Baltimore’s Transition to Healthy Homes

1. 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

2. Overview • Describe Baltimore’s transition to healthy homes • Convey opportunities, resources & barriers • Discuss expansion to community-based initiatives which support healthy housing

3. 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

4. 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 -- willimprove 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.

5. Baltimore’s Housing • 50 years old on average (US is 30 yrs) • 75% of rental units estimated to have lead • Studies of low income housing show: • 24% leaking roofs • 53% peeling paint • 38% mouse droppings • 31% roaches present

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

7. 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

8. 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

9. 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

10. Population Demographics • Mean income = $576/month • Average household size = 4.9 people

11. Population - Renters • 56% live in rental properties • 65% of renters have a written lease • Average monthly rent is $328

12. Population - Asthma • 40% of households have someone with asthma or other respiratory problem • 32% have child with asthma

13. 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?

14. 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

15. 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)

16. How? Resources & Opportunities • City-wide initiatives • Baltimore City Sustainability Commission • Mayor’s Cleaner, Greener Initiative • Food Policy Task Force

17. 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

18. Four Bureaus Lead Inspections & Enforcement LAAP (Lead Abatement Action Program) Asthma Community Planning & Initiatives Current Division Structure

19. 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

20. 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

21. 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.

22. 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.

23. 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

24. Expansion to the Community Healthy Homes Healthy Homes and Communities

25. 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

26. Community Approaches • Support other city-wide initiatives • Weatherization + health • Baltimore City Sustainability Commission • Redline Project

27. 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

28. Weatherization • Broad-based partnership • Housing; CECLP; MD Rehab., Civicworks, Rebuilding Baltimore Together • Weatherization + healthy housing

29. 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