U.S. Department of Housing and Urban Development

Office of Healthy Homes and Lead Hazard Control

Leading Our Nation to 

Healthier Homes:

The Healthy Homes 

Strategic Plan

3

Foreword from Shaun Donovan, Secretary

Executive Summary

I. Introduction

II. Healthy Homes Program Background

III. Strategic Opportunities for Healthy Homes

IV. Healthy Homes Program Future Directions

References

Appendix A: The Current State of Health and Hazards in Housing

Appendix B: HUD Healthy Homes Program Activities and Accomplishments

Appendix C: Focus Areas of Initial Strategic Planning

Appendix D: Abbreviations Used in this Document

4

5

9

12

14

19

32

40

51

56

57

Table of Contents

The Strategic Plan is accessible at www.hud.gov/healthyhomes
4

Foreword by Shaun Donovan, Secretary, 

U.S. Department of Housing and Urban Development

As the nation’s housing agency, HUD is committed to promoting decent, affordable housing and addressing 

housing conditions that threaten the health of residents. Unfortunately, there are still too many homes in the

U.S. with hazards that endanger the health and safety of occupants. The cost of housing-related health 

hazards to the U.S. measures in the tens of billions annually. The time has come for the Department to take 

action to address these issues by unveiling a Healthy Homes Strategic Plan to guide our efforts.

In 1999, HUD recognized that targeting building deficiencies that contribute to a multitude of health and 

safety hazards was more cost-effective than implementing interventions on a hazard-by-hazard basis and 

proposed a healthy homes program, situated in the Office of Healthy Homes and Lead Hazard Control. 

Today, HUD’s commitment to providing safe and healthy homes for all families and children takes another 

significant step forward with the publication of the Healthy Homes Strategic Plan.

The Strategic Plan will serve as a road map for the Department and the Office of Healthy Homes and Lead 

Hazard Control as we strive to protect the health of children and other sensitive populations in a 

comprehensive and cost-effective manner. The Strategic Plan is the result of years of analysis, and 

represents a synthesis of programmatic experience, research, and community feedback. The Strategic Plan 

will help ensure that the Department is focused and effective in achieving program goals and in supporting 

its mission of increasing access to safe, decent, and affordable housing for all Americans.

I would like to thank all our of public and private sector partners that have been instrumental in helping the 

Department forge new paths that advance interventions that address multiple housing-related hazards. We 

look forward to continuing our partnerships on the federal and local levels in pursuit of the ambitious 

agenda that is presented in this Plan.

Shaun Donovan, 

July 9, 2009
5

Executive Summary

Nearly ten years since the inception of the Healthy Homes program in the Department of 

Housing and Urban Development’s (HUD’s) Office of Healthy Homes and Lead Hazard Control

(OHHLHC), the Office is in the  process of evaluating progress, distilling lessons learned, and 

forging a new strategic direction. This new direction will incorporate these lessons, without 

abandoning the Office’s core mission to ensure that lead poisoning is eliminated as a major 

childhood disease. With an established lead hazard control program infrastructure and the 

most comprehensive national healthy homes program, HUD is in a unique position to continue 

to promote national efforts to reduce housing‐related health hazards. 

Program Background

The OHHLHC has administered a successful Lead Hazard Control program since 1993. Through 

robust grants, enforcement efforts, research, and outreach, this program has been instrumental

in achieving a reduction of over 70% in childhood lead poisoning cases from the early 1990s to 

today. In addition to saving lives and improving the health of children, this reduction has saved 

the nation billions of dollars by increasing productivity, decreasing medical and special

education costs, and potentially reducing criminal activity. The “healthy homes” concept grew 

out of the observations  of Lead Hazard Control grantees that homes with lead‐based paint 

hazards often had other important health hazards that could be addressed at the same time. 

The core of this concept is that it is more efficient and cost‐effective to identify and mitigate 

multiple health hazards in high risk housing, rather 

than follow the traditional approach of addressing 

individual hazards through multiple categorical 

programs.

The Healthy Homes program has been guided by a 

strategic plan proposed by a multidisciplinary panel 

of experts convened by HUD in 1999, and funded at 

approximately $10 million annually since then. In 

FY 2009, this was increased to $14.6 million. To 

date, 101 Healthy Homes Demonstration and 

Healthy Homes Technical Studies grants have been 

awarded by HUD for a total of approximately $81 million. Healthy Homes Demonstration grants 

have supported implementation of healthy homes pilot programs throughout the U.S., created 

capacity through the development of a trained workforce, and identified effective practices for 

new and existing housing. Healthy Homes Technical Studies grants have supported research to 

improve hazard assessment and control methods and to better understand the distribution and 

importance of residential hazards and exposures, resulting in more than 30 papers published in 

scientific and professional journals to date.  

According to HUD’s 2007 American Housing Survey, six million households live with moderate 

or severe physical housing problems. Anyone can suffer from housing‐related illness and 

injury; however certain groups such as children, the elderly, or individuals with chronic illness 

are more susceptible.  
6

Key residential health hazards include asthma and allergy 

triggers, such as mold, dampness and pests (e.g., 

cockroaches, mice), injury hazards, and poor indoor air 

quality. The health  and economic burden of housing‐

related hazards is substantial. For 2007, the National 

Heart, Blood, and Lung Institute estimated the  total 

cost to the U.S. economy from asthma at $19.7 

billion (includes $14.7  billion in direct medical 

costs and $5 billion in indirect costs such as lost 

work and school days). In addition, research shows that 

about 21% of asthma cases in the U.S. are linked to dampness 

and mold, at an annual cost of approximately $3.5 billion. Pests 

can also play a significant role in triggering the symptoms of allergies and 

asthma; a recent study of asthma among inner‐city children found that 69% were allergic to 

cockroaches and 33% to rodents. Meanwhile, unintentional injury is the leading cause of death 

and disability among children younger than 15 years of age, with over 2,800 child and 

adolescent deaths occurring each year due to injuries in the home. The elderly are also at an 

elevated risk for residential injuries; each year, 35‐40% of adults 65 and older fall at least once. 

It is estimated that falls account for 33% of injury‐related medical expenditures and cost 

Americans more than $38 billion annually.

Although the health risks associated with homes are many and varied, the household hazards 

which can contribute to them tend to be interrelated.  Excess moisture, poor indoor air quality, 

and high levels of contaminated dust are common root causes for residential health hazards. 

Addressing these deficiencies simultaneously,  rather than attempting to tackle each hazard 

individually, will yield the greatest results in the most efficient, cost‐effective manner. For 

example, dealing with uncontrolled moisture can alleviate conditions associated with allergies 

and asthma (mold and pests), unintentional injuries (structural safety), and poisoning (lead 

paint deterioration).  

The key over‐arching healthy homes principles are to keep homes dry, clean, well‐ventilated, 

pest‐free, free from contaminants, safe, and well‐maintained.

Healthy Homes Trends and Future Directions for the OHHLHC

As the healthy homes approach gains momentum and visibility, HUD must address unique 

challenges and opportunities. The OHHLHC’s lead hazard control funds are  restricted by 

statute to address lead hazards only, but many lead program grantees are interested in 

expanding their focus by also addressing other key residential hazards. The green building 

movement also provides a key opportunity to assess the potential health benefits of green 

practices and promote the inclusion of health‐promoting features into green construction and 

rehabilitation  strategies. Housing professionals, including public housing agencies, are 

beginning to recognize the benefits of a cost‐effective integrated pest management approach 

compared to traditional pest control practices. Smoke‐free housing policies are gaining 

popularity among managers of multifamily housing because of increasing demand from 

residents, reduced maintenance costs, and acknowledgment of the public health need to reduce 

How 

homes are designed, 

constructed, and maintained; 

their physical characteristics; and  the

presence or absence of safety devices 

have many effects on injury, illness, 

and mental health.

The Surgeon General
7

exposure to environmental tobacco smoke. All of these trends represent key components of 

incorporating the healthy homes approach into ongoing practices and programs.

To develop this Strategic Plan, the OHHLHC reviewed past and current activities and 

accomplishments, identified challenges and opportunities, and solicited stakeholder review and 

comments.  

A Vision for Healthy Homes

This effort resulted in a roadmap for  increasing the Office’s impact and better enabling it to 

achieve its newly defined vision:

To lead the nation to a future where homes are both affordable and designed, constructed, 

rehabilitated, and maintained in a manner that supports the health and safety of occupants.

The OHHLHC Mission

To accomplish this vision, the Office’s mission will be:

To reduce health and safety hazards in housing in a comprehensive and cost­effective manner, 

with a particular focus on protecting the health of children and other sensitive populations in 

low­income households.  

Healthy Homes Goals

The Strategic Plan focuses on the following four key goals to guide the program’s activities:

1) Building a National Framework: Foster partnerships for implementing a healthy homes 

agenda.

2) Creating Healthy Housing through Key Research: Support strategic, focused research on 

links between housing and health and cost‐effective methods to address hazards.

3) Mainstreaming the Healthy Homes Approach: Promote the incorporation of healthy 

homes principles into ongoing practices and programs.

4) Enabling Communities to Create and Sustain Healthy Homes: Build sustainable local 

healthy homes programs.

Within the plan, the OHHLHC has developed short‐ and long‐term strategies for achieving each 

of these goals. Short term strategies include: creating a mechanism for coordinating federal

healthy homes activities, conducting research to characterize the potential indoor air quality 

benefits of green construction, collaborating with other HUD offices to promote healthy housing 

principles in areas where there is a critical public health need (e.g., smoke‐free housing, injury 
8

prevention, post‐disaster environments), and enhancing lead hazard control programs’ 

capability to address broader housing issues that impact occupant health. In the long term, the 

OHHLHC will assess the effectiveness of healthy homes training and public outreach/education 

efforts, support the creation and adoption of health‐protective housing codes and enforcement 

strategies, identify and pursue opportunities to promote healthy homes concepts to private and 

public sector entities, and continue to act as a convener of national, state and local partners 

through national healthy homes conferences and workshops. This work will be done in 

coordination with the Office’s ongoing efforts in lead poisoning prevention,  as the need to 

create and maintain lead‐safe housing for low income families remains substantial; many areas 

of the country still lack the infrastructure for an effective lead hazard control program and there 

is a need for ongoing monitoring and maintenance in homes that have received treatments. 

The Healthy Homes Strategic Plan will serve as a dynamic roadmap for developing, 

disseminating, and integrating the healthy homes concept. By coordinating disparate health 

and housing agendas, supporting key research, incorporating the healthy homes approach into 

existing practices, and providing tools to build sustainable local healthy homes programs, the 

OHHLHC’s Healthy Homes program will continue to lead in establishing a framework to help 

ensure an adequate supply of healthy and affordable housing.
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I.   Introduction

The mission of the U.S. Department of Housing and Urban Development is to increase 

homeownership, support community development and increase access to affordable housing 

free from discrimination. The Office of Healthy Homes and Lead Hazard Control (OHHLHC) 

supports this mission by assisting States and local governments to remedy the unsafe housing 

conditions and the acute shortage of decent and safe dwellings for low­income families (Housing 

Act 1937). No one, of any economic class, should have to worry about whether his or her home 

is putting loved ones at risk for illness or injury. Today’s families are challenged with finding 

not only affordable housing options, but homes that offer a safe and healthy place to live. The 

OHHLHC develops and promotes healthy housing tools and enables communities to create and 

sustain healthy homes. 

Past and current Healthy Home program activities have yielded strong results. However the 

OHHLHC recognizes that it operates in a dynamic environment and it is necessary to evaluate 

activities to ensure that we are able to best meet the needs of the populations we serve. The 

Healthy Homes Strategic Plan presents a brief overview of some past and current activities and 

accomplishments to demonstrate the progress that has been 

made and where gaps still exist. It identifies challenges and 

opportunities by surveying the current political, 

scientific, and economic trends that impact the 

success and development of the healthy homes 

concept. This analysis results in the proposed  strategies 

and goals which outline the future direction of the OHHLHC’s 

Healthy Homes program, which will continue to lead in the 

development, dissemination, and integration of the healthy 

homes concepts to improve the availability of decent, safe, 

and affordable housing. For a guide to the abbreviations 

used throughout this plan, please see Appendix D: 

“Abbreviations Used in this Document.”

The Disproportional Burden of Housing­Related Hazards

According to HUD’s 2007 American Housing Survey, nearly 6 million households live with 

moderate or severe physical housing problems, including  heating, plumbing, and electrical

deficiencies (U.S. Dept. of HUD, 2008b).  About 24 million households face significant lead‐based 

paint hazards (Jacobs et al., 2002). Anyone can suffer from housing related illness and injury; 

however certain groups such as low‐income individuals, children, the elderly, or individuals 

with chronic illness are more susceptible.

Low‐income persons are more likely to lack resources for preventive measures in the home, and 

deferred maintenance can lead to the development of residential health hazards. According to 

the U.S. Census Bureau, in 2007, 37.3 million people lived in poverty (Census Bureau, 2008). 

During the current acute shortage of affordable housing, people are forced to live in marginal

housing, or to choose between affordability and their health and safety (JCHS, 2005).  

The burden of a home with physical problems is also disproportionately heavy on minorities. 

This is clearly indicated by the 2007 Census poverty rates, with nearly three times as many 

Focusing on properties that 

pose the greatest health risks; 

that is, those properties that are 

older, low‐income, or in 

substandard condition, will yield 

the greatest improvement in 

health outcomes.

The Surgeon General
10

blacks (24.5%) and more than twice as many Hispanics (21.5%) living in poverty as non‐

Hispanic whites (8.2%).  For American Indians (AI)/Alaskan Natives (AN), this rate was 29.4%

(Census Bureau, 2008). Further, 9.8% of blacks, 7.6% of Hispanics, and 6.9% of AI/AN live with 

moderate or severe physical housing problems, as compared to just 4% of non‐Hispanic whites 

(Figure 1). Housing data indicate that living conditions on tribal lands are generally poorer than 

the rest of the nation. Almost four percent (3.9%) of Native American housing had severe 

problems, as opposed to 1.6% for all housing.

Figure 1: Percent of People in the U.S. Living in Homes with Severe and 

Moderate Physical Housing Problems (2007)

7

5.4

3 2.8 2.7

2.2

3.9

1.3

0

1

2

3

4

5

6

7

8

Black Hispanic American

Indian/Alaskan

Native

White

Race/Ethnicity

Percent

Moderate

Severe

                                                                                    Source: U.S. Dept. of HUD, 2008b

Children are typically more susceptible to biological, chemical, and physical exposures. 

Possible threats include allergens, asbestos, combustion products, pests, lead‐based paint, 

mold, organic gases, pesticide residues, radon, take‐home hazards, and injury hazards (Krieger 

and Higgins, 2002). The rapid development of a child's organ systems during embryonic, fetal, 

and early newborn periods makes children vulnerable when exposed to environmental

toxicants. Children breathe more air, drink more water, and eat more food per kilogram of body 

weight than adults. An infant's respiratory rate is more than twice an adult's rate (Snodgrass, 

1992). Children’s habits (e.g., hand‐to‐mouth contact) also make them more susceptible to 

environmental hazards in the home, especially dust. Since children spend up to 80‐90 percent 

of their time indoors, it is paramount to make every effort to minimize possible dangers (U.S. 

EPA, 2002b).

Older adults are also more susceptible to certain housing‐related hazards. Compared with 

young adults, older adults have smaller airways and are therefore more likely to experience 

bronchial hyper‐responsiveness (Yeatts, 2006), which makes them more vulnerable to indoor 

air quality hazards. The elderly are also at an elevated risk for residential injuries, especially 

falls (Sleet, 2008). The number of people older than 60 years of age is expected to  double 

between 2000 and 2059, and older adults tend to prefer to age in place, in their homes (Yeatts, 
11

2006; National Council on Aging, 2007). This substantial predicted increase in the older adult 

population aging at home underscores the importance of addressing hazards and identifying 

unique risk factors for housing‐related illnesses and injuries in seniors (Selgrade, 2006). 

Although housing hazards place a particularly significant burden on certain socioeconomic, 

racial/ethnic, and age groups, it is important to remember that anyone of any group can be 

harmed by housing‐related illness or injury. Advances in addressing these health concerns will 

benefit all categories of individuals and families.  
12

II.   Healthy Homes Program Background

The healthy homes concept began to take shape in the 1990s as national attention and local

efforts grew. Children’s environmental health issues received national attention with President 

Clinton’s Executive Order 13045, “Children’s Environmental Health Risks and Safety Risks.” In 

the FY 1999 budget, HUD proposed, and the Congress and President Clinton approved, a new 

Healthy Homes Initiative (HHI). Congress and President Clinton agreed that “the healthy homes 

approach appears superior to addressing problems one by one” and appropriated funds for the 

Initiative to “develop and implement a program of research and demonstration projects that 

would address multiple housing‐related problems affecting the health of children.” This 

program was delegated to OHHLHC to build upon the Department’s existing activities and 

expertise in housing‐related health and safety issues.  

Congress directed HUD to submit a preliminary plan 

for the HHI that would establish focus areas and 

objectives and assess the scientific evidence for links 

between housing and health hazards. In April 1999, 

an expert panel convened by HUD prepared the 

“Healthy Homes Initiative Preliminary Plan.” The 

plan identified excess moisture reduction, dust 

control, improving indoor air quality, and education 

as the key focus areas. The five objectives of the HHI 

were the:

1) Identification of homes where interventions would be appropriate;

2) Development of appropriately scaled and efficient intervention strategies;

3) Selection of efficient strategies for evaluating intervention effectiveness;

4) Development of local capacity to operate sustainable programs to prevent and control 

toxic mold hazards in residences of low and very low‐income families; and

5) Determination of biomarkers to address health threshold levels for exposure to mold.

The OHHLHC’s first Notices of Funding Availability (NOFAs) reflected those objectives with a 

housing focus. Funds were initially made available for grants in: 1) Mold and Moisture Control; 

2) Technical Studies (i.e., research): and 3) Demonstration Projects.  

In keeping with the first three recommended objectives, the Healthy Homes Technical Studies 

(HHTS) grant program emphasizes research activities to develop or improve methods for the

identification and control of housing‐related health hazards. The panel’s focus areas, including 

moisture reduction, dust control, and improvements in indoor air quality provided the initial

framework for the scope of HHTS grant projects and framed the interventions, including 

education, that are emphasized in the Healthy Homes Demonstration grant program.  

As the OHHLHC identified additional research gaps, it added other focus areas to the HHTS 

NOFA. For example, beginning in FY 2002, in recognition of the need to address rodent and 

cockroach problems in multifamily housing in a more cost‐effective way, the HHTS NOFA 

solicited projects to improve and assess integrated pest management (IPM) methods.  
13

In conjunction with the HHTS grants, the Healthy Homes Demonstration (HHD) program grant 

recipients develop, demonstrate, and evaluate cost‐effective, preventive measures to correct 

multiple residential safety and health hazards that produce  diseases and injuries in children 

and other sensitive subgroups such as the elderly, with a particular focus on low income 

households. Through its emphasis on promoting the healthy homes approach, the HHD grant 

program also incorporates an education focus. In FY 2008, major categories of eligible activities 

in the HHD program NOFA included direct remediation activities, education and outreach, and 

training in target communities. In recent years the OHHLHC has increased emphasis on 

grantees’ evaluation of the effectiveness of their interventions, including assessment of health 

and environmental outcomes, as well as the use of novel approaches.

While the majority of the OHHLHC’s healthy homes funding is 

provided via grants, the Office also employs contracts, interagency 

agreements, and collaborations with HUD program offices such 

as the Offices of Policy Development and Research (PD&R), 

Public and Indian Housing (PIH), and Housing. With PD&R, 

the Office has developed guidance for the safe rehab of flooded 

homes and is currently supporting studies of residential moisture 

sources and of the costs and benefits of green building practices. 

With PIH, the OHHLHC is working to promote adoption of 

integrated pest management and the creation of smoke‐free 

housing by public housing agencies.  With the Office of Housing, the 

OHHLHC provided technical assistance in the development of an 

indoor air quality monitoring protocol for their green rehab program for 

multifamily housing in their Mark‐to‐Market program. 

Interagency agreements have funded important healthy homes activities by the U.S. Centers for 

Disease Control, the U.S. Department of Agriculture’s (USDA) Cooperative State Research, 

Education and Extension Service (CSREES), the U.S. Environmental Protection Agency (EPA), 

the National Institute of Environmental Health Sciences (NIEHS), and the National Institute of 

Standards and Technology (NIST).

HUD’s partnership with the CDC has been among its most significant collaborations. 

Recognizing the importance of taking a comprehensive approach to addressing healthy homes 

issues, in 2006, then‐Acting Surgeon General Kenneth P. Moritsugu announced that his Office 

would develop a Call to Action to Promote Healthy Homes, to:

“help us link the importance of a healthy indoor environment with our 

priorities of prevention, public health preparedness, and the elimination of 

health disparities. It will help inform the American people of the science, the 

evidence, and the data to help improve our health literacy about this issue. And 

it will call the American people to action based upon this science evidence and 

data.”  Moritsugu, 2006.

The Surgeon General’s final Call to Action was released at a joint HUD and Department of Health 

and Human Services (HHS) press event in June 2009. The associated report documents the 

current state of research on the link between housing and health conditions, which is also 

summarized in Appendix A:  “The Current State of Health and Hazards in Housing.”

When enforced, 

housing and building 

codes have resulted in 

better constructed and 

maintained buildings and

in improved health.

The Surgeon General
14

III.   Strategic Opportunities for Mainstreaming Healthy Homes

As part of strategic planning, the OHHLHC examined not only internal activities and successes 

(see Appendix B: “HUD Healthy Homes Program Activities and Accomplishments”), but also 

considered the social, political, and economic climate. Some key trends and opportunities that 

will impact the implementation of the Healthy Homes Strategic Plan are examined in this 

section. 

The Policy and Political Landscape 

1) Regulations and Codes – National standards for informing residents about lead‐based paint 

hazards apply to all housing. However, similar far‐reaching regulations do not exist for other 

housing‐related health hazards. HUD sets physical property standards only for housing 

receiving HUD assistance. Multifamily and public housing must comply with HUD’s Uniform 

Physical Condition Standards (UPCS; 24 CFR 5, subpart G), while owners housing families with 

Housing Choice Voucher (formerly known as Tenant‐Based Section 8 Voucher) assistance must 

comply with the Housing Quality Standards (HQS; 24 CFR 982.401). For all other housing, state 

or local housing and building codes may be the only occupant protections in place.

A few localities have incorporated healthy homes elements into their communities through the 

enforcement of specialized housing or building codes. However, most jurisdictions that adopt 

and enforce codes use the model codes provided by the International Code Council (ICC). 

OHHLHC staff participates in code reviews, and by working with non‐profit partners, has 

achieved some success in shifting attention to including healthy homes in codes. The OHHLHC’s 

non profit partners are actively working to include additional residential hazards in the model

code and to amend existing codes to better address health and safety issues. Use of model 

codes, adaption of existing codes, or the development of  new code provisions, especially in 

rental housing, is a viable opportunity to address residential hazards in the future.

2) Legislative Climate – Attention to healthy homes issues is evident in the OHHLHC’s program 

funding levels, and in proposed legislation affecting multiple agencies. For Fiscal Year 2009, 

Congress approved an appropriation of not less than $14.6 million for HUD’s Healthy Homes 

program, representing a 67% increase over the FY 2008 program budget of $8.7 million. This 

resulted in a final FY 2009 program budget of $17.5 million. In March  2008, the Healthy 

Housing Council Act was introduced in the Senate with bipartisan sponsorship. The Healthy 

Housing Council Act sought to establish an independent “Council on Healthy Housing” to 

improve coordination amongst federal, state, and local governments, as well as industry and 

non‐profit representatives. In October 2008, the “Research, Hazard Intervention, and National 

Outreach for Healthier Homes Act” was also introduced in the Senate. The bill aimed to improve 

research, enhance the capacity of existing federal programs, and expand national outreach 

efforts. The legislation would have provided statutory authority for the Healthy Homes 

program and authorized additional funding for healthy homes research, hazard reduction, 

enforcement, and outreach. While the housing crisis precluded the bills from being brought to a 

vote during the 110th Session, both are planned to be re‐introduced during the 111th Session, 

and represent Congressional support for the healthy homes movement.
15

3) Federal Partners – Bolstered by the success of the healthy homes approach, other federal 

programs have begun to incorporate, or expand on healthy homes concepts. Improved 

coordination with these programs will increase the reach and impact of the Healthy Homes 

program. While many agencies have contributed to program accomplishments, there are 

especially timely opportunities to develop new initiatives with respect to HUD, the Centers for 

Disease Control and Prevention (CDC), and the U.S. Department of Energy (DOE).

CDC has partnered with HUD in its healthy homes efforts via an interagency agreement 

providing funds from the OHHLHC. CDC continues to demonstrate a commitment to the healthy 

homes approach through its agency‐wide Goal Action Plan for Healthy Homes and recent plans 

to transition its Lead Poisoning Prevention Branch (LPPB) to a Healthy Homes and Lead 

Poisoning Prevention Branch. This change will allow CDC to transition Childhood  Lead 

Poisoning Prevention Program (CLPPP) grantees to the healthy homes approach. Additionally, 

CDC will pursue activities related to healthy homes including surveillance to track housing 

hazards and related health outcomes, and research on healthy homes interventions. The agency 

will leverage its existing programs in environmental health, injury prevention, and asthma to 

directly inform its new healthy homes priorities. As CDC expands its healthy homes efforts, it 

will be critical for HUD and CDC to coordinate research and program agendas.  

DOE programs support improving the energy efficiency of homes as well as other performance 

characteristics. The Weatherization Assistance Program aims at reducing the burden of energy 

prices on low‐income families by increasing a 

home’s energy efficiency. As a part of this 

process, weatherization work crews conduct 

an all‐around safety check in which they 

identify hazards, including carbon monoxide 

leaks and mold. In recent years, DOE has 

expanded its program to allow 

weatherization crews to not only identify but 

mitigate these hazards as well. Several 

Healthy Homes Demonstration program 

grantees have teamed with weatherization 

programs in the implementation of their 

grants; this coordination provides significant 

benefits to the recipients of the combined 

interventions.  

HUD recognizes that improved collaboration among federal and non‐federal partners would 

help to optimize valuable time and resources and achieve more meaningful and widespread 

results in the healthy homes arena. As a first step, in February 2009, HUD hosted a meeting of 

federal agencies that are involved in healthy homes‐related activities, including CDC, DOE, the 

U.S. Environmental Protection Agency (EPA), the National Institutes of Environmental Health 

Sciences (NIEHS), the National Institute of Standards and Technology (NIST), and the U.S. 

Department of Agriculture. In the first meeting, the agencies described their programs related 

to healthy homes, identified common interests, and initiated a process to increase federal

planning efficiency on healthy homes issues. The group developed several subcommittees for 
16

special issues, and will meet regularly to develop a strategic agenda for all agencies, improve 

programmatic collaboration, and reduce duplication of effort.

The Economic Landscape

The affordable housing crisis in the U.S. adds to the complexity 

of  creating healthy homes. It is estimated that in the U.S. 

today, 12 million households pay more than 50% of their 

annual incomes for housing. Further, a family with one full‐

time worker earning the minimum wage cannot afford local 

fair‐market rent for a two‐bedroom apartment anywhere in 

the U.S. (U.S. Dept. of HUD, 2008a). For low‐income families, 

the lack of affordable housing may force them into substandard 

homes, where they are more likely to live in poorly maintained 

homes with health hazards. The high cost of housing may also prevent them from meeting 

other basic needs, such as nutrition and healthcare. At the heart of HUD’s mission is the goal to 

expand the supply of affordable housing to low‐income families. This provides an opportunity 

for the OHHLHC to coordinate with HUD’s major program offices to encourage the adoption of 

healthy homes principles into housing management, construction, and rehabilitation.

Current Trends Among Housing Programs/Professionals

Housing professionals include those who work in public sector federal and local housing 

programs, as well as private sector personnel such as property owners and those who work in 

housing rehabilitation, construction and maintenance. Other relevant professionals include 

public health nurses, social service providers, energy auditors, architects, inspectors, pest 

management professionals, weatherization experts, and others who visit homes to provide 

services or perform other work. Several current movements among housing and related 

professionals present the opportunity to incorporate aspects of the healthy homes approach 

into ongoing practices and programs.

1) Integrated Pest Management (IPM) – There is increasing recognition that traditional pest 

control practices, especially the broadcast application of pesticides, can be hazardous to 

residents and ineffective for sustained pest control. There is evidence that IPM is more 

effective than traditional practices at similar or reduced (long‐term) costs. IPM minimizes 

the use of toxic pesticides and instead emphasizes environmental controls such as 

elimination of harborages and removal of access to food and water. Broad adoption of IPM 

principles by public housing agencies and other property owners and managers has the 

potential to improve the health of  residents by reducing exposure to pests, pest‐related 

allergens, and pesticides.  

2) Energy Conservation, Green Building, and Health – The housing sector accounts for 

approximately one‐fifth of all energy consumption in the U.S. As energy costs have 

increased, HUD has taken aggressive steps to promote energy efficiency in homes. The 

Department’s Energy Task Force, consisting of representatives from HUD program offices 

and Regional Energy Coordinators, developed and are implementing an Energy Action Plan. 

The OHHLHC regularly participates in Energy Task Force activities, as this is a key 

Without an adequate supply of

affordable homes, healthy 

homes cannot be achieved.

The Surgeon General
17

opportunity to incorporate healthy housing principles. As homes become more airtight in 

an effort to conserve energy, proper ventilation becomes increasingly important. The Office 

will work to promote attention to the need of ensuring adequate indoor air quality in 

conjunction with residential energy conservation.  

As a part of the effort to reduce our nation’s energy consumption, the larger concept of green 

building has also gained momentum. Although there is no universally accepted definition of 

“green building,” the EPA describes it generally as “the practice of creating and using healthier 

and more resource‐efficient models of construction, renovation, operation, maintenance and 

demolition” (U.S. EPA, 2008c). Traditionally, the focus of green construction programs has been 

on maximizing energy and water efficiency, selecting environmentally preferable products and 

materials, and minimizing the effects of development on the outdoor environment. Many 

proponents of the concept have also emphasized the potential of green construction to improve 

indoor environmental quality (IEQ) with the potential for resulting benefits to occupant health. 

The momentum of the green building effort is a strategic opportunity for the  OHHLHC to 

underscore that IEQ and occupant health is as important as a reduction in environmental 

impact. 

To better understand the potential for green housing to improve occupant health, in FY 2009, 

the Office is introducing a new Notice of Funding Availability (NOFA) to support research on the 

potential environmental and health benefits of green building methods. The Office is also 

coordinating with CDC and HUD’s Office of Affordable Housing Preservation on research to 

assess the potential environmental and health benefits of low income housing units that have 

undergone green rehabilitation.

Critical Public Health Needs

It is important to acknowledge emerging public health needs and their relationship to the work 

of the OHHLHC.  

1) Smoke‐Free Housing – As the dangers of exposure to secondhand smoke and the benefits of 

smoke‐free environments have become better understood, so has the demand for smoke‐

free housing. As of November 2008, over 100 local Housing Authorities nationwide had 

adopted smoke‐free policies for some or all of their apartment buildings, 27 of which were 

adopted since January 2008 (TCSG, 2008). Letters from multiple HUD field offices, including 

one from the Chief Counsel in HUD’s Detroit field office, have stated that housing authorities 

and HUD‐subsidized owners may adopt smoke‐free “house rules” without approval from 

HUD. HUD and its federal partners have the opportunity to facilitate the adoption of smoke‐

free housing in the immediate future. The OHHLHC will continue to support these efforts 

within assisted housing by collaborating with the program  offices to encourage further 

adoption of smoke free policies. 

2) Unintentional Injuries – Preventing unintentional injuries has been part of the Healthy 

Homes program’s mission since the beginning. The OHHLHC  is a member of the Public/

Private Fire Safety Council (FireSafety.gov), and has sponsored research, demonstration 

projects, and outreach efforts focusing on reducing unintentional residential injuries, 
18

especially for children. Recognizing the major health toll and 

economic burden posed by unintentional injuries, there is a 

continued need to address the cost‐effective identification and 

control of residential injury hazards, especially in the elderly. 

Noting the statistics regarding the increased population that is 

aging in place (in their homes), partnerships in this area will 

be critical. 

3) Natural Disasters – Recent natural disasters, including 

Hurricane Katrina, wildfires in California, and flooding in the 

Midwest, have demonstrated the connection between homes, 

health, and extreme weather events. Disasters such as these 

can contaminate water supplies and cause damage to homes 

that could result in occupant illness or injury (e.g., water 

damage resulting in extensive growth of mold and other 

biological agents). In light of this, OHHLHC has begun to 

develop educational material for home owners and others 

involved in the rehabilitation of homes in an area affected by an extreme weather event. 

Thus far, guidance documents have addressed proper procedures for hurricane and flooding 

cleanup and rebuilding. In preparation for future events, OHHLHC will  continue to work 

with federal and  state partners and HUD program offices to develop outreach and 

educational materials which address additional natural disaster‐related hazards and to 

expand distribution of these materials to victims. OHHLHC is also interested in promoting 

housing design that minimizes potential health hazards commonly resulting from natural 

disasters.  

Expanding the Focus of Lead Hazard Control Programs 

HUD Lead Hazard Control grantees were among the first to observe that homes with lead‐based 

paint hazards often had other important health hazards that could be addressed in a cost‐

effective manner. Indeed, some common lead hazard control interventions, such as preventing 

water intrusion and reducing dust loading would also likely reduce levels of certain asthma 

triggers in dust and air (e.g., mold, dust mites). As the comprehensive healthy homes approach 

gains momentum and childhood lead poisoning is eliminated as a major childhood disease, lead 

hazard control grantees will continue to play an invaluable role in the healthy homes movement 

by expanding their focus to address other residential health hazards. The OHHLHC will work to 

highlight best practices and encourage adoption by other programs and continue to explore 

greater flexibility in the use of Lead Hazard Control funds, which are currently restricted by 

statute for use in addressing lead paint hazards only.
19

IV.   Healthy Homes Program Future Directions

During the strategic planning process, OHHLHC staff broadly examined healthy homes trends, 

reflected on the Office’s accomplishments and mission within HUD to date, and considered 

responses to a set of potential focus areas. This resulted in a targeted Healthy Homes Strategic 

Plan that is current, but also incorporates the OHHLHC’s continued commitment to ensuring 

that childhood lead poisoning is eliminated as a major childhood disease by 2010. After 2010, 

the OHHLHC will continue to provide funding and services for those communities that still have 

a significant amount of high risk housing.  

The Planning Process

To develop this plan, the OHHLHC drafted a list of revised focus areas (see Appendix C: “Focus 

Areas of Initial Strategic Planning”), and solicited feedback from selected internal OHHLHC staff 

and external partners.  Among the federal partners, non‐profit partners, and OHHLHC staff who 

provided feedback, the seven highest priority focus areas were1: 

o Develop standard, evidence‐based healthy homes assessment tools and intervention 

protocols;

o Support the development of objective standards for what is considered a “healthy”

residential environment;

o Increase collaboration internally at HUD and with other federal housing programs;

o Improve overall dissemination of healthy homes information, including best practices, to 

partners, grantees, and the public;

o Conduct cost‐benefit analyses on the effectiveness of a healthy homes approach through 

the analysis of health and financial outcomes; 

o Promote the inclusion of health considerations into green and energy  efficient 

construction; and

o Increase the emphasis on identifying key research questions and supporting larger, more 

definitive studies.

While most respondents were enthusiastic about the breadth of topics covered under the 

potential focus areas, a few points were made about additional  focus areas to consider. Of 

particular note were recommendations about training opportunities and building local capacity, 

enforcement and regulatory options (e.g., housing and building codes), collecting health and 

housing data, and  ensuring that lead hazard control is not neglected as the healthy homes 

approach moves forward. These elements were incorporated into the specific long term and 

short term goals, and supported the development of the Healthy Homes Office’s Vision and 

Mission: 

✦ Healthy Homes Vision 

To lead the nation to a future where homes are both affordable and designed, constructed, 

rehabilitated, and maintained in a manner that supports the health and safety of occupants.

1 Highest priority focus areas are defined as those that were listed as either first or second priority by at least 

half of all respondents.
20

✦ Healthy Homes Mission 

To reduce health and safety hazards in housing in a comprehensive and cost­effective manner, 

with a particular focus on protecting the health of children and other sensitive populations in 

low­income households.  

Healthy Homes Goals and Strategies

To accomplish this mission, the OHHLHC identified the following key goals:

1) Building a National Framework: Foster partnerships for implementing a healthy 

homes agenda.

2) Creating Healthy Housing through Key Research: Support strategic, focused research 

on links between housing and health and cost‐effective methods to address hazards.

3) Mainstreaming the Healthy Homes Approach: Promote the 

incorporation of healthy homes principles into ongoing 

practices and programs.

4) Enabling Communities to Create and Sustain 

Healthy Homes: Build sustainable local healthy 

homes programs.

The following is a description of the goals as well as 

short‐ and long‐term strategies to achieve them. 

Milestones and outcome measures to track progress in 

achieving each goal are also identified.

Goal 1: Foster partnerships for implementing a healthy homes agenda (Building a 

National Framework).

The OHHLHC’s Healthy Homes program has a strong track record of working with other HUD 

program offices and federal partners to accomplish results, and values the unique resources, 

expertise, and perspective that each partner brings to the table. Because of the multi‐faceted 

nature of the healthy homes concept, HUD must create and sustain both formal and informal 

collaborations with its federal partners to help ensure that the program’s mission is achieved as 

efficiently as possible. Through interagency agreements, HUD can leverage professional 

expertise in areas such as epidemiology and health education at CDC, and tap into existing 

networks such as USDA’s Cooperative State Research, Education, and Extension Service 

(CSREES).   

It is also important to develop and maintain less formal relationships with federal programs 

that are active in areas that can influence progress toward the healthy homes goal. For example, 

Actions government 

can take include...work(ing) 

together across agencies and 

sectors to provide guidance and 

technical assistance to support safe, 

healthy, and environmentally friendly 

housing options.

The Surgeon General
21

an ongoing system of coordination would help facilitate and solidify routes of communication 

between the OHHLHC and its federal partners. Such a system would help in necessary efforts to 

understand program roles and responsibilities, identify knowledge gaps and research priorities, 

and share effective healthy homes practices. Collaboration with private sector entities involved 

in housing and health, including non‐profit organizations and industry, will also be critical to 

coordinating and implementing a national healthy homes agenda.

Short Term Strategies 

o Develop New Federal Partnerships: Identify program goals that can be best accomplished 

through the formation of formal partnerships with federal partners and develop new 

partnerships, as needed. The OHHLHC will continue to work  with current federal

partners, including CDC, EPA, and USDA, but may also pursue new partnerships with the 

Department of Energy, organizations within the Department of Health and Human 

Services, and the Federal Emergency Management Agency. Potential topic areas for 

collaboration include, but are not limited to: research on the relationship between 

ventilation and indoor air quality, incorporating healthy homes concepts into 

weatherization and energy assistance programs, cost‐effective injury prevention 

strategies for children and seniors, and strategies for workforce training.

o Create a Mechanism for Coordinating Federal Healthy Homes Activities: This could 

include, for example, regular (e.g., quarterly) meetings of a coordinating committee with 

in‐person meetings as needed. Representatives from state and local governments as well

as private organizations could be invited to participate in meetings to inform the 

committee on effective strategies, opportunities for collaboration, etc.

o Identify and Develop Key Private Sector Partnerships: Reaching out to relevant private 

sector entities, including both non‐profit organizations and industry, is key to achieving 

the healthy homes mission. Key partners include builders, renovators, insurers, 

appraisers, financial institutions, multifamily property owners, and health and housing 

advocacy groups.

Long Term Strategies

o Serve as a Convener of National, State, and Local Partners: Support collaboration and the 

dissemination of information within the healthy homes community by bringing together 

policy‐makers, practitioners, and the public. A National Healthy Homes Conference will 

be organized and held on a regular basis (e.g., once every 2‐3 years). At each conference, 

the focus areas would change to reflect the evolution of the healthy homes concept and 

to address timely issues. At the first conference, held in 2008, planners convened a 

broad community of experts, and included both public and private stakeholders in the 

planning and implementation. 

o Sponsor Workshops on Specific Healthy­Homes Issues: Workshops would focus on specific 

healthy housing topics such as particular scientific or policy issues (e.g., dust sampling 

and preparation for allergens, modification of housing codes, and adoption of smoke‐free 

housing) or the discussion of  the most effective outreach strategies. The goal of the 
22

workshops would be to advance the healthy homes concept in specific areas by helping 

to identify best practices, identify key knowledge gaps, and foster mainstreaming of 

healthy homes into housing policy and practice within HUD and throughout the nation’s 

housing construction, rehabilitation, and management programs.

o Expand Outreach to the Mainstream Housing Industry: Identify and pursue opportunities 

to form partnerships with mainstream housing and construction entities in order to 

expand the base of practitioners.  

o Federal Policy Agenda: Coordinate the development of a cohesive federal policy that 

reflects the missions and statutory authorities of the participating agencies and provides 

the basis for agencies to develop and implement program, policy and regulatory changes, 

and identify potential legislative improvements for consideration by Congress.

Milestones and Outcome Measures

Milestone 1.  Establish an interagency working group to coordinate healthy homes activities.  

Outcomes: a) the development of working group goals and objectives; b) participation of 

partners in regular meetings; c) establishment of new areas of coordination among 

federal and non‐federal partners; and d) demonstrated progress towards meeting 

established work group goals

Milestone 2.  Creation of new federal partnerships.  

Outcomes: a) the creation of new formal federal partnerships through the establishment 

of interagency agreements; and b) the creation of new informal federal partnerships as 

evidenced by the regular exchange of information on healthy homes issues.

Milestone 3.  Create new private sector partnerships.  

Outcomes: a) the creation of new formal private sector partnerships through grants and 

contracts; and b) creation of new informal private sector partnerships as evidenced by 

the regular exchange of information on healthy homes issues.

Milestone 4.  Plan and implement regular national healthy homes conferences and topic‐specific

workshops.  

Outcomes: a) national conferences held at 2‐3 year intervals with success determined by 

the number of public and private sector partners involved in planning and conference 

implementation, the number of attendees, and feedback from attendees; and b) the 

organizing and holding of topic specific workshops on key healthy homes issues with 

success based on feedback from attendees.

Goal 2: Support strategic, focused research on links between housing and health and 

cost­effective methods to prevent and address hazards (Creating Healthy Housing 

through Key Research).
23

The OHHLHC’s  Healthy Homes program has supported research through the funding of 

Technical Studies and Demonstration program grants, contracts, and interagency agreements. 

While most projects have been funded at modest levels (e.g., $400,000 ‐ $900,000), the most 

significant findings have been produced by larger, more costly studies, such as the collection of 

allergen data from a nationally representative sample of homes through the National Survey of 

Lead and Allergens in Housing (NSLAH) (cooperative research with the NIEHS), and a Cleveland 

study that assessed the impact of mold/moisture interventions in the homes of asthmatic 

children. Another important tool for setting the research agenda is the report from the CDC‐

NCHH Healthy Homes expert panel reviews, released in January (NCHH, 2009). Moving 

forward, the Healthy Homes program will coordinate a research agenda with key partners to 

produce definitive and novel research in two key areas:

Developing cost­effective methods and protocols – Healthy homes experts agree that while 

consensus is building on effective protocols to assess, 

prevent, and control housing‐related health and 

safety hazards, knowledge gaps persist. 

Evidence‐based, practical, and widely accessible 

methods are needed to both identify hazards and 

conduct follow‐up interventions. This is challenging 

because of the wide range of both hazards and 

housing types that are encountered. Furthermore, it 

is important to support the development of 

interventions and preventative practices that target 

the highest priority hazards and are cost‐effective. Assessment tools must be reliable (i.e., 

results are reproducible among different users), easily administered, and based on validated 

methods that accurately identify hazards. Intervention protocols should have the backing of 

research that demonstrates their effectiveness in eliminating or reducing hazardous conditions 

with resulting improvements in health outcomes (e.g., reduced incidence of a particular injury, 

improved asthma control) or decreases in the risk of illness or injury.  Cost‐benefit analyses 

should be conducted in order to identify the more cost‐effective interventions and clarify net 

costs.   

Linking housing and health – While much is already known, more research is needed in order to 

improve our understanding of residential exposures and conditions. The Healthy Homes 

program will continue to pursue research on links between housing and health in cooperation 

with federal partners with health expertise, such as CDC and NIEHS.

Short Term Strategies

Developing Methods and Protocols

o Complete research on protocols for processing dust for allergen analysis and develop 

and facilitate the adoption of a standard protocol.

o Conduct initial planning for a potential multi‐site asthma intervention study. 

Government agencies, other research 

organizations, and scientists should 

develop and support a portfolio of 

rigorous healthy homes research.

The Surgeon General
24

o Conduct periodic literature reviews for healthy homes issue areas, including available 

evidence about the effectiveness of residential interventions.

Linking Housing and Health

o Analyze data from National Survey of Lead and Allergens in Housing and the American 

Healthy Homes Study to identify risk factors that predict multiple hazards (e.g. elevated 

allergen burden and lead‐based paint hazards). Results would be expected to improve 

targeting and home assessment tools.

o Conduct research to characterize the potential indoor air quality benefits of green 

construction compared to traditionally built units. Examples include continued 

collaboration with HUD’s Offices of Affordable Housing Preservation (OAHP) and Policy 

Development and Research (PD&R), and CDC to document the effects of green 

rehabilitation efforts on indoor air quality and health.

Long Term Strategies

Developing Methods and Protocols

o Conduct a multi‐site study of asthma interventions focusing on multifaceted 

interventions that include mold/moisture control in different climatic regions of the U.S. 

(follow up to Cleveland asthma study).

o Support research to improve knowledge regarding the health outcomes of IPM 

interventions, particularly in urban multifamily housing. Also support research to 

improve methods for preventing and combating bed bug infestations.  

o Assess effectiveness of healthy housing professional training and public outreach/

education efforts (e.g., knowledge of healthy housing principles, behavior change by 

health and housing professionals, homeowners, and tenants).

o Conduct research to refine a comprehensive healthy housing assessment tool that 

minimizes the burden to the user and maximizes the predictive power of the tool.

o Conduct research on the  efficacy of residential interventions to prevent unintentional 

injuries.

o Conduct cost‐benefit analyses to assess the effectiveness of standard healthy homes 

assessment and intervention protocols and  possibly more specialized protocols (e.g., 

mold/moisture intervention focus, and analysis of IPM vs. traditional pest control

methods). Such analyses will help to identify the most cost‐effective protocols and 

support the need to widely implement these measures.  

o Improve understanding of the relationship between residential indoor air quality and 

ventilation characteristics of homes.
25

o Support research necessary to clarify and strengthen existing evidence for specific 

changes to the building or property maintenance codes.

o Support the development and adoption of a core set of objective measures for what is 

considered a healthy residential environment that can be used to influence housing 

professionals and policy makers as well as  self‐protective actions by homebuyers, 

owners, and tenants.  

      Linking Housing and Health

o Support research on the potential health benefits of 

green construction and rehabilitation (e.g., use of low 

emission materials), and on green construction 

incorporating additional healthy housing factors (e.g., 

improved ventilation, smooth and cleanable floor 

surfaces) (Note: a recent Healthy Homes 

Demonstration grant in Seattle showed significant 

improvements in children’s asthma symptoms in 

newly‐built units).

o Work with federal partners to develop a national 

surveillance system to track residential hazards and 

related health outcomes.

Milestones and Outcome Measures

Milestone 1. Complete the development of tools to facilitate the 

adoption of standardized 

healthy homes assessment methods.  

Outcomes: a) development of a core set of validated home assessment measures; b) 

development of a set of evidence‐based healthy homes intervention protocols; and c) 

creation of standardized procedures for dust sampling and dust preparation for allergen 

analyses.

Milestone 2.  Create a regularly updated healthy housing research agenda, informed by public 

and private partners.  

Milestone 3.  Initiate and complete research on key healthy homes topics.  

Outcomes: a) complete a multi‐site study to assess the benefits of mold/moisture‐

focused interventions on asthmatic children in a variety of climatic zones; b) complete 

research on the environmental and health benefits of green construction (rehab and new 

construction); and c) complete research on the relationship between ventilation and IAQ 

in energy efficient homes.
26

Milestone 4.  Initiate and complete cost‐benefit research on healthy homes interventions. 

Outcomes: a) complete cost‐benefit research on a standard package of healthy homes 

interventions; and b) complete cost‐benefit research on specific HH interventions and 

measures (e.g., IPM, smoke‐free housing, green construction), including their use with 

specific populations (e.g., asthmatic children). 

Goal 3: Promote the incorporation of healthy homes principles through ongoing practices 

and programs (Mainstreaming the Healthy Homes Approach).

Reducing housing‐related health and safety hazards in the maximum number of  U.S. homes 

ultimately  depends on the extent to which healthy homes principles can be successfully 

incorporated into ongoing public and private sector housing practices, programs, and delivery 

systems. Over the short term, collaboration with public sector housing professionals and 

programs will be critical. Target housing audiences can be reached by  the Healthy Homes 

program’s promotion of: 1) cost‐effective aspects of healthy homes assessments  and 

interventions; 2) the incorporation of healthy homes principles into related housing and 

environmental movements; and 3) promoting the use of healthy homes principles in issue areas 

where there is a critical public health need. Over the long term, as the healthy homes approach 

is proven to be cost‐effective and methods are validated, it will be necessary to continue work 

with federal and state housing programs, support health‐protective codes and enforcement 

strategies, and secure private sector input. 

Short Term Strategies

Promote the Incorporation of Healthy Homes Principles into National and Local Planning Efforts 

and Current Housing Trends  

o Integrated Pest Management: Continue cooperative work within HUD’s Office of Housing 

and PIH, USDA, and EPA, to encourage the adoption of IPM by public housing agencies 

(and other low‐income housing providers including owners of subsidized housing) 

through a training program that reaches management, staff, and residents of multifamily 

housing throughout the country. Work toward expanding effort to other HUD program 

offices, such as the Office of Native American Programs, and reach out to local health 

departments to encourage their involvement in conducting outreach and promoting the 

use of IPM in their communities.

o Incorporating Healthy Housing Principles in HUD­Supported Rehabilitation Programs: 

Identify key healthy housing components that can be incorporated into the rehab of 

affordable housing and work with  HUD program offices to identify opportunities to 

promote the inclusion of these components by local programs.

o Energy Conservation: With energy conservation at the forefront of national attention, and 

the OHHLHC’s commitment to the HUD Energy Task Force, the Healthy Homes program 

will encourage an integrated approach to home interventions by facilitating the 
27

incorporation of healthy homes assessments and interventions into weatherization 

programs. The OHHLHC will support the development and field testing of a 

computerized healthy homes assessment module for use by weatherization programs to 

expand the identification and control of additional health and safety hazards and 

improve indoor air quality modeling.

o Green Building: Green housing must include elements that improve indoor 

environmental quality and the health of residents. Through a new Sustainable and 

Healthy Housing Initiative, the OHHLHC will actively promote the inclusion  of health 

considerations into green housing construction, rehabilitation, and maintenance and 

sponsor research to assess resulting health and environmental benefits.

Promote the Use of Healthy Homes Principles in Issue Areas Where There is a Critical Public 

Health Need

o Smoke­Free Housing: As smoke‐free housing policies 

gain momentum among public housing agencies and 

in local jurisdictions, the Healthy Homes program will 

work with HUD program offices to encourage smoke‐

free housing in public and assisted housing, including 

tribes and tribally‐designated housing entities, and 

relevant federal partners like CDC and EPA on public 

health messaging related to eliminating 

environmental tobacco smoke exposure. 

o Unintentional Injury Prevention: The OHHLHC will 

initiate collaboration with HUD program offices that 

coordinate supportive housing for the elderly (Section 

202 of the Housing Act of 1959) and the disabled 

(Section 811 of the National Affordable Housing Act of 

1990), as well as with key federal partners like the 

CDC.

o Radon Risk Reduction: The Office will initiate 

collaboration with HUD program offices that oversee housing assistance and mortgage 

programs, and with EPA coordination, promote testing for radon and sub‐slab 

depressurization systems in properties with high levels of radon.

Long Term Strategies

o Continue to Facilitate the Adoption of Healthy Homes Practices by Existing Housing and 

Mortgage Programs: The Healthy Homes program will continue to work with HUD 

program offices that administer HUD‐assisted housing in an effort to incorporate healthy 

homes practices. Practices to emphasize will include: adoption of IPM practices; 

creation of smoke‐free housing developments; adoption of specifications for “moisture 
28

resistance” by publicly funded housing rehabilitation programs; and radon risk 

reduction where radon levels are high. 

o Support the Creation and Adoption of Health­Protective Housing Codes and Enforcement 

Strategies: In the absence of federal regulations governing healthy homes issues beyond 

lead‐based paint, state and local policies will continue to be key mechanisms for change. 

The Healthy Homes program will support research necessary to clarify and strengthen 

existing evidence for specific changes to the building or property maintenance codes, 

and facilitate the adoption of effective health protective practices into existing codes. 

HUD’s continued membership on the International Code Council will provide a prime 

medium for OHHLHC staff to review model property maintenance and energy 

conservation codes, as well as codes for new construction, existing buildings, and 

residences, to ensure that they reflect healthy homes principles.  

o Gather Critical Private Sector Input: Ultimately, private sector housing professionals will 

need to feel confident about the healthy homes approach and its cost effectiveness in 

order for it to become fully incorporated into standard building and rehabilitation 

practices. The Healthy Homes program will solicit input from private sector 

stakeholders in an effort to identify  and address their key needs and barriers to 

adoption.

o Qualified Allocation Plans and Consolidated Plans: The Healthy Homes program will build 

on the experience of the Lead‐Safe Housing Rule and provide evidence‐based guidance 

regarding how state and local housing agencies can optimally factor healthy homes 

considerations into plans for publicly supported rehab, construction, and ongoing 

maintenance.

Milestones and Outcome Measures

Milestone 1. A majority of federally assisted multifamily housing programs have adopted IPM 

and smoke‐free housing policies in at least some developments

Outcomes: the number of public housing agencies adopting IPM practices and 

establishing smoke‐free housing developments. 

Milestone 2.  The adoption of broader healthy homes assessments and interventions by

 weatherization programs.  

Outcomes: the number of weatherization programs adopting expanded healthy homes 

assessments and interventions.  

Milestone 3.  Strengthening of the health protective provisions of existing housing and

 building codes and development of new codes:  

Outcomes: a) the adoption of modified codes; b) the development and adoption of new 

codes; and c) increase in the number of jurisdictions adopting health‐protective codes.
29

Milestone 4.  An increase in the number of jurisdictions adopting healthy homes 

provisions in qualified action plans and consolidated plans. 

Goal 4: Build sustainable local healthy homes programs (Enabling Communities to Create 

and Sustain Healthy Homes). 

The OHHLHC has provided financial and technical support for local programs for over ten years. 

In order for these programs to succeed beyond the 

federal funding period, a combination of OHHLHC‐

provided tools, innovative private sector 

partnerships, and public awareness will be 

essential. The OHHLHC plans to provide the 

resources and education tools necessary to set local 

communities on the path towards creating and 

sustaining healthy homes. In the short term, this 

includes gathering input from local programs, 

providing continued support for lead and healthy 

homes grantees, and initiating broader marketing 

efforts to engage the public in healthy homes 

awareness. Over the long term, the OHHLHC will 

also need to pursue private sector commitment to 

the healthy homes mission in the form of implementation support and favorable financing.

Short Term Strategies

o Provide Effective Training to a Variety of Audiences: The National Healthy Homes 

Training Center, funded through the OHHLHC via an interagency agreement with CDC, 

will continue to train the variety of housing and health personnel who visit homes to 

provide services or perform other work (such as inspectors, public health nurses, energy 

auditors, and social service providers) to promote healthier housing.

o Enhance Lead Hazard Control Programs’ Capability to Address Broader Healthy Homes 

Issues: The OHHLHC will work to enable grantees to combine funds to  address 

categorical hazards (such as lead paint) with other housing hazards, and continue to 

seek flexibility in appropriated funds. The Office promotes cooperation between health 

and housing agencies to conduct assessments and interventions for lead‐based paint (as 

well as other housing‐related hazards) and pursue code enactment/enforcement and 

educational strategies. The OHHLHC will also provide communication channels for Lead 

Hazard Control grantees to learn from Healthy Homes grantees’ experiences.  

o Facilitate Exchange of Best Practices: Work with local programs to better understand 

successes,  challenges, and remaining needs. Compile and disseminate guidance that 

identifies “best practices” in key healthy housing program areas such as participant 

recruitment, home assessment, and interventions to eliminate hazards. Develop a web‐
30

based system to facilitate the exchange of information between grantees (similar to the 

former “Healthy Homes grantee exchange”). Develop and implement a system for 

summarizing the key findings of Office‐funded projects (e.g., creating and posting final 

project summaries and research results on the web).

o Support the development of an electronic interactive  version of the “Healthy Housing 

Inspection Manual” that was developed through HUD’s interagency agreement with CDC, 

obtain feedback from users of the tool, and revise the instrument if and as necessary.  

o Enhancement of the OHHLHC Communications and Outreach Program: Activities will 

continue to address lead poisoning and healthy homes issues, through a variety of 

channels involving grantees, stakeholders, and low‐income families. External 

information dissemination will also proactively expand into growing audience segments 

(e.g., seniors) and address emerging trends (e.g., green building). The enhanced 

communications and outreach efforts will incorporate new media and tools for 

education and explore, select and implement innovative resources and outreach 

techniques.  

o National Lead and Healthy Homes Marketing Plan: The OHHLHC will research, develop, 

and implement a three‐year National Lead and Healthy Homes Marketing Plan, which will

support a comprehensive strategy to link traditional with new outreach activities. This 

document will be updated annually and will be developed with input from federal

partners and other stakeholders. Components of the Plan will include primary and 

secondary research; tailoring message and media to key target audiences; testing and 

packaging of messaging; finding opportunities to leverage current resources; selecting 

appropriate vehicles for dissemination; tactics (specific campaigns); and evaluation and 

refinement. 

Long Term Strategies

o Evaluate and Improve Training: Evaluate the effectiveness of OHHLHC‐sponsored 

healthy homes training and use the results to improve and standardize available training.

o Expand Training to Build Professional Workforce: Expand training concepts and adapt 

curriculum for trade schools, community colleges, four‐year universities, and graduate 

programs to increase the professional workforce engaged in designing, creating, and 

maintaining healthy homes. 

o Evaluate the National Healthy Homes Marketing Campaign: Evaluate the effectiveness of 

specific aspects of the healthy housing marketing campaign to advance improvement and 

viable alternative strategies.  

o Identify and  Pursue Opportunities to Promote Healthy Homes Concepts to Private and 

Public Sector Entities: Demonstrating the cost‐effectiveness of the healthy homes 

approach should encourage meaningful private and public sector involvement. For 

example, educators (e.g., the American Council for  Construction Education, American 

Association of Community Colleges), housing developers, rehabilitation programs, 
31

builders, financial institutions, component manufacturers, architects, realtors, and health 

insurers have critical roles to play in ensuring that homes are healthy and safe.

Milestones and Outcome Measures

Milestone 1.  Develop a “Healthy Homes Guidance Manual” for health and housing programs 

looking to incorporate healthy homes provisions in programs or to improve 

existing programs.  

Outcomes: the document is completed and updated as needed. 

Milestone 2.  Completion and implementation of a healthy housing marketing plan.

Outcomes: a) a national marketing plan is developed with input from HUD’s federal 

partners; and b) an evaluation of education/outreach efforts is completed. 

Milestone 3.  Develop a web‐based communication exchange for healthy homes professionals. 

Milestone 4.  Healthy housing training centers are established throughout the U.S. and an

infrastructure of professionals trained in healthy housing principles has been 

created.  

Outcomes: a) healthy housing training centers offering recognized courses 

are established throughout the U.S.; b) a workforce of trained and credentialed 

healthy housing professionals is established throughout the U.S.; c) the 

effectiveness of the training is formally evaluated and the training is modified 

based on the findings. 

Milestone 5.  A majority of health and housing programs in major metropolitan areas have 

developed healthy homes programs or incorporated key healthy homes 

components into existing home visitation programs. 
32

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Appendix A:  The Current State of Health and Hazards in Housing

The Healthy Homes program has evolved to address multiple housing hazards that have the 

potential to impact residents’ lives in a cost‐effective manner. Research has shown, and 

continues to clarify, the relationship of housing conditions and how residents’ actions can lead 

to potential illness or injury. Current research has identified a relationship between the home 

environment and the following health conditions: allergies, asthma, unintentional injuries, 

poisoning, cancer, and heart disease. Mold, moisture, contaminated dust, and poor indoor air 

quality are common housing conditions that pose a hazard to residents’ health. There are 

certain hazards for which research is more conclusive. For example, the relationship between 

lead exposure, lead poisoning and the benefits of lead hazard control is well understood. In 

other areas, such as the relationship between mold exposure and the development of asthma, 

further study is needed to devise effective prevention and intervention techniques. This section 

is organized by the health condition, and provides a summary of its impact and cost burden 

(“Health and Cost Burden”), and the evidence that links it to housing, with the recommended 

intervention (“Home Connection.”) 

Asthma and Allergies

The Health and Cost Burden – Asthma and allergies take a heavy toll on quality of life and 

contribute significantly to health care costs. Asthma, which is more common in people with 

known allergies (i.e., atopic), impacts over 20 million Americans, creating a financial burden 

and decreased quality of life (CDC, 2008d). Asthma is recognized as a leading cause of school 

and work absences, emergency room visits, and hospitalizations. Direct health care costs for 

asthma in the United States total more than $14.7 billion annually; indirect costs (lost 

productivity) add another $5 billion for a total of $19.7 billion (Figure 2). Children under the 

age of 18 make up about a third, or almost 7 million, of those diagnosed with asthma (CDC, 

2008d). This leads to 12.8 million missed school days and nearly four million children who 

have had an asthma attack in the previous year (CDC, 2006a). The CDC estimates that, in 2005, 

there were 3,884 asthma deaths (CDC, 2008a).

Research indicates that allergies affect over 50 million Americans, and a recent  nationwide 

survey found that more than half of the population tests positive to one or more allergens 

(Gergen et al., 1987; Arbes et al., 2005). Allergic disease costs Americans $7.9 billion annually, 

with $4.5 billion spent on direct medical care (Stempel, 1997).
41

Source: NIH, 2007

Asthma disproportionately affects children from lower‐income families and from specific racial 

and ethnic groups. In 2005, 13 percent of black children were reported to have asthma as 

compared with 9 percent of both Hispanic and white children (Figure 3). While epidemiological 

data is limited, Tribal Health Officials report that asthma is increasing in American Indian (AI)/

Alaskan Native (AN) children. Asthma rates are also higher in AI/AN children than in the 

general population, estimated at 13% compared to 8.9% in 2008 (Brim, 2008). In the report of 

the “Great Plains Asthma Education Conference” in 2006, health officials cited exposure to 

mainstream and sidestream tobacco smoke, the use of wood‐burning stoves, a high incidence of 

attacks of respiratory viruses in infants, and co‐morbidity of asthma with obesity as major 

factors in the prevalence. While indoor smoking and ventilation are housing‐related causes, the 

relationship of asthma to tribal housing conditions is an area where more research is needed. 

While children are the population most at risk for developing asthma, there is a growing need to 

address the onset of new cases in older adults, and to examine how their risk factors might 

differ from those of children (Selgrade et al., 2006).

Figure 2: Distribution of Asthma Cost in the U.S. (2007): 

$19.7 Billion in Total Costs
42

Source: CDC, 2008d

The Home Connection – Both genetic and environmental factors play an important role in the 

development of allergies and asthma. Allergens not only trigger asthma symptoms, they are 

considered to be a major cause of the disease as well (NIH, 2008). More than half of the 20 

million Americans diagnosed with asthma are considered to be allergic asthmatics (Arbes et al., 

2007). In these cases, airborne particles, or allergens, trigger allergic responses that lead to 

asthma attacks. In addition to acting as triggers, research indicates that residential exposure at 

a young age to some allergens and irritants can lead to the development of asthma (Selgrade et 

al., 2006). Important residential allergens are associated with dust mites, cockroaches, rodents, 

mold, pollen, and animal dander, while important non allergen asthma triggers include chemical

residues in dust, combustion products (e.g., nitrogen dioxide), and environmental tobacco 

smoke. 

The presence of significant levels of allergens in house dust is relatively common in U.S. homes. 

Results from the National Survey of Lead and Allergies in Housing (NSLAH), conducted by HUD 

and the NIEHS in 2000, indicate that approximately 46% of surveyed homes had elevated levels 

of  at least three allergens (Salo et al., 2008). Cockroach levels high enough to trigger asthma 

symptoms were found in dust from approximately 10% of kitchens (Cohn at al., 2005).

Residential exposures to allergen and non‐allergen triggers have been attributed to 

approximately 39% of new asthma cases in children less than 6 years, and to approximately 

44% of new and existing asthma cases in children 6‐16 years (Lanphear, 2001a; 2001b). In a 

study that primarily involved minority children from low income households , 69% of inner city 

children diagnosed with allergic asthma were sensitive to cockroaches, 62% to dust mites, 50% 

to mold, and 33% to rodents (Morgan et al., 2004; Gruchalla et al., 2005). Allergens in rodent 

urine can also contribute to asthma severity (Erwin et al., 2003).  

Environmental interventions often focus on eliminating allergen sources, such as pests and 

mold, and controlling dust, which is a reservoir for allergens. Such interventions have proven to 

Figure 3: Current Asthma

Prevalence in the U.S. (2006 )

9

6

8

1 3

9 9

0

5

1 0

1 5

Black Hispanic White

Race/Ethnicity

P

erc

e

nt

Total Children
43

be effective as components of multifaceted interventions that also include health education and 

optimization of medical care. Common environmental interventions include the installation of 

impervious pillow and mattress covers, use of HEPA vacuums and air filters, specialized 

cleaning, and IPM (NCHH, 2009). Interventions to reduce non‐allergenic triggers include 

eliminating secondhand smoke from the home and ensuring proper ventilation and 

maintenance of heating systems and cooking appliances that produce combustion products.

Excess moisture can amplify levels of allergens such as dust mites and mold, and can support 

pest populations. Damp indoor environments are themselves associated with increased asthma 

and other respiratory symptoms (IOM, 2004). Excess indoor moisture can be due to insufficient 

ventilation or water intrusion, related to both residents’ lifestyle habits and a home’s physical 

condition. It is estimated that 21 percent of asthma cases in the U.S. are linked to dampness and 

mold, at an annual cost of $3.5 billion (Mudarri and Fisk, 2007). Mold and moisture 

intervention work (e.g., dehumidification, elimination of water intrusion, removal of mold, 

ventilation improvements) has had promising results in controlling asthma symptoms, but its 

widespread implementation still requires additional field testing (Kercsmar et al., 2006). In 

HUD’s Mold and Moisture Problems in Native American Housing on Tribal Lands: A Report to 

Congress, mold was present in 15% of homes surveyed. Indian housing is likely more 

susceptible to mold and moisture problems due to increased overcrowding, insufficient thermal 

insulation, physical deterioration, poor site conditions and depressed socioeconomic 

conditions. 

Unintentional Injuries and Poisoning

The Health and Cost Burden – Injuries cause emotional, physical, and economic stress. Injuries 

and deaths from falls, fire, drowning, poisoning,  suffocation, and choking all occur in and 

around the home; the CDC estimates that approximately half of all injuries occur in and around 

the home (CDC, 2008b). Injuries can lead to chronic pain, loss of income, stress, and change in 

lifestyles, impacting the injured and their family and friends.  

Unintentional injury is now the leading cause of death and disability among children younger 

than 15 years of age. A recent HUD‐supported study of deaths among U.S. children and 

adolescents from 1985 to 1997 found that an average of 2,822 unintentional deaths occurred 

annually from residential injuries (Nagaraja et  al., 2005). The highest death rates were 

attributable to fires, submersion or suffocation, and poisoning. Black children were two times 

as likely to die from residential injuries as were white children (Figure 4). Injury in AI/AN 

children is also of special concern. A report from the Great  Lakes Inter‐Tribal Epidemiology 

Center (serving tribes in Minnesota, Wisconsin, and Michigan) indicated that the unintentional 

injury age‐adjusted mortality rates were 70 per 100,000 for AI/AN, vs. approximately 40 per 

100,000 for all races in the three‐state region between 2002 and 2006. 
44

Source: Nagaraja et al., 2005

The elderly are also at an elevated risk for residential injuries (Figure 5). Unintentional fall

rates among elderly Americans have been increasing in recent years. While the exact cause of 

the increase is not well understood, one explanation is that Americans are living longer and 

choosing to age in place in their homes. The fact remains that falls are the leading cause of 

injury death for Americans 65 years and older. Each year, about 35% to 40% of adults 65 and 

older fall at least once (CDC, 2007b). It is estimated that falls account for 33% of injury‐related 

medical expenditures and cost Americans more than $38 billion annually (CDC, 2004).

Figure 5: Unintentional Fatal Fall Rates among U.S. Men 

and Women Aged 65 Years and Older (1994-2003)

Source: CDC, 2006c
45

Although poisoning is considered an unintentional injury, the substantial health hazard it alone 

poses warrants further exploration. Household poisoning results in millions of injuries 

(including death) and billions of dollars spent in the U.S. each year. The American Association of 

Poison Control Centers (AAPCC) reported that in 2005 nearly 2.5 million people were involved 

in poison exposure incidents (Lai et al., 2006). In that same year, 828,899 injuries and 32,691 

deaths were attributed to poisoning; 74% of these were unintentional (CDC, 2008e). In 2000 

alone, it is estimated that poisonings led to $26 billion in medical expenses (Finkelstein et al., 

2006). More than 90% of all cases of exposure occur in the home, and well over half of these 

victims are children (Lai et al., 2006). Children are at greater risk for household poisoning, 

because they are both more likely to be exposed and more susceptible to adverse effects. 

Common sources of  household poisonings include lead, combustion products, pesticides, 

volatile organic compounds (VOCs), cleaning supplies, automotive products, and 

pharmaceuticals.

The Home Connection – Unintentional injuries can be prevented by modifying the  home 

environment and educating residents about risks. Some adjustments to the home, such as 

installing smoke alarms, fencing around pools, and water heaters with pre‐set safe 

temperatures are effective injury prevention interventions. Other modifications (e.g., handrails, 

grab bars, lighting improvements, and window guards) have also had promising results but will

require more field testing. Implementation of injury prevention‐related  safety education, 

building codes, and community based initiatives also need further research (NCHH, 2009).   

Poisonous substances such as cleaning products, pesticides, cosmetics and medications should 

be stored high in a locked cabinet, out of the reach of children. Households can also be 

encouraged to replace toxic substances (e.g., cleaning products, pesticides) with non‐toxic or 

less toxic alternatives.

Important Residential Contaminants

Lead

The Health and Cost Burden –  Although national blood lead levels have fallen over the last 

several decades (Figure 6), lead poisoning continues to pose a threat to many children. 

Reported cases of childhood lead poisoning have declined significantly over the past two 

decades; however, the most recently published federal estimate, for 1999‐2002, was that 

310,000 U.S. children still have elevated blood lead levels (i.e., ≥10 micrograms per deciliter) 

(CDC, 2005).  

Lead poisoning may cause a range of health problems, including: damage to the brain and other 

vital organs, behavioral problems, learning disabilities, seizures, and in extreme cases, death. 

Recent research indicates that even relatively low blood lead concentrations in children and 

adolescents may be associated with deficits in cognitive and academic skills (Lanphear et al., 

2000; Canfield et al., 2003). Thus, despite progress in this area, it is clear that lead poisoning 

continues to be a substantial health risk for young children. The monetary costs associated 

with lead poisoning are also quite large; a 2002 study estimates that childhood lead poisoning 

costs Americans approximately $43.4 billion annually (Landigran, et al. 2002) primarily in lost 

wages and lifetime earning power. Although lead poisoning can affect children from all social 
46

and economic levels, those living at or below the poverty line in older (especially pre‐1940) 

housing are at the greatest risk. A disparity also exists among racial groups; the most recent 

published estimates show 3% of black children and 2% of Mexican American children have 

elevated blood lead levels, as compared to only 1.3% of white children (Schwemberger et al., 

2005).

       Source: CDC, 2005 (from multiple National Health and Nutrition Examination Surveys)

The Home Connection – A large reservoir of lead remains in and around housing, but corrective 

measures have proven to be successful. HUD’s 2000 NSLAH found that, overall, approximately 

40% of U.S. housing units contain lead‐based paint, and 25% have one or more significant lead‐

based paint hazards. The prevalence of lead hazards was strongly associated with housing age, 

with hazards identified in 68% of pre‐1940 housing units compared to 8% of homes built 

during the period from 1960 – 1977 (Jacobs et al., 2002). Further, it was found that 

approximately 1.2 million of these housing units were home to low‐income families with 

children under the age of six (Jacobs et al., 2002). Fortunately, evaluations indicate that lead 

hazard control interventions can be effective in significantly reducing lead levels in the home. 

Corrective measures include: paint stabilization, moisture control, treatment of friction 

surfaces, and enclosure and removal of certain building components coated with lead paint, 

cleanup, and “clearance testing,” have been shown to be effective in reducing dust‐lead levels 

over an extended period (Galke et  al., 2001; Wilson et al., 2006). However, lead hazards can 

redevelop if the home is not properly maintained.  

Figure 6: Decline in Children’s Blood Lead Levels 

due to Regulation
47

Mold and Moisture

The Health and Cost Burden – Mold (fungi) exposure can cause or is associated with adverse 

health effects in addition to those associated with allergic sensitization (e.g., asthma, rhinitis). 

Immune suppressed individuals can be directly infected by exposure to mold. Exposure to 

mold‐produced toxins in food (i.e., mycotoxins) has been long understood to produce illness 

such as liver cancer from aflatoxin exposure. There is some indication that exposure of infants 

to the toxin‐producing mold Stachybotrys may be related to serous lung injury (referred to as 

acute idiopathic pulmonary hemorrhage); however, the causal relationship has not been 

confirmed (Mazur and Kim, 2006). Exposure to volatile organic compounds that are produced 

by different mold species can also cause irritation of the eyes, nose, and throat as well as 

headache and fatigue. Damp conditions can support the growth of mold, bacteria, and dust 

mites, and research has revealed associations between damp conditions and respiratory illness 

without identification of the underlying causal agent(s) (IOM, 2004).

The Home Connection – It is important to mitigate all sources of excess moisture in homes, 

including both interior and exterior sources. Effective measures include sloping soil so water 

drains away from foundations, repairing/redirecting down spouts, promptly fixing leaks 

through the building envelope and plumbing leaks, and ensuring that the home has adequate 

ventilation. Mold can grow on any organic substrate (paper, wood, and textiles) if moisture 

levels are sufficiently high. Moldy porous materials that cannot be cleaned should be removed 

and discarded using proper precautions (U.S. EPA, 2002a). 

Pesticides

The Health and Cost Burden – Pesticides are one of the most common substances associated 

with poison exposures in the U.S. In 2005, the American Association of Poison Control Centers 

reported 101,746 pesticide exposure incidents, 23 of which led to fatalities (Lai et al., 2006). 

Almost half of these incidents (49,232) involved children younger than 6 years (Lai et al., 2006). 

Exposure to toxic pesticides can result in irritation to the eyes, nose and throat; damage to the 

central nervous system and kidneys; reproductive disorders; and an increased risk of 

developing cancer. In particular, organophosphate (OP) pesticides, which account for 

approximately half of all pesticides used in the U.S., can affect the respiratory and nervous 

systems (CDC, 2005).  

The Home Connection – Use of toxic pesticides is widespread in American households. EPA 

estimates that Americans use over five billion pounds of pesticides each year, and that 74% of 

U.S. households use pesticides in the treatment of rodent and insect infestations (U.S. EPA, 

2004). Pesticide residues can remain in homes for a  considerable time period. A  national 

survey that was recently conducted by HUD and the U.S. EPA found residues of DDT and 

chlordane, in 41% and 64% of homes, respectively, even though the use of these pesticides have 

not been used for more than 20 years (Stout et al., 2009). To diminish the risk of poisoning, a 

recommended alternative approach to rodent and insect control is IPM, which, as discussed 

earlier, minimizes the use of pesticides.
48

Airborne Contaminants 

Research has demonstrated that contaminant levels in the indoor environment are often 

considerably higher than in outdoor air (Mitchell et al., 2007). Important contaminants in 

indoor air with respect to occupant health include carbon monoxide and other combustion 

products, environmental tobacco smoke, radon, and volatile organic compounds.  

Carbon Monoxide

The Health and Cost Burden – Exposure to high doses of combustion products can lead to 

severe and even fatal consequences. The burning of any fuel, such as oil, natural gas, kerosene, 

and wood, can release a variety of combustion products of health concern, including carbon 

monoxide (CO), nitrogen oxides (respiratory irritants), polycyclic aromatic hydrocarbons (e.g., 

the carcinogen benzo[a]pyrene), and airborne  particulate matter (can adversely effect 

respiratory and cardiovascular systems). Each year, exposure to CO results in approximately 

500 deaths and 15,000 emergency department visits (CDC, 2007a). A poisonous gas, CO cannot 

be seen, smelled, or tasted, and in large doses it can cause long‐term neurological disabilities, 

coma, cardio‐respiratory failure, and death. Chronic low‐level exposure can also pose a health 

hazard, causing viral‐like symptoms, such as fatigue, dizziness, headache, and disorientation. 

Fatal and non‐fatal CO poisonings can result from exposure to motor vehicle exhaust or from 

exposure to consumer products in the home. The middle‐aged or elderly account for nearly 

60% of unintentional CO fatalities in the home. Risk factors for older adults include pre‐existing 

medical conditions that affect tolerance to carboxyhemoglobin, alcohol and recreational drug 

use, and the tendency to own older consumer products (CPSC, 2004). Unborn fetuses are also 

at increased risk for CO poisoning, as fetal CO accumulation may differ from the mother’s 

(Abelsohn et al., 2002; Liu et al., 2003).

The Home Connection – Improper venting, poor maintenance, and misuse of heating systems 

and cooking appliances can dramatically increase exposure to CO and other combustion 

products. It is estimated that 64% of CO‐related emergency room visits and 66% of CO fatalities 

are attributable to household exposures (CDC, 2007a; CPSC, 2004). Notably, the greatest 

numbers of CO deaths occur in winter months and after natural disasters, when residents are 

more  likely to use fuel‐burning furnaces and alternative heating and power sources indoors, 

such as portable generators, charcoal briquettes, and propane stoves or grills (CDC, 2007a). 

Other practices that can result increased levels of combustion products include the use of gas 

ovens or stoves for heating, the use of unvented portable heaters, and idling cars in attached 

garages. Preventative measures include proper installation, use, and maintenance of fuel‐

burning appliances, installation of ventilation fans in garages, the use of CO detectors, and 

increased public education efforts.

Environmental Tobacco Smoke (ETS)

The Health and Cost Burden – Exposure to ETS, or secondhand smoke, can cause respiratory 

illness, heart disease, cancer, as well as other adverse health effects (HHS, 2006). Each year in 

the United States, secondhand smoke exposure is responsible for 150,000 to– 300,000 new 

cases of bronchitis and pneumonia in children aged less than 18 months. Exposure of adults to 

secondhand smoke has immediate adverse effects on the cardiovascular system and causes 
49

coronary heart disease and lung cancer. Exposure to ETS kills approximately 46,000 adult 

nonsmokers from coronary heart disease and 3,000 from lung  cancer each year (HHS, 2006). 

The elderly in particular bear a disproportionate burden of the negative effects of smoking and 

secondhand smoke. Every major cause of death among the elderly – cancer, heart disease, and 

stroke – is associated with smoking or secondhand smoke. Overall, it is estimated that 

approximately 50,000 deaths result annually from exposure to secondhand smoke (CA EPA, 

2006).

The Home Connection – Indoor air quality can be improved by removing environmental tobacco 

smoke from the home. The Surgeon General has concluded that eliminating smoking in indoor 

spaces is the only way to fully protect nonsmokers from secondhand smoke exposure. It has 

been demonstrated that eliminating exposure to smoke can result in health improvements at 

any age, including in those 65 and over (TCSG, 2001). Because ETS can migrate between units 

in multifamily housing, it is especially important that the availability of smoke‐free multifamily 

housing be increased. However, while non‐residential smoking bans have proven to be effective 

in reducing exposure to ETS, the same evidence does not yet exist for efforts to support smoke‐

free home policies.

Radon

The Health and Cost Burden – Radon is a radioactive, odorless, colorless gas that occurs 

naturally in the earth’s crust and can percolate up to the surface either through porous soils or 

water. Exposure to radon gas leads to approximately 20,000 annual lung cancer deaths (U.S. 

EPA, 2008b). It is the leading cause of lung cancer among nonsmokers (U.S. EPA, 2008b), and 

the risk is even greater for smokers due to the synergistic effects of radon and smoking. 

Excessive exposures in the home are typically related to ventilation, structural integrity and 

geographic location.

The Home Connection – Radon can enter homes through openings in floors and  walls and 

through water. Homes can be easily tested for radon gas using short term tests (2 to 6 days) or 

long term tests (> 90 days). If elevated levels are detected, a radon mitigation system can be 

installed which vents radon gas from under the foundation of the home through a pipe to the 

outside. Research indicates that active systems placed in homes in high‐risk areas post‐

construction have effectively lowered radon levels. The most cost‐effective approach is to 

incorporate radon resistance into new construction. Some interventions to remove radon from 

water have had promising results as well. Passive systems (no operating fan), particularly those 

in new construction, are still in need of formative research (NCHH, 2009).

Volatile Organic Compound s (VOCs)

The Health and Cost Burden – Individual VOCs vary greatly in their potential health impact, 

ranging from compounds that pose very little health risk to those such as benzene, which is 

classified as a known human carcinogen (U.S. EPA, 2009). Information on human health effects 

is generally based on research in occupational settings where exposure levels are generally 

much higher than in homes. Exposure to VOCs can result in eye, nose, and throat irritation, as 

well as nausea, headaches, and loss of coordination (U.S. EPA, 2007). There is also limited 

evidence that exposure to VOCs can exacerbate asthma (Mitchell et al., 2007). Formaldehyde, a 
50

VOC that is commonly found in indoor air because of its use in consumer products and building 

materials (e.g., plywood and other manufactured wood products), can cause can cause irritation 

to the eyes, nose and throat, at relatively low levels and is classified as a probable human 

carcinogen by the International Agency for Research on Cancer (IARC, 2008).  

The Home Connection – Indoor air quality can suffer as a result of high indoor concentrations of 

VOCs. VOCs can be found in synthetic paints, glues, polishes, waxes, carpets, plastics, cabinets, 

air‐fresheners, and building materials commonly used in households. As a result, indoor VOC 

concentrations tend to be two to five times higher than outdoor concentrations (U.S. EPA, 2007). 

The interactions between VOCs and other indoor air contaminants, including combustion 

products, are likely complex and may contribute to the production of any number of secondary 

pollutants including particulate matter (Mitchell et al., 2007). Improper venting and misuse of 

products containing VOCs can exacerbate this indoor air quality problem (U.S. EPA, 2007). 

Construction of detached garages is an important way to lower indoor VOC concentrations, as 

many VOC‐emitting materials are stored there, and overall, the use of VOC‐emitting products 

should be limited when possible (NCHH, 2009).  Low‐ or no‐VOC emitting alternatives are now 

available for many products used in the home, including: paints, primers, sealants, adhesives, 

carpets, and flooring materials. These products are often included in green construction 

specifications. 

Additional Hazards 

In addition to the health conditions discussed in this Appendix, there are many other potential 

residential health hazards for which the evidence linking illness or injury to the home 

environment is not as clear. Emerging issues of concern include deficiencies in and around the 

home, such as a lack of green space, security, or adequate drinking water. Poor outdoor air 

quality may have effects in the home as well, as polluted air migrates indoors. Bed bug 

infestations, once thought to be have  been largely eradicated in the U.S., have reemerged in 

recent years, particularly in urban centers. Though the current evidence does not suggest that 

they, like other pests, carry infectious diseases or have a link to allergies or asthma, their bites 

can be associated with  itching and  skin infections. Also, bed bug  infestations are often 

controlled using multiple applications of  pesticides, which can be costly and present an 

exposure hazard to residents. 
51

Appendix B:  HUD Healthy Homes Activities and Accomplishments

As a pioneer of the healthy homes concept, the HUD’s Healthy Homes program has contributed 

to the understanding of housing conditions and their links to residents’ health and effective 

interventions and preventive measures. Great strides have been made to validate the healthy 

homes concept and set the stage to improve the lives of the most vulnerable populations. 

Progress has been the result  of grant programs, interagency agreements, contracts, and 

collaborations with other HUD offices. Healthy Homes program activities have focused on four 

categories: 1) supporting research; 2) intervention implementation; 3) outreach and education; 

and 4) creating tools and resources. Since FY 1999, 123 grants have been awarded for a total of 

approximately $100 million. Outreach and education promotes the healthy homes concept to 

the general public and educates housing professionals. Over 20,000 people have been trained 

in healthy home concepts through grant activities, and more than 1.5 million individuals have 

been reached by grantee education and outreach. Tools and resources are provided to grantees 

and local health and housing  programs to establish local capacity to address home hazards. 

Research projects are solicited to provide insight into key knowledge  gaps on housing and 

health, and interventions are performed to directly improve the quality of life of residents. 

Reflecting on past successes allows us to determine where resources have been effective and 

what future activities would best compliment current achievements and advance the field of 

healthy housing.

Research and Evaluation

It is critical to understand how elements in the home environment impact health and to 

determine the best methods to identify and control residential hazards with the greatest 

efficacy and efficiency. There is considerable information about lead hazard control strategies; 

however, the best remediation and hazard control techniques for other residential hazards in 

the home are not yet as well understood. The OHHLHC supports a variety of research and 

evaluation activities on a range of healthy homes issues such as the development of improved 

protocols for mold sampling, developing standardized methods for dust sampling, and 

evaluating the effectiveness of residential interventions to improve asthma control. Research is 

conducted through Healthy Homes grant programs, contracts, and interagency agreements with 

key federal partners. Dissemination of this valuable research is conducted primarily through 

the publication of articles in peer‐reviewed scientific and professional journals and the 

presentation of findings at national conferences. To date, OHHLHC grantees and partners have 

published more than 30 papers on healthy homes research issues with more submitted for 

publication.  

Sponsoring Interventions to Mitigate Residential Hazards

Interventions to mitigate residential hazards can directly improve the health and quality of life 

of residents. The Healthy Homes Demonstration (HHD) grants have facilitated improvements in 

thousands of units nationwide. As stated in the 2008 HHD NOFA, the goal of the grant program 

is to “Develop and implement demonstration projects that address multiple housing‐related 

problems affecting the health of children and other sensitive subgroups.” In recent years, the 

HHD NOFA has placed greater emphasis on therequirement that grantees evaluate the efficacy 

of interventions, including cost‐effectiveness. Intervention strategies can range from education‐

focused approaches to those that consist primarily of physical upgrades to new or existing 

homes, although most Healthy Homes program‐supported interventions are multifaceted in 
52

nature. To date, more than 7,500 interventions have been conducted nationwide using healthy 

homes principles.  

Outreach and Education

OHHLHC activities support public education and outreach that furthers the goal of protecting 

children and other vulnerable populations from residential hazards. Activities have focused on 

three main objectives: increasing general awareness of residential hazards, educating residents 

about preventive measures, and reaching out to housing and health professionals. The OHHLHC 

has supported grants with education and outreach components, funded the creation and 

dissemination of targeted educational materials, and entered interagency agreements to 

develop and provide training programs.  

Tools and Resources

The OHHLHC has developed various tools and resources through its grantees to help ensure 

that local healthy homes programs are successful and sustainable. Issue papers, assessment 

tools, sampling methods, guidance documents, and general publications are available to assist 

grantees, researchers, residents, and other housing and health agencies. These resources help 

to establish best practices and disseminate up‐to‐date information in an effort to increase 

effective and efficient identification and control of home hazards – and are available to the 

public (in limited quantities) at no cost. Materials have thus far been developed primarily 

through contracts and interagency agreements.                                                                                              

Highlights of the Healthy Homes program’s accomplishments over the last decade:

Research and Evaluation

o A randomized controlled trial in Cleveland, Ohio demonstrated significant improvement 

in asthma symptoms (including reduced acute care usage) among children following 

remediation focusing on mold and moisture problems in their homes (Kercsmar et al., 

2006).

o HUD teamed with the NIEHS to implement the National Survey of Lead and Allergens in 

Housing in 1999/2000. The survey resulted in estimates of the prevalence and 

distribution patterns for lead‐based based paint hazards  in U.S. housing and the first 

national estimates of the distribution pattern of key residential allergens in the nation’s 

housing (Jacobs et al., 2002; Arbes et al., 2003; Cohn et al., 2005).  

o Development of the Environmental Relative Moldiness Index (ERMI), which is based on 

objective, DNA‐based analyses, through cooperative research between a grantee and an 

EPA scientist. Continued cooperation between HUD and EPA resulted in the analysis of a 

nationally representative set of dust samples from the American Housing Survey using 

the ERMI (Vesper et al., 2007).

o Contract‐directed research on inter‐laboratory variability in analysis of common 

allergens in residential dust, which has lead to the sponsoring of follow‐up efforts to help 

standardize dust preparation and extraction methods for allergen analyses (Pate et al., 
53

2005). Grant‐funded researchers  are currently testing dust sampling methods in the 

laboratory and field with the goal of identifying an optimum protocol.

o Grant‐funded research conducted by Air Quality Sciences in the Atlanta, Georgia 

metropolitan area documented a low prevalence of water indicator molds in air and 

settled dust of homes without known mold and moisture problems (Horner et al., 2004).

o A study demonstrated that intensive IPM treatments and use of the “dust lead cleaning 

protocol” led to significant reductions in cockroach populations and cockroach allergen 

loadings in heavily infested units of publicly assisted housing (see: http://www.ehw.org/

Asthma/ASTH_HUDRoach_Sum.htm). Additional research in two cities has demon‐

strated the effectiveness and feasibility of an IPM approach in public housing.

Sponsoring Interventions to Mitigate Residential Hazards

o In New York State, the Erie County Health Department and partners worked together to 

provide complete inspections for low‐income families with children moving into rental

housing. Potential renters were identified by the Department of Social Services Housing 

Assistance program and encouraged to participate in the program. Health inspectors 

were then sent to participating locations to identify hazards, and landlords were 

informed of any housing code violations. Landlords were also provided with training 

and materials, such as carbon monoxide and smoke detectors. 

o In Seattle, Washington, a Healthy Homes grant to non‐profit Neighborhood House and 

partners was used to upgrade 35 new green‐built public housing units (built through 

HUD’s HOPE VI program) to “Breathe Easy Homes.” These homes have special features 

to improve indoor air quality and reduce indoor asthma triggers and other air pollutants 

(Takaro et al., 2008).  

o In Cuyahoga County, Ohio, the grantee (Cuyahoga County Board of Health) is partnering 

with a weatherization program to provide an integrated approach to improve both 

energy efficiency and indoor environmental quality. A strategy involving weatheriz‐

ation/healthy homes partnering was also implemented in Washington State though a 

grant to non‐profit, Opportunity Council.  

o Grant‐funded projects to the Boston Public Health Commission and the Harvard School

of Public Health included interventions in private and public housing, respectfully, which 

had strong IPM components. In both instances, evaluations identified improvements in 

the symptoms of asthmatic children following the interventions. 

o In North Carolina, grantee Advanced Energy is studying allergens and health outcomes in 

homes that have been retrofitted with a national high‐performance home specification 

package that aims to manage moisture while improving indoor air quality and energy 

savings.

o In Minneapolis and St. Paul, Minnesota, the City of Minneapolis’ project Environmental

Action for Children’s Health (EACH) involved work with day care providers, local schools, 
54

hospitals, and medical home service providers to identify children with asthma and 

perform home interventions to reduce severity of asthma and improve moisture, safety, 

and ventilation conditions.

Outreach and Education

o Sponsorship of the 2008 National Healthy Homes Conference: Building a Framework for 

Healthy Housing. Working with federal partners CDC, EPA, and USDA, the OHHLHC 

gathered a broad community of experts to discuss regulatory, policy, research, and 

outreach needs and their implications in the development of comprehensive, integrated 

approaches linking health and housing to ensure safe, healthy and efficient homes. The 

conference examined the lessons learned from the national lead poisoning prevention 

strategy and the current state of the art in order to begin building the framework needed 

to develop a national healthy housing agenda. More than 1500 policy‐makers, 

practitioners, and members of the public attended the three‐day event held in Baltimore.

o Sponsorship of HUD’s Healthy Homes for Healthy Kids Campaign, a traveling exhibit that 

disseminates health and safety messages in a “home environment.” The exhibit includes 

a Healthy Homes Pavilion and has been displayed at fairs and community events 

throughout the country. HUD’s Office of Field Policy and Management (FPM) has 

provided the OHHLHC with critical support on this campaign, contacting local officials, 

coordinating participation, offering Public Affairs assistance, and attending program 

planning meeting to provide local insight. A USDA extension agent also conducts “peer‐

to‐peer” training to community residents at locations where the pavilion has been 

exhibited.

o Development of a National Healthy Homes Training Center and network through an 

interagency agreement with the CDC. This training center offers a two‐day course, 

delivered through a nationwide network, on basic healthy homes principles for housing, 

health and other professionals, and is developing specialized pilot courses geared 

towards key audiences and emerging trends. 

o Reaching an estimated  1.6 million consumers through the USDA’s CSREES,  which 

partners with universities and other federal agencies to offer public outreach and 

education. An interagency agreement with USDA allowed the OHHLHC to tap into their 

existing national infrastructure to reach the general public and disseminate information 

to healthy homes training programs within the CSREES network. Support is also 

provided in coordination with both CSREES and the Alabama Cooperative  Extension 

System through a Healthy Homes Partnership website, which is a listing of healthy 

homes resources available by state (http://www.healthyhomespartnership.net).

o Coordination with PIH to provide IPM training for public housing authority staff through 

a USDA interagency agreement. In May 2007, PIH distributed a Notice on IPM to all

public housing agencies, encouraging them to explore IPM implementation options. The 

OHHLHC is working with PIH to supplement this Notice with IPM education and training 

for agency staff.
55

o Development of educational material including DVDs, fact sheets, websites, an online 

nurses training site, and publications for diverse audiences, with the help of various 

federal partners and grantees. Specifically, through an interagency agreement with 

USDA, the OHHLHC has supported the development of the booklet, Help Yourself to a 

Healthy Home (English, Spanish, Hmong, Vietnamese and Bosnian) and the DVD and User 

Guide Healthy Homes:  Assessing Your Indoor Environment (English, Spanish).

o Development and  distribution of educational material regarding safe rehabilitation 

practices to home owners and others involved in the rebuilding of areas hit by natural 

disasters. Rebuild Healthy Homes: Safe Rehabilitation of Hurricane­Damaged Homes was 

created specifically for students helping in the clean up efforts after Hurricane Katrina. 

Post‐flooding rehab guidance was also developed in English and Spanish through a joint 

project with HUD’s Office of Policy Development and Research (PD&R). The OHHLHC 

distributed this guidance to state task forces assembled to address flooding in the 

Midwest. 

Tools and Resources 

o A National Healthy Homes Clearinghouse created by the National Center for Healthy 

Housing with the support of a HUD‐CDC partnership. The Clearinghouse is a first cut at a 

centralized website for information on healthy homes issues and contains over 600 

articles, including federal publications and peer reviewed journals. 

o A Healthy Housing Reference Manual and the accompanying Healthy Housing Inspection 

Manual drafted through an interagency agreement with the CDC. The Inspection Manual

covers a variety of housing‐related hazards and is intended to be a voluntary assessment 

tool, for use (specific sections or in its entirety) by property managers, code officials, 

environmental, public health,  housing, energy conservation, and weatherization 

professionals.

o Guidance on moisture resistant construction, published in coordination with the 

Partnership for Advancing Technology in Housing (PATH) within PD&R.

o Development of an initial Weatherization Plus Health assessment tool through a contract 

with ICF International. The tool incorporates health concerns into a weatherization 

assessment and is being used by current as well as former grantees.

o Developed a tool to assist Healthy Homes Technical Studies and Demonstration grantees 

in developing quality assurance (QA) plans and established a dust sampling protocol for 

Healthy Homes grantees to use for collecting dust samples for allergen analyses. A 

system was also established to provide grantees with quality control dust samples for 

allergen analyses. 

o Established a protocol for grantees to collect household dust samples for allergen 

analyses. This environmental sampling method protocol, which called for vacuum dust 

collection, was also the result of a contract with Battelle.
56

Appendix C:  Focus Areas of Initial Strategic Planning 

Following are the potential concepts and goals, which were considered during the planning 

process, to be incorporated into HUD’s Healthy Homes Strategic Plan:

1) Promote the inclusion of health considerations into green and energy  efficient 

construction.

2) Increase the emphasis on identifying key research questions and supporting larger, more 

definitive studies.

3) Increase the emphasis on injury prevention in home assessments and interventions.

4) Expand target population (currently children) to include other high risk populations, in 

particular the elderly.

5) Promote healthy housing concepts to strategic private sector entities, such as developers 

and insurance companies.

6) Improve overall dissemination of healthy housing information, including best practices, 

to partners, grantees, and the public.

7) Develop standard, evidence‐based healthy housing assessment tools and intervention 

protocols. 

8) Support the development  of objective standards for what is considered a healthy 

residential environment.

9) Conduct cost/benefit analysis on the effectiveness of a healthy homes approach through 

the analysis of health and financial outcomes.

10) Increase collaboration internal to HUD and with other federal housing programs.

11) Promote healthy housing concepts in post‐disaster environments, such as the 

dissemination of information on safe rehab and recovery practices.

12) Promote the incorporation of healthy homes principles into ongoing practices/systems. 

Examples include housing codes, rehab specs used by housing and development 

agencies, and maintenance plans for multifamily housing (with a particular focus on the 

incorporation of IPM in low‐income housing).
57

Appendix D:  Abbreviations Used in this Document

AHHS American Healthy Homes Survey

AI/AN American Indians/Alaskan Natives

CDC U.S. Centers for Disease Control and Prevention

CPD HUD’s Office of Community Planning and Development

CO Carbon Monoxide

CSREES USDA’s Cooperative State Research, Education, and Extension Service

DOE U.S. Department of Energy

EPA U.S. Environmental Protection Agency

ETS Environmental Tobacco Smoke

OHHLHC HUD’s Office of Healthy Homes and Lead Hazard Control

HHD OHHLHC’s Healthy Homes Demonstration grant program

HHI OHHLHC’s Healthy Homes Initiative  

HHTS OHHLHC’s Healthy Homes Technical Studies grant program

HUD U.S. Department of Housing and Urban Development

IARC International Agency for Research on Cancer

ICC International Code Council

IEQ Indoor Environmental Quality

IPM Integrated Pest Management

NCHH National Center for Healthy Housing

NIEHS National Institute of Environmental Health Sciences

NIST National Institute of Standards and Technology 

NOFA HUD’s Notice of Funding Availability

NSLAH National Survey of Lead and Allergens in Housing
58

OAHP HUD’s Office of Affordable Housing Preservation, Office of Housing

PD&R HUD’s Office of Policy Development and Research

PIH HUD’s Office of Public and Indian Housing

USDA U.S. Department of Agriculture
59
60 Office of Healthy Homes and Lead Hazard Control

U.S. Department of Housing and Urban Development