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How the President’s Budget Impacts Healthy Housing

The National Center for Healthy Housing is saddened to see the priorities being presented by the president’s FY19 Federal Budget Request. We know that Congress can do better.

We believe most Americans care about health and that our budget should reflect that, but some of the core federal agency programs that work to keep us all healthier will be underfunded or canceled under the president’s latest proposal. Below are just the programs that NCHH tracks and reports on to advocates and policy makers regularly; many more are also on the chopping block in the president’s budget.

Department of Housing and Urban Development (HUD)

  • Office of Lead Hazard Control and Healthy Homes: The president’s budget is $145 million; our request is $230 million. The $145 million is the same as the 2017 request and lower than the Senate’s FY18 number of $160 million. As our understanding of the impact of exposure and the cost-effectiveness of investing in eliminating lead hazards grows, certainly the funding that works to thwart lead exposure and hazards should be keeping pace.
    • Within this program, the president’s budget removes $5 million from the healthy homes account—from $30 million to $25 million—and redistributes those funds to the lead account. 
  • CDBG and HOME: The president’s budget zeroes out these programs, which provide vital services to low-income and underserved populations across the country. The Community Development Block Grant (CDBG) program alone feeds into myriad programs across the states that effect the health and well-being of Americans of all ages.
Learn more about HUD’s valuable programs and services with NCHH’s new Healthy Homes Agency Fact Sheet

Environmental Protection Agency (EPA)

  • Eliminates Indoor Air and Radon Programs. We request level funding for these programs. 
    • Indoor Air: Radon, previously funded at $2.91 million.
    • Reduce Risk from Indoor Air, previously funded at $13.733 million.
  • Eliminates Lead and Radon Categorical Grants. We request level funding for these programs. 
    • Radon Categorical Grant: previously funded at $8.051 million.
    • Lead Categorical Grant: previously funded at $14.049 million. 
  • Eliminates the Lead Risk Reduction Program, which was previously funded at $13.275 million; we request level funding for this program
    • Lead paint certifications will continue, through the Chemical Risk Review and Reduction Program, but this program is also getting a minor cut. 
    • The budget states that “Other forms of lead exposure are addressed through other targeted programs, such as the State Revolving Funds, to replace lead pipes.” 1 
  • Decreases the Children and Other Sensitive Populations program, under Information Exchange/Outreach, from $6.548 million to $2.081 million. We request level funding for this program.

Learn more about EPA’s valuable programs and services with NCHH’s new Healthy Homes Agency Fact Sheet.
 

Centers for Disease Control and Prevention (CDC) – Environmental Health 

Learn more about CDC’s valuable programs and services with NCHH’s new Healthy Homes Agency Fact Sheet. NCHH has also created a fact sheet for the Department of Health and Human Services (HHS), which is CDC’s parent agency.

Other Impacted Line Items

A Note on the Impact of the President’s Budget on State Funding

A note about how these changes would directly impact state budgets: NCHH tracks 11 grant/funding programs on our state healthy housing fact sheets. Between the eliminations and cuts at HHS, CDC, HUD, EPA, and DOE, this budget cuts or eliminates at least seven of them (eight if you count the expiring CDC lead money as a cut). 

The president and his administration have identified their priorities in this new budget. We'll do all we can to convince Congress of the necessity and cost-effective return on investment of these reduced or eliminated programs and implore Congress to restore programs to present funding levels or increase funding, as well as continue to work to educate the administration about what these programs do to have impact on the long-term health of the entire country. If you'd like to join us in that effort, please join our distribution list

1 One wonders how eliminating this program and the state grants supports Administrator Pruitt’s statement to other federal agencies that “All areas of lead exposure – from lead pipes to contaminated soil – need to be pursued and addressed in a comprehensive and consistent approach” (from the invitation to the principal’s meeting).



Citations:

CDC FY19 Budget Documents 
EPA FY19 Budget Documents 
All of our FY18 request numbers and justifications live here



Darcy Scott,
NCHH Senior Policy Adviser, has been engaged in federal advocacy efforts for over 15 years. She has worked with a number of large-scale organizations, such as the ACLU and Susan G. Komen for the Cure, to influence legislators through public engagement. Ms. Scott ran the government affairs department at M+R Strategic Services, leveraging the power of organizations and coalitions to influence the legislative process, and her consulting clients include Habitat for Humanity International and United Way Worldwide. Ms. Scott holds an undergraduate degree from Southern Methodist University and a graduate degree from Northwestern University. 

Sarah Goodwin joined NCHH as a Policy Analyst in June 2017. She previously served NCHH as a policy intern, helping to establish and run the Find It, Fix It, Fund It lead action drive and its work groups. She holds a Bachelor of Arts degree in Interdisciplinary Studies: Communications, Legal Institutions, Economics, and Government from American University.

Introducing NCHH's Healthy Housing Fact Sheets: EPA Region 1

Think about your home community. What makes it special? What specific challenges does it face? I’m sure, if given the chance, we could all go on at length about the individuality in the places we live and work. Those of us doing policy work at national organizations spend much of our time focused on the big picture, but the healthy housing needs of each state are unique and varied. We are far more effective as an advocacy community when we remember to take advantage of the perspective and challenges each state brings.

That’s why the National Center for Healthy Housing has created 53 state healthy housing profiles – including the District of Columbia and an overview of the whole U.S. – for use by policy makers and advocates across the country. Each fact sheet offers eight statistics about the healthy housing situation in each state, covering topics including asthma prevalence and financial burden, childhood lead poisoning numbers and age of housing, radon levels, carbon monoxide fatalities, and unintentional falls among older adults. The fact sheets also tell you which of 11 programs at CDCHUD, and EPA are currently funding your state efforts. Most information was found from federal or state governments, and each fact is hyperlinked back to the source material.

EPA Region 1

Throughout 2018, we’re posting highlights of our state fact sheets by EPA region, one region per month. In January, we’re starting off with EPA Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.

  • It’s well known among the healthy housing community that the Northeast typically has older housing stock than other parts of the country, and that is one of the first things that sticks out among these six states. Between 55% and 73% of housing in each state was built before lead paint was outlawed in 1978; 20-30% was built before 1940.
  • In 2015, the combined regional total of blood lead level tests over 5 µg/dL, the CDC action level, was 9,148. Forty percent (40%) of New Hampshire children are estimated to have had elevated blood lead levels at some point in their lives.
  • The region also shares high predicted and tested radon levels. In Connecticut, one in five homes has elevated radon; in Maine and New Hampshire, this number is nearly one in three. An estimated 628 cases of radon-related lung cancer occur in Massachusetts each year.
  • Rhode Island has the highest proportion of residents 85 and older in the U.S. at 15.8%, and nearly one in four Rhode Islanders are over 65. Risk of falling is a particular healthy housing issue for older adults. For example, hospital charges for unintentional falls among older adults totaled over $630 million in Massachusetts in 2010.
  • Another medical expense that has proved costly to the region is emergency asthma treatment. In 2014, Connecticut spent $135 million on acute care where asthma was the primary diagnosis; in 2012, Rhode Island spent $21 million on asthma hospitalizations.
  • The region also boasts some healthy housing milestones. Vermont was the first state to lower its definition of elevated blood lead levels to 5 µg/dL. This legislation was passed in 2008.
  • Maine was one of 14 states and localities that benefited from the additional funding for CDC’s Lead Poisoning Prevention program passed in December 2016.

Other NCHH Resources

NCHH’s state fact sheets will be updated annually with current information. For questions or comments, please email Laura Fudala at lfudala@nchh.org.


 


Sarah Goodwin joined NCHH as a Policy Analyst in June 2017. She previously served NCHH as a policy intern, helping to establish and run the Find It, Fix It, Fund It lead action drive and its workgroups. She holds a Bachelor of Arts degree in Interdisciplinary Studies: Communications, Legal Institutions, Economics, and Government from American University.

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. 

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