To improve the nation's overall health, we must improve the health of the nation's homes and ensure that safe, healthy, affordable, accessible, and environmentally friendly homes are available to everyone in the United States.
US Surgeon General's Call to Action, 20091
The relationship between housing conditions and health was recognized among public health practitioners in the United States and Europe in the early 1800s.2 Growing awareness of the connection between a specific housing condition and a specific health condition or injury resulted in the development of policies and practices to protect the health and safety of people in their homes. The initial focus was to control communicable diseases and to prevent injuries. For example, requiring housing to have proper sewage connections and regular waste removal controlled several infectious diseases, and adoption of electrical codes helped to reduce the number of deaths due to fires. Over time, studies have provided evidence that a home's physical features can also prevent poisoning and various chronic diseases. These features can support mental and emotional health and independence during a wide range of developmental stages. Such physical features include structural aspects and safety devices in the home (ie, how the home is designed, constructed, and maintained, its physical characteristics, and the presence or absence of safety devices), quality of indoor air, water quality, and chemicals used and stored in the home, as well as the house's immediate surroundings.
Although the evidence supporting the link between housing and health has been increasing, the evidence demonstrating effective interventions to protect health against specific hazards has lagged. In addition, where intervention studies have been reported, public health practitioners may be uncertain about which interventions are likely to be most effective in protecting health. This supplement presents findings from panels of subject matter experts who systematically reviewed evidence of the effectiveness of specific housing interventions in improving health or reducing exposure to hazards related to health. The panels reviewed housing interventions associated with exposure to biological3 and chemical agents,4 structural injury hazards,5 and neighborhood-level interventions.6 The findings from these reviews can be used by programs planning to adopt a healthy homes approach.
A healthy homes approach addresses more than 1 health issue during a home visit. Today, many programs conduct a home visit for a single health or safety concern, as in the instance of a newborn visit. However, focusing resources on a single disease or condition, rather than working to improve the overall housing environment, is inefficient because it fails to address residents' health and safety risks holistically. Addressing multiple issues for residents can improve the quality of life and protect health and safety for more people and ultimately reduce health care costs.
Across the United States, many programs with home visit components have expressed interest in implementing additional interventions. This supplement provides information that emerging healthy homes programs can use to inform a program's development. The information reported represents a wide range of perspectives. Diekman and Huitric7 describe a program that combined smoke alarm installation with the Meals on Wheels program. Kuholski et al8 propose combining health and safety interventions with energy retrofit work. Maring et al9 report on a qualitative study of a healthy homes program in Baltimore that transitioned from a childhood lead poisoning prevention program. Neltner10 describes the National Healthy Homes Training Center and Network, which offers training for staff in healthy homes programs. Brown et al11 describe federal efforts to support healthy homes expansion. Mason and Brown12 provide an overview of economic analyses and present cost estimates of selected individual home interventions to improve health.
A comprehensive, society-wide strategy is essential for successful improvement of health through housing improvements. In June 2009, the US Surgeon General issued a Call to Action to Promote Healthy Homes,1 urging a dynamic and coordinated effort to improve housing factors that affect health. The Call to Action outlined steps people can take to protect their health at home, as well as actions researchers, policy makers, and government can take to increase healthy and safe housing. It is hoped that this healthy homes supplement will inform the development of healthy homes programs. Expansion of these programs will increase the number of healthy and safe homes and lead to healthier communities and ultimately a healthier nation.
1. US Department of Health and Human Services. The Surgeon General's Call to Action to Promote Healthy Homes. Washington, DC: US Dept of Health and Human Services, Office of the Surgeon General; 2009.
2. Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002; 92:758–768.
3. Krieger J, Jacobs DE, Ashley PJ, Baeder A, et al. Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence. J Public Health Manag Pract. 2010; 16(5S):S11–S20.
4. Sandel M, Baeder A, Bradman A, Hughes J, et al. Housing interventions and control of health-related chemical agents: a review of the evidence. J Public Health Manag Pract. 2010; 16(5S):S24–S33.
5. DiGuiseppi C, Jacobs DE, Phelan KJ, Mickalide AD, Ormandy D. Housing interventions and control of injury-related structural deficiencies: a review of the evidence. J Public Health Manag Pract. 2010; 16(5S):S34–S43.
6. Lindberg RA, Shenassa ED, Acevedo-Garcia D, Popkin SJ, Villaveces A, Morley RL. Housing interventions at the neighborhood level and health: a review of the evidence. J Public Health Manag Pract. 2010; 16(5S):S44–S52.
7. Diekman S, Huitric M. The development of the residential fire H.E.L.P. Tool kit: a resource to protect homebound older adults. J Public Health Manag Pract. 2010; 16(5S):S61–S67.
8. Kuholski K, Tohn E, Morley R. Healthy energy-efficient housing: using a one-touch approach to maximize public health, energy, and housing programs and policies. J Public Health Manag Pract. 2010; 16(5S):S68–S74.
9. Maring EF, Singer BJ, Shenassa ED. Making the transition from lead poisoning prevention to healthy homes: a qualitative study. J Public Health Manag Pract. 2010; 16(5S):S53–S60.
10. Neltner T. National Healthy Homes Training Center and Network: building capacity for healthy homes. J Public Health Manag Pract. 2010; 16(5S):S75–S78.
11. Brown MJ, Ammon M, Grevatt P. Federal agency support for healthy homes. J Public Health Manag Pract. 2010; 16(5S):S90–S93.
12. Mason J, Brown MJ. Estimates of cost for housing-related interventions to prevent specific illnesses and deaths. J Public Health Manag Pract. 2010; 16(5S):S79–S89.