Baltimore s transition to healthy homes
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Baltimore’s Transition to Healthy Homes. Structuring a comprehensive, community-based healthy homes effort. Genevieve Birkby, MPH, MA Baltimore City Health Department Healthy Homes & Communities Division. Overview . Describe Baltimore’s transition to healthy homes

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Baltimore s transition to healthy homes l.jpg

Baltimore’s Transition to Healthy Homes

Structuring a comprehensive, community-based healthy homes effort

Genevieve Birkby, MPH, MA

Baltimore City Health Department

Healthy Homes & Communities Division

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  • Describe Baltimore’s transition to healthy homes

  • Convey opportunities, resources & barriers

  • Discuss expansion to community-based initiatives which support healthy housing

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87 square miles; 650,000 people

55,000 children under 6

65% African American

Median family income – $37,000

Limited affordable, healthy housing

Goal - Clean, Green, Healthy


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Healthy Homes & Communities Division

  • Created in May 2006

  • Deputy Commissioner, Dr. Madeleine Shea

  • Mission:

  • The Baltimore City Health Department -- in collaboration with community, city, state and national partners -- willimprove the health and well being of children and their families by developing and targeting resources to make Baltimore homes lead safe, reduce home-based asthma triggers, reduce carbon monoxide poisoning, and decrease preventable home injuries.

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Baltimore’s Housing

  • 50 years old on average (US is 30 yrs)

  • 75% of rental units estimated to have lead

  • Studies of low income housing show:

  • 24% leaking roofs

  • 53% peeling paint

  • 38% mouse droppings

  • 31% roaches present

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Lead Exposure in Baltimore

The number of lead-poisoned children under age 6 in Baltimore decreased from 2,189 in the year 2000 to 626 in 2007.

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Why Transition from Lead to HH?

  • Declining lead cases

  • Unmet needs in asthma prevention and control, and injury prevention

  • Staff capacity in inspections, health education and case management

  • Opportunity to expand public health services and impact

  • New funding and partnership opportunities

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Healthy Homes Demonstration Project

  • CDC-funded; piloted in 2007

  • Goal to develop, implement and evaluate a model to expand an urban childhood lead poisoning prevention program into a comprehensive healthy housing program

  • 100 initial home assessments

  • 50 three-month follow up assessments

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HH Demonstration Project

  • Significant staff training (healthy homes 101; IPM; fire safety; CO etc.)

  • Developed forms, assessments and protocols

  • Identified relevant healthy housing resources

  • Evaluation, evaluation, evaluation

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Population Demographics

  • Mean income = $576/month

  • Average household size = 4.9 people

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Population - Renters

  • 56% live in rental properties

    • 65% of renters have a written lease

    • Average monthly rent is $328

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Population - Asthma

  • 40% of households have someone with asthma or other respiratory problem

  • 32% have child with asthma

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Kitchens without a trash can: 28%

Households reporting any pest problem: 79.5%

44% with no working smoke alarms

Asthma reported: 43%

No working heat: 17%

Indoor smoking: 36%

Results: What did we find?

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Lessons Learned: HH Pilot

  • One-size fits all approach?

  • Need to weigh “comprehensive” assessment with “actionable” interventions

  • Priority intervention areas?

    • Asthma? IPM?

  • Staff

    • Training

    • Morale

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How? Resources & Opportunities

  • City Agencies – (DHCD, HABC, FD, PD, Health Programs, Quasi Orgs, School System)

  • State Agencies (DHMH, MDE, DHCD)

  • Universities (public health, nursing, psychiatry, urban planning, community law, social work, forestry, etc.)

  • Primary Care Providers

  • Federal Agencies (CDC, HUD, EPA)

  • Community Based Orgs (Coalition to End Childhood Lead Poisoning, community groups, etc)

  • National Advocacy and Training Orgs (NCHH, AHH)

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How? Resources & Opportunities

  • City-wide initiatives

    • Baltimore City Sustainability Commission

    • Mayor’s Cleaner, Greener Initiative

    • Food Policy Task Force

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Barriers to Transition

  • Taking programs to scale

    • Requires increased staff, training and supplies

  • Lack of public investment in housing for low-income families

  • Families “in crisis” – social issues beyond housing

  • Resource constraints

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Four Bureaus

Lead Inspections & Enforcement

LAAP (Lead Abatement Action Program)


Community Planning & Initiatives

Current Division Structure

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Lead Inspections & Enforcement

  • Registered sanitarians inspect all homes of children with elevated blood lead levels with a healthy homes approach.

  • Issue violation notices to those homes with lead hazards

  • 2009: Bed bug response

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Lead Inspections & Enforcement

  • Case management for children with an EBL or with significant lead risks

  • Provide integrated healthy homes assessment and risk-specific advice

  • Link families to resources needed to improve the health and safety of their housing

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Lead Abatement Action Program

  • Health intervention program geared towards interim control treatments of lead poisoning hazards in the home.

  • Have completed lead hazard intervention work in over 2,500 units throughout the City.

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  • Home visiting asthma programs

    • Enroll children ages 2- 18 who have moderate to severe asthma

    • Home visits from nurses and trained community health workers to assess medical and environmental needs.

    • Utilize a healthy homes approach.

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Community Planning & Initiatives

  • Community-based initiatives and evaluation

    • Outreach and training

    • Lead Safe Work Practices Initiative

    • Promotores program

    • Community Environmental Health Planning Initiative

    • Safe Pest Management for Health Initiative

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Expansion to the Community

Healthy Homes

Healthy Homes and Communities

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Community Approaches

Response to both identified priorities and emerging needs

  • Promotores program – need for better engagement with the Latino community

  • Safe Pest Management for Health

  • Bed bugs!

  • New and creative approaches (MICA)

  • Asthma community education groups

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Community Approaches

  • Support other city-wide initiatives

    • Weatherization + health

    • Baltimore City Sustainability Commission

    • Redline Project

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Safe Pest Management for Health

  • Baltimore Housing, BCPSS

  • Augment our IPM response within the division

  • 35 site assessments

  • Recommendations for city IPM contracts

  • Bed bug subsidization program

  • Peer education in public housing

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  • Broad-based partnership

  • Housing; CECLP; MD Rehab., Civicworks, Rebuilding Baltimore Together

  • Weatherization + healthy housing

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Future Directions

  • Healthy housing will continue to evolve

  • Tailor according to your community’s needs – don’t take on too much

  • Consider creative approaches and non-traditional partners