Addressing Health Through Home Repair

Ensuring residents live in “healthy” housing is a cornerstone of public health policy. There is significant evidence that repairing substandard home conditions can improve the health of the children and adults living in the house.

The specific interventions recommended to improve the health of the occupants while stabilizing their housing vary from program to program, but most models prioritize the seven principles of a healthy home developed by the National Center for Healthy Housing’s National Healthy Homes Training Center. These seven principles focus on repairs that ensure the home is:

1. Dry
2. Clean
3. Safe
4. Ventilated
5. Pest-Free
6. Contaminant-Free
7. Maintained

The studies cited below describe findings as to how home improvements that improve the health of a home can lower emergency room visits and health care costs, reduce school absenteeism, and improve the health and well-being of adults and children living in a home dramatically.

Resources

• Office of Policy Development and Research (PD&R),U.S. Department of Housing and Urban Development, Secretary Julián Castro. Southwest Alaska: Improving the Respiratory Health of Alaska Native Children (August 23, 2016)
  …ANTHC’s air quality and respiratory health project conducted air quality interventions that reduced the incidence of breathing-related illnesses, to which children are particularly vulnerable. The project focused on improving air quality in individual residences in Southwest Alaska.
• Campbell, Alexa Fernandez “How a House Can Shape a Child’s Future”
  A new study from Cleveland looks at the correlations between living conditions and kindergarten readiness.
• Hayes, Elizabeth Stable housing is a great Rx for better health, Portland study finds
  Pairing access to affordable housing with health care services leads to a significant reduction in Medicaid expenditures, a comprehensive new Portland study found.
• Turcotte DA, Alker H, Chaves E, Gore R, Woskie S., Healthy homes: in-home environmental asthma intervention in a diverse urban community, Am J Public Health. 2014 Apr;104(4):665-71. doi: 10.2105/AJPH.2013.301695. Epub 2014 Feb 13.
  Low cost interventions were completed in 116 households with 170 children with asthma. Home health workers provided household safety, asthma prevention education, and targeted environmental intervention to decrease asthma triggers and improve household safety. The cost of the interventions (not including personnel) was $36 240, whereas the estimated medical savings over a 4-week assessment period was $71 162, resulting in an estimated annual savings of about $821,304.
• New Hampshire: Report on Housing Conditions 2014.
  The report discusses the substandard, unhealthy and sometimes dangerous conditions residents of Manchester New Hampshire live in. Recommendations include more stringent code enforcement and the establishment of a Manchester Housing Commission to study the deteriorating housing stock and make appropriate recommendations.
• Boston College. “For low-income families, substandard housing takes toll on children.” ScienceDaily. ScienceDaily, 22 October 2013.
  The study, one of the most comprehensive assessments ever conducted into the impact of housing on children in the US, found that that housing quality may be more important than affordability on the growth and development of children. Children growing up in poor-quality housing plagued by leaky roofs, broken windows, peeling paint, debris and vermin experience greater emotional and behavioral problems at young ages and later see their school performance suffer.
• Coley, Rebekah Levine; Leventhal, Tama; Lynch, Alicia Doyle; Kull, Melissa, Poor Quality Housing Is Tied to Children’s Emotional and Behavioral Problems (September 2013).
  Study found that poor housing quality was most consistently associated with children’s and adolescents’ development, including worse emotional and behavioral functioning and lower cognitive skills.
• The Healthy Homes Program Guidance Manual , U.S. Department of Housing and Urban Development (July 2012).
  Provides information about strategies and approaches to to assure healthy conditions in housing. Provides case studies of programs that have proven effective.
• Maggie Davidson, Simon Nicol, Mike Roys, Helen Garrett, Adele Beaumont and Charlotte Turner, The Cost Of Poor Housing In Northern Ireland (2012).
  Northern Ireland report finds strong evidence that well well-targeted public investment in housing will bring significant improvements in the physical and mental health and well-being of households, increase the value of the housing stock and facilitate very considerable savings in the health budget.
• Thomas W. Largo et. al, Healthy Homes University: A Home-Based Environmental Intervention and Education Program for Families with Pediatric Asthma in Michigan, Public Health Reports Volume 126 (2011).
  Children’s unscheduled doctor’s visits for asthma decreased by more than 47% after home visits in Lansing, Michigan. From 2005-2008, Healthy Homes University program staff assessed homes of low-income families for asthma triggers and provided products and services to help them to reduce exposures to cockroaches, dust mites, mold, tobacco smoke, and other triggers.
• A Systematic Review of Home-Based Multi-Trigger Multi-Component Environmental Interventions to Reduce Asthma Morbidity (2011)
  Summarizes cost-benefit studies showing a return of $5.30 to $14.00 for each dollar invested in removing home-based asthma triggers, and a cost effectiveness of $12 to $57 per additional symptom-free day.
• DiGuiseppi, Carolyn MD, MPH, PhD; Jacobs, David E. PhD, CIH; Phelan, Kieran J. MD, MSc; Mickalide, Angela D. PhD, CHES; Ormandy, David, Housing Interventions and Control of Injury-Related Structural Deficiencies: A Review of the Evidence (2010).
  Reviews evidence on the effectiveness of housing interventions that affect safety and injury outcomes, such as falls, fire-related injuries, burns, drowning, carbon monoxide poisoning, heat-related deaths, and noise-related harm. Installing working smoke alarms and preset safe hot water temperature were found to be most effective improvements.
• Jacobs, David E. PhD, CIH; Brown, Mary Jean ScD, RN; Baeder, Andrea MPH; Sucosky, Marissa Scalia MPH; Margolis, Stephen PhD; Hershovitz, Jerry BS; Kolb, Laura MPH; Morley, Rebecca L. MSPP A Systematic Review of Housing Interventions and Health: Introduction, Methods, and Summary Findings (2010)
  Experts systematically review evidence on the effectiveness of specific housing interventions in improving health and find 11 interventions that improve health outcomes of housing occupants.
• Mason, Jacquelyn MS, PhD; Brown, Mary Jean ScD, RN, Estimates of Costs for Housing-Related Interventions to Prevent Specific Illnesses and Deaths (2010).
  Summarizes research that estimates the numbers of people who become ill or die because of unhealthy housing and compares the economic burden of housing-related adverse health outcomes with the resources required to implement interventions.
• Krieger, J.W., Takaro, T., Song, L., Beaudet, N., and Edwards, K., The Seattle-King County Healthy Homes II Project: A randomized controlled trial of asthma self-management support comparing clinic-based nurses and inhome community health workers, Archives of Pediatric and Adolescent Medicine 2009 163(2):141–149.
  Higher intensity interventions by community health care workers to encourage completion of action plan and not just provide education, bedding encasements saw much more significant reduction in asthma days.
• Nevin, R., Jacobs, D., Berg, M., and Cohen, H., Monetary benefits of preventing childhood lead poisoning with lead-safe window replacements. Environmental Research, 106(3):410–419 (2008).
  Study quantifies health benefits, costs, market value benefits, energy savings, and net economic benefits of lead-safe window replacement (which includes paint stabilization and other measures). The benefit per resident child from improved lifetime earnings alone is $21,195 in pre-1940 housing and $8685 in 1940-59 housing (in 2005 dollars). Annual energy savings are $130-486 per housing unit.
• An Evaluation of HUD’s Healthy Homes Initiative: Current Findings and Outcomes (2007).
  Identifies the most common healthy homes housing interventions and their average cost including both materials and labor.
• Chenoweth, David. “The Economic Cost of Substandard Housing Conditions among North Carolina Children.” Prepared for the North Carolina Housing Coalition, May 2, 2007.
  Report by the North Carolina Housing Coalition found that North Carolina spent $95 million in 2006 on childhood illnesses and injuries attributable to living in substandard housing. The study also found that illness due to substandard housing is growing at twice the rate of illness generally.
• Boston One Touch: Action Steps for Healthier and Greener Homes for Boston Families, National Center for Healthy Housing.
  Analysis of healthy housing programs in Boston recommends targeting the housing problems that make children sick, focusing on cost-effective interventions with big payoffs and coordinating intake, inspections and interventions across agencies and organizations.
• Priyam Vora, A Practical Guide to Health Impact Assessment and Housing
  Policy decisions can influence whether communities are supportive of or detrimental to community health and well-being. Such housing policies can also play important roles in reducing or even preventing diseases.