Housing and health with apologies to yogi
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Housing and Health (with apologies to Yogi) Common pathways link multiple hazards. It’s 90% moisture, the other half is everything else. Housing is under-appreciated as a health determinant. Your house is really important – without it, where would you keep your TV?

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Housing and health with apologies to yogi l.jpg
Housing and Health(with apologies to Yogi)

  • Common pathways link multiple hazards.

    • It’s 90% moisture,

      • the other half is everything else.

  • Housing is under-appreciated as a health determinant.

    • Your house is really important –

      • without it, where would you keep your TV?

  • Conventional wisdom needs to be tested.

    • The world needs kooks –

      • otherwise, how would we know what’s normal?


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Social Determinants of Health

Socioeconomic Status

Social context

Environment

(incl. Housing)

Interventions

Healthcare

access

Behavior

Stress

Health Status


Slide3 l.jpg

Housing and Health

Housing quality/design/type

Neighborhood Environment

Behavior

Structural

integrity

Contaminant sources

Dust traps/sources

Ventilation

Moisture

Interventions

Consumer products

Etc.

Etc.

allergens

pesticides

lead

Measures

Health


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Measurement needs

  • Exposure-relevant measures

  • Personal exposure

  • Loading vs concentration vs air vs ?

  • When do we need to measure – costs/benefits of information content

  • Community-level exposures – impact on home contamination and individual exposure


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What Works

  • A small proportion of the things that seem to make sense have been proven to improve health.

  • Other things make sense from a housing point of view and may also improve health.

  • This gives us enough to make some program and policy changes.

  • However, much efficacy research as well as effectiveness/ evaluation studies are needed (see handouts for details)


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Research Needs Discussed

  • Causes of the secular and social gradients in asthma and primary prevention of asthma.

  • Impact of rehab/new house vs clean/repair; leverage non-research funding for the housing improvement.

  • Mold/ moisture – mechanisms of impact

  • Costs/ benefits.

  • Feasibility/ efficacy of multi-faceted interventions.

  • Mixed exposures (But how to study?)


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Research needs - II

  • Effects of pre- vs postnatal exposure

  • ETS – development and behavior

  • Injuries at home common – how many are preventable through housing interventions/design (e.g. stairs) vs. consumer products?

  • Physical layout/aesthetics lighting, etc. and mental health/ cognitive development


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Research Issues

  • Need for shift balance toward intervention studies

  • Controlled trials needed to support or ?refute? causation

  • But – when do we know enough to make controlled studies unethical?

  • Do no harm – consider other health domains/hazards: pesticides for cockroach, window replacement for lead


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Data & Surveillance Needs

  • Routine use of existing data (e.g. NAMCS, NHANES)

  • Improvement of housing measures in existing health data systems

  • Improvement of health measures in existing housing data systems

  • Why – “what gets measured gets done”


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Implementation Issues

  • Hierarchy of preferred interventions – passive/ environmental vs behavioral

  • “Wholesale,” primary prevention (e.g. banning products) simpler, more effective than cleaning up

  • Implementation R&D (e.g. lithium-powered smoke alarms, vouchers vs give-aways)

  • Need for life-course approach – critical times for intervention. This is crucial role for health agencies.


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Implementation - II

  • Scaling-up interventions – what works when?

    • Regulation

    • Private sector (e.g. insurers)

    • Cross-training home visitors in existing programs (e.g. Head Start, Healthy Start, building inspectors)

    • Financial incentives

    • Appeal to builder/remodeler concerns

  • Incremental vs. radical change

  • Working across disciplines and organizations


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A mature housing and health research community?

  • Standardized metrics

  • Well-established, routine surveillance data

  • Public awareness

  • Committed leadership

  • NIH and/or CDC - supported centers, RFAs?

  • A study section?


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