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HealthyHomesandLeadPoisoningPreventionProgram

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ExecutiveSummary

Theconnectionbetweenhousingandhealthiswellestablished.Numeroushousing‐relatedhealthissues,includingasthmaandrespiratoryillnesses,leadpoisoning,andinjuries,remainmajorpublichealthchallengesinGeorgia.Ahealthyhomesapproachiseffectiveinreducinghousing‐relatedhealthhazards.Thisapproachisorganizedaroundthe“SevenPrinciplesofHealthyHomes,”whichare:

Keepit:

1. Dry2. Clean3. Safe4. Ventilated5. Pest‐Free6. Contaminant‐Free7. MaintainedRecognizinganeedforamoreintegratedapproachtoimprovinghousing‐relatedhealthoutcomes,theGeorgiaDepartmentofPublicHealth(DPH)embarkedonastatewidehealthyhomesstrategicplanningprocessinthefallof2012.DPHrecruitedkeystakeholderstoparticipateasmembersoftheHealthyHomesStrategicPlanningAdvisoryWorkgroup(theAdvisoryWorkgroup).TheAdvisoryWorkgrouprepresentedcollaborationbetweenadiversegroupofindividualsrepresentinglocal,stateandfederalhealthprograms,socialserviceagencies,housingagencies,realtors,non‐profitsandadvocacyorganizations,andmanyothers.Throughthestrategicplanningprocess,theAdvisoryWorkgroupmembersidentifiedsevenelementsthatdescribetheircollectivestatewidevisionforhealthyhomes.Thesesevenvisionelementsandassociatedkeystrategiesinclude:VisionElement1:ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders

1. Implementandlaunchapublicrelationsstrategy.2. DesignanorganizationalstructuretoadvancethehealthyhomesinitiativeinGeorgia.3. Developahealthyhomescertificationor“sealofapproval.”

VisionElement2:Coordinated,appropriate,andeffectivemarketingandeducation1. Developanddisseminatequality,targetededucationalmaterials.2. Identifylegislativechampionstosupportongoingeducationwithlegislators.3. Developastrategicmarketingandeducationplanwithclearpriorities.4. Launchapublicawarenessandeducationcampaign.5. Identifyfunderstosupporteducationalandpromotionalmaterials.

VisionElement3:Effectivepoliciesandstrongenforcement

1. Educateandmotivatethelegislaturetopassstronglaws.

2. Identifyanddraftneededlegislativeauthoritiesforhealthyhomes.3. Developpersuasive,data‐drivenarguments.4. Convene,convince,andmotivatethepublicandstakeholderstoengageindialoguewith

theirlegislators.5. Implementstatewidecodeenforcementthatisstandardized,effective,andincorporates

healthyhomesprinciples.VisionElement4:Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation.

1. ImplementmandatedreportingofhealthyhomesdatatotheGeorgiaDepartmentofPublicHealth,includinghospitalemergencyroomvisitsduetopoisonings,fallsburns,andasthma.

2. Coordinatethecollectionandmanagementofhealthyhomesdatatoeducateandinformpolicymakersandfunders.

3. Developcomprehensivedatatrackingandsurveillancenetworks.VisionElement5:Diverseresourcesandrevenuegeneratingmechanisms.

1. Communicatethereturnoninvestmentforhealthyhomesactivitieswithpolicymakers,funders,andotherstakeholders.

2. Implementrevenuegeneratingrequirementsforcontractorsandpropertyowners.3. Collaboratewithinsuranceproviderstomandatehealthyhomesassessmentsand

interventionsforspecifichealthcareclaims.4. Conducteffectiveresearchtogarnerfundingsupportforhealthyhomes.5. Ensureefficientuseofresourcesbyestablishingandstrengtheningpartnerships.

VisionElement6:Standardizedprocessesandconsistentimplementation.

1. Identifycommonbenefitsandclearrolesforallstakeholderstosupportcollaborativeparticipation.

2. Establishpropertrainingstandards,qualitycontrol,andcertificationprocesses.3. Conductcross‐trainingofagenciesandorganizationsstatewidetoensureconsistent

approachestoidentificationandremediationofhazards.4. Engagehomevisitingagenciesinintegratinghealthyhomesstandardsintotheirprotocols.

VisionElement7:Healthier,SaferHomesforGenerations.

‐ Thisvisionelementrepresentstheculminatingoutcomethatwouldresultiftheothersixelementsofthevisionwererealized.

Georgiahasanumberofexistingassetstosupportthesestatewidehealthyhomesefforts.Buildingandmaintainingextensivepartnershipsacrossadiverserangeofstakeholderswillbenecessaryforsuccessfulimplementationofthesekeystrategies.Asaresultofthestrategicplanningprocess,AdvisoryWorkgroupmembersagreedtosustaintheircollectiverelationshipandprovidecontinueddirectionandleadershipfortheactivitiesidentifiedinthisstrategicplan.TheirleadershipandcommitmentwillassureGeorgia’sabilitytorespondcollectivelyandindividuallytoanybudgetaryandpoliticalchangesahead.

IntroductionTheGeorgiaDepartmentofPublicHealth’sHealthyHomesandLeadPoisoningPreventionProgram(GHHLPPP)(formallyknownastheGeorgiaChildhoodLeadPoisoningPreventionProgram)hasbeeninoperationsince1992underfundingreceivedfromtheCentersofDiseaseControlandPreventionintheformofcooperativeagreement.Sincethen,GHHLPPPhassuccessfullyworkedtogetGeorgia’shighriskchildrentestedforleadpoisoningwhilealsoidentifyingthosewhoareleadpoisonedandrequiringcasemanagementandenvironmentalfollowup.

ThekeyaimsofGHHLPPPareto:

TransitionintoacomprehensiveHealthyHomesProgramwhilecontinuingtomonitorchildrenforleadexposureandprovidecasemanagementandenvironmentalinvestigationsforleadpoisonedchildren;

Developandimplementastrategicplanforthestatetoreduceoreliminatehousing‐relatedhealthhazardsandtopromotehousingthatishealthy,safe,affordable,andaccessible;

Buildaconsortiumofstrategicpartnerstoaddressunsafeand/orunhealthyhousingconditionscausedbyhousing‐basedhazardsbyleveragingresourcesandseekingsustainabilityinfunding;

Assurethatfollowupcareandinterventionsareprovidedforvulnerablepopulationswhoareidentifiedwithhousing‐relatedhealthissues;

ExpandtheGHHLPPPsurveillancesystemtoincludenotonlybloodleadlevels,butalsoenvironmentaltestsresultsandselectedhealthyhomesvariables;

ConsolidateexistingrelatedDepartmentofPublicHealth(DPH)programsintoacomprehensiveHealthyHomesandLeadPoisoningPreventionProgram;

WorkwithhousingagenciestoenforcehazardreductionininspectedhousingthroughexistingHUDhazardreductionprograms,healthyhomeslocalprograms,andhousingcodeenforcementmechanisms;

EngageourEnvironmentalJusticeandFaithBasedPartnerstoeducatethecommunityconcerningthedangersofhousing‐basedhazards,includingleadpoisoning,andidentifyingvulnerablepopulationsthatmaysufferthemostfromthesehealththreateningsourcesofexposure;

ContributetoDPH’smissionofresponsiblehealthplanningandimprovedhealthoutcomesfortheresidentsofGeorgia;

ExpandGHHLPPPbyaddingstafftraininginhealthyhomesconceptsandimplementinginterventionsandreferralsinresponsetothedetectionofhousing‐basedhealthhazards;

Reducetheoverallcostofexpensivemedicalresponsestoinjuriesandtheexasperationofhealthconditionssuchasasthmabyapplyingprimarypreventionprinciplestoreducehousing‐basedhazardstoreduceexposurepriortoneedingmedicalinterventions;

Employindicatorbasedevaluationtechniquestoevaluateeveryaspectoftheprogramtoincreaseefficiencyandimplementresponsiblehealthcareplanningandutilizationofresources;and

ContinuetotrainandcredentialexistingEnvironmentalHealthBranchandlocalenvironmentalhealthspecialistsinleadinspectiontechniquesaswellasHealthyHomesPractitionerprinciples.

Recognizinganeedforamoreintegratedapproachtoimprovinghousing‐relatedhealthoutcomes,GHHLPPPassembledaGeorgiaHealthyHomesAdvisoryCommitteewiththemissiontodevelopastrategicplantodirectandfocushealthyhomesinitiativesfortheStateofGeorgia.WhatfollowsisacomprehensivehealthyhomesstrategicplantobeimplementedbyGHHLPPPwithintheprogram’skeyaimsinconjunctionwithkeypartneragenciesandorganizations.

WhyDoHealthyHomesMatter?Theconnectionbetweenhousingandhealthiswellestablished.TheU.S.DepartmentofHousingandUrbanDevelopment(HUD)andtheNationalCenterforHealthyHousing(NCHH)havesummarizedalargebodyofscientificresearchdemonstratingthatnumeroushousing‐relatedhazardsposeathreattohumanhealth(HUD,2011;NCHH,2009).ThesehazardsarefrequentlygroupedintofourmajorcategoriesbasedontheAmericanPublicHealthAssociations“BasicPrinciplesofHealthfulHousing”publishedin1938:

PhysiologicalRequirements:Anumberofindoorchemicalcontaminants,includinglead,environmentaltobaccosmoke,carbonmonoxide(CO),radon,volatileorganiccompounds(VOC),asbestos,andpesticides,poseseriousthreatstohumanhealth.

PsychologicalRequirements:Poorlightinghasbeenlinkedwithdepressionandmooddisorders,suchasseasonalaffectivedisorder.Adequatelightingisimportantinallowingpeopletoseeunsanitaryconditionsandtopreventinjury,thuscontributingtoahealthierandsaferenvironment.Noisecancausehearingimpairment,sleepdisturbance,negativecardiovascularandpsycho‐physiologiceffects,psychiatricsymptoms,andpoorfetaldevelopmentandcanalsoreduceattentiontotasksandimpedespeechcommunication.

ProtectionAgainstInfection:Inadequatedesignandmaintenanceofhousingcanresultinconditionsthatfacilitatethegrowthofmoldandbacteriaaswellasinfestationofrats,mice,andotherpests.

ProtectionAgainstUnintentionalInjuries:Inadequateanddeferredmaintenanceofhomes,inadequatedesignofnewhomes,andlackofimportantsafetydevicescanresultinpreventableinjuries,illness,anddeathinthehome.

Thissectionhighlightsthreehousing‐relatedhealthissuesthatwillrequireacoordinated,housing‐basedapproachasakeystrategy:asthmaandrespiratoryhealth,childhoodleadexposure,andunintentionalinjuries.

Asthmaandrespiratoryhealth:Asthmaisachronicdiseaseinwhichtheairwaysofthelungsbecomeinflamedornarrowed,resultingindisruptionstonormalbreathingpatternsandsignificanthealthconsequences.Asthmadisproportionatelyimpactslow‐incomefamiliesandpeopleofcolorlivinginsubstandardhousingbecauseofthepresenceofpests,mold,environmentaltobaccosmoke,andotherasthmatriggers.Mold,pests,andotherallergenscantriggerasthma,whichistheleadingcauseofschoolandworkabsences,emergencydepartmentvisits,andhospitalizationsintheUnitedStates(AmericanLungAssociation,2011).Asthmaresultsinannualcostsof$20.7billiontothenation(AmericanLungAssociation,2011).Exposuretomoldanddampnesswithinhomescontributestoanestimated21%ofallasthmacasesintheUnitedStates(Mudarri&Fisk,2007).Inaddition,dampnesscanleadtoinsomnia,allergies,headache,cough,andotherrespiratoryhealthissues(Eggleston,etal.,2005;Kercsmar,etal.,2006).Chronicobstructivepulmonarydisease(COPD)isthefourth‐leadingcauseofdeathintheUnitedStates(CDC,2010).COPDmaybeexacerbatedbyenvironmentalexposures,includingtobaccosmokeandairpollutants.ThehighestCOPDhospitalizationratesareseenamongolderadults.

Childhoodleadexposure:Housingconditionsassociatedwithincreasedriskofleadpoisoningincludechipping,peeling,andflakingpaintontheexteriorandinteriorofahome;leadpaintonfriction‐impactsurfacessuchaswindows,doors,stairs,andrailings;waterleaks,moistureproblems;andrenovationofoldhouseswithoutproperuseoflead‐safeworkpracticesandclean‐up.Childhoodleadexposureremainsacriticalpublichealthissue.Childrenareexposedtoleadintheirhomesfromdeterioratingleadpaintandthecontaminateddustandsoilitgenerates,leadinwaterfromleadedsupplylinesorplumbing,andothersources.Theconnectionsbetweenleadexposureandnegativehealthimpactsincludeneurologicaldamage,decreasedIQ,increasedbloodpressure,anemia,gastrointestinalissues,stuntedgrowth,seizures,coma,and–atveryhighlevels–death(Gould,2009;Fewtrell,Pruss‐Ustan,Landrigan,&Ayuso‐Mateos,2004).Evenlowlevelsofleadexposurecanhavealastingimpactonachild’sIQ,likelihoodofhavingalearningdisability,andeducationalattainment(Chandramouli,Steer,Ellis,&Emond,2009;Miranda,Kim,Galeano,Paul,Hull,&Morgan,2007;Miranda,Maxson,&Kim,2010).Nosafebloodleadlevelinchildrenhasbeenidentified,emphasizingtheimportanceofprimaryprevention,“astrategythatemphasizesthepreventionofleadexposure,ratherthanaresponsetoexposureafterithastakenplace(AdvisoryCommitteeonChildhoodLeadPoisoningPrevention,2012).”TheCDCreferencevalueforchildhoodleadexposureprovidesawaytocompareanindividualchild’sbloodleadleveltoapopulationofchildrenthesameage(AdvisoryCommitteeonChildhoodLeadPoisoningPrevention,2012).Thecurrentreferencevalueis5microgramsofleadperdeciliterofblood(μg/dL)andwillshiftwithpopulationbloodleadlevels.Morethan535,000U.S.childrenages1‐5haveBLLsgreaterthan5μg/dL(MMWR,2013).

Unintentionalinjuries:Inadequateanddeferredmaintenanceofhomes,inadequatedesignofnewhomes,andlackofimportantsafetydevicescanresultinpreventableinjuries,illness,anddeathinthehome(HUD,2011).Theleadingcausesofdeathinthehomearefalls,drowning,fires,poisoning,suffocation,choking,andguns.Fallsaloneaccountforoverhalfofallunintentionalhomeinjurydeaths.Veryyoungchildrenandadultsoverage70arethemostlikelytobehurtathome.Poorlydesignedhomescanalsoprovideanunsafeorunsuitableenvironmentforolderadultsandpeoplewithadisability.Becauseoffalls,manyeldersexperiencedevastatingconsequencessuchasbrokenbonesandheadinjuries.Eachyear,approximately18,000injurydeathsand12millionnon‐fatalinjuriesoccurnationallywithinhomes(Runyan,etal.,2005a;Runyan,etal.,2005b).Fallsaccountforoverhalfofallunintentionalinjurydeathswithinthehome(Runyan,etal.,2005b);fires,drowning,poisoning,suffocation,choking,andgunsareotherleadingcausesofdeathinthehome.

UsingaHealthyHomesApproach

Asubstantialevidencebaseofeffectiveinterventionsexiststoaddressthesehousing‐relatedhealthhazardsthroughahealthyhomesapproach(U.S.DepartmentofHousingandUrbanDevelopment,2011;NationalCenterforHealthyHousing,2009).A“healthyhome”isahomedesigned,constructed,maintained,orrehabilitatedinamannerthatsupportsthehealthofresidents.Thehealthyhomesapproachsystematicallyandholisticallyidentifiesandaddresseshealthandsafetyhazardsinthehomeenvironment.Applyingahealthyhomesapproachismoreefficientthansingleissue‐focusedprogramsbecauseitpromotescost‐efficienthousinginterventionsthataddress

multiple,interrelatedhealthhazards.Thehealthyhomesapproachisorganizedaroundthe“SevenPrinciplesofHealthyHomes,”whichare:

Keepit:

Dry Clean Safe Ventilated Pest‐Free Contaminant‐Free Maintained

Thehealthyhomesapproachusesthreeinterrelatedstrategiestoaddressenvironmentalhazardsinthehome(HUD,2011).Thesestrategiesinclude:(1)Changesinstructuralconditionsandbuildingpractices;(2)modificationofresidentandpropertyowners’behaviors;and(3)developmentorrevisionofpolicies,legislation,andservicesystemstoenablehealthyhousingpractices(HUD,2011).Extensiveevidenceexiststosupporttheimplementationofspecifichealthyhomesinterventions,suchas(NCHH,2009):

Multi‐faceted,tailoredasthmainterventions Integratedpestmanagement Moistureintrusionelimination Radonairmitigationthroughactivesub‐slabdepressurization Smokingbans Leadhazardcontrol Installationofworkingsmokealarms Pre‐setsafetemperaturehotwaterheaters

Thisevidence‐baseprovidesthefoundationfortheidentifiedpriorityactionstrategiesoutlinedinthisplan.

HousingandHealthinGeorgia–AnOverviewofExistingConditionsToday,mostAmericansspendnearly90%oftheirtimeindoors,andmostlyathome(EPA,2013).Formany,ahomeisconsideredaplaceofsafetyandcomfort,howevertherearepotentialhazardsthatcancauseillnessorinjury.In2009,theU.S.SurgeonGeneralrecognizedthepublichealthimpactsofhousingandissuedanationwideCalltoActiontopromotehealthinhomes.Thissectiongivesanoverviewaboutcurrenttrendsindemographics,housingquality,indoorairquality,asthma,injury,leadpoisoning,andemergencypreparedness.Thissectionalsohighlightscurrentprogramcapacityandactivities.DemographicsGeorgiaishometoadiversepopulationwithavarietyofcultures.Accordingtothe2011U.S.CensusEstimate,thestate’sestimatedpopulationfor2011was9.8million.Ofthistotal,46%ofpeoplearenon‐whiteorHispanicand16%ofindividualslivebelowpovertylevel.InGeorgia,32%percentofhouseholdshaveoneormorechild,19%ofhouseholdshaveoneormoreelderlyresidents,and15%offamiliesarebelowthepovertylevel.Renterscompriseapproximately35%ofresidents,and56%ofrentersand28%ofhomeownerspay35%ormoreoftheirincomeforhousing.IndoorAirQualityIndoorairqualityislinkedwithmanyhealtheffectsincludingasthma,lungcancer,chronicobstructivepulmonarydisease,andotherdiseases.Poorindoorairqualitycannotonlyaffecthealthofadultsandchildren,butalsoachild’sabilitytolearn.InGeorgia,indoorairqualityissuesincludecarbonmonoxidepoisoning,householdchemicalexposure,airbornemoldspores,radongases,volatileorganiccompounds,particulatematter,allergensandenvironmentaltobaccosmoke.BasedonJanuarytoOctober,2012statewideinquiries,themajorityofcallstotheHealthyHomesProgramwererelatedtohealthconcernsfromexposuretomoldormildew.Additionally,86%ofthosecallerswererenters.

ThemostcommonhouseholdpestsinGeorgiaincludeants,cockroaches,fleas,spiders,flies,wasps,rats,bats,mice,and,increasingly,bedbugs(UniversityofGeorgia’sCollegeofAgriculturalandEntomologicalSciences,2013).Pestscarrydisease,exacerbateasthma,andcreateanuisancewheninsideahome.Theprevalenceofpesticideuseinresponsetothesepestspecieshasraisedsignificantconcernoverthepotentialhealtheffectsassociatedwithbothacuteandchronicexposuretothesechemicals(http://portal.hud.gov/hudportal/documents/huddoc?id=DOC_12484.pdf). The GeorgiaDepartmentofPublicHealth

promotesIntegratedPestManagementandsaferalternativestohouseholdchemicalstoassisthouseholdswithreducingpestsandchemicalgasesinsidethehome.CommercialpestcontrolandpesticideapplicationisoverseenbytheGeorgiaDepartmentofAgricultureandtheGeorgiaEnvironmentalProtectionDivision. TobaccosmokeistheleadingcauseoflungcancerintheU.S.(CDC,2013).Eachyear,approximately150,000peoplediefromlungcancerintheU.S.,andlungcanceristhecauseofone

ofeverysixcancerdeaths.InGeorgia,environmentaltobaccosmokehasbeenbannedinmanypublicbuildingsinGeorgiaundertheGeorgiaSmokefreeAirAct(2005),andordinancesexistwhichrestrictsmokingnearpublicentrances.Asthesecondleadingcauseoflungcancer,radonisanotherhealthyhomesconcerninGeorgia.TheU.S.EnvironmentalProtectionAgencyidentifiedmostofnorthGeorgiaasmoderatetohighpotentialforexposuretoradoninhomes.Overthelast25years,therewere1,632homesinGeorgiawithashort‐termradonlevel≥4pCi/L.Whencombinedwithsmokingregularly,aperson’sriskforlungcancerincreasesexponentially.Maintaininggoodindoorairqualitywithproperventilationisessentialforreducingasthmaandotherrespiratorydiseases.Approximately230,000(9%)childrenages0‐17yearsand570,000(8%)adultshaveasthmainGeorgia(2010GeorgiaBRFSS).Asthmaisthesecondleadinghealthproblemamongschool‐agedchildren.Inthepastyear,38%ofchildreninGeorgiawithasthmahadanasthmaattackinthepastyear,and14%ofchildrenwithasthmahadtovisitanemergencyroomorurgentcare(2010GeorgiaProgramandDataSummaryonAsthma).Itisestimatedthathospitalizationchargesrelatedtoasthmatotaledmorethan$132millionandERchargesrelatedtoasthmatotaledover$63millioninGeorgia(2010GeorgiaProgramandDataSummaryonAsthma).InGeorgia,amongchildrenwithasthma,hospitalizationratesarehighestforthoseagesfourandunder(2010GeorgiaProgramandDataSummaryonAsthma).

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Lifetimeasthmaamongadults 11.5% 13.5%

Lifetimeasthmaamongchildren 14.5% 12.6%(38states)

AsthmaEDvisitrateper10,000residents 54.5 55.4

Asthmahospitalizationrateper10,000residents 11.6 14.4

%ofchildrenwhomissedoneormoredaysofschoolduetoasthma

LeadExposureGeorgiahasnearly300yearsofhousinghistory,andmanyofGeorgia’shistorichomescontainlead‐basedpaint.ThroughoutGeorgia,39%ofhomesarepre‐1978and8%arepre‐1950.Withinatwoyearperiod(2010‐2012)GHHLPPPidentified206homeswithconfirmedinteriororexteriorleadhazardsthataredirectlylinkedtopoisonedchildren.Riskindicatorsestablishinghousingashighriskincludelocationinanurbanarea,highnumbersofrentalhousing,andnumbersofMedicaidchildrenasanindicationofsocioeconomicstatus.Riskindicatorswereoriginallyusedtoidentifychildhoodleadpoisoningriskbutcanbeappliedtohealthyhomesriskfactorsaswellduetobuildingconditionandhousingdisparities.

Fig.1.(above)Mapofhigh‐riskhousingcounties,2010.In2011,therewere120,797childrenlessthan6yearsoldtestedforleadpoisoning(GeorgiaDepartmentofPublicHealth,2011).Ofthesechildren,5,361werefoundtohaveabloodleadlevelof5microgramsperdeciliter(mcg/dL)orgreater,and778werefoundtohaveabloodleadlevelof10microgramsperdeciliter(mcg/dL)orgreater.Amongthecasesofleadpoisoning,70%aremanagedcarechildren(GeorgiaDepartmentofPublicHealth,2011).GHHLPPPidentifiedseveralcountiesthroughoutthestatethatposeahigh‐riskforleadpoisoningbasedonleadscreeningdataincluding:

Bibb Fulton Carroll Gwinnett Chatham Hall Cobb Laurens Crisp Muscogee DeKalb Richmond Dougherty Whitfield

Fig.2.Mapofhigh‐riskcountiesidentifiedbybloodleadscreeningdata,2010

InjuriesInjuriesinGeorgiacauseanaverageof4,750deathsperyear.Fall‐relatedinjuriesaretheleadingcauseofhospitalizationsinGeorgia.Poisoningandfallsarethe3rdand4thleadingcauseofinjurydeathinGeorgiaforallages,respectively.Themajorityoffiresoccurinresidentialhomes.Injury‐relatedhospitalizationscostnearly$668millioninhospitalchargesperyear(GAVitalStatisticsData&GeorgiaInjuryPreventionStrategicPlan:2010‐2015).

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In2012,theprogramconductedahealthyhomesneedsassessmenttodetermineenvironmentalhealtheducationmaterialsneeds,andhasdevelopedseveralhealtheducationmaterialsfordistributiontothegeneralpublic.Theprogramhastrainedtwenty‐onelocalEnvironmentalHealthSpecialiststhroughoutGeorgiaashealthyhomespractitioners.SeveralbrochuresonvarioushealthyhomestopicshavebeenmadeavailabletoeverypublichealthdistrictinGeorgia.

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meetingwashWeekandChhealthandhsfromacroshensivehealtsinGeorgiaameeting,heldlvisionstatestrategiesforhefirstyearngprocess.

ingProcess

homesstrateealthyHousiolderstooup(theenadiverseerviceagencers.AcompleresponsibiliningprocesseimplementDPHbyensurs,sharinganandprogram

heldinOctobhildHealthhousingsstheUnitedthyhomesanddevelopedinDecembementidentifrachievingtofplan

egicng

ies,eteties

tationuringndms

edaerfiedthe

Meetingevaluationssuggestthattheplanningprocesswashighlysuccessfulandwell‐receivedbyparticipants.OfthosewhorespondedtotheOctober2012meetingevaluation,100%ofparticipantsfelttheirinputwas“verymuch”consideredandincorporatedatthemeeting.Eighty‐threepercentofparticipantsfeltthepracticalvisionstatementdeveloped“verymuch”resonatedwiththeirorganization,and17%feltthatit“somewhat”resonatedwiththeirorganization.Fifty‐sevenpercentofparticipantsanticipatestaying“highlyinvolved”and43%anticipatestaying“somewhatinvolved”intheimplementationoftheplan.

57%ofAdvisoryWorkgroup

membersplantostayhighly

involvedintheimplementationofthestrategic

VisionforHealthyHomesinGeorgiaTheAdvisoryWorkgroupmembersidentifiedsevenelementsthatdescribeacollectivestatewidevisionforhealthyhomesinresponsetothequestion,“WhatdowewanttoseeinplaceinGeorgiain3‐5yearsasaresultofcollaborationamonghealth,housing,andeducationprograms?”ThepracticalvisionstatementresultingfromthisexerciseisdetailedinAppendixB.Theresultingsevenvisionelementsareasfollows:

1. Comprehensivestrategiestosupportdiverseandengagedstakeholders2. Coordinated,appropriate,andeffectivemarketingandeducation3. Effectivepoliciesandstrongenforcement4. Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation5. Diverseresourcesandrevenuegeneratingmechanisms6. Standardizedprocessesandconsistentimplementation7. Healthier,saferhomesforgenerations

Aftergeneratingtheircollectivevision,theAdvisoryWorkgroupmembersidentifiedkeyobstaclestoachievingit.ObstaclestotheVisionAnumberofimportantobstaclessurfaced,includinglimitedknowledgeandmisinformationabouthealthyhousingamongdecision‐makers,andasaresult,alackofprioritizationofhealthyhomes.AdvisoryWorkgroupmembersalsoidentifiedun‐mobilizedresourcesasanobstacletoacollaborative,statewidehealthyhomesapproach.ThecurrentundevelopedlegalauthoritytosupporthealthyhomesinGeorgiaisanotherbarrier.Finally,theAdvisoryWorkgrouppinpointedlanguageandculturalbarriers,competingpriorities,andpoliticaloppositionasimportantobstaclestoaddress.AssetsandOpportunitiestoSupporttheVisionDespitetheseexistingbarriers,AdvisoryWorkgroupmembersidentifiedanumberofexistingassetsthatwillsupportGeorgiainitsstatewidehealthyhomesefforts.Georgiahasstrongexpertiseinkeyhealthyhomescontentareasandsignificantresearchanddatacapacity.ThelocalpresenceoftheCentersforDiseaseControlandPreventionandregionalofficesoftheEnvironmentalProtectionAgencyandDepartmentofHousingandUrbanDevelopmentbringcapacity,historicalknowledge,

Key Obstacles: Un‐mobilizedandunidentified

resources Politicalopposition Cutstoexistingfundingstreams Competingpriorities Languageandculturalbarriers Undevelopedauthority Limitedknowledgeand

misinformation Inconsistentdataandreporting Unidentifiedstakeholders Limitedoutreachtounder‐

representedgroups

andcrediWorkgrothisstratagenciesmembersensuresu

ibilitytotheupmembersegicplanproandorganizas’existingconuccessfulimp

GeorgiaDepsfeltthattheovidesexcitinations.Finallnnectionswiplementation

partmentofPenewstatewngopportunly,thestatewiththerealenofthestrat

PublicHealthidenetworkitiesforstrowillbeabletestatesector,egicplan.

h’shealthyhoofpartnersbngercollabooleverageA,contractors

omeswork.AbroughttogeorationamonAdvisoryWor,andlocalco

Advisoryethertodevengstateandlrkgroupommunitiest

elopocal

KeyStrategiesandActionPlansTakingintoaccounttheexistingassets,strengths,andobstaclesforachievinghealthierhomesinGeorgia,theAdvisoryWorkgroupdevelopedspecificstrategiestoadvanceeachelementofthestate’svisionforhealthyhomes.TheAdvisoryWorkgroupdeterminedthattheseventhvisionelement‐Healthier,saferhomesforgenerations–representstheculminatingoutcomethatwouldresultiftheothersixelementsofthevisionwererealized.Therefore,theAdvisoryWorkgroupdidnotidentifyspecificstrategiesorconductactionplanningforthisvisionelement.Thekeystrategiesinclude:VisionElement1:ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders

1. Implementandlaunchapublicrelationsstrategy.2. DesignanorganizationalstructuretoadvancethehealthyhomesinitiativeinGeorgia.3. Developahealthyhomescertificationor“sealofapproval.”

VisionElement2:Coordinated,appropriate,andeffectivemarketingandeducation.1. Developanddisseminatequality,targetededucationalmaterials.2. Identifylegislativechampionstosupportongoingeducationwithlegislators.3. Developastrategicmarketingandeducationplanwithclearpriorities.4. Launchapublicawarenessandeducationcampaign.5. Identifyfunderstosupporteducationalandpromotionalmaterials.

VisionElement3:Effectivepoliciesandstrongenforcement.

1. Educateandmotivatethelegislaturetopassstronglaws.2. Identifyanddraftneededlegislativeauthoritiesforhealthyhomes.3. Developpersuasive,data‐drivenarguments.4. Convene,convince,andmotivatethepublicandstakeholderstoengageindialoguewith

healthyhomesprinciples.VisionElement4:Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation.

1. ImplementmandatedreportingofhealthyhomesdatatotheGeorgiaDepartmentofPublicHealth,includinghospitalemergencyroomvisitsduetopoisonings,fallsburns,andasthma.

2. Coordinatethecollectionandmanagementofhealthyhomesdatatoeducateandinformpolicymakersandfunders.

3. Developcomprehensivedatatrackingandsurveillancenetworks.VisionElement5:Diverseresourcesandrevenuegeneratingmechanisms.

1. Communicatethereturnoninvestmentforhealthyhomesactivitieswithpolicymakers,funders,andotherstakeholders.

2. Implementrevenuegeneratingrequirementsforcontractorsandpropertyowners.3. Collaboratewithinsuranceproviderstomandatehealthyhomesassessmentsand

interventionsforspecifichealthcareclaims.

4. Conducteffectiveresearchtogarnerfundingsupportforhealthyhomes.5. Ensureefficientuseofresourcesbyestablishingandstrengtheningpartnerships.

VisionElement6:Standardizedprocessesandconsistentimplementation.

1. Identifycommonbenefitsandclearrolesforallstakeholderstosupportcollaborativeparticipation.

approachestoidentificationandremediationofhazards.4. Engagehomevisitingagenciesinintegratinghealthyhomesstandardsintotheirprotocols.

StrategiesandActionPlanTables:ThefollowingpagesincludethespecificactivitiesandsuccessindicatorstohelpmovetowardGeorgia’svisionforhealthyhomes.Thetablesincluderecommendedfirst‐yearactivities,theleadorganizationandpartnerswhoareresponsibleforimplementation,andindicatorsofsuccessfulimplementation.

VisionElement1:ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders

KeyStrategies:

1. EngageandRecruitkeyhealthyhomesstakeholdersthroughoutGeorgia.2. DesignanorganizationalstructuretoadvancethehealthyhomesinitiativeinGeorgia.3. Developahealthyhomescertificationor“sealofapproval.”First‐YearActivities Lead

Organization(s)Partners

(Includingbutnotlimitedto)

SuccessIndicators

DevelopasustainablehealthyhomescoalitionledbytheGeorgiaDepartmentofPublicHealth(DPH).Thecoalitionshould:o Identifyaclearpurposeandconsistentmessage;

o Setclearlydefinedrolesandresponsibilities;

o Seekoutkeystakeholderswhoarenotyetrepresented;

o Identifyatimeframeforongoingmeetings;

o Seekresourcestosustainthecoalition.

EstablishastandardizeddefinitionofhealthyhomesforthestateofGeorgiaandidentifythekeyprocessesrequiredtomakeahomehealthy.

Initiatethedevelopmentofacomprehensivepublicrelationsstrategy.

Identifystatewideandlocalspokespeopletosupporthealthyhomes.

Proactivelyincludeunder‐representedgroups,includingruralandenvironmentaljusticecommunities.

Examineopportunitiesforengagingpropertyownersandcontractorsthroughacertificationor“sealofapproval”process.

GeorgiaDepartmentofPublicHealth(HealthyHomesandLeadPoisoningPreventionProgram)

MembersoftheGeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroup

Traditionallyun‐orunder‐representedcommunities,trades,andsectors.

Thereisanestablishedcoalitionthatissuccessfulinimplementingitsstrategies

Astatewidehealthyhomesprogramiswell‐establishedandwellknown

Acomprehensivepublicrelationsstrategyisinplaceandisactivelybeingimplemented.

Stakeholdershaveacommonunderstandingofhealthyhomes.

VisionElement2:Coordinated,appropriate,andeffectivemarketingandeducation.KeyStrategies:1. Developanddisseminatequality,targetededucationalmaterials.2. Identifylegislativechampionstosupportongoingeducationwithlegislators.3. Developastrategicmarketingandeducationplanwithclearpriorities.4. Launchapublicawarenessandeducationcampaign.5. Identifyfunderstosupporteducationalandpromotionalmaterials.

First‐YearActivities LeadOrganization(s)

Partners(Includingbutnotlimitedto)

SuccessIndicators

Initiatedevelopmentofamarketingandeducationstrategicplan.

Usefocusgroupstodevelopeffectivemessagesforkeytargetaudiencessuchasfamilies,homeowners,renters,schoolsandchildcares,andapartmentassociations.

Developtargetededucationalandmarketingmaterials(e.g.pamphlets,slidedeck,pressreleases,etc.)forkeyaudiences.

Inventoryexisting,qualityeducationalmaterialsanddevelopaneasilyaccessiblelistofresources.

Developaneasytonavigate,multi‐lingualwebsiteforthepublicandkeystakeholders(keyhealthyhomesissues,whattodo,etc.)

Continuetoprovidehealthyhomestrainingstatewide.

Developaqualitycontrolprocessforhealthyhomestrainingtoassurequalityeducation.

Identifycommunitychampions. Lookforpartnerswithinterestinfundingmarketingandeducation(e.g.HomeDepot,Lowes).

Hosteducationalforums. EngageGeorgiaPublicBroadcastingtoeducatethepublic.

GeorgiaDepartmentofEarlyCareandLearning

Federalpartnersandregionaloffices:CentersforDiseaseControlandPrevention,EnvironmentalProtectionAgency,andHousingandUrbanDevelopment

Healthdistricts Maternalandchildhealthhomevisitors

ChildrenFirstProgram

BabiesCan'tWait

Anti‐smokingcoalition

Housingauthorities

GeorgiaAssociationonYoungChildren

Corporations Foundations Stateagencies VoicesforGeorgia’sChildren

FamiliesFirst FamilyConnectionPartnership

Resourceandreferralagencies

SafeKidsGeorgia

HeadStart

Marketingandeducationstrategicplanisinplace

Georgiaispassingsuccessfullegislationtosupporthealthyhomes

Standardizedmessagingandmaterialsareinplace

Corporationsprovidesignificantfundingtosupportconsumereducationefforts

Legislativechampionsareinplace

Pre‐postsurveydemonstratesincreasedawarenessinpublic

VisionElement3:Effectivepoliciesandstrongenforcement.KeyStrategies:

1. Educateandmotivatethelegislaturetopassstronglaws.2. Identifyanddraftneededlegislativeauthoritiesforhealthyhomes.3. Developpersuasive,data‐drivenarguments.4. Convene,convince,andmotivatethepublicandstakeholderstoengageindialoguewith

healthyhomesprinciples.First‐YearActivities Lead

SuccessIndicators

IdentifyexistingGeorgiahealthyhomesrequirements,andidentifygapsordeficienciesintheseexistingrequirements.

Researchandaddressexistingbarrierstohealthyhomespolicydevelopmentandadoption.

Determinepolicystrategiestostrengthenexistinghealthyhomesrequirementsandaddressexistingpolicygapsanddeficiencies.

Identify,contact,andengageacomprehensivelistofstakeholderstosupportstatewidepolicypriorities.

Initiateconversationswithlegislativechampionstoidentifykeybarrierstohealthyhomespolicydevelopmentandadoption.

Hostalegislativedaytoencouragedialogueamongthepublicandpolicy‐makers.

Developaclearplanforenforcementofexistingrequirements.

Initiativethedevelopmentofstandardized,statewidecodeenforcement.

Aclear,definedstrategyforstrengtheninghealthyhomespolicyisinplaceandactivelybeingimplemented.

Meetingsandcontactsbetweenkeystakeholdersandlegislatorsaretrackedasameasureofdialoguewithpolicy‐makers.

Existingrequirementsarefullyenforced.

Statewidecodeenforcementisinplace.

VisionElement4:Comprehensive,accurate,andtimelydatatracking,surveillance,andevaluation.KeyStrategies:1. ImplementmandatedreportingofhealthyhomesdatatotheGeorgiaDepartmentofPublic

Health,includinghospitalemergencyroomvisitsduetopoisonings,fallsburns,andasthma.2. Coordinatethecollectionandmanagementofhealthyhomesdatatoeducateandinformpolicy

makersandfunders.3. Developcomprehensivedatatrackingandsurveillancenetworks.

SuccessIndicators

Establisheffectiveandefficientprotocolsforreportingrequiredhealthinformation.

Inventoryexistingdataandsurveillancesystemsandinitiateaplanfordevelopingacomprehensivetrackingandsurveillancenetwork.

ExpandtheGHHLPPPsurveillancesystemtoincludenotonlybloodleadlevels,butalsoenvironmentaltestresultsandselectedhealthyhomesvariables.

GeorgiaDepartmentofPublicHealth(HealthyHomesandLeadPoisoningPreventionProgram)OHIPGeorgiaDepartmentofPublicHealth

CDC Surveillancesystemhasbeenassessedandissueshavebeenaddressed

Successfulcollectionofsurveillancedata

ComprehensiveHHsurveillancesystemisinplacewithintheGHHLPPPPProgramandbeingutilized.

VisionElement5:Diverseresourcesandrevenuegeneratingmechanisms.KeyStrategies:1. Communicatethereturnoninvestmentforhealthyhomesactivitieswithpolicymakers,

funders,andotherstakeholders.2. Implementrevenuegeneratingrequirementsforcontractorsandpropertyowners.3. Collaboratewithinsuranceproviderstomandatehealthyhomesassessmentsand

interventionsforspecifichealthcareclaims.4. Conducteffectiveresearchtogarnerfundingsupportforhealthyhomes.5. Ensureefficientuseofresourcesbyestablishingandstrengtheningpartnerships.

SuccessIndicators

Instituteahealthyhomescomprehensivedatabaseusingastandardizedtooltoenablereturnoninvestmentcalculations.

Identifyopportunitiestouseresourcesmoreefficientlyamongagenciesandorganizationsinvolvedinstrategicpartnerships.

Approachmedicalinsuranceproviderstobegindialogueregardingreimbursementforhealthyhomesassessmentsandinterventions.

Partnerwithlocalcollegesanduniversitiestoresearchimplementablerevenuegeneratingstrategies.

Identifyincentivesthatcouldbeusedtosupportpropertyownersinremediatinghazards.

Launchcoordinatedtrainingforcontractorsandpropertyowners.

Postasearchableonlinelistingofallfederal,state,andlocalfundedhealthyhomesinitiatives.

Createafee‐for‐servicehomevisitingprogramwithaslidingscalepaymentstructure.

NationalHealthyHomesTrainingCenterandNetworkPartners

Healthinsurers CentersforDiseaseControlandPrevention

Localcollegesanduniversities

Comprehensivedatabaseisinplace

Georgiahascalculatedandcommunicatedthereturnoninvestmentforhealthyhomes

Increasedtrainingofprofessionalsandpropertyownersinhealthyhomesprinciples

Dialoguewithinsuranceprovidersresultsinreimbursementmechanisms.

Newrevenuegeneratingstrategiesareidentifiedandimplemented

VisionElement6:Standardizedprocessesandconsistentimplementation.KeyStrategies:

1. Identifycommonbenefitsandclearrolesforallstakeholderstosupportcollaborativeparticipation

approachestoidentificationandremediationofhazards.4. Engagehomevisitingagenciesinintegratinghealthyhomesstandardsintotheir

protocols.First‐YearActivities Lead

SuccessIndicators

FinishtheGeorgiaHealthyHomesStrategicPlantoprovideaframeworkforcollaborationandimplementation.

Alignhealthyhomesconsiderationsacrossallentitiesandorganizations.

Begintodevelopqualitycontrolprocesses.

Initiatetheidentificationofcommonbenefitsandclearrolesforstakeholders.

Identifyachampionfromeachorganizationandagencyinvolvedincoordinatedhealthyhomeseffortsacrossthestate.

Gainparticipationandbuy‐infromkeystakeholders.

Establishaone‐stoplocationforapplicationintakeandeducation.

Encourageandincentivizeinformationsharingamongpartners.

Begindialoguewithhomevisitingagencies.

GeorgiaDepartmentofPublicHealthandregionalhealthorganizations

Federalagencies

Homevisitingagencies

Strategicplaninplaceandinoperation

Onechampionfromeachorganization/agencyisinvolved

Partnersrecognizecommonbenefitsandbuy‐intostatewideefforts

Homevisitingagenciesfullyintegratehealthyhomesstandardsintotheirprotocols.

SustainabilityPlanThe2012FederalBudgetcutCDCfundsforlead/healthyhomesby94%.SeveralmonthsintotheprocessCDCofficiallynotifiedGHHLPPPthattherewouldbenofundingbeyondthefirstyear.Asaresult,thisplanwasdevelopedwithanassumptionthatthefutureGHHLPPProleinpromotingandimplementingtheplanmaybeverylimited.However,Georgiahasanextensivebaseofpeople,programs,andorganizationsthatcancontributetohealthyhomesandcommunities,withmultipleexistingcommunityassetsandresourcesidentified.Asofthiswriting,manyprojectsarebeingconsideredforreducingprogramcostsand/orgeneratingfunds.Theseconceptsarebeingevaluatedfortheireffectiveness,cost‐benefitcapacity,barriersandsustainability.Theyincludebutarenotlimitedtoconceptswithstaffreductionandreassignment,resourcereallocation,alternativeactivities,reductionandgenerationoflowercostservices.CareManagementOrganizationsarebeingutilizedtoassistGHHLPPPwithpatientcasemanagementandMedicaidreimbursementforhomeinspectionsofelevatedbloodleadchildren.Additionally,grantfundingopportunitieswillbeexploredandappliedforwhendeemedappropriateforthisprogram’smission.Toachievethevisionelements,strategies,andactionstepsdeveloped,extensivepartnershipswillbenecessaryforsuccessfulimplementation.TheHealthyHomesAdvisoryCommitteerepresentsabroadlistofkeystakeholdersselectedfortheirexpertise,specificfocusandcommondirection.Theseconsistoflocal,stateandfederalgovernmentalhealthandhousing‐relatedagencies,privateindustry,andnon‐governmentaleducationandadvocacyorganizations.AdvisoryCommitteemembershavecommonorganizationalgoalsandhaveindicatedacommitmenttoworktogethertogainsupportforcommonobjectivesandimplementtheplan.Asaresultofthestrategicplanningprocess,membersagreedtosustainthisrelationshipandservetoprovidecontinueddirectionforGHHLPPPactivitiesidentifiedinthisstrategicplan.

ReferencesAdvisoryCommitteeonChildhoodLeadPoisoningPrevention.(2012).LowLevelLeadExposureHarmsChildren:ARenewedCallforPrimaryPrevention.Availableat:http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf.AmericanLungAssociation.(2011).CharlesD.ConnorAppropriationsTestimony(DepartmentofHealthandHumanServices‐SummaryofPrograms)totheU.S.HouseofRepresentatives,SubcommitteeonLabor,HealthandHumanServicesandEducation.RetrievedAugust14,2012,fromhttp://www.lung.org/get‐involved/advocate/advocacy‐documents/connor‐appropriations‐testimony.pdfChandramouli,K.,Steer,C.,Ellis,M.,&Emond,A.(2009).Effectsofearlychildhoodleadexposureonacademicperformanceandbehaviourofschoolagechildren.ArchivesofDiseaseinChildhood,94(11),844‐848.Eggleston,P.,Butz,A.,Rand,C.,Curtin‐Brosnan,J.,Kanchanaraksa,S.,Swartz,L.,etal.(2005).Homeenvironmentalinterventionininner‐cityasthma:Arandomizedcontrolledtrial.AnnalsofAllergy,Asthma,andImmunology,95(6),496‐497.Fewtrell,L.,Pruss‐Ustan,A.,Landrigan,P.,&Ayuso‐Mateos,J.(2004).Estimatingtheglobalburdenofdiseaseofmildmentalretardationandcardiovasculardiseasesfromenvironmentalleadexposure.EnvironmentalResearch,94,120‐133.Gould,E.(2009).Childhoodleadpoisoning:conservativeestimatesofthesocialandeconomicbenefitsofleadhazardcontrol.EnvironmentalHealthPerspectives,117(7),1162‐1167.Kercsmar,C.M.,Dearborn,D.G.,Schluchter,M.,Xue,L.,Kirchner,H.L.,Sobolewski,J.,etal.(2006).Reductioninasthmamorbidityinchildrenasaresultofhomeremediationaimedatmoisturesources.EnvironmentalHealthPerspectives,114(10),1574‐1580.Miranda,M.,Kim,D.,Galeano,M.,Paul,C.,Hull,A.,&Morgan,S.(2007).Therelationshipbetweenearlychildhoodbloodleadlevelsandperformanceonend‐of‐gradetests.EnvironmentalHealthPerspectives,115(8),1242‐1247.Miranda,M.,Maxson,P.,&Kim,D.(2010).Earlychildhoodleadexposureandexceptionalitydesignationsforstudents.InternationalJournalofChildHealthandHumanDevelopment,3(1),77‐84.Mudarri,D.,&Fisk,W.(2007).Publichealthandeconomicimpactofdampnessandmold.IndoorAir,17,226‐35.NationalCenterforHealthyHousing.(2009).HousingInterventionsandHealth:AReviewoftheEvidence.Columbia,MD:NationalCenterforHealthyHousing.Portier,C.(2012).TheLatestScienceonLead'sImpactsonChildren'sDevelopmentandPublicHealth.TestimonybeforetheCommitteeonEnvironmentandPublicWorks,UnitedStatesSenate.Availableat:http://epw.senate.gov/public/index.cfm?FuseAction=Files.View&FileStore_id=c7b84ff9‐468a‐4d92‐8adc‐c84aee2e6ff1.

Runyan,C.,Casteel,C.,Perkis,D.,Black,C.,Marshall,S.,Johnson,R.,etal.(2005a).UnintentionalinjuriesinthehomeintheUnitedStatesParkI:Mortality.AmericanJournalofPreventiveMedicine,28,73‐79.Runyan,C.,Perkis,D.,Marshall,S.,Johnson,R.,Coyne‐Beasley,T.,Waller,A.,etal.(2005b).UnintentionalinjuriesinthehomeintheUnitedStatesPartII:Morbidity.AmericanJournalofPreventiveMedicine,28,80‐87.U.S.CentersforDiseaseControlandPrevention(2010).ChronicObstructivePulmonaryDisease.RetrievedOctober11,2012fromhttp://www.cdc.gov/Features/COPD/index.html.U.S.DepartmentofHousingandUrbanDevelopment.(2011).TheHealthyHomesProgramGuidanceManual.Washington,DC:U.S.DepartmentofHousingandUrbanDevelopment.U.S.EnvironmentalProtectionAgency.(2003).EPAAssessmentofRisksfromRadoninHomes.Washington,DC:U.S.EnvironmentalProtectionAgency.

AppendixA–AdvisoryWorkgroupMembersJohnArmour,CityofAtlantaDept.ofPlanningandCommunityDevelopment

SandraBell,GeorgiaCommunityActionAss.(GCAA)Weatherization

KaronBush,WestCentralHealthDistrict,GDPHJuliaCampbell,GDPHHealthyHomesProgramEileenCarrol,HUDSimoneCharles,GeorgiaSouthernUniversityRyanCira,DekalbCountyBoardofHealthMindyCrean,GEPDLead‐BasedPaintProgramToriEndres,WestCentralHealthDistrict,GDPHFoziaEskew,GA.ChapterofAmericanAcademyofPediatricsKimGrier,GDHSDivisionofAgingServicesMargaretGunter,NorthCentralHealthDistrict,GDPHJaniceHacker,Georgia,BrightFromtheStartStephanieHall,GDPHAsthmaProgramCorbyHanna,TheCenterforWorkingFamilies‐LeadSafeAtlantaDebJunkin,GeorgiaRealtorsAssociationChristyKuriatnyk,GDPH,HealthyHomesProgramTomLaubenthal,TheEnvironmentalInstituteBeverlyLosman,SafeKidsGeorgiaFrancescaLopez,GDPHAsthmaProgramBonnieMaurras,LeadnologyTodayMeganPopielarczyk,SafeKidsGeorgiaKennethRay,GDPHTobaccoUsePreventionPennyRound,GAApartmentOwnersAssociation

SteedRobison,GeorgiaDept.ofCommunityAffairs(DCA)‐HousingSanjeebSapkota,CDCJanSimmons,GEPDLead‐BasedPaintProgramJonnetteSimmons,HUDGwenSmith,GDPHLeadHazardControlProgramForrestStaley,GDPHLeadHazardControlProgramChrisStevens,StateFireMarshall’sOfficeYuSun,GDPHHealthyHomesProgramShawnTaylor,ColumbusHDVectorControlTracyTeague,GDPH,HealthyHomesProgramLaniiThomas,CityofAtlanta,Dept.ofPlanning&CommunityDevelopmentPamelaTurner,UGAJeremyWeir,PrivateLeadInspectorLizWilde,USEPAMelindaFordWilliams,GeorgiaDept.ofCommunityHealthStateMedicaidProgram

AppendixB–PracticalVisionStatement

GeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroupPracticalVision

WhatdowewanttoseeinplaceinGeorgiain3‐5yearsasaresultofcollaborationamonghealth,housing,andeducationprograms?

Healthier,SaferHomesforGenerations

Makehealthyhomesprinciplessecondnaturetoall. Decreasepoorhealthoutcomesandinjuries. Makeallhomessafeandhealthy. Ensurethatallchildrenarefreefromleadandhousing‐relatedhealthissues.

ComprehensiveStrategiestoSupportDiverseandEngagedStakeholders

Developanorganizationalchartthatclarifiestherolesandresponsibilitiesofthediverseorganizationsinvolved.

Establishfunctioningmulti‐sectorcollaborationswithchampions(e.g.,anassociation).

Encouragecollaborationamonghealth,housing,andeducationsectorstoscreenfor,followupon,andeliminateleadpoisoning.

Createafee‐for‐servicehomevisitingprogramwithaslidingscalepaymentstructure.

Establishabroadercoalition. Proactivelyincludeunder‐representedgroups,includingruralandenvironmentaljusticecommunities.

Ensurecommunityengagementtofosternewprogramsandactivities. Identifychampionsatlocallevel. Coordinateaccesstomaterialsandeducationalresources.

Coordinated,Appropriate,andEffectiveMarketingandEducation

Marketandeffectivelycommunicatethebenefitsandsavingsofthehealthyhomesapproachforresidents,contractors,andlegislators.

Developacomprehensiveeducationcampaign. Hosteducationalforums. Increaseawarenessamongfamilies/consumersandagencyofficials. Provideaccesstoresourcestoassistwithhousingimprovements.

EffectivePoliciesandStrongEnforcement

Conducteffectivepolicyanalysis,planning,andmonitoring. Reviewandstrengthenexistinglegislation. Establisheffectivepolicies. Implementstatewidecodeenforcementthatisstandardized,effective,andincorporateshealthyhomesprinciples.

Developaclearplanforenforcement.

Comprehensive,Accurate,andTimelyDataTracking,Surveillance,andEvaluation

Establishdataprocessesandmonitoroutcomes. Developcomprehensivedatatrackingandsurveillancenetworks. Identifyandremediategapsindatasystemprocesses. Collaboratewithinternalandexternalpartnerstoshareappropriatedataasneeded.

Establisheffectiveandefficientprotocolsforreportingrequiredhealthinformation.

GeorgiaHealthyHomesStrategicPlanningAdvisoryWorkgroupPracticalVision

WhatdowewanttoseeinplaceinGeorgiain3‐5yearsasaresultofcollaborationamonghealth,housing,andeducationprograms?

DiverseResourcesandRevenueGeneratingMechanisms

Provideincentivesforpropertyownersandotherstakeholders. Leveragefundswiththeprivatesector. Developclear“sellingpoints”togeneratefundingsupport. Providelow‐costhomemodificationopportunities. Establishpublic/privatepartnershipstosupportaffordablehousing.

StandardizedProcessesandConsistentImplementation

Establishaone‐stoplocationforapplicationintakeandeducation. Developstandardizedlanguageandacommondefinitionforahealthyhome.

Conductstandardizedcomprehensivehomeassessments. Cross‐trainstakeholdersontechniquestoachievehealthyhomes. Trainallprogramsworkingwithyoungchildrenontheeffectsofleadandotherhealthyhomesissues.

Developawebportaltoassiststakeholdersinsharingresourcesandinformation.

Encourageandincentivizeinformationsharingamongpartners. Developacentralwebresourceforbothinternalandexternalstakeholders.

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