Baltimore’s Transition to Healthy Homes

Structuring a comprehensive, community-based healthy homes

effort

Genevieve Birkby, MPH, MA

Baltimore City Health Department

Healthy Homes & Communities Division

Overview

Describe Baltimore’s transition to healthy homes

Convey opportunities, resources & barriers

Discuss expansion to community-based initiatives which support healthy housing

87 square miles; 650,000 people 55,000 children under 6 65% African American Median family income – $37,000 Limited affordable, healthy housing Goal - Clean, Green, Healthy

Baltimore

Healthy Homes & Communities Division

Created in May 2006 Deputy Commissioner, Dr. Madeleine Shea Mission: The Baltimore City Health Department -- in

collaboration with community, city, state and national partners -- will improve the health and well being of children and their families by developing and targeting resources to make Baltimore homes lead safe, reduce home-based asthma triggers, reduce carbon monoxide poisoning, and decrease preventable home injuries.

Baltimore’s Housing

24% leaking roofs 53% peeling paint 38% mouse droppings 31% roaches present

50 years old on average (US is 30 yrs) 75% of rental units estimated to have lead Studies of low income housing show:

Lead Exposure in Baltimore

0

500

1000

1500

2000

2500

2000 2001 2002 2003 2004 2005 2006 2007

The number of lead-poisoned children under age 6 in Baltimore decreased from 2,189 in the year 2000 to 626 in 2007.

Why Transition from Lead to HH?

Declining lead cases Unmet needs in asthma prevention

and control, and injury prevention Staff capacity in inspections, health

education and case management Opportunity to expand public health

services and impact New funding and partnership

opportunities

Healthy Homes Demonstration Project

CDC-funded; piloted in 2007 Goal to develop, implement and

evaluate a model to expand an urban childhood lead poisoning prevention program into a comprehensive healthy housing program

100 initial home assessments 50 three-month follow up assessments

HH Demonstration Project

Significant staff training (healthy homes 101; IPM; fire safety; CO etc.)

Developed forms, assessments and protocols

Identified relevant healthy housing resources

Evaluation, evaluation, evaluation

Population Demographics

Mean income = $576/month Average household size = 4.9 people

Population - Renters

56% live in rental properties 65% of renters have a written lease Average monthly rent is $328

Population - Asthma

40% of households have someone with asthma or other respiratory problem

32% have child with asthma

Kitchens without a trash can: 28% Households reporting any pest

problem: 79.5% 44% with no working smoke alarms Asthma reported: 43% No working heat: 17% Indoor smoking: 36%

Results: What did we find?

Lessons Learned: HH Pilot

One-size fits all approach? Need to weigh “comprehensive” assessment

with “actionable” interventions Priority intervention areas?

Asthma? IPM? Staff

Training Morale

How? Resources & Opportunities

City Agencies – (DHCD, HABC, FD, PD, Health Programs, Quasi Orgs, School System)

State Agencies (DHMH, MDE, DHCD) Universities (public health, nursing, psychiatry,

urban planning, community law, social work, forestry, etc.)

Primary Care Providers Federal Agencies (CDC, HUD, EPA) Community Based Orgs (Coalition to End Childhood

Lead Poisoning, community groups, etc) National Advocacy and Training Orgs (NCHH, AHH)

How? Resources & Opportunities

City-wide initiatives Baltimore City Sustainability Commission Mayor’s Cleaner, Greener Initiative Food Policy Task Force

Barriers to Transition

Taking programs to scale Requires increased staff, training and

supplies Lack of public investment in housing

for low-income families Families “in crisis” – social issues

beyond housing Resource constraints

Current Division Structure

Four Bureaus Lead Inspections &

Enforcement LAAP (Lead

Abatement Action Program)

Asthma Community

Planning & Initiatives

Lead Inspections & Enforcement

Registered sanitarians inspect all homes of children with elevated blood lead levels with a healthy homes approach.

Issue violation notices to those homes with lead hazards

2009: Bed bug response

Lead Inspections & Enforcement

Case management for children with an EBL or with significant lead risks

Provide integrated healthy homes assessment and risk-specific advice

Link families to resources needed to improve the health and safety of their housing

Lead Abatement Action Program

Health intervention program geared towards interim control treatments of lead poisoning hazards in the home.

Have completed lead hazard intervention work in over 2,500 units throughout the City.

Asthma Home visiting asthma programs

Enroll children ages 2- 18 who have moderate to severe asthma

Home visits from nurses and trained community health workers to assess medical and environmental needs.

Utilize a healthy homes approach.

Community Planning & Initiatives

Community-based initiatives and evaluation Outreach and training Lead Safe Work Practices Initiative Promotores program Community Environmental Health

Planning Initiative Safe Pest Management for Health

Initiative

Expansion to the Community

Healthy Homes

Healthy Homes and Communities

Community Approaches

Response to both identified priorities and emerging needs

Promotores program – need for better engagement with the Latino community

Safe Pest Management for Health Bed bugs! New and creative approaches (MICA) Asthma community education groups

Community Approaches

Support other city-wide initiatives Weatherization + health Baltimore City Sustainability Commission Redline Project

Safe Pest Management for Health

Baltimore Housing, BCPSS Augment our IPM response within the

division 35 site assessments Recommendations for city IPM

contracts Bed bug subsidization program Peer education in public housing

Weatherization

Broad-based partnership Housing; CECLP; MD Rehab.,

Civicworks, Rebuilding Baltimore Together

Weatherization + healthy housing

Future Directions

Healthy housing will continue to evolve Tailor according to your community’s

needs – don’t take on too much Consider creative approaches and

non-traditional partners