I NTRODUCTION

The U.S. Environmental Protection Agency (EPA) is pleased to issue the Healthy

Buildings, Healthy People (HBHP) report, a vision for indoor environmental

quality in the 21st Century. The importance of the indoor environment to human

health has been highlighted in numerous environmental risk reports, including

the 1997 report of the Presidential and Congressional Commission on Risk

Assessment and Risk Management. On average, we spend about 90 percent of

our time indoors, where pollutant levels are often higher than those outside.

Indoor pollution is estimated to cause thousands of cancer deaths and hundreds

of thousands of respiratory health problems each year. In addition, hundreds of

thousands of children have experienced elevated blood lead levels resulting from

their exposure to indoor pollutants.

The report challenges all of us to work together to improve the quality of our

environment. It can also serve as the basis for discussion and education among

professionals in public policy, health, building sciences, product manufacturing,

and environmental research. The report is also a blueprint for channeling available resources. Already, EPA has undertaken program initiatives focusing on

childhood asthma, characterizing the effect of building and consumer 

products on the indoor environment, increasing the demand for cleaner indoor

products for use in schools, creating standards of care for existing buildings, and

designing guidance for new schools. EPA is also integrating good indoor environmental quality (IEQ) concepts into the Energy Star® label program for commercial office buildings. Moreover, other current federal programs, while not

direct outgrowths of the HBHP effort, are complementary of it. For example, at

the Department of Housing and Urban Development (HUD), the Healthy

Homes project has identified moisture and molds as a priority to be addressed in

its grants process, and the Healthy People 2010 effort at the Department of

Health and Human Services (DHHS) contains several goals relating to IEQ

progress in existing buildings. We challenge others, including government, tribes,

the health community, academia, non-profit organizations, and industry, to

embrace the HBHP goals and work together to invest in the actions outlined in

the report. In this way, we can begin to make progress towards realizing the

vision of HBHP.

The HBHP report is the outcome of a cross-Agency effort to define a strategic

vision and potential actions for improving the quality of our indoor environment

and was jointly led by the Office of Air and Radiation (OAR) and the Office of

Prevention, Pesticides, and Toxic Substances (OPPTS) with substantial involvement from the Office of Research and Development (ORD). As part of this

effort, we sought the advice of many outside experts and visionaries.
During this collaborative process, we learned a great deal from our stakeholders.

For example, we need to further understand indoor sources of pollutants and

their health effects, integrate building design and maintenance, encourage 

federal buildings to be “model”indoor environments, support the development

of new product technologies, and educate the public. Also, we need to work

closely with other federal agencies; state, local and tribal governments; health

and community organizations; and industry and other private groups to improve 

the Nation’s health.

Based on stakeholder and cross-Agency input, EPA issued a draft report in

March 2000 containing a vision, goals, guiding principles, and potential actions

to improve human health indoors. The draft report was available on EPA’s web

site and was sent to over 300 stakeholders representing the public, environmental and health interests, academia, federal agencies, state and local governments,

tribes, non-profit organizations, trade associations, and industry. The public was

asked to submit comments by May 31, 2000. This comment period was extended

to June 30, 2000 at the request of several commentors. We received comments

from over 40 individuals and organizations; many of them have been incorporated into the final report, or have been addressed in Appendix C. Interestingly, this

effort has attracted attention in Canada where a parallel effort, Healthy Indoors:

Achieving Healthy Indoor Environments in Canada (www.HealthyIndoors.com)

is using our draft report as a centerpiece in its stakeholder dialogues.

The draft HBHP report was positively received, and many indicated that the 

document was a significant step in addressing an important, but often overlooked, public health issue. Although there were a number of specific suggestions for changes to the draft report, nearly all commentors felt the report was

comprehensive, and that the vision and goals captured the central themes and

needs of the issue. Several indicated that the potential actions contained in the

draft report were strategic, and that, when implemented, would be helpful in

addressing the quality of our indoor environment. A summary of the comments

is contained in Appendix C.

While many of the comments we received were incorporated, the basic structure

of the draft report has been maintained in the final HBHP report. Chapter 1

focuses on why human health indoors deserves the scrutiny, concern, and action

of policy makers. These reasons are primarily health-related. Health risks associated with indoor environments include asthma, cancer, and reproductive and

developmental effects. However, significant gaps still exist in the current state of

knowledge about indoor environmental risks and exposures. We also believe that
a particular emphasis must be placed on children’s health. Chapter 2 presents a

vision statement and outlines goals, broad strategies, and guiding principles to

achieve success in every sector of our society over the next 25 to 50 years. In short,

our objective is to realize major human health gains over the next 50 years by

upgrading indoor environments. Five goals or strategies have been set to accomplish this objective: (1) achieve major health gains and improve professional 

education; (2) foster a revolution in the design of new and renovated buildings; 

(3) stimulate nationwide action to enhance health in existing structures; (4) create

and use innovative products, materials, and technologies; and (5) promote healthconscious individual behavior and consumer awareness. In addition to providing

information on actions and strategies that can be taken to protect people indoors,

EPA’s vision acknowledges the important role played by individuals in protecting

their own health and the health of those around them. Chapter 3 lays out potential

actions that EPA or others may pursue.

Appendix A provides an overview of current indoor environmental program priorities in various offices within EPA. Appendix B examines the roles of the Agency’s

partners in indoor environmental protection, including federal, state, local, and

tribal organizations, as well as stakeholders in the private sector. Appendix C provides a summary of the comments on the draft report and how the comments can

be accessed through our docket.
ACGIH American Conference of Governmental Industrial Hygienists

AIA American Institute of Architects

AIDS Acquired Immune Deficiency Syndrome

AMCL Alternative Maximum Contaminant Level

ANSI American National Standards Institute

ASHRAE American Society of Heating, Refrigerating, and Air-Conditioning Engineers

ASTHO Association of State and Territorial Health Officials

ASTM American Society for Testing and Materials

ATSDR Agency for Toxic Substances and Disease Registry

BEIR National Academy of Sciences’Committee on the Biological Effects of Ionizing

Radiation

CDC Centers for Disease Control and Prevention

CDN Clinical Directors Network

CDPHE Colorado Department of Public Health and the Environment

CERCLA Comprehensive Environmental Restoration Compensation and Liability Act

CLI Consumer Labeling Initiative

CO Carbon Monoxide

CPSC U.S. Consumer Product Safety Commission

DHHS U.S. Department of Health and Human Services

DINP Diisononyl Phthalate

DOC U.S. Department of Commerce

DOE U.S. Department of Energy

DOL U.S. Department of Labor

ECOS Environmental Council of the States

EPA U.S. Environmental Protection Agency

ETS Environmental Tobacco Smoke

ETV Environmental Technology Verification

FCIC Federal Consumer Information Center

FHA Federal Housing Administration

FIFRA Federal Insecticide, Fungicide, and Rodenticide Act

GSA General Services Administration

HBHP Healthy Buildings, Healthy People

HMOs Health Maintenance Organizations

HUD U.S. Department of Housing and Urban Development

HVAC Heating,Ventilating, and Air-Conditioning

IAQ Indoor Air Quality

IEQ Indoor Environmental Quality

IQ Intelligence Quotient

IUR TSCA Inventory Update Rule

MCL Maximum Contaminant Level

ACRONYMS
MHE Master Home Environmentalist 

NAHB National Association of Home Builders

NAHB-RC National Association of Home Builders-Research Center

NAS National Academy of Sciences

NCEA EPA National Center for Environmental Assessment

NCI National Cancer Institute

NCSL National Conference of State Legislatures

NEHA National Environmental Health Association

NERL EPA National Exposure Research Laboratory

NGA National Governors Association

NH COSH New Hampshire Coalition for Occupational Safety and Health

NHEERL EPA National Health and Environmental Effects Research Laboratory

NIH National Institutes of Health

NIOSH National Institute for Occupational Safety and Health

NIST National Institute of Standards and Technology

NRMRL EPA National Risk Management Research Laboratory

OAR EPA Office of Air and Radiation

OARM EPA Office of Administration and Resources Management

OCHP EPA Office of Children’s Health Protection 

OECA EPA Office of Enforcement and Compliance Assurance

OEJ EPA Office of Environmental Justice

OGWDW EPA Office of Ground Water and Drinking Water

OPEI EPA Office of Policy, Economics, and Innovation

OPPTS EPA Office of Prevention, Pesticides, and Toxic Substances

ORD EPA Office of Research and Development

OSHA Occupational Safety and Health Administration

OSHAct Occupational Safety and Health Act

OSW EPA Office of Solid Waste

OSWER EPA Office of Solid Waste and Emergency Response

OW EPA Office of Water

PBT Persistent, Bioaccumulative, and Toxic

PESP Pesticide Environmental Stewardship Program

PHSA Public Health Services Act

PTI Public Technology, Inc.

SBS Sick Building Syndrome

SIDS Sudden Infant Death Syndrome

TSCA Toxic Substances Control Act

UL Underwriters Laboratories

USDA U.S. Department of Agriculture

VA Veteran’s Administration

VOC Volatile Organic Compound
C HAPTER 1

Why Study Human Health Indoors? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Principles for HBHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Indoor Human Health Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Uncertainties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Who is Most at Risk? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

C HAPTER 2 

Vision and Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Goals to Achieve the Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Principles for the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

C HAPTER 3

Potential Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Potential Actions for Goal 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Potential Actions for Goal 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Potential Actions for Goal 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Potential Actions for Goal 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Potential Actions for Goal 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

CONTENTS
REFERENCES

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

APPENDIX A

Indoor Environments: Current Program Priorities . . . . . . . . . . . . . . . . . . 53

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Office of Air and Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Office of Prevention, Pesticides, and Toxic Substances . . . . . . . . . . . . . 60

Office of Research and Development . . . . . . . . . . . . . . . . . . . . . . . . . 63

Office of Solid Waste and Emergency Response . . . . . . . . . . . . . . . . . 67

Office of Enforcement and Compliance Assurance . . . . . . . . . . . . . . . 69

Office of Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Office of Children’s Health Protection . . . . . . . . . . . . . . . . . . . . . . . . . 71

Office of Administration and Resources Management . . . . . . . . . . . . . 74

Regional Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

APPENDIX B 

Partners in Indoor Environmental Protection . . . . . . . . . . . . . . . . . . . . . 77

Other Federal Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

State, Local, and Tribal Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Other Stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

APPENDIX C 

Comments on the Draft Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97