Washblog

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For more information and references, see earlier Washblog story entitled Visionary asthma pilot program helps children breathe and learn

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I testified in support of this budget item before the Senate Ways and Means committee, citing my experience as a volunteer with the American Lung Association's Master Home Environmentalist Program.  So I was invited to the lunch by John Roberts, an engineer who retired from the Puget Sound Clean Air Agency to begin a new career as an advocate for protecting children from exposure to indoor toxics,    According to Roberts, there are 39,000 children in Washington, many of whom are low income, who have moderate to severe asthma.  He believes that the model this new pilot tests, would help many of these children.  'Why,' he asked at the lunch, 'should we let children with asthma suffer when we can save money by helping them?'

Aileen Gagney, Asthma & Environmental Health Program Manager, American Lung Association of Washington, and John Roberts.  At the Icon Grill on May 16, 2007.  This was Roberts' 83rd birthday.

New programs such as this one compete with many others and are difficult to find funding for.  But this one, as Representative Schual-Berke noted, had all the elements that make it "sellable" to fellow legislators. It ties in with educational as well as health goals.  It projects a potential $1.7 of cost avoidance for every dollar spent.  And previous experience in Washington provided a workable, tested model and data that showed a high likelihood of success.   Peer reviewed analysis of the Seattle King County Healthy Homes Project showed that children who participated experienced fewer school absences and emergency room visits and that health costs were reduced by over $2,000 per child over a year. (1)  

Jim Krieger of Seattle-King County Department of Health, who was Project Director for Healthy Homes, said that he is optimistic that this program will result in health improvements and cost savings.  Previous experience from Healthy Homes, as well as from programs in other cities that were modeled on Healthy Homes, provide a strong foundation for this optimism.

Schual-Berke, who is an M.D., made the program a priority in the House.  But because it got a late start, and because there were so many other competing programs, it didn't gain enough traction to succeed there.  However, her work set the stage for the Senate Ways and Means committee, where Senator Kohl-Welles next championed it. Kohl-Welles, who has a Ph.D. in sociology, also recognized the strong program model and data backing up the proposal. 'I recognize good study design when I see it,' she said. And it didn't hurt, she noted, that Senator Prentice, Chair of Senate Ways and Means, was a nurse and able to appreciate the significance of the research from that perspective. Toward the end of the lunch, Senator Kohl-Welles told the group that, when her children were very young, one of them woke in the middle of the night struggling for breath and needed to be rushed to the hospital for treatment. The experience was terrifying for her. Her child didn't develop asthma, but she developed a sensitivity to what parents of children who have asthma can feel.

Beyond Asthma Reduction: Other Benefits of Improving the Indoor Environment
Although this pilot progam will measure outcomes in terms of reduced asthma symptoms, it will offer other benefits for participating families that are not planned to be measured.  One of the goals of the program is to reduce childrens' exposure to household dust, which contains allergens and irritants known to cause asthma symptoms.   House dust also happens to be the main source of exposure to lead and PBDEs (flame retardants) as well as a major source of pesticides, toxic metals, and other endocrine disruptors that interfere with hormones in the body. The risks from house dust are high for children and the costs of monitoring and control are low.

Beginning January, 2008, Washington will see a gradual phase-out of PBDEs in consumer products, thanks to the work of Washingtonton's legislature, including Representative Ross Hunter.  Hunter prime sponsored and championed HR 1024, the historic PBDE phase-out bill last session, overcoming considerable opposition from the bromine industry to make a successful case for action. This was a major victory that has national implications.

The PBDE phase-out and the home visits program provide good illustrations of the critical need both to reduce pollution at the source -- and to reduce human exposure to pollutants once they enter the environment. Although Washington now has the strongest laws in the nation on PBDEs, there will be a legacy of this chemical in house dust for many years after consumers products are free from it. So a logical followup to the PBDE phase-out -- and the phase out of other chemicals -- would be more attention to reducing childrens' exposure to house dust.

Roberts noticed the potential synergy between the pollution reduction effect of the PBDE phase-out -- and the exposure reduction effect of home visit programs.  He contacted Representative Hunter for an appointment to discuss the potential of using the home visit approach to increase the impact of the PBDE phase-out.  I was lucky enough to be invited to that meeting and it was evident to me that Representative Hunter appreciated the potential and is likely to act on it if there is an opportunity.

Another bill that made it into law this session, SB 5830: Providing Home Visitation Services for Families, prime sponsored by my Senator Claudia Kauffman, may provide further opportunities for improving indoor environments and was discussed at the meeting with Representative Hunter and at the luncheon.

Pollution reduction measures such as Hunter's bill are critical.  From the standpoint of impacts on human health, it is equally important to reduce indoor personal exposure to pollutants.  Toxics don't cause disease unless someone is exposed to them; and most exposure happens indoors. Washington's public health community and legislators are ahead of the national curve on understanding and acting on these realities. Individuals, particularly those living in households with young children, can also be ahead of this curve. Check out the American Lung Association of Washington web page ((206) 441-5100) to request a free home health assessment -- available in several areas in Washington -- or to download a Do-it-Yourself HEAL^TM (Home Environmental Assessment List).

[Minor updates made 4/21/07 in response to feedback.]

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Notes

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1. Krieger, JW; Takaro, TK; Song, L; Weaver, M.  The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers. American Journal of Public Health. Washington: Apr 2005.Vol.95, Iss. 4;  pg. 652.

2. From HR 1024
   Polybrominated diphenyl ethers (PBDEs) have been used extensively as flame retardants in a large number of common household products for the past thirty years.  Studies on animals show that PBDEs can impact the developing brain, affecting behavior and learning after birth and into adulthood, making exposure to fetuses and children a particular concern.  Levels of PBDEs are increasing in people, and in the environment, particularly in North America.  Because people can be exposed to these chemicals through house dust and indoor air as well as through food, it is important to phase out their use in common household products, provided that effective flame retardants that are safer and technically feasible are available at a reasonable cost.

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