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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

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
Overview
  • Describe Baltimore’s transition to healthy homes
  • Convey opportunities, resources & barriers
  • Discuss expansion to community-based initiatives which support healthy housing
slide3
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

Baltimore

healthy homes communities division
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.
baltimore s housing
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
lead exposure in baltimore
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.

why transition from lead to hh
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
healthy homes demonstration project
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
hh demonstration project
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
population demographics
Population Demographics
  • Mean income = $576/month
  • Average household size = 4.9 people
population renters
Population - Renters
  • 56% live in rental properties
    • 65% of renters have a written lease
    • Average monthly rent is $328
population asthma
Population - Asthma
  • 40% of households have someone with asthma or other respiratory problem
  • 32% have child with asthma
slide13
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?

lessons learned hh pilot
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
how resources opportunities
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)
how resources opportunities16
How? Resources & Opportunities
  • City-wide initiatives
    • Baltimore City Sustainability Commission
    • Mayor’s Cleaner, Greener Initiative
    • Food Policy Task Force
barriers to transition
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
current division structure
Four Bureaus

Lead Inspections & Enforcement

LAAP (Lead Abatement Action Program)

Asthma

Community Planning & Initiatives

Current Division Structure
lead inspections enforcement
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
lead inspections enforcement20
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
lead abatement action program
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.
asthma
Asthma
  • 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.
community planning initiatives
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
expansion to the community
Expansion to the Community

Healthy Homes

Healthy Homes and Communities

community approaches
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
community approaches26
Community Approaches
  • Support other city-wide initiatives
    • Weatherization + health
    • Baltimore City Sustainability Commission
    • Redline Project
safe pest management for health
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
weatherization
Weatherization
  • Broad-based partnership
  • Housing; CECLP; MD Rehab., Civicworks, Rebuilding Baltimore Together
  • Weatherization + healthy housing
future directions
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