ECA Conference Session 4: Palak Raval Nelson

ASTHMA TASKFORCE: PHILADELPHIA HEALTH

DEPARTMENT – LEAD AND HEALTHY HOMES PROJECT

ENVIRONMENTAL HEALTH SERVICES (EHS) MISSION STATEMENT

To maintain environments, prevent disease, and promote public health through education and regulation. EHS monitors, assesses, inspects, and educates the public about vectors, food safety, lead & healthy homes, and environmental engineering.

Environmental Health Services

Vector Control

Food Protection

Environmental

Engineering

Lead & Healthy Homes Program

Pb

Child Asthma Hospitalization Philadelphia (2000-2012)

CHILD ASTHMA HOSPITALIZATION RATE PER 1000,000 <18 YEARS (PHILADELPHIA 2010)

Asthma Related ER Visits Children < 18 yrs. Philadelphia, P A

2009 10,55502010 9,958

PDPH Syndromic Surveillance System

PA Health Care Cost Containment Council 2010

• Americans spend up to 90% of their time indoors• Indoor concentrations of most pollutants are higher than outdoor

Indoor Environment and Asthma

The Healthy Homes Healthy Kids Program City of Philadelphia Department of Public Health

HEALTHY HOMES HEALTHY KIDS PROGRAM

• Collaboration with St. Christopher’s Hospital forchildren with severe asthma

• Integrates clinical, environmental and educational strategies to successfully mitigate and manage a child’s asthma, prevent lead poisoning and address other health and safety hazards

• Close collaboration family, medical team and HHHK team to address housing conditions and behavior.

• Services are provided in English and Spanish in anappropriate cultural framework.

1. Reduce Environmental Health and Safety Hazards• Repair Leaks• Remove mold and repair water damage• Rip up old carpeting and refinish floors• Replace leaded windows where children can reach• Vector Control Unit services (Integrated Pest Management)• Energy Audit and Weatherization

2. Help Families Engage in Healthier Behavior• Personalized Environmental Action Plan & Motivational Interviews• Issues include: clutter, tobacco smoke, stop use of perfumes, candles,

noxious cleaning and pest control supplies

3. Partner with Clinical Team• Biweekly calls for information sharing• Ensure child and caregiver understand and use medication as prescribed

HEALTHY HOMES HEALTHY KIDS: WHAT WE DO

HEALTHY HOMES HEALTHY KIDS % OF PROPERTIES WITH HEALTH AND SAFETY HAZARDS

(January 2013 – December 2014) N=160

AVERAGE COST PER UNIT OF HEALTHY HOMES HEALTHY KIDS INTERVENTION

Activity/Personnel Cost

Remediation $ 3000Integrated Pest Management $ 150Staffing $ 110Client supplies $ 200Total Cost For HHHK Services per unit

$3500

Weatherization (selected homes only)

$1200

HEALTHY HOMES HEALTH KIDS CHILD HEALTH OUTCOMES

Outcome Pre 6-9 months

post

Difference

% improvemen

tHospital visits in last 6 months

1.8 0.6 1.2(p<0.0001)

67%

ER visits in last 6 months

3.7 1.6 2.1*(p<0.0001)

57%

Doctor visits in last 6 months

3.8 2.2 1.6(p=0.002)

42%

Missed school days in last 1 month

3.3 3.6 -0.3(p=0.69)

--

Albuterol use in last 2 weeks

9.3 6.7 2.7(p=0.09)

--

Revised 6.2.1593 families surveyed based on per and post test questionnaires

LESSONS LEARNED FROM THE HEALTHY HOMES HEALTHY KIDS PROGRAM

It works! It is a cost effective intervention. Must address both housing condition and

residents’ behavior. Important to involve child’s medical

providers. Important to allow residents to determine

their Healthy Homes priorities. Must be culturally appropriate and language

accessible. More evidence-based research needed on

reducing second hand smoke in private homes of low income residents.

HEALTHY HOMES HEALTHY KIDS CHALLENGES Funding is needed to support program

expansion. Homeowners need resources to improve

housing. Landlords should be required to adhere

to their legal responsibilities under the Philadelphia law.

Retaliatory evictions are illegal and tenants need adequate representation.

Next Steps-Goals to Help Philadelphia’s Children Partnerships

with community organizations, health care providers, government agencies, health insurers, housing organizations, landlord associations and legal services.

Sustainable Funding for services and home repairs to reduce

the health and safety hazards in homes and support families’ healthy behavioral changes.

Next Steps-Goals to Help Philadelphia’s Children Data & Information

to develop a robust understanding of housing quality in Philadelphia, to understand the prevalence of health and safety housing issues and the impact on children’s health and to evaluate the effectiveness of interventions.

Legal Services and Other Support to ensure families have the legal services along with

have the information, resources, support, access to health care they need to reduce the health and safety hazards in their homes.

Enhanced Enforcement of the Health Code, Property Maintenance Code, Lead

Disclosure and Notification Law and other laws as needed to help improve the housing conditions of children.

Palak Raval-Nelson, PhD, MPH

Director- [email protected]