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Ensuring an Asthma-Safe Home: The Role of Tenants and Landlords


Creating a safe and healthy home for someone with asthma is challenging. The home can play host to many serious asthma triggers, including pests like cockroaches and dust mites, dampness, and ventilation problems that allow accumulation of particulate matter and other types of air pollution. People spend a significant portion of their time inside their home, and about 20% to 30% of asthma cases are linked to home environmental conditions.

While there are certainly steps that individual households can take to reduce these triggers in their home, renters often face unique barriers.

For example, while a household can take steps to remediate a pest problem in their apartment, the infestation may be present in the entire building. Mold and fungi due to leaks or dampness may be caused by structural problems outside of the renter’s control. Tenants may also be restricted in the changes they can make to their unit, like removing carpeting.

Given that over a third of U.S. households rent and one in four live in multiunit buildings, challenges like these warrant particular attention. Moreover, communities of color are both disproportionately burdened by asthma and more likely to live in rental housing.

Preventing and resolving housing issues is most successful when landlord and tenant work together. Multnomah County, Oregon’s Public Health Department, created a resource that highlights these opportunities: What Makes a Healthy Home: A Guide for Landlords and Tenants. The toolkit outlines the seven principles* of a healthy home (dry, clean, safe, ventilated, pest-free, maintained, and contaminant-free), and outlines how both tenants and landlords can play a role in maintaining the healthy status of a unit.

Regarding moisture, for example, the guide explains how landlords are responsible for ensuring all fans are in proper working order and are ventilated outside of the property, regularly inspecting the gutters and making sure all windows are well sealed. Tenants, on the other hand, are in charge of using the fans when showering or cooking, communicating water leaks to landlord immediately, and keeping their unit temperature around 68 degrees to both prevent mold and keep it well ventilated.

While in many case tenants and landlords can work together to solve these problems proactively, if a problem does arise that the landlord is not addressing, tenants have rights. When considering issues of tenants rights, it would be wise to seek legal assistance, especially before taking any action regarding the lease or payment. The U.S. Department of Housing and Urban Development (HUD) allows tenants to search for legal aid by state.

Most states have an implied warranty of habitability, which means that landlords must keep their properties “habitable” even if the upkeep isn’t specifically stipulated in the lease. Every state except Arkansas requires rental housing be kept in “livable condition,” which means that it must have safe electrical, plumbing, heating, and ventilation systems, as well as clean and safe hallways and stairs. These requirements also require garbage removal and vermin extermination. Beyond these baseline standards, the definition of “habitable” varies under state and local law. Households living in Section 8 or other federally-sponsored housing are covered under more strict federal standards.

If an issue goes unaddressed, tenants can contact the building manager with a written request about the situation. It is important to document the problem in detail including photos, a description of the issue, and the date and time of the issue. If the building manager is not responsive, however, tenants can request a city or county inspection for violations. Each state has slightly different processes for such complaints, but a call to the local health department is often a good place to start.

Finally, the U.S. Fair Housing Act (FHA) and the Americans with Disabilities Act (ADA) provide additional protections for individuals with disabilities who live in subsidized rental housing. Asthma is specifically classified as a disability under FHA and ADA. Tenants with asthma have “a legal right for reasonable accommodations to rules, policies, practices or services. They also are entitled to structural changes by the reasonable modification provision when a particular asthma trigger in the housing environment impacts their disability.” FHA and state fair housing laws provide similar protections for market-rate housing.

The process of submitting a formal complaint or request for accommodations can be challenging and new for tenants. Many tenants often don’t feel comfortable making complaints about their housing quality due to uncertainty as to how their landlord will respond or fear of retaliation. This is especially true for tenants living in high-demand rental markets where eviction rates are high. Many tenants also face other barriers to submitting complaints, including language access and work schedules. Local asthma coalitions, tenants rights organizations, and  local public health departments can provide support to tenants through this process. While there is no comprehensive list of asthma coalitions, you can usually find resources by searching “asthma coalition city, state” or “public health department city, state.” Some of these groups even coordinate environmental assessments using the EPA environmental assessment checklist and are able to triage violations directly.

For households living in rental housing, the challenges to creating a healthy home environment can be significant. Ideally, tenants and landlords can work together to prevent asthma triggers and remediate any issues. However, while protections and processes are in place to support this collaboration, in practice resolving these problems can be time-consuming and discouraging for tenants. Understanding their rights as tenants and enlisting the support of local organizations can be critical to a tenant’s success.


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*Note: At the time that What Makes a Healthy Home: A Guide for Landlords and Tenants was published, there were seven accepted principles of healthy housing. An eighth, "thermally-controlled," has since been adopted by the healthy homes community.

A version of this article was published in July 2013 as "How to Create an Asthma Safe Home Part II: Solutions for Tenants and Landlords" on the Propeller Health site. The author has modified portions of the article for publication here.




Justine Marcus is currently pursuing a dual degree, Masters in City Planning and Masters in Public Health, at the University of California Berkeley. Through her graduate studies, Justine is exploring how community infrastructure‎ – from housing, to water, to governance ‎– can be used to address health disparities and build community power. She is currently a graduate student researcher for the UC Berkeley Center for Community Innovation, where she is examining the health and material impacts of evictions on households. Justine is a proud Wisconsinite and lifelong public school alumna.  

Alternative Financing Mechanisms: Exploring Options for Healthy Homes Services



The National Center for Healthy Housing (NCHH) is a “go-to” resource for practitioners in the housing as healthcare industry. We get inquiries regularly: “Where is this being done? By whom and how?” We also look at the industry landscape ourselves and ask the same questions.

As we looked at the landscape in 2015, we closely reviewed the robust evidence base about the potential for transforming health outcomes and reducing healthcare costs by incorporating home-based interventions into patient care. Such interventions target social determinants of health, and investing in them has the potential to reduce the burden of preventable housing-related illness dramatically. The investing bit caught our attention, because we heard two conflicting scenarios.

On the one hand were states or individual managed care organizations providing Medicaid coverage for services delivered in the home environment related to asthma and lead exposure. On the other hand were states that indicated an interest in delivering home environment services but had not yet achieved Medicaid coverage. It seemed like their only option was to wait for Medicaid expansion coverage. But was it? As these conversations continued, we were aware of some states utilizing other financing mechanisms as either a complement or alternative to healthcare financing. The inevitable a-ha moment happened, and a series of questions followed: “What if more people know about these alternative financing mechanisms being used by certain states?” “Can someone, somewhere adopt an existing model as-is or with some modification?” “Is there a chance to increase the number of people receiving home environment services around the country?” We liked all the positive answers to these questions, and what followed was the alternative financing mechanism information project – after we secured funding from the W.K. Kellogg Foundation, of course. (Yes, our ideas depend on funding to be actualized.)

In 2016, NCHH interviewed several states providing one or more home-based asthma services, childhood lead services, or healthy home services using funding other than Medicaid or grants. The interviews provided information on the funding mechanism and how it operates, the program being funded and how it operates, outcome and evaluation information (where available), and lessons learned. We are pleased to share our findings of 12 different financing mechanisms.

This project does several things, but I would like to highlight one major feature—the “behind-the-scenes” information that the interviews provide.

The Montana Asthma Home Visiting Program (MAP) website tells us about the program. It is the interview that lets us know that not only does the program receive funding from the Master Settlement Agreement (MSA), it began to receive funding in 2007, nine years after the MSA accord was reached! This implies that even if MSA funds have not been a source for home-based asthma services or lead-based follow-up services, it is a potential source. Who else can begin to receive funding from their state’s MSA for home environment services?

One of the Massachusetts program interviews tells us how a trade-off was instrumental to raising funds for the program. The state amended the lead law to remove liability from organizations, and as a trade-off they accepted “surcharge on fees assessed by certain boards of registration, or state agencies for the licensure or certification of certain professionals, and on fees assessed for the renewal of such licensure or certification.” These surcharges raise about $2.5 million annually for Massachusetts Lead Education Trust Fund, income that would otherwise have been unavailable to support lead education services in the state!

The Maine interviewee spoke about the need to make the distinction between primary and secondary prevention. Just like several other states, Maine had a secondary prevention program. But secondary prevention only reacts after the fact. With the Lead Poisoning Prevention Fund, Maine now tests homes not just after a child has been poisoned in it, but before poisoning can happen to prevent poisoning.

Here are two things that stand out from the New Jersey’s project ReHEET interview: One, you can start where you are: Although they have received funding as high as $480,000, they have also worked with funding as low as $80,707! They began work with a few units. Two, the interviewee also pointed out how addressing more than one issue when intervening in a home lowers cost. They are committed to promoting energy and weatherization services to be incorporated with healthy homes services as a total package. Was someone thinking this might be a good idea? It is. They are working with it in New Jersey.

The page includes many more insights from our interviewees. For practitioners, we hope you are thinking “If them, why not us?” That’s what we are thinking too. Unhealthy homes are costing our nation too much in lost school and work days, medical expenses, and reduced quality of life. We encourage states and nonprofits to continue exploring alternate financing mechanisms that can support implementing evidence-based interventions for healthy homes.


Visit NCHH's Alternative Financing Mechanisms page here. Visit NCHH's Healthcare Financing page here.


Dr. Lillian Agbeyegbe is a public health practitioner with over a decade of experience in program development, implementation, and evaluation. As a project manager, she leads and supports NCHH’s Housing as Healthcare portfolio by developing resources, training, and providing technical assistance to support states in providing healthy home services.

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