Academic journal article Journal of Environmental Health

Health and Housing Outcomes from Green Renovation of Low-Income Housing in Washington, DC

Academic journal article Journal of Environmental Health

Health and Housing Outcomes from Green Renovation of Low-Income Housing in Washington, DC

Article excerpt


The connection between housing quality and health has received renewed attention in recent years because the environmental burden of disease associated with inad equate housing is large (Braubach, Jacobs, & Ormandy 2011; Surgeon General, 2009). Housing affects health directly and indirectly (World Health Organization, 2005), and disparities in housing quality and health outcomes are persistent, especially in low-income and minority communities (Jacobs, 2011). Physical, chemical, and biological exposures in the home that produce adverse health outcomes and those housing interventions that are known to be effective have been reviewed elsewhere (DiGuiseppi, Jacobs, Phelan, Mickalide, & Ormandy, 2010; Jacobs et al., 2010; Krieger et al., 2010; Sandel et al., 2010). Yet actual investment in housing improvements associated with health gains and environmental sustainability has been limited, in part due to lack of standardization and inadequately quantified health and housing outcomes. We conducted this study to quantify such outcomes.


Several new "labeling" systems for housing have appeared recently, including the Enterprise Green Communities criteria (Enterprise Community Partners, 2005), the U.S. Environmental Protection Agency's (U.S. EPA's) Energy Star Plus Indoor Air Program (U.S. EPA, 2011), and the U.S. Green Building Council's Leadership in Energy & Environmental Design (LEED) program (LEED, 2008). The systems treat health requirements differently: the Enterprise standards used in this renovation include required health-related specifications, while LEED only provides a certain number of optional points for health items. This project is also one of the first projects to comply with the new green building law in the District of Columbia (2006).

While such systems may improve health, evidence to support this claim is sparse in both new housing construction (Takaro, Krieger, Song, Sharify, & Beaudet, 2011) and housing rehabilitation (Breysse et al., 2011). Studies show significant improvements in asthma and other respiratory symptoms in new construction that meets energy efficiency and other green housing standards (Krieger, 2010; Leech, Raizene, & Gusdorf, 2004; Takaro et al., 2011), such as large improvements in number of trips to emergency rooms for asthma attacks, caregiver quality of life, and asthma trigger reductions using home-based asthma intervention. Leech and co-authors (2004) found important health gains in wheeze (10%), headache (23%), and fatigue (30%).

Only two studies have been conducted so far of rehabilitation of existing housing, where housing improvements and compliance with green healthy housing systems may be more constrained by existing housing conditions. A randomized controlled trial in New Zealand showed a 9% improvement in general self-reported health, 15% improvement in lost workdays, and an 11% improvement in school absences (Howden-Chapman et al., 2008). A smaller study in Minnesota showed statistically significant improvements in general health, chronic bronchitis, sinusitis, and asthma, all in adults following green renovation of low-income housing (Breysse et al., 2011). The Minnesota study showed large statistically significant improvements in excellent, very good, and good general health one year after renovation in adults.


Participants and Procedures

Of the 102 occupied housing units available, 44 units containing 57 adults and 64 children were enrolled at baseline, with 25 units containing 27 adults and 31 children completing the follow-up approximately one year after the rehabilitation was completed (retention rate = 57%). To be eligible for the follow-up, the same participants in each unit must have completed the baseline. Persons lost to follow-up either moved away from the study housing or could not be contacted at follow-up. Study participants were primarily African-American, very low-income U. …

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