Green Homes Give Families a Healthy Foundation

Initiative Braids Funding Programs to Assist Households

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Ruth Ann Norton is executive director of the Coalition to End Childhood Lead Poisoning. Her agency designed and implemented the Green and Healthy Homes Initiative (GHHI), a national public-private partnership "that refocuses how we as a nation repair and improve housing in economically challenged communities."

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Posted: Wednesday, October 26, 2011 10:43 am

Safe, comfortable, pleasant housing is what many people dream of having. But if housing is dangerous, inefficient and a detriment to neighborhoods, it can turn into a nightmare instead of a dream.

Hazardous housing though, if properly treated, can become green, healthy and sustainable, according to Ruth Ann Norton, executive director of the Coalition to End Childhood Lead Poisoning. Her agency designed and implemented the Green and Healthy Homes Initiative (GHHI), a national public-private partnership "that refocuses how we as a nation repair and improve housing in economically challenged communities."

As Norton told an audience at the Growing Sustainable Communities conference Oct. 11 in Dubuque, Iowa, unhealthy and energy inefficient homes place a burden on communities. She said nearly six million people live in households that put them at risk for illness, injury, and high energy costs, and that people in these households are disproportionally low-income. The health issues they face include lead poisoning in children, asthma, carbon monoxide, and radon-related cancer deaths. When houses and their occupants are unhealthy, communities suffer too, Norton explained. Wealth depletion, disinvestment, foreclosures, abandonments, condemnation and homelessness are all conditions communities have difficulty overcoming.

Norton presented the "case for change" by invoking national health data. She said 250,000 cases of childhood lead poisoning occur each year. Furthermore, 24 million U.S. homes contain lead hazards, and children poisoned by lead are seven times more likely to drop out of school and end up in the juvenile justice system than their counterparts.

According to Norton, there are 800,000 asthma-related emergency room visits annually, which is one of the five most costly health conditions. Asthma, she said, is the third leading cause of hospitalizations among children under age 15 and a leading cause of school absenteeism. There are 20,000 carbon monoxide poisonings and 21,000 radon-related lung cancer deaths each year. Added to that are 13 million preventable home-related injuries, which are the second leading cause of death for children under age 5 and which prompt more than 10 million ER visits per year.

Solutions to these difficulties exist from various government programs. That's part of the problem, according to Norton: too many programs through HUD, HHS, DOE and more overwhelm individuals as they seek help. But where GHHI is being put into place, it serves as a "single intake portal" where problems of health, injury and energy expenses can be traced to their source: unhealthy homes.

Norton said GHHI has federal and local government, as well as philanthropic and community support. Its initial 17 sites include large cities such as Atlanta, Baltimore and Chicago, smaller cities like Dubuque, the Spirit Lake Tribe and the Cowlitz Indian Tribe.

Norton outlined the program's several initiatives, which include breaking the link between unhealthy housing and unhealthy children through innovations in government, and creating stable and sustainable healthy, energy efficient and safe homes. To do this they must ensure measurable improvements in health, economic and social outcomes for children, seniors and families through effective housing interventions, along with other goals. They hope to expand their range to 60 cities in the next two years. That should be easy to do, since there are over 44 locations requesting designation as a GHHI site, and because the U.S. Conference of Mayors adopted a resolution in support of the GHHI platform.

They take an ABC approach to the program, which in this case stands for Align, Braid and Collaborate. Basically, that means finding away to collaborate through "strategic coordination of relative funding streams, sequenced funding and activities, and co-investment." In these difficult economic times, Norton said, it is important to achieve the most that can be achieved with limited resources. A few examples of existing programs to "braid" with housing initiatives include Maternal and Child Health Title V Block Grant Funds; Low Income Home Energy Assistance Program (LIHEAP); National Institute of Environmental Health Sciences (NIEHS); Rebuilding Together/Habitat for Humanity; and Federal Home Loan Bank Board Grants/Federal Reserve Outreach Programs.

Since GHHI started nationally, various organizations have committed to support its efforts, Norton said. Results have included reduced ER visits and hospitalizations among residents of households receiving services. As she explained, a $35 million investment has led to reductions in annual health care expenses treating injury, lead poisoning and asthma. The result is $318.8 million in health care savings.

Norton gave several examples of how individuals experience the current system designed to help with unhealthy housing problems like mold, chipping paint and other hazards. Depending on the condition, they may have to seek help from numerous agencies and private contractors on their own. As an illustration, she described one family of five that included a son with severe asthma. His repeated attacks led to an average of three hospitalizations each year, lasting a week each. He lived in a home contaminated with asthma triggers like rodents, dust mites, excessive moisture and poor weatherization. After GHHI intervened, engaging various government and philanthropic programs, the allergens and lead hazards were remediated and the home was weatherized. As a result, the boy was not hospitalized due to asthma triggers in the home in the 12 months following the intervention, resulting in savings of avoided medical costs of $48,300 in the first year alone, while costing less than $20,000.

At the local level, representatives from Dubuque explained how they've functioned as a GHHI site. Mary Rose Corrigan, public health specialist with the City of Dubuque Health Services department, had been working with associates involved with housing on the question of childhood lead poisoning. Her goals were similar to GHHI and the Coalition to End Childhood Lead Poisoning. She explained that Dubuque is the oldest city in Iowa, with some of the oldest housing stock. More than 14,000 of Dubuque's homes were built before 1978, the year lead paint was banned from household use. So, 70 percent of the homes in Dubuque are at least 50 years old and prime candidates to have harmful lead levels. Thanks to local efforts, she said, more than 950 residences have been made lead-safe in the last 15 years.

GHHI and sustainable cities are connected, according to Corrigan, which is why the city wanted to be involved. Dubuque's definition of sustainability includes environmental and ecological integrity, economic prosperity, and social and cultural vibrancy. So for them, it made sense to take a household-centric approach; in other words, focusing on the people inside the home.

"Housing is a perfect place for primary interventions since so many health and well-being issues have their start in the home: indoor air quality, tripping hazards," Corrigan said.

Where you work, eat, play, and how you get around all affect your health," she added.

Dubuque developed a GGHI team from several programs throughout the city. Eric Dregne, vice president of programs for the Community Foundation of Greater Dubuque, explained local philanthropy's role in GHHI. "Green and healthy homes is a cost-effective and integrated approach to housing interventions that combines local, state, federal and philanthropic investments." The Community Foundation's focus is on sustaining the change that healthy homes create. "Healthy homes plus healthy households equal improvement for everyone, individuals and communities alike," he said.

The Community Foundation's involvement includes sending a team of "home advocates" to residences that are being considered for GHHI intervention. One member of the team assesses what is happening with the individuals in the home, including the sorts of behavioral choices they make in terms of health and safety. The other member of the team performs an assessment of the home's physical environment, quantifying what hazardous aspects of the house need immediate attention.

Leading officials in Dubuque came together to streamline the process of individuals receiving help for problems stemming from a hazardous household. But according to David Lyons, project manager for Smarter Sustainable Dubuque, the concern goes beyond just checking a box on a form indicating a home has been weatherized. They want to take a broader and longer look. What were energy costs at the home before weatherization? What were they like three or six months after weatherization? Is there now money in the household for other needs, since less of it is goes for heating bills?

Environmental risks affect people but are often invisible. Program advocates say GHHI gives communities a chance to quantify what the risks are, and a systematic and efficient way to deal with them.

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