Washblog

Good News:  Our homes are our most toxic environments

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Not only is our exposure to nearly all pollutants 5 to 50 times higher indoors - indoors is where we spend about 90% of our time.  (2) This is actually good news because most of us have a great deal of control over the safety of our home environments.  New and emerging policies take advantage of this fact to help protect children's life potential and health.

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If you don't drink that glass of poison, it won't hurt you.  That, roughly, is the idea behind reducing "exposure" - keeping bad stuff out of our bodies.  Historically, exposure reduction in laws addressing environmental toxics has been an underutilized approach.  We have tended to focus more on source control -- how much of a certain toxic is emitted from a smokestack, for example.  Source control laws, like the landmark HR 1024, Representative Ross Hunter's bill that phases-out toxic flame retardants (PBDEs), are urgent priorities.  They turn off the toxic "faucet" and protect human and environmental health.  But they're not enough, by themselves, to keep people safe from toxics.  Even after a chemical is taken out of consumer products, it can persist for years in soil, dust, and food.  And phasing out one chemical doesn't protect us from the others that remain unregulated. Ideally, once we know a chemical is harmful to human health, we would stop using it in ways that endanger people -- and we would also find ways to reduce as much as possible people's total exposure to all contaminants at home, daycare, school, and workplace.  

I sat in on a conversation a couple of months ago between Representative Hunter and John Roberts, an environmental engineer who founded the Master Home Environmentalist Program and previously worked for Puget Sound Clean Air Agency.  They were discussing the possibility of an exposure-side follow-up to the phase-out of flame retardants.  Now that the PBDE phase-out is in motion, are there ways to help families reduce the exposure of their children to the stuff that's already in their homes?  Hunter was a supporter of the Home Visits for Children with Asthma program described below.  This program helps reduce the exposure of children to house dust, among other asthma triggers. House dust happens to be children's main source of exposure to lead and PBDEs, as well as a major source of exposure to pesticides, toxic metals, and endocrine disruptors that interfere with hormones in the body.  (5) What is the potential of voluntary programs such as this one for reducing the total exposure of at-risk children to all indoor environmental toxics? I thought that Representative Hunter seemed very alert to the potential in exploring this approach.

Home Visits for Children with Asthma: We can count on parents to protect their children
Recent research shows that home visitation programs can help at-risk children stay healthy and do better in school. Well-planned programs in which families participate on a voluntary basis are demonstrated to help children more successfully navigate a wide range of challenges that affect health and educational success.  They also are shown to be cost-effective.

Last session, Washington's legislature responded to the opportunities suggested by this research -- some of it in Washington state -- with two policies.  One was inclusion in the state budget of funding for a pilot home visitation program for low-income children with asthma.  As reported on Washblog in February and May, the Healthy Homes Project in King County had previously demonstrated that this approach reduced asthma symptoms, hospital emergency room visits, school absences, and healthcare costs.  Jim Krieger, Chief of Epidemiology, Planning & Evaluation for Seattle King County Department of Health, directed Healthy Homes and will be directing the pilot program now funded by the state.  

In addition, the legislature passed SB 5830: Providing Home Visitation Services for Families, prime sponsored by Senator, Claudia Kauffman.  This new law increases funding for other home visitation programs and calls for a plan, under the direction of The Children's Trust of Washington, to coordinate and consolidate all home visitation programs now administered or funded by multiple state agencies. The Children's Trust is a state government agency that provides funding and technical support to community groups for the delivery of evidence-based programs that help at-risk children.  Its director, Joan Sharp, has primary responsibility for directing the plan for home visitation services in Washington.  

Program Effectiveness and Cost Savings Allow More Children to be Helped
There is obvious potential for synergies between the various home visitation programs.  Representative Schual-Berke, a medical doctor who was the main proponent of the asthma pilot project in the House (Senator Kohl-Welles championed it in the Senate, where it passed), recently convened an informal meeting to explore some of this potential. She met with Joan Sharp, Director of the Children's Trust, Jim Krieger, of Seattle-King County Department of Health, and John Roberts in a Normandy Park coffee shop.  I sat in on the meeting.  

In bringing together the primary administrators of both new home visitation programs, Representative Schual-Berke was also inviting consideration of connections that might, in the long run, increase program effectiveness, for example, identifying ways to cross-refer among the programs where appropriate. The first report of The Children's Trust to the legislature is due this December, and so now is the time to look at possible connections such as this.  

This kind of search for program efficiencies gets at an critical goal. One of the objectives of the Home Visits for Asthma pilot is to demonstrate that this approach works and saves money.  Previous experience with Healthy Homes in King County showed a cost-avoidance of approximately $1.7 for every dollar spent, primarily because of a reduction in emergency hospital visits. If this pilot demonstrates similar results, we are more likely to see many more low-income children in Washington state receive help from this program in the future. Roberts estimates that there are approximately 39,000 children in the state who have moderate to severe asthma, many of them low-income.  His eyes light up when he talks about the possibility of helping all these children.  "Why should we let children with asthma suffer when we can save money by helping them," he asks.  

Being able to show that an effective intervention can subsidize its own operations or even be wholly self-funding, may be a kind of golden-grail for public health programs.  In-home asthma interventions take us in this direction because asthma is not only widespread and expensive to treat, but its symptoms can be significantly reduced by environmental improvements that are relatively inexpensive to put into place.

Wouldn't it be nice if there were ways to make home and other environments safer -- before asthma and other health conditions developed?  The intensive work that legislators and public health professionals are doing to lessen the impact of indoor pollution on children with asthma may very well lead to approaches that can be used in the general population.  In the meantime, Washington's legislature has taken a big step forward in improving indoor environments with green building legislation passed in 2005.

Standards for Healthy and Sustainable Housing
In 2005, Washington passed the green buildings law, which required that all public facilities be built to a LEED Silver Standard.  LEED is the "nationally accepted benchmark for the design, construction, and operation of high performance green buildings" and covers "five key areas of human and environmental health: sustainable site development, water savings, energy efficiency, materials selection, and indoor environmental quality."

The LEED standard is sometimes used for building affordable housing.  Traugott Terrace in Belltown was the first affordable housing project in the nation to achieve the LEED designation.  But Washington's new law allowed a somewhat less stringent standard for affordable housing. The Department of Community, Trade & Economic Development (CTED) was assigned the task of choosing this standard and putting it into place by July, 2008.

The Evergreen Standard
To comply with Washington's new law, CTED brought together technical experts in the field of sustainable development to choose and adapt a standard for affordable housing in the state. Green Communities^TM, offered by Enterprise Community Partners, was chosen. This standard had been in use for awhile, having already guided the design and construction of approximately 8,500 units across the country. CTED's team adapted it for use in Washington and renamed the Evergreen Sustainable Development Standard.  An interesting twist is that Green Communities^TM was originally based on Seattle's own home-grown standard, called SeaGreen, which was developed by the Seattle Office of Housing, which brought together many sustainable building experts and affordable housing stakeholders for the task.

On June 14, I attended one of the first training for The Evergreen Standard, held by CTED for developers, architects, and others in the building trades and government agencies, including Joanne Quinn, sustainability specialist for Seattle Office of Housing -- one of the experts who had developed SeaGreen.  The session was also an opportunity to take input from attendees on how the standards could be further improved. The standards include a number of mandatory elements, requiring that a "Green Development Plan"  be used from the beginning of the design process.  A larger number of optional elements is also included.  From these, builders choose enough to earn a minimum number of "points" in order to qualify for state funding.

Resident, Community, and Environmental Health under the Evergreen Standards
Resident health is a priority under Evergreen Standards. Non-toxic building materials, such as paint and wood for kitchen cabinets that don't emit volatile fumes, are encouraged.  Building and ventilation standards keep dust and excess moisture lower. Bill Duncan, the presenter from Enterprise Community Partners, who traveled from out of state to give the presentation, focused in part of his talk on the significant help these building standards provide to children with asthma and their families. The 8,500 homes already built across the nation under these standards, he said, have helped over a thousand children with asthma and saved $429,000 in asthma-related medical costs.

The Standards also address climate and other environmental goals -- by encouraging, for example, the use of recycled building materials -- and the recycling of materials removed during renovation. Climate goals are also addressed by construction methods that optimize heating, cooling, and light.  Saving money on energy and transportation costs makes a huge difference in the lives of people living on the economic edge.  Energy and transportation costs can 'make-or-break' the budgets of these families and contribute toward homelessness.  A reduction in fossil fuel use - and household transportation costs -- is also addressed by encouraging building for density, and in areas in which services and employment opportunities are within walking and public transit reach.  

More densely-built neighborhoods where people experience fewer health impacts from indoor pollution and are better able to control household transportation, medical, and energy costs, certainly are ahead of the game.  

The city doesn't want me to go thirsty: The built and living environments and the "whole citizen"
While writing this article, I kept thinking of a phrase I encountered in Barack Obama's book, Dreams from my Father. Obama refers to our laws as an expression of "a nation arguing with its conscience." (6)  Our laws  reflect our development as a culture, our attempts to create a more fair and livable society -- and also the forces in  our culture that work in the opposite direction, and thus are a kind of argument in which we hope our better nature prevails.  Laws that affect the built environment seem to me just such a conversation.  In their particulars they are technical, even esoteric. And yet their impact is the most personal possible -- getting right down to what substances are in our blood and how the brains and bodies of our children develop.  

Not only does the indoor environment have a direct physical impact, but it also affects, I believe, the degree to which children feel on a deep level that they live in a caring and safe society, a society that takes care to address crises like climate change with all it's got,  a society that doesn't allow children to breathe in poison.

Daniel Kemmis, former Mayor of Missoula has written extensively on place.  In his book, The Good Life and The Good City, he proposes that whole societies create whole people:  "Only citizenship can save politics, and only relatively whole people are capable of reclaiming the human meaning of citizenship..." he writes.  (7) Might our ability to be good citizens be influenced by the indoor environments that begin shaping us even before we are born, while our mothers carry us? I think so.  

Kemmis quotes another author in describing an emotion that might be felt  "when you stoop to drink from a public fountain: 'The city doesn't want me to go thirsty.'"(8)  Those in Washington's public health community and legislature who are putting us on a better path are in acting to protect children from direct harm -- but also helping to inspire in countless ways the kind of sense of belonging and safety that helps make people and communities whole.

 

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Notes

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1. Linking Public Health, Housing, and Indoor Environmental Policy: Successes and Challenges at Local and Federal Agencies in the United States,  David E. Jacobs, Tom Kelly, and John Sobolewski.  115 (6), June 2007. Environmental Health Perpectives
   
2. SeaGreen: Greening Seattle's Affordable Housing, Seattle Housing Authority, November, 2002.  p. i.
3. Wayne R. Ott, "Exposure Analysis: A Receptor-Oriented Science". Chapter in: Exposure Analysis, Ott, Steninemann, Wallace.  CRC Press.  2007.  p. 15-16.

   The environments "inside buildings have greater direct impacts on people than outside.  In addition to spending large amounts of time indoors, demonstrate that people breathe air pollutant concentrations in indoor settings that generally are higher than those measured outdoors.  The results from many studies for a large number of pollutants."

4. Indoor Pollution: Status of Federal Research Activities.  United States General Accounting Office, August 1999. p. 26.

   Research supported by federal agencies and others in the 1980s  ... demonstrated that, for a broad range of hazardous chemical and biological pollutants, indoor exposures can greatly exceed exposures received outdoors.  This research also showed that, in addition to inhalation risks, many building materials; furnishings; and products routinely used in homes, offices, schools, and other buildings; as well as many commonplace activities carried out in these buildings could pose health risks trough such other routes of exposure as skin contact and ingestion.

   While indoor environmental pollution is a matter of concern for all who spend a large portion of their time indoors, it poses special risks for particularly susceptible groups, such as the very young, the infirm elderly, and those with chronic health problems..."

5. Ott WR. 2007. Exposure analysis: A receptor-oriented science. In: Exposure Analysis. (Ott WR, Steinemann AC, Wallace LA, eds.), CRC Press, Taylor and Francis Group, LLC, Boca Raton, FL. 3-32.
6. Dreams from my Father: A Story of Race and Inheritance.  Barack Obama. Three Rivers Press.  2004.  p. 437.

   The study of law can be disappointing at times, a matter of applying narrow rules and arcane procedure to an uncooperative reality; a sort of glorified accouting that serves to regulate the affairs of those who have power -- and that all too often seeks to explain, to those who do not, the ultimate wisdo and justness of their condition.  But that's not all the law is.  The law is also memory; the law also records a long-running conversation, a nation arguing with its conscience.

7. The Good City and the Good Life: Renewing the Sense of Community.  Daniel Kemmis, Mayor of Missoula, Montana.  Houghton Mifflin, 1995. page 14
8. Tony Hiss, Annals of Place (Baltimore), The New Yorker April 29, 1991. p. 64.  (Quoted in Kemmis, 1995, p. 16).