Substandard Housing and Health:

• The health of children and other vulnerable citizens (such as older Americans) is directly impacted by their home environments.
• Indoor hazards typically pose far greater risks to children’s health than outdoor exposures because children spend as much as 90 percent of their time indoors, where toxic substances can reach more concentrated levels than they do outside.[1]
• Among the health hazards encountered in homes are those that cause and worsen asthma (such as dust allergens, mold, and pests), carcinogens (such as asbestos, radon, and chemical pesticides), and toxins (such as carbon monoxide and lead).
• Five million families live in physically substandard housing or pay more than 50% of their income for rent.[2] In addition to the direct health effects of substandard housing, children’s health suffers when high housing costs leave families without enough money for medical care, prescriptions, food, and sufficient heat.

Growing Costs of Unhealthy Housing:

• Lead poisoning, chronic low-level carbon monoxide exposure, and asthma all profoundly interfere with a child’s ability to learn and perform in school. Lead poisoning causes reduced IQ and attention span, reading and learning disabilities, hyperactivity, and impaired growth. Asthma is the top cause of missed school days.[3] Chronic carbon monoxide exposure causes dizziness and headaches; at high levels it impairs vision, learning ability, and basic functioning.
• The economic costs to society are substantial, encompassing lost learning and earning potential of children; lost work days for parents caring for ill children; medical expenses including emergency room visits; and special education costs. Asthma costs the US economy $14 billion each year in direct and indirect costs.[4]
• The total annual costs for responding to childhood diseases that can be attributed to the environment – lead poisoning, asthma, and cancer – is $54.9 billion, approximately 3 percent of total U.S. health care costs.[5]

Striking Disparities in Health Impacts:

• The burden of housing-related health hazards falls disproportionately on our most vulnerable children and communities:
  • African American children are twice as likely to have asthma and six times as likely to die from it than white children.[6]
  • Children from low-income families are eight times as likely to be lead poisoned as those from higher income families, and African American children are five times as likely as whites to be lead-poisoned.[7]
• National data camouflage the true picture of housing-related health problems:
  • Rates of lead poisoning among children living in the highest risk neighborhoods can be more than 10 times the national average.[8]
  • In Harlem, NY, 25% of children tested have asthma, a rate four times the national average.[9] In New England, one in five households with children has at least one child that has been diagnosed with asthma, and lower income minority populations exhibit the highest rates of asthma.[10]

Cost-Effective Solutions:

The ballooning expenses for medical care and other costs of housing-related health hazards underscore the need for primary prevention – addressing unhealthy housing conditions before they cause illness. The good news is that much of the infrastructure to achieve healthy housing is in place. Unfortunately, numerous existing programs are routinely missing opportunities to make housing healthier. Modest adjustments in policies and practice could harness those missed opportunities and maximize resources and results.

The Healthy Homes grant program serves as a resource to all other government programs by developing methods for integrating health considerations into construction, maintenance, rehab, and weatherization efforts. Early results from the program document that methods to improve health conditions also improve the soundness, value, and durability of the housing stock. Through the Healthy Homes grant program, HUD has competitively funded a wide variety of projects ranging from technical studies and research in new technologies to education, outreach, and demonstration efforts that have already produced a host of valuable tools, models, and outcomes. For example:

• “Weatherization Plus Health,” an innovative new program that incorporates health issues into the assessment and repair phases of weatherization and housing rehabilitation work;
• “Healthy Building Guidance,” produced by the Asthma Regional Council of New England, that recommends specific building practices and provides technical resources to support healthy building practices, particularly in the construction of affordable housing;
• Demonstration of strategies to reduce mold and moisture problems in low-income housing;
• Improvements in indoor air quality and reduction of asthma triggers in homes of low-income children with asthma;
• New assessment tools that more effectively determine the presence of housing-related health hazards.

Healthy Homes funding has remained at $10 million (or slightly less due to across-the-board cuts) since its initial appropriation in 1999. While HUD has provided funding to 41 grantees in 20 states, it typically can fund only about one out of eight proposals submitted, leaving many creative and promising projects unfounded.

Creating decent, safe, and affordable housing is HUD’s central mission, yet the $10 million devoted to Healthy Homes grants is a mere 0.03% of the President’s $31.4 billion budget request for HUD in FY2005. Another $164 million has been appropriated for controlling lead-based paint hazards, a proven and much needed program. Expanding funding for Healthy Homes will accelerate creation of knowledge and tools that, in turn, will help make lead safety grants more effective. Increasing the Healthy Homes grant program to $20 million is a sound investment that will yield multiple pay-offs: improved intelligence, learning, and school success for children from low-income families; health gains; savings in health care costs; more durable housing; reduced housing maintenance and energy costs; and more efficient and cost-effective publicly funded housing programs.

Notes:
[1] Environmental Protection Agency, The Inside Story: Guide to Indoor Air Quality, 1995.

[2] Department of Housing and Urban Development, Trends in Worst Case Housing Needs 1978-1999 Plus Update on Worse Case Needs in 2001, 2003.

[3] Centers for Disease Control and Prevention, Surveillance for Asthma, MMWR, 2002.

[4] National Heart, Lung, & Blood Institute, Chart Book on Cardiovascular, Lung, and Blood Diseases, 2002.

[5] Landrigan, P., Schechter, C., et. al., Environmental Pollutants and Disease in American Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities, Environmental Health Perspectives, Vol. 110, No. 7, July 2002.

[6] Kaiser Family Foundation, Key Facts: Racial and Ethnic Differences in Medical Care, 1999.

[7] Centers for Disease Control and Prevention, Update: Blood lead levels – United States 1991-1994, MMWR, 1997.

[8] Brown, et. al., Small Area Analysis of Risk for Childhood Lead Poisoning, 2001.

[9] New York Times, Study Finds Asthma in 25% of Children in Central Harlem, April 19, 2003.

[10] Asthma Regional Council, Asthma in New England: Part II: Children, www.asthmaregionalcouncil.org, January 2004.