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Catalyze National Leadership and Accountability

  • Congress should delineate the roles and responsibilities of the appropriate federal agencies, including Housing and Urban Development (HUD); Environmental Protection Agency (EPA); Centers for Disease Control and Prevention (CDC) and National Institute for Environmental Health Sciences (NIEHS) within Health and Human Services (HHS); and Department of Energy (DOE).

  • HUD’s Office of Healthy Homes and Lead Hazard Control should serve as the center for investigating, demonstrating, and disseminating tools and techniques for assessing, correcting, and preventing housing-related health hazards.

Expand Scientific Knowledge

  • Congress should create an interagency task force chaired by CDC and HUD to coordinate research among the federal agencies.

  • The National Institute of Environmental Health Sciences should conduct research to identify mechanisms of disease for housing-related health hazards and dose-response relationships; increase scientific understanding of indoor environmental factors that sensitize children to asthma and other respiratory problems and trigger attacks; evaluate the health risks of chronic indoor exposure to carbon monoxide; and conduct clinical trials to document the health benefits of preventing and controlling health hazards in housing.

  • HUD’s Healthy Homes Grant Program should fund studies to test, evaluate, and validate low-cost tools and methods to detect housing-related health hazards; fund demonstration projects of cost-effective integration of healthy homes safeguards into housing programs; and identify and validate effective healthy homes practices for private-sector housing.

  • The Environmental Protection Agency should conduct monitoring studies to compare the relative risks of indoor and outdoor exposure to environmental health hazards and fund basic research to develop low-cost monitoring and detection technologies for housing-related health hazards.

Establish Health-Based Protective Practices

  • EPA should aggressively promote integrated pest management (IPM) as the standard of care for controlling pests in residential settings, and EPA should issue guidelines for the remediation of cumulative residues of pesticides, including any needed interventions for serial applications of multiple toxic pesticides.

  • EPA should ban the sale of unvented gas appliances and educate consumers about the importance of adequate ventilation and the danger of carbon monoxide from automobiles in attached garages.

  • State and local governments should incorporate health-based standards into building and housing codes.

Assure Housing Quality

  • HUD programs that provide housing assistance should give consistent attention to decent housing quality and serve as models for integrating health considerations into housing programs and practice by
    • issuing and implementing preemptive good building and maintenance practices to prevent hazards;
    • incorporating inspections for and disclosure of health hazards into homebuyer assistance programs; and
    • requiring that public housing authorities and other providers of federally assisted housing meet health-based standards.


  • Rental property owners, the building industry, and painting and construction trades should embrace and implement these models throughout the US housing stock.

  • Congress should require property owners to disclose potential health hazards to tenants and purchasers.

  • State and local governments should consolidate or closely link agencies that have enforcement responsibilities for health and housing standards.

  • State and local code enforcement agencies should give priority to enforcing provisions that protect against health hazards.

  • Mortgage lenders and underwriters should require radon testing for all home purchases.

Coordinate Health and Energy Improvements

  • DOE’s Weatherization Assistance Program should incorporate safeguards to ensure that energy efficiency measures do not compromise health and should revise management and accountability systems to encourage state programs to address health hazards in homes undergoing weatherization treatment.

  • EPA’s Energy Star program should be expanded to encompass the Voluntary IAQ standard and other healthy homes measures and address rehab programs and low-income housing in addition to new home construction.

Strengthen Local and State Capacity

  • Local and state agencies' goals and strategies should evolve beyond responding to sick children to screening high-risk housing and prevention of hazards before exposure occurs.

  • State and local governments should take advantage of federal funding and invest local resources to prevent and correct health hazards in low-income and very low-income housing, commit to reduce health hazards in their Consolidated Plan, and prioritize using CDBG and HOME funds to rehab housing for low- and moderate-income families with children.

  • The CDC should provide technical assistance and grants to equip state and local health departments to prevent, identify, and correct housing-related health hazards.

Integrate Medical and Housing Treatments

  • The Center for Medicare and Medicaid Services, Medicaid agencies, managed care organizations, and private insurance providers should pay for low-cost home investigations as part of case management for lead poisoning and asthma patients, and reimburse for Community Health Workers providing patient education and home assessment services for asthma.

  • Providers should factor housing condition and other environmental circumstances into determining cause and treatment of patients with asthma, allergies, and other respiratory illnesses as well as lead poisoning, and advocate and make referrals to motivate control of causative hazards in the home.

Build Community Capacity

  • HUD, in collaboration with CDC and EPA, should ensure the development and delivery of training for
    • health departments and code enforcement agencies in the assessment of health hazards in housing;
    • the building trades (architects, builders, contractors, and housing providers on healthy homes practices, including construction, rehab and maintenance practices; and
    • code inspectors and home inspectors in assessment, remediation, and prevention of housing-related health hazards.

  • HUD, EPA, and CDC should provide funding, training, and technical assistance to community- and faith-based organizations to build local capacity to prevent and address housing-related health hazards.

  • State and local governments should implement cross-training of health, housing, and code enforcement agency personnel.

Ensure Tenants’ Rights

  • Rental property owners should adopt and apply preemptive maintenance practices that prevent health hazards while improving durability and energy efficiency.

  • Governments should require rental property owners to identify and remedy any potential health hazards at unit turnover.

  • Governments should require that workers doing repairs, repainting, or renovations in buildings built prior to 1978 are trained in and use lead-safe work practices.

  • Local governments should require a warranty of habitability for all rental properties and local code enforcement agencies should conduct periodic inspections of all rental units.