. We need a National Institute for Healthy Green Housing to fund independent solid scientific research, which can be expected to produce numerous innovations, as it has for pharmaceuticals and other interventions.

The costs and benefits of green healthy housing need to be quantified. We have completed such cost/benefit analyses for housing interventions associated with childhood lead poisoning and asthma, but this has not yet been done for broader green healthy housing efforts. Such a cost/benefit analysis could help to produce financing mechanisms to expand the resources available for green healthy housing for the vast majority of housing.

Currently, there is some limited funding available for low-income housing (HUD’s Green Sustainability Initiative) and for upper-income housing, but virtually nothing for the broad middle. Financing systems that enable average homeowners to make green healthy housing investments in their own homes will help to create a marketplace that allows for competition and innovation in green healthy housing.

In short, the evidence on how green healthy housing improves health has grown substantially in the past few years. We must act on that evidence and make green healthy housing the norm, not the exception. One way to do this is to persuade government and industry that indoor environmental improvements will have a huge beneficial impact on reducing medical costs. A recent study completed in Great Britain revealed a sevenfold reduction in medical costs directly related to improvements in housing standards.

We should apply all we learned from lead mitigation to all housing hazards—mold, asthma, radon, and injury prevention. Right now, we’re looking into how much money the federal government could save in Medicaid expenses just by improving indoor environmental quality standards—and containing health care costs is a crucial issue now before the nation. Better indoor environmental quality standards should be an important part of that conversation.