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Healthy Homes: Integral to Disease Prevention and Health Promotion

REMARKS BY:

Robert Williams, Acting Deputy Surgeon General

PLACE:

Baltimore, Maryland

DATE:

Monday, September 15, 2008

Remarks as prepared; not a transcript.

RADM Robert C. Williams, PE, DEE
Acting Deputy Surgeon General
U.S. Department of Health and Human Services 

Address to Healthy Homes Conference

September 15, 2008
Baltimore, MD

Good morning.

Thank you to Mary Jean Brown for that gracious introduction.

It is my pleasure to be with you today. 

On behalf on my bosses, Assistant Secretary for Health, Admiral Joxel Garcia, and Acting U.S. Surgeon General Steven Galson, I extend our greetings and best wishes to everyone here.

At the outset of these remarks, let us take a moment to remember for our fellow citizens in the Gulf Coast Region affected by Hurricanes Gustav and Ike…

When thinking about my remarks for today, I reflected upon the fact that one’s home may not come to mind first when one thinks about how to improve individual and public health; however, maybe it should.  The connection between housing and health is well established.

Considering the amount of time we spend indoors, and that a good portion of that time is at home, providing healthy home environments is a real factor in illness prevention; and should be a component in the broader culture of wellness which we at the Department of Health and Human Services seek to create in our Nation.

We seek to foster communities in which individuals and families live longer, healthier and more productive lives.

We are committed to sharing accurate information about healthy activities, healthy habits, and healthy eating – all those things that make for good health; we are advocates for a better quality of life for all people - and, that quality of life begins at home.

In 2005, then Surgeon General Carmona convened the Surgeon General’s Workshop on Healthy Indoor Environment. 

The goals of the Workshop were to enhance understanding of the public health consequences of the indoor environment, provide information to the public, medical and public health community, and to provide the construction and housing industry with a better understanding of public health issues.  Those goals resonated with the participants then and they remain no less important today.

As you scan the program for this conference and observe the vast array of presentations, you can see that all sectors of health, construction, education, and government are coming together with renewed interest and focus on promoting healthy housing.

The connection between health and housing has been known for centuries. 

During the 1800s, physicians advocated for decent housing as a strategy to reduce death and illness among the poor.  Later on, experiences with diseases such as typhoid and tuberculosis showed that basic sanitation, ventilation, reduced household crowding, and other improvements in housing were significant contributions towards triumphing over those epidemics.

However, in the mid-20th century, housing and health agencies became organizationally separated, resulting in a diminished focus on the prevention of housing-related diseases and illness.

That is not the case today – as this panel demonstrates - there is great interest in re-invigorating the essential link between public health, environmental, and housing agencies.  As you could tell by their presentations, I am quite confident that this objective is shared by my fellow panelists, as well as by other federal agencies.

The Office of the Surgeon General remains steadfast in our support of the importance of healthy homes to promoting the health of Americans. 

We also see healthy homes as a necessary part of the emphasis that the Department of Health and Human Services places on prevention.

Priorities

Disease prevention is one of the Surgeon General’s priorities, and is certainly at the forefront of our health education campaign.

Our office, and particularly the Surgeon General as the Nation’s health educator, is responsible for giving Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury.  

Right now, we spend a large proportion of our health care dollars in this country treating preventable diseases.

Seven out of 10 Americans die each year of preventable chronic illnesses such as heart disease, diabetes, and cancer.

As this conference demonstrates, there is an ever growing body of scientific evidence linking housing conditions to health outcomes such as asthma, lead poisoning, lung cancer, and unintentional injuries.  In most, if not all cases, these chronic or acute conditions are also preventable.

The medical care costs of people with chronic diseases account for as much as $1.4 trillion of the nation’s medical care costs.  These are not, of course, all relatable to home environments.

But, home environments contribute to these substantial costs in a manner that relatively few of us may realize.

For instance, exposure to dampness and mold in homes is estimated to contribute to approximately 21 percent of current asthma cases alone in the United States, at an estimated annual cost of $3.5 billion. (Mudarri and Fisk 2007; 2004 dollars). 

To reduce such human and financial costs, we know that a shift in social norms will be necessary – moving from a treatment-based society to a prevention-focused society.

A modest increase in the time, emphasis and resources we invest to prevent chronic diseases will save lives and potentially reduce healthcare costs.  Toward this end, preventive interventions at home, and those which improve housing, can produce net health and economic benefits to society.

For example, lead poisoning prevention policies and programs have greatly reduced childhood lead exposure in the United States, reducing associated intelligence and behavioral impacts as well. 

By doing so, we have improved the quality of life and the health of our children - a prevention effort that has resulted in economic benefits estimated to range from $110 to $319 billion dollars annually(Grosse et al. 2002;2000 dollars) .

Of course, we know that we have a lot of work left to do:

  • To move prevention higher in our national health investment list.
  • To make healthy habits, healthy choices, healthy homes, and healthy living routine in the lives of all Americans.

Prevention, in the context of a healthy home, begins with how the house is sited, designed, built, renovated, and maintained; all done in ways that support the health of residents. 

It includes consideration of physical characteristics (including the presence or absence of safety devices) and the quality of the indoor air and water, as well as reduction in contaminants and pests.  Residents have a responsibility as well, such as installing and maintaining smoke alarms, implementing smoke-free rules, and controlling or eliminating hazards such as lead paint and radon gas – all of which are important aspects of healthy and safe housing environments.

While no population is immune to illness or injury that may occur as a result of living in a home,  some populations are disproportionately affected by health and housing issues – these populations include the elderly, those with low incomes, and persons with disabilities.

This underscores another priority of the Office of the Surgeon General - Eliminating Health Disparities.

Far too many of our citizens - from members of racial and ethnic minority groups to seniors, the poor, and disadvantaged populations - experience disparities in health outcomes and health care.  

Some of these disparities may be linked to poor access to safe and healthy housing.

In 2005, 6 percent of all U.S. residents and 14 percent of low-income renters lived in housing with severe or moderate physical problems, such as water leaks that can cause mold growth and trigger allergic reactions and asthma attacks (U.S. Census Bureau 2006).   

Residents of homes with significant upkeep problems and structural and safety defects, such as deferred maintenance, moisture, pest infestation, and lack of specific safety devices, are also at increased risk for housing-related illnesses and injury.

On the other hand, with appropriate housing design and construction, some elderly can remain at home and function independently rather than move to an assisted living facility or nursing home.  In addition, a home’s design features can either exclude or enhance the ability of a person with disabilities to participate in the community

Bottom line - it is simply unacceptable in our Nation - with our global leadership in science and medicine - that significant disparities in health status persist; and certainly, and housing need not contribute to those disparities.

Health Literacy

Important to everything that we do in the Office of the Surgeon General, is the concept of health literacy – it is the currency of our success.

We need to steadily improve the ability of an individual to access, understand, and use information and services to make appropriate health decisions.  This same philosophy must also be applied to decisions regarding the home environment.

At the conclusion of the Surgeon General’s Workshop on Healthy Indoor Environment, the Surgeon General noted that indoor environment issues are not widely recognized or understood by the public at large. 

What was needed was a “translational element,” something that reduced the chasm between what health professionals know and what the public understands.

That translational element can be health literacy.  Health literacy should be everyone’s practice – to make sure that good health information is getting into the hands of the people who need it.    

One excellent example is the Housing and Urban Development Fact Sheet – “Seven Tips for Keeping a Healthy Home.”   

It provides simple, relatively easy to accomplish tips for residents to follow in safe-guarding their homes.  In addition, the National Healthy Homes Training Center and Network, a collaboration of CDC, EPA, HUD, and other organizations, has a wealth of information to guide and direct those seeking improve their homes. 

The information is available - it is up to us to help people use it.

What can be done

Public health is about assuring conditions in which people can be healthy.   It is about promoting health, preventing disease, monitoring populations – creating healthier communities.  These are cross-cutting objectives, and Healthy Homes speaks to all of them.

They are objectives shared by all with whom we work – whether scientist or practitioner, administrators, health professionals, at the local, state and federal levels, and the building construction industry, as well as all the non-profit and private sector stakeholders with whom we partner.

The actions that are needed to make our housing healthier call on the many disciplines represented at this conference to make informed decisions and develop realistic and compassionate solutions to ensure that safe, healthy, affordable and accessible housing is available to everyone in the United States.

We do this because creating healthier housing promotes growth and development of our children and can save millions, if not billions, of dollars in health care costs.

We do this because it will help address the striking health disparities borne by low-income and minority families.

We do this because ensuring that the Nation’s housing is safe, healthy, affordable, accessible, and environmentally friendly will have a direct, immediate, and measurable affect on the health of the Nation.

Where we can start:

  • By providing property owners, residents and community health and housing workers with information about steps they can take immediately to make housing safer and healthier
  • By increasing public awareness and promoting health literacy
  • By continuing ongoing healthy housing research and
  • By translating this research into practice and policy.

It is imperative that change occurs now, and through this conference, and others like it, I believe we are making great strides forward.

Closing

The Office of the Surgeon General is uniquely situated to advocate for and help to promote healthy homes.

Broad outreach is needed to educate homeowners, builders, architects, and re-modelers, and medical and public health professionals about healthy indoor environment issues – the time is now for a national dialogue to promote healthy homes.

Homes should be conducive to good health – they should be sanctuaries for building healthy minds, bodies, and spirits.

Toward that end, we must all work to make every American home a healthy one.

I assure you the Surgeon General will continue to advocate, as a public health policy, timely action to improve residential and indoor environments – after all, it is our pre-eminent focus area, to motivate people to adopt healthy practices in their everyday lives.

Let us work together to make it happen.

Thank you.