Www.nchh.org David Jacobs, PhD, CIH, Research Director NATIONAL CENTER FOR HEALTHY HOUSING (Mark James, Jay Wilson, Peter Levavi, Susan Aceti, Carol Kawecki,

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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

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

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

www.nchh.orgMethods

Administered standardized health interview at rehab and one year later

Administered standardized visual assessment

Air sampling

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

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

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

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

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

www.nchh.orgContaminants

▪ Year-long average CO2 = 982 ppm

▪ All VOCs below ATSDR minimum risk levels

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

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

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)

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)

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

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

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 . . .“

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

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

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

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

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.

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

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]

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