1. www.nchh.org David Jacobs, PhD, CIH, Research Director NATIONAL CENTER FOR HEALTHY HOUSING (Mark James, Jay Wilson, Peter Levavi, Susan Aceti, Carol Kawecki, Emily Ahonen, Sherry L. Dixon, Samuel Dorevitch, Jill Breysse, Janet Smith, Anne Evens, Doborah Dobrez, Marjie Isaacson, Colin Murphy, Lorraine Conroy, Jonathan Wilson.) Going Green in Low Income Housing: Perspectives from Developers and Researchers

2. www.nchh.org Outline

3. www.nchh.org Cuyahoga River ca. 1960

4. www.nchh.org Is Housing a Shared Commons? Is Housing Part of the Infrastructure?

5. www.nchh.org Housing Market Price & Health

6. www.nchh.org Green Communities Criteria ▪ Integrated Design Process ▪ Location and Neighborhood Fabric ▪ Site ▪ Water Conservation ▪ Energy Conservation ▪ Materials and Resources ▪ Healthy Living Environment ▪ Operations and Management

7. www.nchh.org Health Criteria ▪ ASHRAE 62.2 ▪ Kitchen and bath exhaust ventilation ▪ No carpet in kitchens/baths ▪ Low VOC paints/adhesives ▪ Integrated Pest Management ▪ Radon testing & mitigation ▪ Moisture & mold mitigation ▪ Low/no formaldehyde wood composite products

8. www.nchh.org Viking Terrace Worthington, MN

9. www.nchh.org Methods

10. www.nchh.org Results *p<0.05

11. www.nchh.org Children

12. www.nchh.org Adults Increased Excellent or very good general health increased from 33% to 62%* Decreased Non-asthma respiratory decreased from 32% to 9%* Asthma decreased from 17% to 13% *p ≤ 0.05

13. www.nchh.org Moisture *p<0.05

14. www.nchh.org Pests *p<0.05

15. www.nchh.org Contaminants ▪ Year-long average CO 2 = 982 ppm ▪ All VOCs below ATSDR minimum risk levels

16. www.nchh.org Energy & Water 46% Reduction in total energy use 39% Estimated reduction in CO 2 emissions from power plants

17. www.nchh.org Moving Into Green Healthy Housing: The Yield (Chicago, IL) J Public Health Manag Pract. 2014 Jan 7 David E. Jacobs, PhD, CIH a,b Emily Ahonen, PhD a Sherry L. Dixon, PhD b Samuel Dorevitch, MD a Jill Breysse, MHS, CIH b Janet Smith, PhD, a Anne Evens, PhD, a,c Doborah Dobrez, PhD a Marjie Isaacson, PhD c Colin Murphy, MS a Lorraine Conroy, PhD, a Peter Levavi d a University of Illinois at Chicago, 2121 W Taylor St., MC 922, Chicago, IL 60612 b National Center for Healthy Housing, Columbia, MD c Center for Neighborhood Technology Energy, Chicago, IL d Brinshore Michaels Development, Northbrook, IL

18. www.nchh.org Methods ▪ Compared: ▪ Health status of public housing residents before and after a move from old poor-quality public housing into new green healthy housing ▪ These residents to a control group that did not move

19. www.nchh.org General Health

20. Mental Health (Adults)

21. Asthma

22. www.nchh.org Statistically Significant Physical Health Improvements

23. www.nchh.org Medicaid Expenditures

24. www.nchh.org Medicaid Data 1. Adult medicaid expenditures did not vary between time intervals or between study and control groups 2. At Interval 2, Child medicaid expenditures were marginally significantly higher for the study gp ($1226) than control ($785) (p=0.053) but trend not consistent across other time intervals 3. Overall conclusion: Some time intervals showed Medicaid savings and other showed costs, but none of the trends reached statistical significance. 4. Medicaid data were difficult to interpret-trends seen in self- reported health may not have been observable due to “secular trends in program administration, eligibility, and rising cost of medical care in general...“

25. www.nchh.org Air Contaminants Contaminant New Development 1 New Development 2 Control Group CO 2 (ppm)777839635 CO (ppm)0.430.440.31 PM 2.5 (ug/m 3 )232617 Formaldehyde (ug/m 3 )262822 VOCs (ppm as hexane equiv) 649347 (24 hour samples, geometric means, n=45 units)

26. www.nchh.org Wheeler Terrace: From Battered…

27. www.nchh.org …to Bright…

28. www.nchh.org Kitchen - Before

29. www.nchh.org Kitchen Renovation - After

30. www.nchh.org Bathroom - Before

31. www.nchh.org Bathroom - After

32. www.nchh.org Healthy and Green Rehab Elements  Integrated Pest Management  No carpet in wet areas  New local exhaust fans in kitchens and baths vented to outdoors  Low-VOCs paints and carpet in bedrooms  Non-PVC floor tiles  Waterproofing/damp-proofing  Plumbing repairs  Fire extinguishers in unit  Asbestos Abatement  Improved insulation  Energy Star appliances and fixtures  Energy efficient lighting  Upgraded infrastructure  Door/window repair and replacement  Site improvements to improve walkability

33. www.nchh.org Adult & Child Health Changes Health EndpointsAdult PrePost General Health Status Very good or excellent Good Fair or poor 31% 35% 32% 41% 30% Injury14%4% Health EndpointsChild PrePost General Health Status Very good or excellent Good Fair or poor 58% 31% 9.5% 61% 39% 0% Injury3%0% # ER Visits due to Asthma140

34. Specific Housing Condition Changes

35. www.nchh.org WATTS to Well-Being Chicago, NYC, Boston Compared: ▪ Health status of residents before and after energy upgrades ▪ N= 248 households ▪ Chicago, NYC, Boston ▪ Buildings with one to more than 3 units

36. www.nchh.org Results Worsened Days with problems sleeping* Frequency of symptoms* Improved Mean general health score decreased from 3.07 to 2.78* Improvements in: Sinusitis (5%)* Hypertension (14%)* Overweight (11%)* Use of asthma medication during asthma attacks (20%) *p<0.05

38. www.nchh.org Energy & Water Results

39. www.nchh.org MIGHHTY, Highline, DC Green, Watts to Well-Being, and GREAT Studies ▪ These projects were funded by the U.S. Department of Housing and Urban Development, Office of Healthy Homes and Lead Hazard Control. The work that provided the data for part of this presentation was supported by “Recovery Act or American Recovery and Reinvestment Act (ARRA)” funding under an award with the U.S. Department of Housing and Urban Development. The substance and findings of the work are dedicated to the public. The authors are solely responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not necessarily reflect the views of the Government.

40. www.nchh.org Conclusions ▪ Using modern green & healthy housing principles in low- income housing produces substantial self reported health and housing quality benefits ▪ All low-income housing construction and rehab should include green healthy housing requirements

41. NATIONAL CENTER FOR HEALTHY HOUSING www.nchh.org @nchh Facebook.com/Healthy Housing www.nchh.org/Resources/Blog.aspx David Jacobs, PhD, CIH, Research Director Djacobs@nchh.org