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A Shower of Benefits: Drinking Water and Healthy Housing

The American Public Health Association today hosts a Twitter chat on “What's in Your Water: The State of Water and Our Health” (#SafeWater). The state of the nation’s infrastructure that delivers drinking water to our homes is nothing short of appalling, with Flint being only the tip of the iceberg. It’s outdated, and like much of our roads, bridges, electrical grid and housing stock, it’s seriously underfunded and ill-maintained, causing high healthcare costs and needless suffering. At best, this is penny-wise and pound-foolish; at worst, it’s criminally negligent. Just today, Pew Charitable Trusts, Robert Wood Johnson Foundation, NCHH, and others released a major new report showing that the benefits of lead poisoning prevention far outweigh the costs.

The nation still has no health-based standard for lead in drinking water, and protocols for sampling for lead in water are all over the place and hard to interpret. The only real standard that does exist is designed to determine how well corrosion control treatments are working, not whether health is being adequately protected. The same is true for other contaminants, like PFAS/PFOS/PFOAs (e.g., perfluorooctanoic acid [PFOA], perfluorooctane sulfonate [PFOS], and other perfluoroalkyl substances [PFASs], which are chemicals used for stain-resistance, Teflon coatings for frying pans, and other purposes. We hear of outbreaks of legionella and other diseases related to poor water treatment standards.

How did we come to this mess? After all, indoor plumbing was installed in housing to help conquer tuberculosis, typhoid, and cholera as part of the sanitation movement—and it worked! But today, the reality is that the failure to invest in infrastructure maintenance and improvements has provided local water authorities with limited options and complex, delicately balanced water chemistry trade-offs. Adding or subtracting one water treatment option often leads to unintended outcomes resulting in dire public health consequences. In a previous blog, "Infrastructure and Mortgages," we wrote that lead in water and housing in general must be part of the nation’s infrastructure rebuilding.

Are we really going to allow our nation to be forced to buy millions of plastic bottles to access drinkable water, instead of a high-quality water supply system? We should also point out that the quality of that bottled water and all those plastic bottles have their own problems and environmental costs.

What does this mean for parents? I recently had the opportunity to sample the water in the home of a friend with a newborn baby. They had previously gut-rehabbed their home and had asked the local water and sewer authority to sample their water for lead content. The results suggested a very low level—but  this was after flushing the system for 5-10 minutes, which means it didn’t determine the presence of a lead service line or lead in solder for copper pipes, and it didn’t reflect the water they actually drank. (Do you know anyone who runs the faucet for five minutes before filling a glass or pot with water?) As part of the rehab, their contractor had replaced the lead service line on their private property but failed to notify the water authority, who would’ve replaced the section on the public side at the same time as the private side was being replaced. The mom and dad thought the problem had been taken care of, but they asked me to check just to be sure. When I sampled the water, I did a first-flush and then, using a back-of-the-envelope calculation, took a second sample after a two-minute flush, which I suspected would be the water that had stayed in the public side of the lead service line overnight. Sure enough, when I got the results back, the second sample was much higher than what the earlier testing had showed. I contacted the local water authority, and they confirmed that they had not replaced their public section of the lead pipe, but they said they would do so after I sent them the results, which I did.

Parents shouldn’t have to put up with such a scattershot, hit-or-miss approach. We have to do better. And we have to put our people back to work with good paying jobs to fix things like this, instead of waiting for children to get sick or overexposed to contaminants. Here’s what needs to happen:

  1. Make drinking water quality a clear part of the healthy homes strategy. There are currently eight key principles for such a home: A healthy home means one that is free of excessive moisture and mold, free of injury hazards, properly ventilated, well-maintained, clean, free of pests, thermally controlled, and free of contaminants. “Free of contaminants” includes a drinking water supply without lead or other contaminants.
  2. Locate exactly where drinking water lead pipes are located using state-of-the-art technologies. (We created technologies to locate lead in paint, and we can do it for water too).
  3. Improve water treatments to minimize lead and other chemicals and contaminants entering the drinking water system.
  4. Implement a long-term plan to replace all lead drinking water pipes
  5. Implement a plan to eliminate other contaminants and biological agents.
  6. Create a health-based exposure standard for lead in water like we have for lead in dust and soil and enforce it. The current EPA maximum contaminant level goals in drinking water for lead is “zero,” which doesn’t help anyone to make real decisions on taking action.
  7. Fund an infrastructure improvement program that includes improving children’s health. (It makes no sense to treat children only after they get sick—that’s expensive and causes needless suffering.)
  8. Ensure that the infrastructure work creates good paying jobs for our people. An estimate suggests that at least 75,000 jobs can be created for lead mitigation alone doing this type of work. 
  9. Implement the recommendations provided in National Environmental Health Partnership Council’s Environmental Health Playbook: Investing in a Robust Environmental Health System.
  10. Implement the National Safe and Healthy Housing Coalition's “Find It, Fix It, Fund It” campaign, which would save billions of dollars and protect our children.

The science is clear, and we must act on what it tells us, not ignore it or create some so-called “alternative facts.” That action must include all of us—parents, citizens, government, private and public entities, foundation, workers, engineers, scientists, and advocates. 

There is simply no reason to tolerate lead or other contaminants in our drinking water. I’m going back to my friend’s house to see what happens when that pipe gets replaced. But it should never have happened in the first place. And if we eliminate the lead, we eliminate exposures. We’ve taken lead out of food canning, gasoline, new paint, many consumer products, and we have efforts to address lead in existing homes—all of which have succeeded in reducing blood lead levels by more than 90% over the past several decades. But with over half a million children with too much lead, we can and must do better.


Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Helping Older Adults to Age Gracefully in Place

When my mom was in her early seventies, her health began to decline. It seemed like she had appointments with different specialists every other day: endocrinologist, cardiologist, ophthalmologist, podiatrist, dentist, general physician, et cetera, et cetera. I don’t know if she talked to a doctor about her increasing physical weakness, but there didn’t seem to be an appointment for this problem, which rapidly and distressingly worsened. She went from walking on her own to a cane and to a walker, and her frailty sometimes caused her to fall in her own (admittedly cluttered) home. Luckily, these falls did not often land her in the ER; however, they were scary and debilitating, and she became more and more reluctant to venture outside her home, finally no longer even walking to the end of her own short driveway to pick up her mail.
 
This rather unremarkable story is surely familiar. Frailty, falls, and fear are all too often perceived as a “normal” part of aging. Older adults – particularly those living on a fixed income and dealing with adverse health conditions – may not be able to adequately maintain their homes or move safely within those homes, making falls and unplanned hospitalizations a distinct hazard. Low-income adults are particularly vulnerable to this scenario because they may have even less money and little or no access to needed healthcare. NCHH’s new Aging Gracefully in Place study hopes to demonstrate that this story does not have to be the norm for older adults.

NCHH is collaborating with Johns Hopkins School of Nursing (Hopkins) and organizations in four communities around the country to evaluate the replicability of Hopkins’ “Community Aging in Place, Advancing Better Living for Elders” (CAPABLE) intervention program.Hopkins’ CAPABLE program is a client-centered, home-based, unified set of interventions utilizing an occupational therapist (OT), a registered nurse (RN), and a home improvement professional (see text box) to increase older adults’ mobility and physical function so they can more safely age in place and move more independently both inside and outside their homes.

Archstone Foundation and the Harry and Jeanette Weinberg Foundation are funding the CAPABLE interventions, and the U.S. Department of Housing and Urban Development’s (HUD) Office of Policy Development and Research (PD&R) is funding an evaluation to determine whether the Hopkins’ CAPABLE program improves low-income elders’ physical function and decreases home safety hazards both immediately after CAPABLE interventions are completed and one year after they began.

The three-year Aging Gracefully project is helping these organizations help 142 low-income elders in their communities remain safely in their cherished homes as long as possible. Without a doubt, my mom would have been happier if a program like CAPABLE could have helped her to move confidently in and around the home she’d lived in for almost 50 years. 

Through this formative evaluation, Aging Gracefully is also fostering a learning community among the following four diverse partners to see if Hopkins’ CAPABLE program can be replicated in their communities and to document vital information needed to scale up and sustain the CAPABLE program across the country:
The CAPABLE program has already shown promise in Baltimore, MD (see text box above). The hope is that CAPABLE and other similar programs will ultimately fit within larger efforts, such as the “Well-Home Network.” In collaboration with LeadingAge and Families USA, NCHH is working on a plan to design and implement this national network of housing-based service models (HBSMs) at affordable nonprofit housing organizations to ensure that low-income older adults age successfully in their communities by helping them to achieve better health, well-being, and social engagement while also reducing Medicare and Medicaid costs.

COMMENT: What’s your story? NCHH wants to hear from you. Tell us how a program in your area has or could have benefited your aging parents or relatives. Leave your comment on our Facebook page, or tell your story here


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1©2015 Johns Hopkins University. All rights reserved.


Jill Breysse, CIH, Project Manager, has worked for NCHH since 1998. During that time, she has overseen more than 10 healthy homes research studies, analyzing the relationship between green affordable housing renovation and health outcomes and exploring the impact of energy retrofits on both lead poisoning and asthma outcomes. Ms. Breysse has authored several peer-reviewed research articles evaluating healthy homes hazard assessment tools and interventions. Most recently, she was lead author of guidance on conducting health impact assessments for housing decisions and helped to develop the National Healthy Homes Standard, an evidence-based standard of care for existing owner-occupied and rental housing. 

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.  

Threats or Promises: Which Way for the Trump Administration on Childhood Lead Poisoning Prevention?

Recent news articles suggest that Trump’s EPA hopes to drastically cut funding and staff for its lead poisoning prevention programs ("EPA Memo Outlines Plans to Defund Lead-Paint Program," in Remodeling, April 4; and "Trump’s EPA Moves to Dismantle Programs that Protect Kids from Lead Paint," in The Washington Post, April 5). This follows on the heels of a high-level meeting between the EPA’s new administrator, Scott Pruitt, and the National Association of Home Builders (NAHB). NAHB complained about so-called “excessive” regulations, specifically EPA’s Renovation, Repair, and Painting (RRP) Rule

But it was exactly inadequate regulations that led to the Flint crisis and others like it, such as the East Chicago disaster in Indiana, the vice-president’s home state.
 
The fact is that congressional action and regulations have worked: Blood lead levels in the nation’s children have been greatly reduced  as a result of the implementation of statutes and regulations (see "U.S. Policies vs. Children's Average Blood Lead Levels" below). When we as a nation mandated the removal of lead from food canning, gasoline, new residential paint, plumbing and other sources, all through regulations, it worked. If anything, the regulations should be strengthened, not weakened, because over half a million children still have blood lead levels above the CDC reference value.1 

Some industries have supported these regulations over the years,2 but a few others have actively opposed them.3 Most recently for example, the National Association of Home Builders (NAHB) wants the EPA’s RRP regulation restricted to only pre-1960 housing, even though lead paint was not banned (by regulation) until 1978. They want “training” of their contractors to be only online, when in fact construction contractors don’t really learn that way. They want a new cost-benefit analysis, even though many previous studies have already shown that the benefits far outweigh the costs.4, 5 NAHB already succeeded in previous years in eliminating a dust testing requirement that has existed for years in federally assisted housing rehab work with scientifically proven positive results.6 (Children’s blood lead levels in assisted housing are lower than in non-assisted low-income housing, and dust testing [dust is one of the main ways children are exposed] is the major reason why). NAHB should protect the interests of its members by ensuring that homes are safe, not cutting corners and weakening laws and regulations that, if anything, need to be strengthened. And it should work to ensure that its member contractors don’t inadvertently do sloppy work that can cost $100,000 per house to clean up.7

Furthermore, preventing childhood lead poisoning not only protects children, it will create at least 75,000 good-paying jobs.8

During his campaign, the president promised to fix things that don’t work right. What better example is there that lead poisoning needs to be fixed than the 24 million homes that still have lead paint hazards, or the 6-10 million homes that still have lead water pipes? The solution is not to weaken regulations or to cut budgets but to strengthen them, putting the resources in place to end this preventable disease. Lead problems are a sign of our crumbling infrastructure, something the president also vowed to fix. We think that an infrastructure bill should include lead poisoning prevention. 

At HUD, the new Secretary, Dr. Ben Carson, promised to “enhance” lead poisoning prevention and healthy housing, proposing to increase the budget for that program from $110 million to $130 million. But at the same time, the proposed HUD budget wipes out the multi-billion-dollar Community Development Block Grant (CDBG) program. Many local jurisdictions use CDBG to provide their local “match” funding, anywhere from 10% - 25%, for lead hazard control. So, even though the proposed increased funding for the lead program is welcome, it appears that with the CDBG proposed elimination, the net effect will reduce, not increase, the total HUD resources to protect our children from lead poisoning. Why give with one hand only to take away more with the other? 

The National Safe and Healthy Housing Coalition has produced a number of recommendations that will protect our children

We urge the new administration and the new Congress to act on those recommendations to improve (not weaken) regulations and to propose a budget that will get the job done.

Instead of paying over $50 billion a year for lead poisoning, let’s solve the problem, not eliminate EPA programs or reduce HUD funding. At its beginning, the Flint fiasco was supposedly an attempt to save money, and NAHB’s wishes sound just like that, don’t they? We cannot afford another Flint, and we cannot afford to continue to pay the high costs of needlessly poisoned children. In Flint and across the nation, we will now spend far more now than had we acted to solve the problem in the first place. And we do know how to solve it. We should act on what we know, put our people to work, protect our children, and stop wasting money by caving in to a few narrow short-sighted industries at the expense of the rest of us.





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1 Wheeler, W., & Brown, M. J. (2013, April 5). Blood lead levels in children aged 1–5 years — United States, 1999–2010. Morbidity and Mortality Weekly Report (MMWR), 62(13), 245-248. Retrieved April 6, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a3.htm

2 National Safe and Healthy Housing Coalition. (2016). Declaration of the Lead and Environmental Hazards Association. Retrieved April 6, 2017, from  http://www.nchh.org//Portals/0/Contents/LEHA_Declaration_2016.pdf 

3 Jacobs, D. E. (2016 July-August). Lead poisoning: Focusing on the fix. Journal of Public Health Management and Practice, 22(4):326-330. doi: 10.1097/PHH.0000000000000430. Retrieved from http://journals.lww.com/jphmp/Citation/2016/07000/Lead_Poisoning___Focusing_on_the_Fix.2.aspx
   
4 Gould, E. (2009, July). Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives, 117(7), 1162-1167. Retrieved April 6, 2017, from https://ehp.niehs.nih.gov/wp-content/uploads/117/7/ehp.0800408.pdf

5 Nevin, R., Jacobs, D. E., Berg, M., & Cohen, J. (2008, March). Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement, Environmental Research, 106(3), 410-419. Retrieved April 6, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/17961540
 
6 Ahrens, K. A., Haley, B. A., Rossen, L. M., Lloyd, P. C., & Aoki, Y. (2016, November). Housing assistance and blood lead levels: Children in the United States, 2005-2012. American Journal of Public Health, 106(11), 2049-2056. Retrieved April 6, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/27631737
 
7 Jacobs, D. E., Mielke, H., & Pavur, N. (2003, February). The high cost of improper removal of lead-based paint from housing: A case report. Environmental Health Perspectives, 111(2), 185-186. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1241348/
 
8 National Center for Healthy Housing & National Safe and Healthy Housing Coalition (2017, February). Find It, Fix It, Fund It: A lead elimination action drive: Policy recommendations to Congress and the new administration. Retrieved April 6, 2017, from http://bit.ly/FFFAdmin

9 Jacobs, D., & Weinberg, A. (2017, February 22). Infrastructure and mortgages: What about the kids? National Center for Healthy Housing website. Retrieved April 6, 2017, from http://bit.ly/Infra_Kids



Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Infrastructure and Mortgages: What about the Kids?


During the 2016 election season, Donald Trump (the Republican presidential nominee, now president) proposed spending $1 trillion dollars on infrastructure to put people to work and rebuild the sinews of the nation. Democrats have also called for infrastructure improvements. Those improvements must include making our homes and schools safe for our children. In its recent (January 2) editorial, "Housing that Ruins Your Finances and Your Health," The New York Times wrote, “One solution would be for Fannie Mae to eliminate dangerous lead conditions in foreclosed homes.” But lead requirements are antiquated or nonexistent not only at Fannie Mae but also at Freddie Mac and HUD’s FHA single-family mortgage insurance program. These federal housing programs are the only ones that were not reformed back in 1999 and are long overdue to be fixed.

In years past, both parties worked together to reduce childhood lead poisoning. But Flint is only the tip of the iceberg, and parents of lead-poisoned children are demanding that we do more to put a stop to the needless suffering. Lead poisoning costs us an estimated $50 billion annually for healthcare, substandard school performance, and lost work productivity (2008 dollars).1 The real tragedy is that we know how to fix lead hazards. The disasters in Flint and elsewhere could have been prevented and will now cost much more than if we had made the necessary upfront investments and reforms. The inadequate lead requirements at FHA, Fannie Mae, and Freddie Mac should comply with HUD lead-safe housing regulations, but they currently do not.

Traditionally, infrastructure spending only goes for roads and bridges and the basic equipment and structures that are needed for a country to function properly. But many are surprised to learn that the lead services lines bringing water into their homes are NOT part of the “infrastructure” and that the burden was on families to replace them. They are also surprised that home inspections required by mortgage companies do not include lead inspections. 

We think infrastructure and federally guaranteed mortgages should be used to make our homes safe for our children. Indeed, we have “shared” our homes with guests and friends and, of course, our families. But 37 million homes built before 1978 have lead paint,2 and at least six million homes have lead water service lines. This “shared” lead has poisoned millions of our children, sometimes poisoning one child after another as one family leaves and another moves in. Existing FHA, Fannie, and Freddie underwriting standards are part of the problem, but they could be part of the solution.

The biggest culprit is old single-pane painted windows, which have the highest lead paint and lead dust levels of any building component. Replacing windows is already a proven strategy. In a pilot program, Illinois replaced lead-contaminated windows in Peoria and Chicago in 500 homes,3 resulting in huge and sustained lead dust reductions not only on windows but also on floors; and many other studies have reached similar conclusions.

The time has come to replace all those old contaminated windows, those lead drinking water pipes, and the other lead hazards in our homes. Enormous benefits follow if infrastructure funds are used to address lead in homes:
  • First, over 75,000 jobs – good-paying jobs for both made-in-America window manufacturing and installation workers;
  • Second, increased property values anywhere from $5,900 to $14,300 per home4
  • Third, a return on investment of at least $17 per dollar spent on lead remediation or removal5
  • Fourth, up to $500 per household saved each year on reduced fuel bills, because new windows are more energy efficient.6 
With the right infrastructure improvements, we can all share safe drinking water and lead-safe homes. 

The evidence is clear – whether in small towns or big cities, rural or urban: We all win when we eliminate lead hazards and protect our children. Our traditional approach has been to respond only after a child is poisoned, but there is no reason to wait until the damage has already been done. We should test our homes and schools, not just our children’s blood. And we should insist that housing finance institutions like FHA, Fannie, and Freddie do the right thing and eliminate those hazards before children are poisoned.

As part of our new national infrastructure initiative, let’s include solving the lead problem. We urge the new president and Congress to protect our children. Let’s not wait for another Flint or another poisoned child. Get Fannie, Freddie, and FHA to do the right thing. Get rid of those old lead-contaminated windows and old lead pipes and put our people back to work to protect our children and our future.

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1 Tresande, L., & Liu, Y. (2011, May). Reducing the staggering costs of environmental disease in children. Health Affairs 30(5), 863. Retrieved February 21, 2017,
from http://content.healthaffairs.org/content/30/5/863.long
2 Cox, D. C., Dewalt, G., O'Haver, R., Salatino, B. (2011, April). American healthy homes survey: Lead and arsenic findings. Washington, DC: U.S. Department of Housing and Urban Development. Retrieved February 21, 2017, from  https://portal.hud.gov/hudportal/documents/huddoc?id=AHHS_Report.pdf
3 Jacobs, D. E., Tobin, M.,Targos, L., Clarkson, D., Dixon, S. L. Breysse, J., et al. (2016, September-October). Replacing windows reduces childhood lead exposure: Results from a state-funded program. Journal of Public Health Management & Practice, 22(5), 482-491. Retrieved February 21, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/26910871
4 Nevin, R., Jacobs, D. E., Berg, M., & Cohen, J. (2008, March). Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement, Environmental Research, 106(3), 410-419. Retrieved February 21, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/17961540
5 Gould, E. (2009, July). Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives, 117(7), 1162-1167. Retrieved February 21, 2017, from https://ehp.niehs.nih.gov/wp-content/uploads/117/7/ehp.0800408.pdf
6 Nevin, R., Jacobs, D. E., Berg, M., & Cohen, J. (2008, March). Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement, Environmental Research, 106(3), 410-419. Retrieved February 21, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/17961540



Related: Portuguese Translation
Infraestrutura e hipotecas: E as crianças: "Infrastructure and Mortgages: What about the Kids?" was translated into Portuguese by Artur Weber and Adelina Domingos. Note that this article was not translated by NCHH; therefore, we cannot be responsible for any errors or omissions in the translation. [url]


 
Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Anita Weinberg is a Clinical Professor and the Director of the ChildLaw Policy Institute at Loyola University Chicago School of Law, which spearheaded lead poisoning prevention efforts in Illinois for over 10 years.

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