Healthy Housing: Moving the Needle from Intervention to Prevention

Plastic houses

By: Marcus Smith, MBA and Jacquelyn M. Rose, MPH

This is the third in a series of four blog posts that we plan to publish during Healthy Homes Month that explores how organizations can leverage housing innovations as a platform to help children to flourish, thrive, and succeed.

At Childhood Prosperity Lab (the Lab), we don’t think about innovation as a single idea or moment in time. Rather, we think about innovation as the evolution and growth of novel strategies on a continuum. Yes, many innovative strategies start off as an idea, but their potential impact is realized as the idea evolves and grows over time. We also recognize that one of the distinguishing features of innovative strategies that promote child health, development, and well-being is their focus on strengthening systems and the ability to leverage systems and policies to support sustainability and impact.

When exploring how Connecticut Children’s Healthy Homes Program (Healthy Homes) could best pivot its approach in response to COVID-19 and continue efforts to remove environmental drivers of poor health in homes, we couldn’t help but wonder how other communities leverage systems and policies to enhance access to safe, healthy, and affordable housing. How do healthy housing initiatives collaborate with different partners and stakeholders, including local and state governments? What resources are needed to support and sustain those collaborations? How are healthy homes initiatives framing and delivering their value proposition? To what extent are healthy housing initiatives leveraging systems and policies to integrate healthy housing into the fabric of the communities they serve? Perhaps most importantly, given the current global health pandemic, how are these strategies and partnerships benefiting children and families as they #StayHome to #StayHealthy?

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Healthy Housing Lessons Learned from Rochester, New York

Rochester, New York is well known for its progressive healthy housing policies. In December of 2005, the Rochester City Council amended its housing code to require lead inspections of rental proprieties built before 1978. The amendment was passed in response to data demonstrating children in Rochester had a high prevalence of elevated blood lead (EBL) levels and recognition of the lasting impacts of lead poisoning on children, even at low doses.

An article published in the journal Environmental Health Perspectives evaluates the law. The law includes notable provisions designed to target the riskiest properties. A tenant complaint provision allows residents to request a free inspection by the municipality. Families that receive housing assistance from the Temporary Assistance for Needy Families program get more lead inspections under the law. Finally, the city targeted high-risk areas first, which are those determined to be most likely to have an increased lead levels in their homes.

Under the lead law, properties receive a visual inspection for deteriorated paint. The city included the mandate for an inspection into the existing certificate of occupancy inspection system for all rental housing built before 1978. Properties in designated high-risk areas that pass the visual inspection must also pass a dust-wipe test based on federal standards. If properties fail the inspection, property owners must correct any identified lead hazard violations before a certificate of occupancy is issued.

The city had to invest in their infrastructure in order to implement the law. The city hired and trained four new lead inspectors responsible for performing dust wipe tests in high-risk units that passed the visual inspection checking for deteriorated paint. The city also had to invest in administrative needs and analysis of the dust wipe tests. This investment totals approximately $600,000 per year.

Evaluation efforts indicate the lead law contributes to continued declines in children’s blood levels by decreasing exposure to lead hazards in rental housing built before 1978. Within the first four years of the passage of the law, inspectors conducted 58,177 interior visual inspections, which accounts for nearly all of the pre-1978 rental units in the city. During that time frame, inspectors also administered 17,050 dust wipe tests to high-risk homes.

The results are impressive: 94% of homes inspected passed the visual inspection and 89% of homes receiving the dust wipe test also passed. Passing rates increased from years 1 and 2 to years 3 and 4. According to the study, these passing rates were both much higher than predicted based on prior local and national studies, which the authors note is perhaps the strongest indicator that lead safety in Rochester rental homes has improved since passage of the lead law. In addition, findings from a survey of landlords and focus groups confirm that landlords learned how to repair hazards effectively and completed repairs before inspections to comply with the law. The study found that the law has not created any new unintended hazards related to lead exposure, such as those that may occur from the improper removal of lead paint from homes.

Attainable and Sustainable Change

One point that does not come up in the Rochester case study is the role of broader community health measures. Rochester was able to implement and scale its mandate through effective, cross-sector collaboration between community-based organizations, local universities and medical centers, and public agencies. These public-private partnerships seek to remove silos and focus otherwise disparate initiatives. They are crucial to aligning stakeholders for optimum impact.

Healthy Homes and the Lab understand the value of cross-sector partnerships and stress the importance of building such partnerships to enhance the collective impact of our work. At a time when resources are increasingly constrained and we are all asked to “do more with less,” the Rochester case study highlights the impact innovation at a local level can have on children and families. It also demonstrates that real change is both attainable and sustainable.

Are you a changemaker working at the intersection of housing and children’s health? We want to hear from you! Email us at childhoodprosperitylab [at] connecticutchildrens.org and tell us how you are supporting childhood prosperity.

Read additional blogs in this series:
Part 1 – When #StayHome Does Not Equal #StayHealthy
Part 2 – Healthy Housing: Innovation Gone Wrong
Part 4 – Innovation and Housing as a Platform for Childhood Prosperity

Marcus Smith is the senior manager of Connecticut Children’s Healthy Homes Program, which is a program of Connecticut Children’s Office for Community Child Health.

Jacquelyn M. Rose, MPH, is the program manager for the Childhood Prosperity Lab, which is a program of Connecticut Children’s Office for Community Child Health.