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Office of the Surgeon General (US). The Surgeon General's Call to Action to Promote Healthy Homes. Rockville (MD): Office of the Surgeon General (US); 2009.

Cover of The Surgeon General's Call to Action to Promote Healthy Homes

The Surgeon General's Call to Action to Promote Healthy Homes.

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4Homes and Health Research

The Importance of Research

Although in the last decade research has matured that demonstrates the link between specific home conditions and health, significant knowledge gaps remain. Addressing these gaps will require research linking home conditions with specific health outcomes. That effort must also account for personal, housing unit, neighborhood, and community-level factors as well as applied research that evaluates the effectiveness of home interventions in different communities. Unless the effectiveness of home improvements to protect health is carefully studied, the risk remains that families, property owners, and government agencies responsible for providing housing assistance will undertake expensive but ineffective interventions.

Because the poor are more likely to live in unhealthy homes, investigating the economic tension between making homes healthier and keeping it affordable is one critical area of study. If the simultaneous importance of individual- and social-level determinants of health is recognized, it follows that housing is a likely mediator between socioeconomic status and health. Recent evidence (Dunn et al. 2004; Jargowsky 1997; Shenassa et al. 2004) suggests that housing may in fact be a fulcrum between individual- and social-level determinants of health.

Research Methods

Improvements are needed in the scientific methods available for formative research in this area. Unique challenges remain, however, in conducting intervention and prevention research in homes, and these issues would need to be addressed (Bingenheimer and Raudenbush 2004; Institute of Medicine 2005).

Consensus is needed to standardize home hazard identification systems. One recent review showed wide variation in existing home inspection protocols ( Jacobs 2006). A better formal determination of what constitutes a “healthy” house and standardized assessment methodology would contribute to a more consistent evaluation. In that regard, the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Housing and Urban Development (HUD) recently released environmental healthy home inspection recommendations that begin to address that need (Centers for Disease Control and Prevention and U.S. Department of Housing and Urban Development 2008).

Intervention studies in this area raise multiple and difficult issues in study design and analysis. Randomized studies can be difficult or impossible to conduct, multiple influences at the individual and group levels affect outcomes, and multiple risk and protective factors simultaneously influence multiple outcomes. Statistical methods that can address these issues need to be designed and disseminated.

Costs and Benefits

Progress made in achieving safe and affordable homes will depend, perhaps in large part, on our ability to demonstrate that healthy homes are feasible, affordable, and beneficial (Proscio 2004). In some cases, studies that assess the costs and benefits of interventions to improve homes show a net economic benefit to society. For example, preventing lead exposure among children has been estimated to improve their intelligence and behavior, resulting in increased earning potential and lower health care costs, which in turn result in economic benefits ranging from $110 to $319 billion dollars annually (Brown 2002; Grosse et al. 2002). Other interventions have been demonstrated to improve health outcomes at an acceptable cost. For example, home-based environmental interventions for asthma can reduce the number of unscheduled medical visits, symptom days, and beta-agonist inhalers at the cost of less than $28 per symptom-free day (Kattan et al. 2005). Similar economic benefits could result from injury prevention. National adoption of childproof cigarette lighters has reduced smoking-related injuries and also produced net cost savings to society. Many home interventions are needed that simultaneously result in multiple health benefits and in economic evaluations that consider benefits holistically. For many interventions, however, good quality economic information is not yet available to guide policy. For example, although the lifetime costs of serious falls experienced in 2000 is estimated at over $80 billion, data on the benefits of housing interventions to reduce or eliminate falls are not available (Corso et al. 2006).

Additional Topical Research

For many areas discussed in this document, additional research is needed that will better quantify the relationship between homes and health. For other areas, more research is needed to identify the most effective, feasible, and cost-effective interventions. Finally, when effective interventions are known, additional research on how to translate them to widespread use may be needed. This section provides selected examples.

  • Clarify the health impact of the home environment:
    • Quantify the benefits of various green practices on health and the environment. This research should also assess whether there are tradeoffs between environmentally friendly practices and health.
    • Define effects of noise in households on physical health, mental health, and well-being.
  • Clarify relationships of home characteristics and mental health:
    • Define effects of exposures to natural light, mold, crowding, and multifamily homes on mental health outcomes.
  • Assess and reduce risk from household chemicals:
    • Determine safe levels and frequency of use of household chemicals, such as pesticides, particularly to sensitive populations, such as children, pregnant women, and seniors.
  • Better evaluate the effectiveness and cost effectiveness of home interventions on health outcomes including asthma, mental health, well-being, and consequences of noise.
  • Assess the effectiveness of interventions to prevent or reduce the duration of homelessness:
    • Perform additional research on ways to more rapidly translate effective interventions in homes into policy and practice.
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