Responding to New CDC Lead Guidelines: Strategies for Public Health, Housing and 

Environmental Health Professionals and AgenciesDavid E. Jacobs, PhD, CIH

National Center for Healthy HousingAmerican Public Health Association Conference,

Oct 31, 2012

Energy Efficiency, Housing and Health

David E. Jacobs, PhD, CIH, Director of Research, National Center for Healthy Housing

Reuven Walder, Vice-President, Breathe Easy Home / ecobeco

BEEAC PresentationOctober 15, 2015

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• David Jacobs is the Research Director at the National Center for Healthy Housing (www.nhcc.org), and is a faculty member at both the University of Illinois – Chicago, and the Johns Hopkins Bloomberg School of Public Policy. David is the former Director of the Office of Healthy Homes and Lead Hazard Control at the US Department of Housing and Urban Development. David is a certified Industrial Hygienist, and is a member of the American Society of Heating Refrigeration & Air Conditioning Engineers (ASHRAE) 62.2 Residential Ventilation Standards Committee. David has written extensively on Healthy Homes.

• Reuven Walder is Co‐Founder of Breathe Easy Home (a division of ecobeco), a Rockville‐based provider of healthy home improvements for existing homes. Reuven is a certified Building Analyst by the Building Performance Institute, and a certified Healthy Home Specialist by the National Environmental Health Association. Reuven oversees Home Energy Audits and Healthy Home Assessments for the company.

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What are Energy-Efficient Homes?1) ENERGY STAR appliances2) High Efficiency HVAC3) Well sealed and insulated building

envelopes4) Insulated ducts5) Smart thermostats (with demand

control)The Climate Change/Environmental agenda for existing housing focuses on Energy Efficiency!

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What are Healthy Homes?1) 2009 Surgeon General Call to Action defines

it as: “A healthy home is sited, built, renovated, and maintained in ways that support the health of residents.”

2) “KEEP IT” - A healthy home is kept dry, clean, ventilated, pest-free, safe, contaminant-free, and maintained.

3) Homes need to be healthy for sensitive populations too. Children and older adults have more respiratory issues.

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Allergen & Pollution Control1) Mold, dust mites, insect fras, pet and rodent dander,

pollen, ragweed, etc. are common allergens. VOCs, particulates, formaldehyde, radon, acrolein, etc. are common pollutants.

2) Illness depends on length of exposure and concentration of exposure.

3) Eliminating or reducing exposure reduces illness.4) Plan ahead – build structures that contain materials less

susceptible to emitting or hosting allergens and pollution, and systems that control for allergens and pollution.

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The features of a Healthy Home

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Ventilation “Trade-off”1) Tight houses are better at keeping conditioned air in the

house, and unconditioned air out. a) Tighter means slower air exchange. This helps

reduce heating load required for any given time period, which saves energy and improves comfort.

b) Tighter means fewer outdoor pollutants enter the house in any given time period, a health benefit.

2) However, if not ventilated, tight houses could increase allergens concentration, pollutants and contaminants that cause:a) Short term: Asthma, allergy, COPD exacerbationb) Long term: Lung disease, heart disease, stroke

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Ventilation Standards1) ASHRAE 62.2 is a ventilation standard in the United

States that provides the minimum air exchange rate for a home based on its size and occupants.

2) The standard has changed over time. The standard’s goal is to reduce/dilute pollutants for most people. The standard is NOT geared to sensitive populations.

3) Due to new research into fine particles, 62.2-2013 is about 75% “looser” than 62.2-2010. The 2016 standard will likely give reductions for high performance filters.

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How to Meet Ventilation Standards1) Weatherization programs typically seal up the house,

then put bathroom fans on timers to exhaust air for required minutes per hour, although some still rely on passive ventilation.

2) Exhausting conditioned air provides big incentive for consumers to disable these controls.

3) A better solution is an Energy Recovery Ventilator, which costs more up front, but will provide a balanced flow of fresh air and exhaust air to meet ventilation requirements with substantially less energy penalty.a) Technology has been around for decades and is

used in Europe and Canada. Has not caught on here due to low energy prices.

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ERVs recover 70%+ of the Energy

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Healthy and Energy Efficient HomesOther important features:1) Use high-quality air filtration media (MERV13+) in

central air handler. No more thin cheap filters!2) Maintain 30-60% relative humidity year round through

dehumidification and humidification. Allergen-creating insects, animals and molds love high humidity. Viruses love low humidity. Homes are for humans!

3) Seal and redesign ducts so that they effectively supply and return air throughout the entire house in similar amounts.

4) Continuous, low velocity air circulation from the ERV dilutes pollutants and allergens that make people sick, and enables the return air system to carry pollutants effectively back to the filter.

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Other Emerging Issues1) Lawrence Berkeley

National Laboratory & others are doing extensive research on health-based ventilation standards.1) Fine particles, PM2.5,

has particularly harmful long-term effects.

2) Range hood standards. Both gas and electric cooking produce significant pollution including airborne grease and acroleinthat have long term detrimental impacts.

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Studies on Healthy Housing1) Green Communities Minnesota2) MIGHHTY Study3) Breathe Easy Home, Seattle/King County, WA4) Federal WAP Evaluation (Oak Ridge National

Lab)5) Health-V 6) Watts-to-Well Being7) DC Green8) CDC/NCHH Review of the Evidence

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Common Themes1) Using modern green healthy housing principles

in low-income housing produces substantial self reported health and housing quality benefits

2) Multi-faceted interventions that focus on housing improvements, education, coordinated care and hygiene substantially reduce the impact of asthma in low-income households. For every $1 spent, we get $5 to $14 in benefits, according to CDC.

3) The non-energy benefits of weatherization in low-income households greatly exceeds the energy savings.

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Common Themes1) 80% of homes have detectible levels of dust

mite allergen, 46% had enough to sensitize, and 24% had levels associated with asthma morbidity (exacerbating asthma).

2) Integrated Pest Management reduces pesticides by making the home inhospitable to animals/insects. IPM lowers asthma impacts.

3) People with respiratory illness do better when you remove the illness triggers from their homes.

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Issues/Opportunities for MWCOG1) EDUCATION: Current new construction codes set an air

exchange maximum that is very energy efficient, and could be detrimental to health in sensitive populations. These homes may have mechanical ventilation, but may need to be reconfigured to provide more fresh air.

2) EDUCATION: There are no building codes or standards for ventilation in the residential retrofit market or in the maintenance (rental) markets. Home owners are completely uneducated about ventilation and its impacts on health.

3) EDUCATION: For most people in older houses, tightening will produce a health and energy benefit. But for some people, including sensitive populations, over-tightening is a real risk that is not being disclosed to home owners.

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Issues/Opportunities for MWCOG4) EDUCATION: Make it easier for doctors to refer people to

trusted resources for home evaluations when doctors suspect environmental causes for respiratory illness.

5) PROGRAMS: Weatherization Programs could incorporate healthy home technologies such as ERVs, filtration, dehumidifiers and improved ventilation. There are multi-family whole building equivalents. It is difficult to treat individual apartments.

6) PROGRAMS: Low-income citizens with respiratory illness could receive home evaluations from certified assessors, and could receive interventions that include structural enhancements to their homes including weatherization, ERVs, filtration, dehumidifiers and continuous ventilation.

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Issues/Opportunities for MWCOG7) PROGRAMS: Make it easier for people whose homes

are too tight to get relief. Identify people whose home is making them sick, and provide a pathway to resolve it.

8) REGULATIONS: Obtain IRS guidance that Healthy Home upgrades are deductible medical expenses. Allow home owners to make these upgrades using FSA or HSA Account funds, and to make schedule A deductions.

9) SPONSOR A STUDY WITH NCHH: While low-income (Medicaid) populations have been studied previously as part of federal programs, no controlled scientific study has been conducted to quantify the health benefits for low to moderate income families on private health insurance.

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References• David E. Jacobs, Jill Breysse, Sherry L. Dixon, Susan Aceti, Carol Kawecki, Mark James, Jay 

Wilson. Health and Housing Outcomes from Green Renovation of Low‐Income Housing in Washington DC. J Environ Protection (Accepted May 2013)

• Moving Into Green Healthy Housing:  The Yield in Health (The MIGHHTY Study. David E. Jacobs, Emily Ahonen, Sherry L. Dixon, Samuel Dorevitch, Jill Breysse, Janet Smith,AnneEvens, Doborah Dobrez, Geraldine Walton, Marjie Isaacson, Colin Murphy, Lorraine Conroy, Peter Levavi. US Department of Housing and Urban Development 2013

• Jill V. Breysse, Sherry Dixon, Joel Gregory, Miriam Philby, David E. Jacobs, James Krieger, The Highline Communities Healthy Homes (HCHH) Project: Home Education and Weatherization Improve Asthma. American Journal of Public Health (Accepted April 2013)

• Jonathan Wilson, Sherry L. Dixon, David E. Jacobs, Jill Breysse, Judith Akoto, Ellen Tohn, Margorie Isaacson, Anne Evens, Yianice Hernandez. Watts‐to‐Wellbeing: Does residential energy conservation improve health? J Energy Efficiency (On‐line May 14, 2013, doi: 10.1007/s12053‐013‐9216‐8).

• Breysse J, Jacobs DE Weber W, Dixon S, Kawecki C, Aceti S, Lopez J. Health Outcomes and Green Renovation of Affordable Housing. Public Health Reports 126:2011 supplement 64‐75.

Contact Information

David Jacobs, PhD, CIHResearch DirectorNational Center for Healthy HousingWashington DC

djacobs @nchh.orgwww.nchh.org

Reuven WalderVice PresidentBreathe Easy Home / ecobecoRockville, MD

reuven@breatheeasyhome.comwww.breatheeasyhome.com(240) 396‐2141 x705