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
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?
social determinants of health
Social Determinants of Health

Socioeconomic Status

Social context


(incl. Housing)






Health Status

Housing and Health

Housing quality/design/type

Neighborhood Environment




Contaminant sources

Dust traps/sources




Consumer products








measurement needs
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
what works
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)
research needs discussed
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?)
research needs ii
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
research issues
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
data surveillance needs
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”
implementation issues
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.
implementation ii
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
a mature housing and health research community
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?