Q: By way of background, how would you describe your current position as research director at the National Center for Healthy Housing (NCHH)?

A: We conduct research that informs policy and provide training related to the connection between housing and public health. The NCHH is a nonprofit education and research group started in 1991 as the National Center for Lead Safe Housing, which emphasized our primary focus on removing lead-based paint hazards from the U.S. housing stock. In 2001, we broadened our mission to include other housing-related health hazards, such as mold, asthma, radon injury, and others. We were also instrumental in changing the nation’s approach to childhood lead poisoning, which originally focused on completely removing all lead paint from homes. This approach proved to be impractical and also dangerous because it failed to recognize the main pathway of exposure to lead paint, which is lead in household dust. Scientists initially thought the pathway to elevated lead exposure was kids eating lead-based paint chips; now we know that for most children it’s the lead particles settled in dust on the floor, kids play on the floor, and ingest the lead off their hands. If you remove the lead paint without controlling dust, then you can make things even worse. In short, the new definition of a “lead-based paint hazard,” derived from the scientific research, is not simply “all lead-based paint,” but instead “deteriorated lead paint and the contaminated settled dust and soil it generates.”

Q: Did the concern with indoor environmental quality begin with the EPA and HUD’s lead paint mitigation initiatives? 

A: Yes and no. A little history lesson can help. Public health concerns are actually one of the main reasons our nation has any housing laws at all. About 100 years ago, a sanitation movement emerged in response to overcrowded and unsanitary factory housing complexes that had become breeding grounds for diseases like cholera and typhoid. The sanitation movement introduced laws to reduce crowding and require daylight, indoor plumbing, and especially ventilation. But then after 1920 and up until 1971, the public health and the housing people went their separate ways, one got into improving access to medical care (treating people only after they became sick); the other went into financing homes and improving housing durability. 
Lead-based paint got them back together again in the 1970s, when Congress passed the original lead-based paint poisoning prevention act. As usual, we were behind the rest of the world. In 1920, there already existed an international treaty, signed by most industrialized nations, which effectively ended the use of lead additives in paint, but we did not sign on until 1978, by which time millions of homes had been contaminated with lead-based paint. Then in the late 1970s, the federal government, through the Centers for Disease Control and Prevention (CDC), started to count the number of lead-poisoned children by measuring their blood lead levels. They found children in older homes, especially those children at the lower economic strata, and children who were African-American or Hispanic had significantly elevated levels of lead in their blood. 
By 1992, the nation became more focused on lead paint hazards in housing when Congress passed the Residential Lead Hazard Reduction Act. And since then, we’ve made a lot of progress. Lead levels in blood have come down dramatically—we used to poison nearly 2 million kids a year in the late 1980s, now it’s down to about 450,000, which, of course, is still far too many; there is still much more work to do. Sadly, Congress and the administration have recently decided to virtually eliminate the CDC lead poisoning prevention program, which will harm many children needlessly. In 1999, HUD launched its Healthy Homes Initiative and together with the CDC and EPA, Healthy Homes has advanced considerably. For example, the U.S. surgeon general recently issued a Call to Action to Promote Healthy Homes.

Q: What about other indoor environmental quality concerns, such as asthma? 

A: Asthma has doubled over the last 20 years. While no one knows exactly why, one main reason may be that houses are not as well-ventilated as they used to be. We have a lot more carpet on the floor, which traps allergens, and almost everyone has air conditioning, which means that windows remain closed all year. But asthma is more complex than lead, with both genetic and developmental elements. The medical establishment remains uncertain on what causes it. There is a stress component and an outdoor air component and other factors, and, of course, each child is different—in short, it’s a constellation of diseases, including bronchial allergies to dust mites, cockroach droppings, and allergens, other pest allergens, and mold. But if we focus on the airborne components alone, we will again, as with lead, miss some significant pathways to poisoning. This is why I prefer the term indoor environmental quality to the more limited IAQ (indoor air quality). We do know that tailored in-home asthma interventions do work remarkably well for asthmatic children.

Q: What about concern for products, such as off-gassing from formaldehyde containing particle boards and volatile organic compounds in paint?

A: You mean, “Why don’t we have a system in this country that allows us to test products before they are put into homes?” The Europeans do test building materials for off-gassing and other hazards. But the United States allows materials into the construction process, and if they do harm, only then do we react—after the damage has been done. This is, of course, terribly shortsighted. EPA’s Toxic Substance Control Act (TSCA) is now being considered for reauthorization by Congress. TSCA does not currently include testing building materials, but it could (and should). The Consumer Product Safety Commission does not test building materials either. It makes more sense and costs less to test for health and safety before introducing products into the market place. It’s especially costly to our medical system that deals with the aftermath and also the construction industry that often installs toxic materials unwittingly, such as Chinese drywall. Green is mostly a set of voluntary standards right now, but it is clearly a step in the right direction, because it is one way of limiting the entrance of toxic building materials into the construction and rehabilitation industry. We have been focusing on developing the scientific knowledge of how building “green” can improve health, which will enable us to develop a cost-benefit analysis not just for the energy conservation component, but also health. This is what we need now to drive to incorporate health standards throughout the construction industry. We have completed several such studies, and we have more under way.

Q: How much commitment or engagement with indoor environmental quality does the DOE’s Weatherization Assistance Program have? 

A: They have moved forward quite a bit, and we’ve been involved in working with them to include some housing health hazard mitigation requirements in the program. The main issue is that when you add insulation and seal a home tightly, you may increase moisture, mold, and other problems. But done properly, this need not happen at all. We have a study under way comparing two groups of housing where half of the houses will be weatherized under the new ASHRAE 62.2 standard, requiring mechanical ventilation; the other will be done under the ASHRAE 1989 standard, which only requires a certain level of leakage to allow for ventilation. A similar, albeit smaller, study we did in Minnesota showed that mechanical ventilation with a planned amount of fresh air, combined with building envelope sealing and other green features, provided statistically significant, in fact large, indoor environmental health improvements and large energy savings. In other words, there’s no energy penalty for ventilation and a health dividend if we are smart about it. Our findings, and those of others researching this field, show that green building does indeed improve health and energy efficiency.

Q: What’s next? 

A: We’ve made notable improvements in lead, but given the number of houses and hazards overall, we have yet to make sufficient progress. One way to do this is to persuade government and industry that indoor environmental improvements will have a huge beneficial impact on reducing medical costs. A recent study completed in Great Britain revealed a sevenfold reduction in medical costs directly related to improvements in housing standards. We should apply all we learned from lead mitigation to all housing hazards—mold, asthma, radon, and injury prevention. Homes are now the second leading place of death for children under 18, just behind automobile collisions. Right now, we’re looking into how much money the federal government could save in Medicaid expenses just by improving indoor environmental quality standards—and containing health care costs is a crucial issue now before the nation. Better indoor environmental quality standards should be an important part of that conversation.