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Young children spend the vast majority of their time indoors at home. This truism has been documented by several studies and forms the basis for many of Healthy Child’s recommendations to minimize the use of dangerous chemicals, such as pesticides, harsh cleaning materials, and oil-based paints, in homes.

For many children, however, the physical condition of their home environment is often beyond the control of their parents and is dangerous to their health and development. An estimated 1.2 million U.S. children in low-income families younger than 6 years old live in housing that contains one or more lead hazards. Roughly another 14 million, or about 1 in 5, live in crowded housing conditions.

The vast majority of these children are low income. The problems children encounter in these homes include cockroach and rodent infestations, mold, water damage, peeling paint, dangerous structural elements, exposed wiring, leaking pipes, inadequate plumbing, and crowding. In many housing units, appliances, including stoves, water heaters, and clothes dryers are not properly vented. Smoke alarms are often not present, and when they are, are often not functional.

These conditions have demonstrable effects on children’s health. For example, children living in dilapidated homes suffer disproportionately from lead poisoning and injuries. Respiratory irritants and allergens from mold, rodents, and cockroaches cause or exacerbate asthma and increase children’s susceptibility to infections. Rodents and cockroaches are also known carriers of infectious disease.

In many ways these conditions create a particularly vicious cycle. For example, one recent study showed that housing disrepair and crowding is related to pest infestations. This makes sense because deteriorated housing provides more habitat for pests because there are more places for animals to enter buildings, hide, and reproduce and there are water sources from leaking pipes and condensation. Crowded households are also more difficult to clean so there is more food available. Pest infestations then lead to increased pesticide use, which can then expose children living in the home. Crowded housing also increases ambient moisture and condensation, which leads to more mold and water sources for pests, which leads…STOP! Clearly, we have a serious, multifaceted problem with numerous feedback mechanisms, and the net result is that many children live in unhealthy environments. So what can be done?

The first step is to better count the number of children exposed to inadequate housing and develop specific national and local objectives to reduce these numbers. The U.S. Department of Housing and Urban Development (HUD) administers the American Housing Survey, which compiles broad information on American housing stock, including data about housing quality such as poor structural elements, leaks, and rodent infestations. This survey could be expanded to include factors such as cockroach and mold infestations and, combined with information about resident children, incorporated into the environmental quality indicators tracked by the U.S. Environmental Protection Agency (EPA). For example, EPA tracks children’s exposure to lead and environmental tobacco smoke; housing quality, however, is not addressed.

The federal government has taken some steps to address housing quality as an environmental issue. For example, in response to Executive Order 13045 — Protection of Children from Environmental Risks and Safety Risks, HUD launched the Healthy Homes Initiative (HHI). The primary goal of the HHI is to protect children from housing conditions that are responsible for diseases and injuries. HUD also runs programs to reduce lead-based paint in housing. Healthy People 2010, the primary preventative health planning program in the U.S., has developed “Healthy Homes and Healthy Communities” objectives that directly address housing quality. Specific objectives include reductions in dust mite and cockroach allergen levels and the proportion of occupied units that are substandard (Objectives 8-16 and 8-23). Healthy People 2010 also targets increasing the number of pre-1950’s housing that have been tested for lead (Objective 8-22). Healthy People 2020 is currently being developed.

The HUD programs and the objectives included in Healthy People 2010 represents a new awareness about deteriorated housing as a children’s environmental health problem. The next step in defining the scale of the problem is to use available information sources to target specific communities and regions with a high prevalence of deteriorated housing and large populations of children. Then the really hard work begins.

Efforts to improve housing need to focus on both individual-level behaviors as well as policies to improve access to quality housing. For example, recent successful intervention studies of cockroaches have included repairs such as sealing cracks and fixing leaks along with other integrated pest management techniques that minimize the use of toxic pesticides. These studies provide a model for educational interventions that can make real differences in children’s lives. However, many factors are beyond the control of individual families. Existing programs to address adverse housing conditions should be strengthened, including increased inspections and enforcement of existing housing codes. Other strategies include programs to strengthen renters’ ability to negotiate housing improvements with landlords. In many areas, construction of new, high quality, affordable housing is needed; thus, housing policy is often a component of local and regional land use decisions.

Programs to improve housing availability, affordability, and quality are the focus of a variety of federal and local government and private initiatives aiming to fill the needs of diverse communities. Given that poor quality housing quality is a chief contributor to persistent health disparities in children, this issue needs to be prioritized as a key children’s environmental health concern with substantial opportunities for success.

Resources:
American Housing Survey
U.S. Department of Housing and Urban Development (HUD) Healthy Homes Initiative
America’s Children and the Environment
Health People 2010

Updated 02/09

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