Re: Housing Interventions and Health: A Review of the Evidence

[Guest guest]

In a message dated 1/12/2009 2:12:51 P.M. Pacific Standard Time,

kmtown2003@... writes:

2009 - National Center for Healthy Housing

Housing Interventions and Health: A Review of the Evidence

_http://www.nchh.http://www.nhttp://www.nchhttp://www.htt_

(http://www.nchh.org/Housing_Interventions_and_Health.pdf)

The paper is good as far as public health policy from the building science

side. But it is NOT going to help advance clinical practices that treat for

the toxins and non IgE mediated responses such as hypersensitivity pneumonitis

or (myco)toxicosis from indoor environmental exposures. While it does

effectively call out what needs to be done to advance the building science from

construction and clean up aspects, it leaves the impression that all illnesses

from indoor microbe exposure can simply be chalked up to asthma and allergy.

It is hard to write these papers to where they are all encompassing without

being over broad. These are honorable scientists I know to be working hard

toward a change in public policy to prevent future illness. However, regarding

the health science, the paper is not consistent the Federal GAO audit into

the matter with the recommendations of public warnings of potential adverse

health effects. It looks like this paper was drafted before the GAO Report

came

out. Maybe they could add an addendum.

Excerpts of Summary, GAO Report

Recent research suggests that indoor mold poses a widespread and, for some

people, serious health threat. Federal agencies engage in a number of

activities to address this issue, including conducting or sponsoring research.

For

example, in 2004 the National Academies' Institute of Medicine issued a report

requested by the Department of Health and Human Services (HHS) summarizing the

scientific literature on mold, dampness, and human health. In addition, the

Federal Interagency Committee on Indoor Air Quality supports the

Environmental Protection Agency's (EPA) indoor air research program. With

respect to the

health effects of exposure to indoor mold, GAO was asked to report on (1) the

conclusions of recent reviews of the scientific literature, (2) the extent

to which federal research addresses data gaps, and (3) the guidance agencies

are providing to the general public. GAO reviewed scientific literature on

indoor mold's health effects, surveyed three agencies that conduct or sponsor

indoor mold research, and analyzed guidance issued by five agencies.

In general, the Institute of Medicine's 2004 report, and reviews of the

scientific literature published from 2005 to 2007 that GAO examined, concluded

that certain adverse health effects are more clearly associated with exposure

to indoor mold than others. For example, the Institute of Medicine concluded

that some respiratory effects, such as exacerbation of pre-existing asthma,

are associated with exposure to indoor mold but that the available evidence was

not sufficient to determine whether mold and a variety of other health

effects, such as the development of asthma, cancer, and acute pulmonary

hemorrhage

in infants, are associated. While the reviews GAO examined generally agreed

with these conclusions, a few judged the evidence for some health effects as

somewhat stronger. For example, the American Academy of Pediatrics concluded

in 2006 that a plausible link exists between acute pulmonary hemorrhage in

infants and exposure to toxins that some molds produce. In addition, the 2004

Institute of Medicine report identified the need for additional research to

address a number of data gaps related to the health effects of indoor mold. The

65 ongoing federal research activities on the health effects of exposure to

indoor mold conducted or sponsored by EPA, HHS, and the Department of Housing

and Urban Development (HUD) address to varying extents 15 gaps in scientific

data reported by the Institute of Medicine. For example, many of the

research activities address data gaps related to asthma and measurement

methods,

while other data gaps, such as those related to toxins produced by some molds,

are being minimally addressed. Further, less than half of the ongoing

mold-related research activities are coordinated either within or across

agencies.

This limited coordination is important in light of, among other things, the

wide range of data gaps identified by the Institute of Medicine and limited

federal resources. The Federal Interagency Committee on Indoor Air Quality

could

provide a structured mechanism for coordinating research activities on mold

and other indoor air issues by, for example, serving as a forum for reviewing

and prioritizing agencies' ongoing and planned research. However, it

currently does not do so. Despite limitations of scientific evidence regarding

a

number of potential health effects of exposure to indoor mold, enough is known

that federal agencies have issued guidance to the general public about health

risks associated with exposure to indoor mold and how to minimize mold growth

and mitigate exposure. For example, guidance issued by the Consumer Product

Safety Commission, EPA, the Federal Emergency Management Agency, HHS, and HUD

cites a variety of health effects of exposure to indoor mold but in some

cases omits less common but serious effects. Moreover, while guidance on

minimizing indoor mold growth is generally consistent, guidance on mitigating

exposure to indoor mold is sometimes inconsistent about cleanup agents,

protective

clothing and equipment, and sensitive populations. As a result, the public may

not be sufficiently advised of indoor mold's potential health risks.

Recommendation: The Administrator, EPA, should use the Federal Interagency

Committee on Indoor Air Quality to help relevant agencies review their

existing guidance to the public on indoor mold--considering the audience and

purpose

of the guidance documents--to better ensure that it sufficiently alerts the

public, especially vulnerable populations, about the potential adverse health

effects of exposure to indoor mold and educates them on how to minimize

exposure in homes. The reviews should take into account the best available

information and ensure that the guidance does not conflict among agencies.

Sharon

**************New year...new news. Be the first to know what is making

headlines. (http://www.aol.com/?ncid=emlcntaolcom00000026)

[Guest guest]

Actually, a, ACOEM is not involved. Nor are the methods or

conclusions anywhere close. This is part of the new National

Center for Healthy Housing program as an extention of the

previous lead removal program from the federal government.

They are reconnecting housing and health.

From the Introduction:

Our housing and our health are at once inseparable and

distinct. Together, they reflect two of our most basic

needs for individual and collective identity, privacy, social

progress and indeed survival itself. Yet scientific research

in both fields historically has been hampered by a

fragmented approach that has made ready identification

of common avenues of improvement problematic...

This paper helps to close the gap in understanding about

a vast array of housing interventions and their impact on

health status.

Excerpts from Conclusions:

... improved health was not stated as a program goal at

the outset of the MTO, even though health impacts from

this program are now a large area of research...

...efforts to improve neighborhood environments are a

critical component in ensuring safe, healthy, and

affordable housing for all individuals and families in the

U.S...

Improved research designs that specifically identify direct

and indirect health improvements related to the policies

discussed above are clearly needed...

Future studies should also include better measurement

of health outcomes...

This is an even bolder step forward from the HUD/CDC/EPA

Baltimore conference last fall. I see it as quite encouraging.

Carl Grimes

Healthy Habitats LLC

-----

>

> I smell ACOEM!

>

> 2009 - National Center for Healthy Housing

> Housing Interventions and Health: A Review of the Evidence

> http://www.nchh. org/Housing_Interventions_and_Health.pdf

>

> Table of Contents

> Introduction.....................................

..............................................

..............................................

> ..........................................7

> Summary of Intervention Findings........................................

..............................................

> ............................................. . 10

> Panel 1: Interior Biological Agents (Toxins)

Interventions.....................................

..............................................

> ............ 13

> Panel 2: Interior Chemical Agents (Toxics)

Interventions.....................................

..............................................

> ............. 25

> Panel 3: External Exposures (Drinking water and sewage

treatment)......................................

> ...................................... 37

> Panel 4: Structural Deficiencies

(Injury)........................................

..............................................

> ...................................... 41

> Panel 5: Intersection Between Housing and

Community.......................................

..............................................

> .............. 51

> Bibliography.....................................

..............................................

..............................................

> ........................................69

> Appendix A: Meeting Minutes.........................................

..............................................

> ............................................. ........87

> Appendix B: Manuscript Review Instrument......................................

..............................................

> .................................. 89

[Guest guest]

Important distinction, Sharon.

Carl Grimes

Healthy Habitats LLC

-----

>

> In a message dated 1/12/2009 2:12:51 P.M. Pacific Standard Time,

> kmtown2003@... writes:

> 2009 - National Center for Healthy Housing

> Housing Interventions and Health: A Review of the Evidence

> http://www.nchh. org/Housing_Interventions_and_Health.pdf

>

> The paper is good as far as public health policy from the building science

side. But it is NOT

> going to help advance clinical practices that treat for the toxins and non IgE

mediated responses

> such as hypersensitivity pneumonitis or (myco)toxicosis from indoor

environmental exposures.

> While it does effectively call out what needs to be done to advance the

building science from

> construction and clean up aspects, it leaves the impression that all illnesses

from indoor microbe

> exposure can simply be chalked up to asthma and allergy.

>

> It is hard to write these papers to where they are all encompassing without

being over broad.

> These are honorable scientists I know to be working hard toward a change in

public policy to

> prevent future illness. However, regarding the health science,the paper is not

consistent

> theFederal GAO audit into the matter with the recommendations of public

warnings of potential

> adverse health effects. It looks like this paper was drafted before the GAO

Report came out.

> Maybe they could add an addendum.

>

> Excerpts of Summary, GAO Report

> Recent research suggests that indoor mold poses a widespread and, for some

people, serious

> health threat. Federal agencies engage in a number of activities to address

this issue, including

> conducting or sponsoring research. For example, in 2004 the National

Academies' Institute of

> Medicine issued a report requested by the Department of Health and Human

Services (HHS)

> summarizing the scientific literature on mold, dampness, and human health. In

addition, the

> Federal Interagency Committee on Indoor Air Quality supports the Environmental

Protection

> Agency's (EPA) indoor air research program. With respect to the health effects

of exposure to

> indoor mold, GAO was asked to report on (1) the conclusions of recent reviews

of the scientific

> literature, (2) the extent to which federal research addresses data gaps, and

(3) the guidance

> agencies are providing to the general public. GAO reviewed scientific

literature on indoor mold's

> health effects, surveyed three agencies that conduct or sponsor indoor mold

research, and

> analyzed guidance issued by five agencies.

> In general, the Institute of Medicine's 2004 report, and reviews of the

scientific literature published

> from 2005 to 2007 that GAO examined, concluded that certain adverse health

effects are more

> clearly associated with exposure to indoor mold than others. For example, the

Institute of

> Medicine concluded that some respiratory effects, such as exacerbation of

pre-existing asthma,

> are associated with exposure to indoor mold but that the available evidence

was not sufficient to

> determine whether mold and a variety of other health effects, such as the

development of asthma,

> cancer, and acute pulmonary hemorrhage in infants, are associated. While the

reviews GAO

> examined generally agreed with these conclusions, a few judged the evidence

for some health

> effects as somewhat stronger. For example, the American Academy of Pediatrics

concluded in

> 2006 that a plausible link exists between acute pulmonary hemorrhage in

infants and exposure to

> toxins that some molds produce. In addition, the 2004 Institute of Medicine

report identified the

> need for additional research to address a number of data gaps related to the

health effects of

> indoor mold. The 65 ongoing federal research activities on the health effects

of exposure to indoor

> mold conducted or sponsored by EPA, HHS, and the Department of Housing and

Urban

> Development (HUD) address to varying extents 15 gaps in scientific data

reported by the Institute

> of Medicine. For example, many of the research activities address data gaps

related to asthma

> and measurement methods, while other data gaps, such as those related to

toxins produced by

> some molds, are being minimally addressed. Further, less than half of the

ongoing mold-related

> research activities are coordinated either within or across agencies. This

limited coordination is

> important in light of, among other things, the wide range of data gaps

identified by the Institute of

> Medicine and limited federal resources. The Federal Interagency Committee on

Indoor Air Quality

> could provide a structured mechanism for coordinating research activities on

mold and other

> indoor air issues by, for example, serving as a forum for reviewing and

prioritizing agencies'

> ongoing and planned research. However, it currently does not do so. Despite

limitations of

> scientific evidence regarding a number of potential health effects of exposure

to indoor mold,

> enough is known that federal agencies have issued guidance to the general

public about health

> risks associated with exposure to indoor mold and how to minimize mold growth

and mitigate

> exposure. For example, guidance issued by the Consumer Product Safety

Commission, EPA, the

> Federal Emergency Management Agency, HHS, and HUD cites a variety of health

effects of

> exposure to indoor mold but in some cases omits less common but serious

effects. Moreover,

> while guidance on minimizing indoor mold growth is generally consistent,

guidance on mitigating

> exposure to indoor mold is sometimes inconsistent about cleanup agents,

protective clothing and

> equipment, and sensitive populations. As a result, the public may not be

sufficiently advised of

> indoor mold's potential health risks.

>

> Recommendation: The Administrator, EPA, should use the Federal Interagency

Committee on

> Indoor Air Quality to help relevant agencies review their existing guidance to

the public on indoor

> mold--considering the audience and purpose of the guidance documents--to

better ensure that it

> sufficiently alerts the public, especially vulnerable populations, about the

potential adverse health

> effects of exposure to indoor mold and educates them on how to minimize

exposure in homes.

> The reviews should take into account the best available information and ensure

that the guidance

> does not conflict among agencies.

>

> Sharon

>

>

>

>

> New year...new news. Be the first to know what is making headlines.

[Guest guest]

_http://www.nchh.org/Housing_Interventions_and_Health.pdf_

(http://www.nchh.org/Housing_Interventions_and_Health.pdf)

After reading this document more closely, and considering the broad number

of exposures discussed within this document, I think they did a good job of

getting as much as one can about mold induced illnesses, at this point in time,

in a mainstream policy paper.

This paper should help a lot to direct the focus of tying illnesses to the

indoor environment and help to focus research dollars in that direction. And

it does acknowledge that it is plausible that mold in the indoor environment

can cause symptoms more indicative of poisoning as opposed to allergy/asthma.

(missed this on my first read thru)

I don't see this changing clinical treatment protocols for serious mold

induced illnesses at this point in time - such as HP, CFS, TILT and mold

toxicity. But it does appear that the physicians will be taught that it is not

impossible for mold to cause these serious illnesses. Maybe people who are

seriously ill from mold will at least be met with less skepticism and disdain

by the

doctors. That in itself is a big step.

All and all, I think this paper, which is tied to the CDC, is a good step in

the right direction. Another key point: I am pleased that they have

acknowledged mold can cause illness in the general population, not just the

immunocompromised.

Pg 14

Fungi (Mold) and Excessive Moisture

There is a broad body of epidemiologic and laboratory

evidence linking the presence of mold and moisture to poor

health outcomes. National and international expert panels

have reviewed the evidence, finding consistently that both

mold and moisture are associated with a wide variety of

adverse health effects in both the general population and in

specific vulnerable segments of the population (Institute of

Medicine 2000, 2004). From a public health and prevention

perspective these clinical findings point to the importance

of controlling moisture sources within the home, correcting

water damage as soon as it occurs, fixing leaks promptly,

and safely cleaning or removing mold-contaminated

materials promptly.

In indoor environments, mold originates from two

sources, including mold infiltrating from outdoors (e.g.,

through open windows), and mold colonization on the

interior of the home. Molds obtain nutrients and moisture

sufficient for growth from water-affected building

materials such as wallboard and insulation materials,

as well as carpets, furniture, and bedding (Institute of

Medicine 2004; Woodcock et al. 2006). The features of

a home that increase moisture levels and fungal growth

include condensation on cool surfaces, water intrusion...

Pg 15

Molds not only have allergenic effects, but can also have

toxic or irritant effects. Evidence from occupational studies

suggests that exposure to mycotoxins can result in mucus

membrane irritation, skin rashes, dizziness, nausea and

immunosuppression (Burge and Ammann 1999). Fungi

also produce irritants such as microbial volatile organic

compounds (MVOCs) and (1→3)ß-D-glucans that may be

responsible for some “sick building†symptoms (Douwes

2005; Walinder et al. 2005).

**************New year...new news. Be the first to know what is making

headlines. (http://www.aol.com/?ncid=emlcntaolcom00000026)