NCHH: Green Building Testimony before the Environmental Public Works Committee United States Senate

Statement of Rebecca Morley, MSPP
Executive Director
National Center for Healthy Housing

Columbia, MD

Before the Environmental Public Works Committee
United States Senate

May 15, 2006

We applaud Senator Lautenberg for proposing legislation to create High Performance Green Buildings (S. 506).

While others will speak to you today about how Green Buildings promote energy efficiency, sustainability, durability, affordable housing and reduce overall impact on the environment, we would like to discuss the public health consequences of building in a healthy and safe manner. Incorporating specific principles into green building can be expected to improve health in ways that presently still remain too unrecognized. This inhibits our ability to make informed choices about investments in the homes we build, repair and rehabilitate.

The National Center for Healthy Housing in Columbia, Maryland sponsors cutting edge, policy relevant scientific research on identifying and eliminating hazards in homes across the country. We work to alert everyone to those hazards, especially low income families who are at greatest risk, to help them protect their children and themselves from housing-based health hazards. But we also work to find ways to actually improve both housing and health status, not only the elimination of hazards, which is why we find the Green Buildings effort so important. Our work in childhood lead poisoning prevention has been implemented in standards and programs established by all levels of government and others, including owners, insurers, lenders, federal and state laws and regulations, community organizations and the courts.

In the United States, we have dramatically reduced the number of lead poisoned children in our country from nearly a million in the early 1990's to 310,000 at the turn of the past decade.[1] While there is clearly more to do, much of this improvement has been due to important changes in the ways in which we build and maintain our housing stock, with the number of homes with lead paint declining from 64 million in 1990 to 38 million in 2000.[2]

But lead poisoning is only one example of housing conditions that contribute to adverse health effects. In some respects, linking housing and health is not fundamentally a new idea. Florence Nightingale said, "The connection between health and the dwelling of the population is one of the most important that exists."[3]

There has been a great deal of new interest in how housing quality affects public health.[4] For example, the World Health Organization is undertaking an important project to estimate the global burden of housing related disease and injury. While that project is not yet complete, it is clear that the burden is quite large. Here in this country, the U.S. Surgeon General conducted an important workshop on indoor environmental quality in January 2004 and the Centers for Disease Control and Prevention has recently reorganized so that "place," which includes housing and other buildings and transportation infrastructure, figure more prominently in their public health efforts.

Prevention of environmental disease among children has important social and economic benefits.[5] Because children spend as much as 80-90% of their time indoors, many of the health risks they face can be traced to homes, schools, and other indoor environments.[6] One study recently estimated that the total annual costs for environmentally attributable childhood diseases in the United States--lead poisoning, asthma, cancer, and developmental disabilities--is $54.9 billion.[7]

In the U.S., asthma rates have increased by 73.9% during 1980—1996, making it perhaps the most prevalent environmental childhood disease.[8] While the causes of asthma still remain controversial, more evidence is accumulating that factors in the home environment play an important role in sensitizing children to asthma and triggering attacks. Chronic exposure to allergens in the indoor environment from mold, pets, mice and rats, cockroaches, and dust mites is associated with asthma. For example, recent exhaustive reviews by the National Academy of Sciences found there was sufficient evidence to establish a causal link and/or association between a number of respiratory conditions including asthma (or asthma exacerbation) and the presence of dust mites, cockroaches, fungi and mold, pet dander, tobacco smoke and other substances[9] and dampness.[10] Green building practices, such as integrated pest management can help to eliminate pests in housing and result in a reduction in asthma morbidity.[11]

There is also evidence that housing interventions are indeed effective in reducing the onset and severity of asthma. A large randomized controlled trial in 7 U.S. cities enrolled 937 children with atopic asthma, aged 5-11 years old. The experimental group received remediation of allergens in the home and other housing-based interventions, together with individualized medical care. The results showed that the intervention group experienced significantly fewer symptom days for 2 years (p<0.001) and there were significant reductions in dust mite and cockroach allergens, also for 2 years (p<0.001).[12]

There is similar evidence for other health outcomes, which is described in more detail elsewhere.[13] Yet despite all this, the link between making health investments in houses, buildings and communities and its impact on our nation's increasing healthcare expenditures still remains too unrecognized and under appreciated. In far too many cases, we have introduced new building materials or techniques and when there were unintended health consequences, the costs were simply transferred to the medical sector. This is not only inefficient and costly, but, more importantly, causes unnecessary pain, suffering, disability and in some cases (such as carbon monoxide poisoning) death. Overcoming this lack of coordination between housing and health is one of the promising features of the Green Communities program.

In the past, well-meaning housing programs, including those targeted at reducing energy consumption and improving the environment, have made costly mistakes by failing to fully consider the health impacts of changes in building design.[14] At worst, these mistakes have jeopardized the health of occupants, but also they have missed opportunities to provide more holistic services to clients. For example, under the weatherization program (a program intended to create energy-efficient housing for low-income homeowners and renters) many building envelopes were sealed without providing for an alternative supply of fresh air. This led to poor indoor air quality and also created moisture and mold problems. Today, nearly all weatherization programs incorporate health and safety measures, such as testing combustion appliances, testing the tightness of the structure, and following lead safe work practices. Clearly, there are pitfalls of not taking a holistic approach. EPA recognized the tension between energy efficiency and health when it began the development of its Energy Star with Indoor Air Package initiative. EPA was concerned that its Energy Star program could lead to new problems for its clients if health and safety were not considered. Therefore, it has developed a complementary label to the Energy Star brand to encourage more builders to create healthy indoor environments.

How exactly can Green Building principles be expected to improve public health? The National Center for Healthy Housing worked with Enterprise Community Partners to develop key health-based specifications for its Green Communities initiative. In order for a housing development to meet the Green Communities criteria, builders and property managers comply with the following housing-based health improvements:

1. All paints, primers, sealants, and adhesives must meet low-volatile organic compound (VOC) levels. VOCs can cause cancer and eye, nose and throat irritation.

2. All composite wood must not have added urea formaldehyde, which is classified as a substance known to cause cancer by the International Agency for Research on Cancer.

3. All carpets must also meet VOC standards and cannot be installed in areas prone to moisture and mold. This can be expected to reduce asthma, allergies and other mold-induced illnesses.

4. Proper ventilation is required, which means adding exhaust fans for kitchens, bathrooms and other areas, not only reducing moisture and mold but also removing combustion products such as carbon monoxide, oxides of nitrogen and other harmful gases. Fresh air supply is also included, instead of the common practice of simply relying on building leakage to provide the needed air quality.

5. Radon testing and mitigation is required for EPA Zone 1 areas, and highly recommended for EPA Zone 2 areas. Radon is the second leading cause of lung cancer in the U.S.[15]

6. Eliminating other sources of moisture and potential mold is accomplished through use of tankless hot water heaters or drains or catch pans under hot water heaters. Cold water pipes are required to be insulated to prevent condensation and use of moisture resistant materials in wet areas also prevents leaks. Ensuring proper drainage from basements, foundation walls and for surface water will also contribute to a healthy living environment.

7. Carbon monoxide alarms will be installed in or near areas with combustion sources to help warn occupants of unintended buildup of this potentially fatal gas.

8. Using integrated pest management will not only reduce diseases carried by rats, mice, fleas and other vectors, it will also reduce exposures to pesticides, some of which are potent neurotoxicants.

Beyond the physical improvements in housing summarized above, Green Communities and your green buildings work will also make neighborhoods more walkable and diverse, promoting physical activity, reducing the epidemic of childhood obesity, and increasing social cohesion.[16]

It is clear that we can expect substantial health gains by building green. Instead of paying for medical care that could have been avoided, occupants in Green Communities will be able to keep more of their income and avoid the suffering and loss associated with poor health. As your important work proceeds, I urge you to incorporate a significant evaluation of health outcomes so that we can learn as much as possible in this new exciting area. Thank you.

Endnotes

[1]Blood Lead Levels- United States, 1999-2002, U.S. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report 54(20) 513-516, May 27, 2005, reported by D. Brody, M.J. Brown, R.L. Jones, D.E. Jacobs, D. Homa, P.J. Ashley, J.E. Mosby, J.G. Schwemberger and M.J. Doa

[2] D.E. Jacobs, R.L. Clickner, J.Y. Zhou, S.M. Viet, D.A. Marker, J.W. Rogers, D.C. Zeldin, P. Broene and W. Friedman, The Prevalence of Lead-Based Paint Hazards in U.S. Housing, Environ Health Perspect 110:A599-A606, Sept 13, 2002.

[3] Cited in Lowry S. (1991) Housing, British Medical Journal 303 (6806), 838-840.

[4] D.E. Jacobs, Housing and Health: Challenges and Opportunities, Keynote Address, Proceedings of the 2nd WHO International Housing and Health Symposium, WHO European Centre for Environment and Health (Bonn Office), Noise and Housing Unit, Bonn Germany, September 29 - October 1, 2004, Vilnius Lithuania, October 20, 2005, p. 35-50 .

[5]Patrick Breysse,Nick Farr, Warren Galke, Bruce Lanphear, Rebecca Morley, and Linda Bergofsky, The Relationship between Housing and Health: Children at Risk Environ Health Perspect 112:1583-1588 (2004). doi:10.1289/ehp.7157

[6]U.S. EPA. 2002. Child-Specific Exposure Factors Handbook (Interim Report). EPA-600-P-00-002B. Washington, DC:U.S. Environmental Protection Agency, Office of Research and Development, NationalCenter for Environmental Assessment.

[7] Landrigan PJ, Schecter CB, Lipton JM, Fahs MC, Schwartz J. 2002. Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environ Health Perspect 110:721-728.

[8]Mannino D.M. et al. (2002) Surveillance for Asthma—United States1980-1999, Morbidity and Mortality Weekly Report 51 (SS 01), Centers for Disease Control and Prevention, Atlanta, GA, 1-13.

[9]NAS (2000) Clearing the air—asthma and indoor air exposures, National Academy of Sciences/Institute of Medicine, National Academy Press, WashingtonDC.

[10] NAS (2004) Damp indoor spaces and health, Board on Health Promotion and Disease Prevention, Institute of Medicine, National Academy of Sciences/Institute of Medicine, National Academy Press, WashingtonDC.

[11] Sandel M. Can Integrated Pest Management Affect Asthma in Urban Children? BostonUniversity (submitted)

[12] Morgan et al. (2004) Results of a home-based environmental intervention among urban children with asthma, New England Journal of Medicine 351, 1068-80.

[13] Matte T and DE Jacobs, Housing and Health: Current Issues and Implications for Research and Programs, Journal of Urban Health: Bulletin of the New YorkAcademy of Medicine, 77(1):7-25, March 2000

[14] See "Ocular, nasal, dermal, and respiratory symptoms in relation to heating, ventilation, energy conservation, and reconstruction of older multi-family houses." EngvallK, Norrby C, Borback D.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pub med& dopt=Abstract&list_uids=12950582 and "House-dust mite allergen concentrations and mold spores in apartment bedrooms before and after installation of insulated windows and central heating systems." Hirsch T et. al.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db =pubmed &dopt= Abstract&list_uids=10696861

[15] U.S. Surgeon General Health Advisory on Radon, January 13, 2005. http://www.surgeongeneral.gov/pressreleases/sg01132005.html

[16] Frumkin H., Frank L., Jackson, R., Urban Sprawl and Public Health: Designing Planning and Building for Healthy Communities.

Comparing Green Building Guidelines and Healthy Homes Principles: A Preliminary Investigation

Regulations and Policy

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