Making homes healthier requires trained health care and housing professionals who can identify housing problems and their connection to resident health and then undertake steps to resolve these problems.1 While some professionals may have had a good understanding of specific problems such as radon, lead-based paint, mold, and carbon monoxide, their hazard-by-hazard approach limited their ability to get at root causes and often left them with inefficient or counterproductive fixes.
With this in mind, the US Department of Housing and Urban Development (HUD) launched the healthy homes movement when it proposed a Healthy Homes Initiative in its fiscal year 1999 budget and was funded by Congress.2 As part of this initiative, the HUD established an interagency agreement with the Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services, to develop and pilot a “National Healthy Homes Training Center and Network” (Training Center). Both the HUD and the CDC agreed that the major goals of the training would be to educate public health care and housing professionals on the identification and treatment of housing-related health hazards and the creation of a forum for practical guidance on healthy housing strategies among various stakeholders.3
Through a competitive process, in 2003, the CDC entered into a cooperative agreement with the National Center for Healthy Housing (NCHH) to host and manage the Training Center. The US Environmental Protection Agency provided support in 2005 as well. The Training Center's goals were to
* increase awareness of healthy housing principles;
* increase competency of target audiences in performing healthy housing activities;
* develop a mechanism for the introduction of new research and intervention best practices into the training of the Training Center target audiences; and
* identify and optimize opportunities for networking, collaborations, and partnerships among the key target audiences of the Training Center.4
In 2005, the CDC and the NCHH developed 7 principles that take a holistic approach to healthy homes and shift focus from the problems to solutions. The 7 principles of healthy housing are as follows: Keep It Dry, Clean, Pest-Free, Ventilated, Contaminant-Free, and Maintained.5 On the basis of these principles, the NCHH developed and began offering its flagship course, the 2-day Essentials for Healthy Homes Practitioner course, through 5 regional training partners. It also launched a Web site to support the training and provide useful information resources.
In the 5 years since its launch, the Training Center has flourished. It has trained more than 6500 people, delivering more than 220 one- or two-day trainings in 40 states. About two-thirds of these were health professionals, with the balance being housing professionals. It offers 8 courses, including 1 online course, with several more on the way. As of 2010, it has 25 state or regional training partners covering 40 states. It maintains an extensive Web site of resources at www.healthyhomestraining.org.
In 2010, the Training Center uses the following resources to achieve its goals:
* Network: The NCHH cultivated a network of 25 state and regional training partners to deliver the healthy homes courses and promote healthy homes in the communities they serve. The training partners are generally based in universities either through schools of public health or cooperative extension services. Recently, partners have been state and local health departments, with 1 nonprofit extension service. Often a health department and university work together to deliver the training (Figure).
* Information: The NCHH maintains a Web site at www.healthyhomestraining.org of essential information on healthy homes including state and local laws, analysis of federal and local American Housing Survey, lead-safe work practices, and integrated pest management. It also maintains a searchable clearinghouse of more than 600 references.
* Recognition: In partnership with the NCHH, the National Environmental Health Association offers the Healthy Homes Specialist Credential to recognize health care and housing professionals who demonstrated knowledge and abilities in the area of healthy homes. The National Environmental Health Association has credentialed more than 380 individuals since launching the program in 2007. See www.neha.org/credential/HHS.
* Training: The NCHH curriculum consists of 8 courses, with 2 more under development to respond to the growing demand and interest for healthy homes training.
The following are the 10 courses that the Training Center routinely offers through the network:
1. Essentials for Healthy Homes Practitioners: Two-day flagship training course ideal for health and housing professionals who want the basics of healthy housing in an interactive format that allows students to learn from their peers in small group exercises. Typically, the host offers the Healthy Homes Specialist Credential examination at the end of the course. Course materials are also available in Spanish. It is the most popular of the courses, providing a thorough review of healthy homes issues and challenges.
2. Launching a Healthy Homes Initiative: One-day course is targeted toward health care and housing leaders seeking to establish healthy homes programs and activities in their communities. In essence, it is a facilitated discussion of a community's needs, priorities, and objectives, with an action plan as the final work product.
3. Building Healthy Homes: Two-day course offered in partnership with the NeighborWorks Training Institute for architects, housing developers, and property managers to learn in a small group discussion format how to build healthier homes.
4. Online Pediatric Environmental Home Assessment for Nurses: Two-hour online training course prepares public health and visiting nurses to conduct a comprehensive healthy home assessment with their clients and to prepare a corresponding nursing care plan geared for their clients. Nurses have found the videos of actual interviews and the interactive nature of the assessment to be very useful.
5. Integrated Pest Management in Multifamily Housing: One-day course brings together property managers, staff, residents, and the pest management professional to have them jointly understand how to effectively control cockroaches, rodents, bed bugs, and other pests in a hands-on format. It is designed to be delivered at a property development for people associated with the development who want to implement an integrated pest management program.
6. Healthy Homes for Community Health Workers: One-day course to enable community health workers to effectively educate their clients in a peer-to-peer or small group setting on healthy homes issues. Community health workers provide essential education to communities in need and have benefited from understanding the connection between health and housing.
7. Code Inspection for Healthy Homes: Five-hour course for housing and building code inspectors so they can better understand the connection between health and housing and can conduct inspections and undertake enforcement action by using their existing codes to more effectively protect resident health. Many code inspectors are uncomfortable in addressing health-related hazards because they are unfamiliar with the science. The course helps them prioritize and communicate health-related hazards for the communities they serve.
8. Certified Lead Renovator and Related Courses: Several courses including Certified Lead Renovator and Dust Sampling Technician Courses allow individuals to work on renovation projects covered by Environmental Protection Agency's Renovation, Repair, and Painting Rule. Complementary online courses for do-it-yourselfers and paint retailers.
9. Health Opportunities in Energy Audits and Upgrades: One-day course being piloted for weatherization and energy auditors and contractors to ensure their work does not undermine resident health and to identify opportunities and set priorities that can improve resident health. It is important especially with the recent growth of energy efficiency and weatherization programs.
10. Healthy Homes Specialist Review: One-day course being piloted for housing professionals who have a similar knowledge of healthy homes issues and need training to better prepare themselves to take the Healthy Homes Specialist Credential examination. The NCHH tailors the review course to meet the needs of the specific audience so that they get the information they need in a concise manner.
The Training Center has become a central part of the federal government's healthy homes initiatives. In 2009, the Surgeon General reaffirmed the critical role of training and education in his Call to Action to Promote Healthy Homes.6 The Surgeon General said:
Improving healthy homes requires the talents and skills of traditional and nontraditional health and housing partners. Each member of a multidisciplinary healthy homes workforce must understand basic housing-related health issues. This knowledge base will arm team members with a common, science-based framework for identifying, developing, and implementing healthy housing practices.6
In 2009, HUD's Healthy Homes Strategic Plan stated:
The National Healthy Homes Training Center, funded through the OHHLHC via an interagency agreement with CDC, will continue to train the variety of housing and health personnel who visit homes to provide services or perform other work (such as inspectors, public health nurses, energy auditors, and social service providers) to promote healthier housing.7
Through this training, students will be prepared to implement the healthy homes interventions that have been demonstrated to be effective. The need and demand for this type of training are expected to increase as more programs across the United States adopt a more comprehensive, healthy homes approach.
1. US Department of Health and Human Services. The Surgeon General's Call to Action to Promote Healthy Homes. US Washington, DC: Department of Health and Human Services, Office of the Surgeon General; 2009. http://www.surgeongeneral.gov/topics/healthyhomes
. Accessed February 8, 2010.
2. US Department of Housing and Urban Development. The Healthy Homes Initiative: A Preliminary Plan (Full Report). Washington, DC: US Department of Housing and Urban Development, Office of Lead Hazard Control; 1999. http://www.nhl.gov/offices/lead/library/hhi/HHIFull.pdf
. Accessed February 8, 2010.
3. US Department of Housing and Urban Development. Controlling and Preventing Household Mold and Moisture Problems: Lessons Learned and Strategies for Disseminating Best Practices, A Report to Congress. Washington, DC: US Department of Housing and Urban Development; 2005. http://www.hud.gov/offices/lead/library/hhts/report040105.pdf
. Accessed February 8, 2010.
5. National Center for Healthy Housing. National Healthy Homes Training Center and Network: What Is a Healthy Home? Columbia, MD: National Center for Healthy Housing; 2010. http://www.healthyhomestraining.org/what_HH.htm
. Accessed February 15, 2010.
6. US Department of Health and Human Services. The Surgeon General's Call to Action to Promote Healthy Homes. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2009. http://www.surgeongeneral.gov/topics/healthyhomes
. Accessed February 8, 2010.
education; environmental health; housing; maintenance; pest control; public health nursing; safety; ventilation