Undoubtedly the biggest news this month, and perhaps this year, is the landmark passage of the Patient Protection and Affordable Care Act. The bill expands health insurance coverage to 32 million Americans - including close to 9 million children and 12 million women of reproductive age in 2014. Comprehensive summaries of the law have been posted elsewhere, so I’ll focus on a few provisions relevant to the healthy homes community.
First, the bill adds a new Section to Title V of the Social Security Act and provides $1.5 billion over five years for Maternal, Infant and Early Childhood Home Visiting Programs (see Section 2951, page 561 of the legislation). The bill will require States, as a condition of receiving the Maternal and Child Health block grant funds for FY2011, to conduct a needs assessment to identify communities that are at risk for poor maternal and child health and have few quality home visitation programs.
The bill also creates a $7 billion Prevention and Public Health Fund (over five years) for programs authorized by the Public Health Service Act (see Section 4002 or page 1121 of the legislation). The purpose of the fund is to “provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.”
Finally, the bill creates “Community Transformation Grants” (see Section 4201, p. 1182), which are competitive grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming.
These bill provisions offer outstanding opportunities for state and local governments and community-based organizations to embed our healthy homes agenda into broader community health initiatives. Now is a good time to connect with your state health agency leadership and key partners from other agencies including child welfare, early education, child care, Medicaid, and others to lay the groundwork for the collaboration that will be needed to optimally implement this in your state and to look for opportunities to incorporate healthy homes assessments and referrals.
In this Issue:
NCHH Releases Green and Healthy Housing Tools and Training Resources
NCHH and the Alliance for Healthy Homes Join Forces
Update on National Safe and Healthy Housing Coalition
RRP Implementation Continues, Two More States Accept Delegation
White House Launches Neighborhood-Based Initiatives
New Training Course - Health Opportunities in Energy Audits
New Report on Managing Bed Bugs
New Report Finds Asthma adds 50 Cents to Every Health Care Dollar Spent on Children with Asthma
Low Levels of Lead Still Cause Damage to Children’s Kidneys
Prenatal Phthalate Exposure Causes Attention and Behavior Problems
Bed Bug Resistance to Insecticides is Widespread
Ask NCHH: What’s the RRP Rule? What do I need to know when hiring a contractor?
Dr. Kathryn R. Mahaffey Awarded the Distinguished Career Service Award
Idea to Send FEMA Trailers to Haiti Offers No Safe Shelter
New Report on How Businesses Can Reduce Asthma Burden of Employees
Main Feature
NCHH Releases Green and Healthy Housing Tools and Training Resources
NCHH has released a new suite of training and informational resources to help affordable housing professionals adopt sustainable and healthy building practices. With funding from the Home Depot Foundation, NCHH partnered with affordable housing organizations including Enterprise Community Partners, Inc. (Enterprise), NeighborWorks America, and the Local Initiatives Support Corporation to provide practical information local housing organizations can use to cost-effectively integrate healthy homes upgrades into their existing programs.
The new series of fact sheets, videos, Webinars and other resources are available online through the NCHH Web site. The materials provide affordable housing professionals with information on the latest innovations in green building techniques as well as practical technical information community development corporations can use in carrying out green building projects.
NCHH and the Alliance for Healthy Homes Join Forces
As you may know, NCHH and the Alliance for Healthy Homes (Alliance) recently announced plans to join forces. The consolidated organization will continue to operate as the National Center for Healthy Housing, led by Rebecca Morley, with offices in Columbia, Maryland and Washington, DC. The merger consolidates all aspects of healthy homes within a single organization – research and evaluation, policy advocacy, consumer education, training, and assistance to local governments and community-based organizations. Nearly 5.7 million families live in substandard housing conditions placing millions of children at risk for asthma, cancer, lead poisoning, and injuries. As a unified organization, the groups will be able to better serve the interest of these families.
Policy
Update on National Safe and Healthy Housing Coalition
The National Safe and Healthy Housing Coalition has grown to 51 member organizations. It will hold its first annual meeting on May 24th and 25th in Washington, DC. In the first quarter of 2010, Coalition members have held numerous meetings on the Hill to promote the Safe and Healthy Housing Act, the Code Administration Act, and to ensure the timely implementation of the EPA Renovation, Repair, and Remodeling Regulation. The Coalition is also supporting increased appropriations for the offices that are responsible for grant making in the area of healthy housing, including the Healthy Homes and Lead Poisoning Prevention Branch at CDC and the Office of Healthy Homes and Lead Hazard Control. The Coalition recently presented its priorities and efforts to the Federal Healthy Homes Interagency Workgroup. Visit the Coalition website for the latest information on these efforts and for updates about the annual meeting.
RRP Update
RRP Implementation Continues, Two More States Accept DelegationWith less than a month before the US EPA’s Renovation, Repair, and Painting rule goes into effect, efforts continue to get renovators and contractors up to speed on working safely and in compliance with the rule’s requirements. As of March 22, 2010, 60,000 renovators have been certified and an additional 50,000 are likely to achieve certification before the April 22 rule implementation date.
Contractor Awareness
A number of private as well as state and local government efforts continue to spread the word about the April 22 deadline for becoming certified under the rule. Many contractors who provide home-installation services for the “big box” retailers, like Lowe’s or Home Depot, report receiving letters from the stores informing them of the rule and requiring them to become in compliance to continue working. Angie’s List, a web-based resource for identifying home-service professionals, will be identifying which listed contractors are certified under the rule. Several states and localities have also reached out to their contractors, sending letters to licensed contractors, or, in the case of Illinois, hosting seminars across the state for contractors to learn more about the requirements.
Training Results
EPA has approved 184 training providers. Of these training providers, more than 90 are accredited to provide training in multiple states. North Carolina and Iowa have joined Wisconsin in accepting delegation of the RRP rule. These three states will be responsible for enforcing the rule, rather than the EPA, in their jurisdictions. NCHH strongly supports states in accepting delegation, as this means that enforcement of the rule will be more directly connected to the local authorities who already know or work with the regulated community. In addition to NC, IA, and WI, we expect four or five more states to take it on by April 22, and then several more, later in the year. When states take over the rule, however, they may also add additional requirements or restrictions. Several states, even though they are not taking on the rule at this time, have existing requirements that may impact trainers or renovators. Please visit our website for a summary of state plans to adopt the rule as well as state specific additions we are aware of. If we are missing information for your state, please let us know by e-mailing Tom Neltner. By April 22, EPA estimates that more than 5,600 classes will have been offered. Seventeen states have each had more than 100 training classes. California, Massachusetts, Michigan and New York have each had more than 200 classes.
EPA has been working with the Laborers' International Union of North America (LiUNA) to accredit their local affiliates as RRP training providers. LiUNA has estimated that they can easily train more than 50,000 additional renovators. EPA expects that even greater numbers of renovators will seek and obtain training once the rule has been implemented, and that any delay in the implementation date would likely result in far fewer renovators making a decision to complete a training program.
NCHH has also been actively working to ensure contractors are certified and trained. Our RRP training network has certified over 2400 renovators, and will be offering nearly 150 RRP classes in March alone. In partnership with the Custom Electronic Design and Installation Association (CEDIA), NCHH became the first USEPA approved provider of an e-learning training system, which allows contractors to complete the “lecture” portion of the class at their own pace and at their own schedule prior to reporting to a training facility for the hands-on portion of the class. NCHH is also working with the Oregon Home Builders Association and the Childhood Lead Action Project to offer hands-on training in conjunction with their e-learning systems and ensure multiple options for contractors in need of training.
Awareness Materials
To assist in getting the word out to contractors, the US EPA has created a number of pamphlets and promotional materials. NCHH strongly encourages state and local advocates to take advantage of these materials and help ensure contractors are aware of the new requirements. EPA has also developed a “Lead Safe” logo certified firms will be able to print on their materials, helping the public to identify firms who are in compliance and serving as a marketing device.
White House Launches Neighborhood-Based Initiatives
Building sustainable communities is a top priority of President Barack Obama and there have been a number of new or revamped initiatives introduced by the Administration (as evidenced by the FY2011 President’s Budget). To help you navigate the array of new neighborhood programs, we’ve provided a summary below.
Building on the successes and lessons learned from the HOPE VI program, the Choice Neighborhoods effort aims to integrate public housing revitalization efforts with social services. Beyond public housing, the initiative takes an interdisciplinary approach to community development that would involve public, private, and nonprofit institutions. It is expected to operate alongside the Promise Neighborhoods program in several communities. Promise Neighborhoods is modeled after the Harlem Children’s Zone, and supports the development of plans for comprehensive neighborhood programs designed to combat the effects of poverty and improve education and life outcomes for children, from birth through college.
Other key initiatives include HUD, DOT, and EPA’s interagency Partnership for Sustainable Communities, geared towards improving regional planning efforts that integrate housing and transportation decisions, and increasing state, regional and local capacity to incorporate livability, sustainability, and social equity principles into land use and zoning. The National Safe and Healthy Housing Coalition submitted comments suggesting that health considerations be incorporated into HUD’s Sustainable Communities Grant Program. CDC’s Healthy Communities program engages communities and mobilizes national networks to focus on chronic disease prevention. Finally, the First Lady’s Let’s Move initiative is geared toward dramatically reducing Obesity. The program will provide healthier food in schools, help kids to be more physically active, and make healthy, affordable food available nationwide.
Training
New Training Course - Health Opportunities in Energy Audits
The National Healthy Homes Training Center and Network is offering a new course titled Health Opportunities in Energy Audits and Upgrades. It will help energy efficiency staff to learn about healthy homes and understand that energy efficiency is only one part of a safe and healthy home.
The training will also provide an opportunity for staff from healthy homes and weatherization programs to meet and discuss common issues, including eligibility requirements, audit or assessment parameters, the types of services each program provides to their clients and opportunities for referrals.
Participants in the course will learn about strategies for combining healthy homes and energy efficiency work for more of a “one-touch” home improvement approach. This approach is more convenient for the owner or tenant, is a more efficient use of staff time and public funds, and it is a way to be sure that one repair does not leave behind a bigger problem unbeknownst to a contractor only trained in energy efficiency.
New Report on Managing Bed Bugs
NCHH recently released a new report titled “What’s Working for Bed Bug Control in Multifamily Housing.” This report is designed for health professionals, housing professionals, and pest management professionals seeking to plan for or respond to a bed bug infestation in multi-family housing. There is no silver bullet for eliminating bed bugs. They present a challenge to modern pest control that the industry is still struggling to meet. To make up for the lack of chemical power we have for battling this insect, additional people and tools must be involved. Bed bug success stories usually involve people who live and work in a building (including a pest management professional) coming together as a team to battle this pest. Throughout the report, you will see how communication and cooperation among residents, staff, and the pest control service provider are keys to success.
Research
New Report Finds Asthma adds 50 Cents to Every Health Care Dollar Spent on Children with Asthma
A new report from George Washington University, School of Public Health and Health Services (GW), Changing pO2licy: The Elements for Improving Childhood Asthma Outcomes, found that asthma adds about 50 cents to every health care dollar spent on children with asthma compared to children without asthma. Those most at risk – low income, medically underserved, and African-American and Hispanic children – have the least access to preventive care and the most visits to the ER.
The report, supported by the Merck Childhood Asthma Network, Inc., (MCAN) and the RCHN Community Health Foundation (RCHN CHF), is the result of a year-long investigation into America’s childhood asthma problem to discover why the country has not benefited more from what is known about asthma, the single most common chronic disease among children.
Specific healthy housing recommendations in the report include: addressing indoor air environment and other indoor asthma triggers and reducing asthma triggers in homes and communities.
Low Levels of Lead Still Cause Damage to Children’s Kidneys
A new study published in Archives of Internal Medicine has found evidence of early kidney damage in children with lead levels far below what is normally considered dangerous. “To our knowledge, this is the first study to show that very low levels of lead may impact kidney function in healthy children, which underscores the need to minimize sources of lead exposure,” said Dr. Jeffrey Fadrowski of Johns Hopkins University in Baltimore, who led the study.
The study reviewed test results from 769 adolescents aged 12 to 20 who took part in the Third National Health and Nutrition Examination Survey from 1988 to 1994. When divided into four equal groups, those in the quarter with the highest lead levels had evidence of slowing kidney function. The teens in the study had a mean lead level of 1.5 micrograms per deciliter, considered safe by the U.S. Centers for Disease Control and Prevention. The CDC's level of concern for lead is 10 micrograms per deciliter of blood.
Prenatal Phthalate Exposure Causes Attention and Behavior Problems
A study of New York City school-aged children published this week in Environmental Health Perspectives online by researchers from Mount Sinai School of Medicine, CDC, and Cornell University concludes that children are more likely to have attention and behavioral problems when exposed to phthalates in cosmetics and fragrances in the womb. The connection was only detected for the types of phthalates used in perfumes, shampoos and other personal care products, not the ones found in vinyl toys and other soft plastics. “More phthalates equaled more behavioral problems,” said Stephanie Engel, an associate professor of preventive medicine at Mount Sinai School of Medicine. “For every increase of exposure, we saw an increase in frequency and severity of the symptoms,” including attention problems, poor conduct and aggression.
Bed Bug Resistance to Insecticides is Widespread
Entomologists at the University of Kentucky College of Agriculture found the majority of bed bugs in the United States appear to have developed genetic mutations, making them resistant to the most commonly used insecticides called pyrethroids. While there are many different types of pyrethroids, UK researchers have found once a bug is resistant to one, they are likely resistant to others in the same category. Their findings support recognition within the healthy homes community that non-traditional methods of Integrated Pest Management (IPM) are safer and smarter ways to control pests. IPM techniques include more aggressive and regular monitoring of pests, cleaning to remove harborage, using non-chemical alternatives where possible, and use of chemical pesticides when needed. The study will be published in an upcoming issue of the Archives of Insect Physiology and Biochemistry.
Ask NCHH: What’s the RRP Rule? What do I need to know when hiring a contractor?
Common renovation activities like sanding, cutting, and demolition can create hazardous lead dust and chips by disturbing lead-based paint, which can be harmful to adults and children. To protect against this risk, the Renovation, Repair and Painting (RRP) Rule is a new regulation that will be enforced by the EPA starting April 22, 2010 (Earth Day). The rule requires that any contractor working in homes or “child-occupied facilities” built before 1978 (the year lead paint was banned) must be EPA-certified, and take extra steps to avoid creating lead-paint hazards commonly caused by renovation activities. This rule is a drastic change for the contracting industry, as it requires certain regulated set-up and cleaning activities, as well as prohibits some work practices that have been found to cause harm to workers and occupants. Details can be found on the EPA website.
After April 22nd, if you are hiring a contractor for any renovation activity that disturbs paint in a pre-1978 house, check to make sure they are a “Certified Renovator.” (These contractors are required to hold a certificate verifying they have completed an 8-hour class). Contractors must provide you with the “Renovate Right” pamphlet and follow all work practices required by the RRP Rule.
News
Dr. Kathryn R. Mahaffey Awarded the Distinguished Career Service Award
On March 5, 2010, Dr. Kathryn R. Mahaffey was presented with the Distinguished Career Service Award by the US Environmental Protection Agency. Kate was the rare scientist who knew how to apply the lessons from academic research to protect public heath. Her work greatly contributed to the fields of epidemic heavy metal poisoning, endocrine disruption and many other areas including exposure of children, pregnant women and at-risk populations to environmental pollutants. Literally millions of children have avoided the tragedy of lead and mercury poisoning as a consequence of her work. To award her, although posthumously, with the Distinguished Career Service Award recognizes her considerable accomplishments and the timeless influence of her work to protect human health and the environment.
Idea to Send FEMA Trailers to Haiti Offers No Safe Shelter
As reported in the Los Angeles Times, the trailer industry and lawmakers are pressing the government to send Haiti thousands of potentially formaldehyde-laced trailers left over from Hurricane Katrina — a move that could cause more harm than good.
More than 120,000 families rendered homeless by Hurricane Katrina have lived in FEMA trailers, found to contain dangerously high levels of formaldehyde after an investigation began in 2006 when occupants began falling ill and one even died. Formaldehyde, commonly found in pressed wood, cabinets, particleboard, and carpeting, is a potent respiratory irritant that can cause breathing problems and is a known carcinogen. Formaldehyde levels in some trailers reached 75 times the federal limit for worker exposure to the chemical.
Now lobbyists for the Recreational Vehicle Industry Association have been talking with members of Congress, the government and disaster relief agencies to see if it would be possible to send the trailers that have sat idle for years to Haiti. This push to send trailers to Haiti is motivated by more than charity. A government-run online auction is currently underway to sell the old trailers for rock-bottom prices, as long as buyers sign an agreement not to use the auctioned trailers for housing. The RV industry is concerned this will lower demand for new products, hence their readiness to send the trailers overseas.
Though the formaldehyde fumes in the trailers may have lessened with time, Haiti’s hot, humid weather would boost the amount released, formaldehyde experts have warned. The idea to dump inferior American products on the poor based on the logic that “something is better than nothing” is quite backwards. During a time when so many Haitians have nothing, the hazardous trailers would only add new problems.
To quote the Los Angeles Times, “In Haiti, Emite Bellade said she has had no shelter since losing her three-story house. Still, she doesn’t want one of the trailers. ‘We have nothing,’ she lamented. ‘But I would rather sleep outside than be in a metal box full of chemicals.’”
New Report on How Businesses Can Reduce Asthma Burden of Employees
The New England Asthma Regional Council, a program of Health Resources in Action, and the University of Massachusetts/Lowell are pleased to announce the release of “Asthma: A Business Case for Employers and Health Care Purchasers.”
The report urges businesses to invest in reducing the burden of asthma among their employees and dependents, as asthma that is out of control impairs quality of life, reduces productivity, and generates high costs. The report details three strategies employers can pursue to cost-effectively bring asthma under control:
1. Aligning employee health benefits with recommended best practices for asthma;
2. Building on worksite health promotion programs to support employees in effective self-management of asthma
3. Ensuring healthy work environments.
Though the primary audience is employers, the report may also be useful to unions and advocates for improving the health of employees and others with asthma. We urge you to use this tool and to disseminate it widely. A companion “Insurance Coverage Checklist” is forthcoming. This tool is intended to support employers and other purchasers of health care as they design health benefits on behalf of employees.
Upcoming Events
“Lead and Beyond: Progress in Eliminating Lead Poisoning and New Opportunities for Collaboration in New Jersey” will be held at the Sheraton Edison Hotel, Raritan Center, 125 Raritan Center Parkway, Edison, NJ on April 16, 2010. The conference is sponsored by the New Jersey Interagency Task Force on the Prevention of Lead Poisoning and the Governor's Council on the Prevention of Mental Retardation and Developmental Disabilities. The deadline to register is April 2, 2010.
“The Indoor Environmental Health and Technologies Conference” sponsored by the Lead and Environmental Hazards Association and “The Lead and Healthy Homes Grantees Conference” sponsored by the National Association of Lead and Healthy Homes Grantees will he held April 27 – 30, 2010, at the Astor Crowne Plaza Hotel, New Orleans, LA. There also will be some pre-conference workshops on Monday, April 26th. The joint national conference includes program tracks and technical assistance workshops dealing with lead hazard control, lead poisoning prevention and healthy home program issues. Program tracks, technical assistance workshops and consultation roundtables are offered from Tuesday afternoon through Thursday afternoon to provide in-depth education and discussion.
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