Lessons learned: Regional Approaches to Environmental Health Issues

Lessons learned: Regional Approaches to Environmental Health Issues Eileen Gunn, Healthy Homes Project Director, Asthma Regional Council of New England

Building a Healthy Homes Promotion Effort across New England Eileen Gunn, Healthy Homes Project Director, Asthma Regional Council of New England

Healthy Homes Needs and Resource Assessment Report – New England Eileen Gunn, Healthy Homes Project Director, Asthma Regional Council of New England

The Project • Grant from the Jessie B. Cox Trust to assess and assist the New England states with efforts that address healthy homes using a holistic, coordinated approach. • The broad vision of ARC’s Healthy Homes Promotion Project (H2P2) is to promote healthier housing across New England, focusing on the environmental health and safety of low income populations.

National Scope of Housing-related Illness • Childhood lead poisoning, injuries, respiratory diseases such as asthma, and quality of life issues have been linked to the more than 6 million substandard housing units nationwide. • Residents of these units are also at increased risk for fire, electrical injuries, falls, rodent bites, and other illnesses and injuries. Other issues of concern include exposure to pesticide residues, indoor toxicants, tobacco smoke, and combustion gases. (CDC)

Scope of Housing-related Illness Low income populations are disproportionately impacted and at the greatest risk for asthma, poisonings, cancer, and unintentional injuries that arise from biological, physical, and chemical exposures within the home environment.

Traditional Approaches Health Housing Lead Radon Secondhand smoke Asthma Triggers Combustion products Mold Insects/RodentsChemicals/Pesticides Fire/Injury Drinking water Structural Approach Disease/Hazard approach Care Prevention Well Constructed Energy Efficiency Affordable Ventilated Maintained Safe Adapted

What is a Healthy Homes Approach? “A Healthy Homes approach is holistic and comprehensive and provides public health professionals, including environmental public health practitioners, public health nurses, and housing specialists, the requisite training and tools necessary to address the broad range of housing deficiencies and hazards associated with unhealthy and unsafe homes.” (CDC)

What is a Healthy Homes Approach? • Coordination of programs and activities to more effectively identify, correct and prevent hazards in the home and improve public health outcomes. • Policy and Technical Assistance Level • Federal and State health and housing programs: policies, funding, assessment tools, coordination • Intervention Level • Local health and building departments, community health workers, asthma and early intervention experts, weatherization and energy efficiency services – inspections, remediation. • Education, Outreach, and Advocacy Level • Public health NGOs, community-based orgs., educational institutions, other.

Healthy Homes Needs and Resource Assessment Report – New England Eileen Gunn, Healthy Homes Project Director, Asthma Regional Council of New England

Objectives Objectives: • Identify perspectives on a coordinated approach • Current activities and innovations • Barriers and challenges • Keys to success • Needs from ARC

Methodology • 32 confidential interviews across six New England states • Program directors of single hazard programs at public health agencies, housing agencies, non-governmental organizations. • Semi-structured interview guide • Limitations of the Assessment

Perspectives on a Coordinated Healthy Homes Approach “Coordination is the most effective way of preventing asthma, lead poisoning and a range of environmental hazards” “Different agencies and departments bring varied perspectives and approaches to reaching diverse audiences about home hazards. Coordination could lead to a more strategic approach and better outcomes.”

Perspectives on a Coordinated Healthy Homes Approach “It is best for families when all of the hazards can be taken care of at one time.” “When different subject expertise is brought to the table there is greater understanding of the complexities of the issues and the need for coordination. “

Resource Barriers The majority of interviewees stated that funding and capacity are the most significant barriers to creating sustained, integrated healthy homes programs.

Resource Barriers • Categorical funding limits an integrated healthy homes approach. • Funding sources are unsustainable. • Reduced funds limit capacity. • Lack of time for activities that would support the development of a healthy homes program.

Technical Barriers • Few specialists can provide comprehensive home assessments: “As environmental problems have become more complex, professionals have become more specialized, leaving few generalists to provide a more holistic perspective. In general, inspectors are not trained to recognize and respond to all home hazard issues.”

Organizational/Cultural Barriers • Determining the structure of a healthy homes program is challenging. • Uniting partners under a common mission while maintaining program goals is challenging. • Ownership and buy-in are difficult to achieve.

Organizational/Cultural Barriers • “The general public does not understand the relationship between substandard housing and health.” • Coalitions are underutilized.

Legal Barriers • Privacy laws prevent coordination on cases. • Inspectors are required to take legal action. • Asthma interventions do not have legal backing. • Housing and sanitation codes need to be strengthened and enforced.

Coordinated Program Innovations • Integration of multiple home hazards • Advocacy and private enterprise innovation • Research innovation • Unique funding sources • New partnerships and audiences • Policy/legislative

Keys to successful coordinated Healthy Homes efforts • Leadership - Top Management Support • A commitment to the process of change • Strong working relationships with other departments and community-based organizations • Taking the time necessary to collaborate • Identifying efficiencies to coordination • Physical proximity of departments

Summary • The majority of the interviewees expressed strong interest in pursuing a more coordinated healthy homes program within their state agencies. • Many believed that a coordinated approach is absolutely critical at this time. • They thought there were many opportunities to increase efficiency and effectiveness of individual programs by integrating with other programs that address home hazards. • They want to create programs that are data driven, strategic, and responsive to community needs.

Ways ARC Can Assist • Provide examples of best practices in coordinated Healthy Homes programs • Provide opportunities to foster networking and regional collaboration among Healthy Homes programs • Develop standardized methods • Provide trainings and educational programs • Provide technical and other assistance • Identify and disseminate funding opportunities • Research and information collection

Lessons Learned in creating a Regional Approach • Develop relationships • Beyond Asthma contacts • Know perspective, needs, barriers • Needs Assessment • Develop opportunities for collaboration • Healthy Homes Working Group • Focus on Opportunities

Lessons Learned in creating a Regional Approach • Provide Technical Assistance • Strategic Planning and Facilitation Services • Training • Research and disseminate Best Practices and Innovations • Website • Webinars • Make the “Case for Healthy Homes” • Case for Insurer to pay for Asthma Interventions • Biz case for IPM

Healthy Homes Resources HUD’s Help Yourself to a Healthy Home http://www.hud.gov/offices/lead/healthyhomes HUD’s HH strategic plan: www.hud.gov/offices/lead Websites www.asthmaregionalcouncil.org National Center for Healthy Homes www.nchh.org

Healthy Homes Resources EPA’s Healthy Homes Brochure http://www.epa.gov/region1/healthyhomes/pdfs/healthyhomes.pdf Healthy Housing Reference Manual - http://www.cdc.gov/healthyplaces/healthyhomes.htm

Eileen Gunn, Healthy Homes Project Director, www.asthmaregionalcouncil.org egunn@hria.org

Lessons learned: Regional Approaches to Environmental Health Issues