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Our Buildings Ourselves: Connecting Human, Community, and Ecological Health Published on Washblog on 7//07 A June, 2007 article in Environmental Health Perspectives reports on a new trend in state and local policymaking. (1) Decisions on the built environment - the structures we live and work in -- are increasingly recognized to have key policy implications for human, ecological and community health. To effectively address challenges as difficult and diverse as the asthma epidemic, sprawl, and climate change, we need to continue to innovate and improve how we design, construct, and interact with buildings. Washington state policymakers and advocates are "getting" these connections - and we are seeing significant changes in how we do business.
The Global Environment, Your Living room, Your Bloodstream Here's a how-to from National Resources Defense Council on protecting your health from indoor toxics and other contaminants that are known to contribute to asthma and to be especially dangerous for babies and young children. In case you want to go deeper into the topic or to ask a volunteer from the American Lung Association of Washington to do an environmental assessment on your home, here's a link to the Master Home Environmentalist program. Good News: Our homes are our most toxic environments Not only is our exposure to nearly all pollutants 5 to 50 times higher indoors - indoors is where we spend about 90% of our time. (2) This is actually good news because most of us have a great deal of control over the safety of our home environments. New and emerging policies take advantage of this fact to help protect children's life potential and health. If you don't drink that glass of poison, it won't hurt you. That, roughly, is the idea behind reducing "exposure" - keeping bad stuff out of our bodies. Historically, exposure reduction in laws addressing environmental toxics has been an underutilized approach. We have tended to focus more on source control -- how much of a certain toxic is emitted from a smokestack, for example. Source control laws, like the landmark HR 1024, Representative Ross Hunter's bill that phases-out toxic flame retardants (PBDEs), are urgent priorities. They turn off the toxic "faucet" and protect human and environmental health. But they're not enough, by themselves, to keep people safe from toxics. Even after a chemical is taken out of consumer products, it can persist for years in soil, dust, and food. And phasing out one chemical doesn't protect us from the others that remain unregulated. Ideally, once we know a chemical is harmful to human health, we would stop using it in ways that endanger people -- and we would also find ways to reduce as much as possible people's total exposure to all contaminants at home, daycare, school, and workplace.
I sat in on a conversation a couple of months ago between Representative Hunter and John Roberts, an environmental engineer who founded the Master Home Environmentalist Program and previously worked for Puget Sound Clean Air Agency. They were discussing the possibility of an exposure-side follow-up to the phase-out of flame retardants. Now that the PBDE phase-out is in motion, are there ways to help families reduce the exposure of their children to the stuff that's already in their homes? Hunter was a supporter of the Home Visits for Children with Asthma program described below. This program helps reduce the exposure of children to house dust, among other asthma triggers. House dust happens to be children's main source of exposure to lead and PBDEs, as well as a major source of exposure to pesticides, toxic metals, and endocrine disruptors that interfere with hormones in the body. (5) What is the potential of voluntary programs such as this one for reducing the total exposure of at-risk children to all indoor environmental toxics? I thought that Representative Hunter seemed very alert and interested at the potential in exploring this approach.
Home Visits for Children with Asthma: We can count on parents to protect their children
Last session, Washington's legislature responded to the opportunities suggested by this research -- some of it in Washington state -- with two policies. One was inclusion in the state budget of funding for a pilot home visitation program for low-income children with asthma. As reported on Washblog in February and May, the Healthy Homes Project in King County had previously demonstrated that this approach reduced asthma symptoms, hospital emergency room visits, school absences, and healthcare costs. Jim Krieger, Chief of Epidemiology, Planning & Evaluation for Seattle King County Department of Health, directed Healthy Homes and will be directing the pilot program now funded by the state.
In addition, the legislature passed SB 5830: Providing Home Visitation Services for Families, prime sponsored by Senator, Claudia Kauffman. This new law increases funding for other home visitation programs and calls for a plan, under the direction of The Children's Trust of Washington, to coordinate and consolidate all home visitation programs now administered or funded by multiple state agencies. The Children's Trust is a state government agency that provides funding and technical support to community groups for the delivery of evidence-based programs that help at-risk children. Its director, Joan Sharp, has primary responsibility for directing the plan for home visitation services in Washington.
Program Effectiveness and Cost Savings Allow More Children to be Helped
In bringing together the primary administrators of both new home visitation programs, Representative Schual-Berke was also inviting consideration of connections that might, in the long run, increase program effectiveness, for example, identifying ways to cross-refer among the programs where appropriate. The first report of The Children's Trust to the legislature is due this December, and so now is the time to look at possible connections such as this.
This kind of search for program efficiencies gets at an critical goal. One of the objectives of the Home Visits for Asthma pilot is to demonstrate that this approach works and saves money. Previous experience with Healthy Homes in King County showed a cost-avoidance of approximately $1.7 for every dollar spent, primarily because of a reduction in emergency hospital visits. If this pilot demonstrates similar results, we are more likely to see many more low-income children in Washington state receive help from this program in the future. Roberts estimates that there are approximately 39,000 children in the state who have moderate to severe asthma, many of them low-income. His eyes light up when he talks about the possibility of helping all these children. "Why should we let children with asthma suffer when we can save money by helping them," he asks.
Being able to show that an effective intervention can subsidize its own operations or even be wholly self-funding, may be a kind of golden-grail for public health programs. In-home asthma interventions take us in this direction because asthma is not only widespread and expensive to treat, but its symptoms can be significantly reduced by environmental improvements that are relatively inexpensive to put into place.
Now, wouldn't it be nice if there were ways to make home and other environments safer -- before asthma and other health conditions developed? The intensive work that legislators and public health professionals are doing to lessen the impact of indoor pollution on children with asthma may very well lead to approaches that can be used in the general population. In the meantime, Washington's legislature has taken a big step forward in improving indoor environments with green building legislation passed in 2005.
Evergreen Standards: Sustainable Affordable Housing
LEED is sometimes used for affordable housing. Traugott Terrace in Belltown was the first affordable housing project in the nation to achieve the LEED designation. But Washington's new law allowed a somewhat less stringent standard for affordable housing. The Department of Community, Trade & Economic Development (CTED) was assigned the task of choosing this standard and putting it into place by July, 2008.
CTED brought together technical experts in the field of sustainable development to choose and adapt a standard. Green CommunitiesTM, offered by Enterprise Community Partners, was chosen. It had already been used in approximately 8,500 units across the country. It was adapted for use here and renamed the Evergreen Sustainable Development Standard. An interesting twist is that Green Communities was originally based on Seattle's own home-grown standard, called SeaGreen, which was developed by Joanne Quinn, sustainability specialist for the Seattle Office of Housing.
On June 14, I attended one of the first training for The Evergreen Standard, held by CTED for developers, architects, and others in the building trades and government agencies. The session was also an opportunity to take input from attendees on how the standards could be further improved. The standards include a number of mandatory elements, requiring that a "Green Development Plan" be used from the beginning of the design process. A larger number of optional elements is also included. From these, builders choose enough to earn a minimum number of "points" in order to qualify for state funding.
The Evergreen standards are an integrated approach to improving human, community, and environmental health. Non-toxic building materials, such as paint and wood for kitchen cabinets that don't emit volatile fumes, are encouraged. Building and ventilation standards keep dust and excess moisture lower. Bill Duncan, the presenter from Enterprise Community Partners, who traveled from out of state to give the presentation, focused in part of his talk on the significant help these building standards provide to children with asthma and their families. The 8,500 homes already built across the nation under these standards, he said, have helped over a thousand children with asthma and saved $429,000 in asthma-related medical costs.
The new Evergreen standards address climate and other environmental goals -- by encouraging, for example, the use of recycled building materials -- and the recycling of materials removed during renovation. Climate goals are also addressed by construction methods that optimize heating, cooling, and light. Saving money on energy and transportation costs makes a huge difference in the lives of people living on the economic edge. Energy and transportation costs can 'make-or-break' the budgets of these families and contribute toward homelessness. A reduction in fossil fuel use - and household transportation costs -- is also addressed by encouraging building for density, and in areas in which services and employment opportunities are within walking and public transit reach.
More densely-built neighborhoods where people experience fewer health impacts from indoor pollution and are better able to control household transportation, medical, and energy costs, certainly are ahead of the game.
The city doesn't want me to go thirsty: The built and living environments and the "whole citizen"
Not only does the indoor environment have a direct physical impact, but it also affects, I believe, the degree to which children feel on a deep level that they live in a caring and safe society, a society that takes care to address crises like climate change with all it's got, a society that doesn't allow children to breathe in poison. Daniel Kemmis, former Mayor of Missoula has written extensively on place. In his book, The Good Life and The Good City, he proposes that whole societies create whole people: "Only citizenship can save politics, and only relatively whole people are capable of reclaiming the human meaning of citizenship..." he writes. (7) Might our ability to be good citizens be influenced by the indoor environments that begin shaping us even before we are born, while our mothers carry us? I think so.
Kemmis quotes another author in describing an emotion that might be felt "when you stoop to drink from a public fountain: 'The city doesn't want me to go thirsty.'"(8) Those in Washington's public health community and legislature who are putting us on a better path are in a real sense protecting children from direct harm, -- and helping to inspire in countless ways the kind of sense of belonging and safety that helps make people and communities whole.
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