Several government and private-sector bodies are involved in various issues of climate change, indoor environment, and health. This chapter identifies them and summarizes their work in those issues. It also lists some major sources of data on the characteristics of buildings, the indoor environment, and public health and discusses how they might inform questions about the intersection between them.
The 2010 National Research Council report Informing an Effective Response to Climate Change lists 19 US federal executive and legislative branch bodies that are involved in or affected by decisions about climate change (NRC, 2010). This section lists the entities that are most directly involved in issues related to the intersection between climate change, the indoor environment, and health and identifies some of their work. Chapter 8 provides additional detail on programs related to building weatherization and energy efficiency.
US Environmental Protection Agency
The US Environmental Protection Agency (EPA)—the sponsor of the present study—conducts and coordinates research on a broad array of issues associated with climate change. Its purview includes both the outdoors
and some indoor environments.1 The bulk of EPA’s efforts are directed toward research on and regulation of greenhouse gases, but the agency’s Indoor Environments Division addresses climate-change questions as part of its objective to protect the public’s health by promoting healthier indoor environments.
One major initiative is the ENERGY STAR voluntary building-certification program, which promotes the use of low-energy–demand designs, construction, and appliances. EPA cites lower greenhouse-gas emissions as one the benefits of certified homes (EPA, 2010e). The voluntary Indoor airPLUS standard allows builders who have already met ENERGY STAR requirements to apply an additional label to structures that have met criteria that include resistance to outdoor water intrusion, mitigation of opportunities for indoor dampness, a heating, ventilating, and air-conditioning (HVAC) system that meets American Society of Heating, Refrigerating, and Air-Conditioning Engineers standards for ventilation, and low-emission building materials (EPA, 2009b).
In late 2010, the agency released a draft of voluntary Healthy Indoor Environment Protocols for Home Energy Upgrades for public comment (EPA, 2010b). The protocols were developed in conjunction with the Department of Energy (DOE) Workforce Guidelines for Home Energy Upgrades (DOE, 2011) and focus on potential health effects of weatherization and other retrofits intended to promote energy efficiency. They touch on such issues as moisture, emissions from building materials, and ventilation and offer guidance on exposure assessment, mitigation, and adaptation strategies.
EPA specifically addresses the subject of the present report in an Indoor Air Quality and Climate Readiness Web site that in late 2010 included weatherization and indoor air-quality briefing material and links to more general indoor environmental-health information (EPA, 2010d). Several other information and education programs indirectly address building problems and exposures that have been associated with climate change and the indoor environment and with remediation of their adverse effects. The Agency’s Tools for Schools program, for example, seeks to “prevent and solve the majority of indoor air problems with minimal cost and involvement” (EPA, 2009a, p. i).2 As was the case with Indoor airPLUS, actions address outdoor-water intrusion, indoor dampness, proper ventilation, well-maintained HVAC systems, and low-emission building materials.
1 Workplace environmental problems are under the jurisdiction of the Occupational Safety and Health Administration. This report touches on issues in offices but does not address industrial environments, which may also be adversely affected by climate change (Nilsson and Kjellstrom, 2010).
2 These topics are also dealt with in the 2006 National Academies report Green Schools: Attributes for Health and Learning (NRC, 2006).
A cooperative agreement program announced in late 2010 disseminated $2.4 million to local government, educational institutions, and nonprofit organizations for “demonstration, training, education, and/or outreach projects that seek to reduce exposure to indoor air pollutants” and that would yield measurable results (EPA, 2010c).
EPA’s Environmental Technology Verification (ETV) Program was initiated in 1995 to evaluate environmental technologies and make them readily available for the mass market for the benefit of the general public (EPA, 2011a). One of its main goals is to standardize testing among different companies and products. One such standardization was of the accuracy of technology that tests building pressure to determine whether contaminants in buildings are due to vapor intrusion or to other product emissions (ETV, 2010). Another initiative investigates microorganism-resistant building material for mold resistance, emissions of volatile organic compounds (VOCs) and aldehydes, and moisture content (RTI International, 2008).
EPA also partners with other federal agencies to conduct research. In collaboration with the Department of Housing and Urban Development (HUD), EPA conducted a national survey that measured allergens, including mold, and pesticides in homes (Stout et al., 2009). The data have since been used to examine the indoor environment and potential health risks to occupants. It also cochairs the Federal Interagency Committee on Indoor Air Quality with four other federal agencies.3 This committee coordinates research and facilitates communication on indoor-air topics, including excessive dampness, mold, ventilation, emissions from building materials, and “green buildings.”
National Institutes of Health
The National Institutes of Health (NIH) is the principal biomedical research arm of the Department of Health and Human Services (HHS). It conducts and sponsors investigations on a broad array of health topics and fosters both basic and applied research. Climate-change–related work at NIH falls principally under the aegis of the National Institute of Environmental Health Sciences (NIEHS), which holds primary responsibility for conducting and funding environmental health research. In 2010, that institute released the results of an effort by the Interagency Working Group
3 The committee’s Web site notes that “the CIAQ is co-chaired by EPA, the Consumer Product Safety Commission, the Department of Energy, the National Institute for Occupational Safety and Health, and the Occupational Safety and Health Administration. Other federal departments and agencies participate as members” (EPA, 2010a).
on Climate Change and Health4 (NIEHS, 2010). The stated purpose of A Human Health Perspective on Climate Change was to (p. iv)
identify research needs for all aspects of the research-to-decision making pathway that will help us understand and mitigate the health effects of climate change, as well as ensure that we choose the healthiest and most efficient approaches to climate change adaptation.
Among the research needs identified were studies addressing the health effects of indoor dust on asthma exacerbation, including changes in dust composition resulting from climate change (p. 15); how changes in temperature and precipitation affect exposure to toxic chemicals (p. 19); the effects of climate change on outbreak incidence, geographic range, and growth cycles of insect pests and pathogens that cause human disease (p. 27); risk factors for illness and death associated with acute exposure to extreme heat events and chronic exposure to increased average temperatures; and the health benefits of the use of environmental design principles to reduce the high thermal mass of urban areas (p. 31). The report also called for research aimed at anticipating, detecting, and responding to climate-change–induced and –exacerbated health problems and identifying vulnerable populations. In July 2010, NIH announced that it would operationalize those recommendations by providing research funding through a program intended to “examine the differential risk factors of populations that lead to or are associated with increased vulnerability to exposures, diseases and other adverse health outcomes related to climate change” (NIH, 2010).
NIEHS collaborates with EPA to support several Children’s Environmental Health Research Centers, which conduct and support studies of the effects of environmental exposures. As noted later in this chapter, it cooperated with the Department of Housing and Urban Development’s Office of Lead Hazard Control to conduct the National Survey of Lead and Allergens in Housing. The study gathered data on indoor allergen exposure that allowed NIEHS to “assess the magnitude of levels of indoor allergens in the United States housing stock” and “evaluate differences in population exposure to allergens based on factors such as region/geography, ethnicity, socioeconomic status, and housing type” (NIEHS, 2011).
4 The working group comprised representatives of the Centers for Disease Control and Prevention, HHS’s Office of the Secretary, EPA, the National Aeronautics and Space Administration, NIEHS, NIH’s Fogarty International Center, the National Oceanic and Atmospheric Administration, the Department of State, the US Department of Agriculture, and the US Global Change Research Program.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC), which also falls under the aegis of HHS, takes a public-health approach to climate-change–related work that includes (CDC, 2009b)
- Tracking data on environmental conditions, disease risks, and disease occurrence related to climate change.
- Expanding capacity for modeling and forecasting health effects that may be climate-related.
- Enhancing the science base to understand the relationship between climate change and health outcomes better.
- Identifying locations and population groups at greatest risk for specific health threats, such as heat waves.
- Communicating the health-related aspects of climate change, including risks and ways to reduce them, to the public, decision-makers, and health-care providers.
One component of the work is the Climate-Ready States and Cities Initiative. The initiative is intended to support health-department efforts to assess, plan for, and build capacity to respond to climate-change–related health effects (CDC, 2010a). Eight states5 and two cities6 were awarded grants totaling $5.25 million in 2010 to pursue projects. Many of them listed issues related to the indoor environment, such as heat-stress morbidity and mortality, as subjects to focus on, but indoor environmental quality does not appear to be among the concerns being addressed.
CDC’s National Center for Environmental Health (NCEH) seeks to improve the nation’s health status by avoiding diseases and disability caused by noncommunicable environmental factors (CDC, 2011a). It assigns high priority to vulnerable populations—specifically, children, the elderly, and people who have disabilities. NCEH’s activities include lead-poisoning prevention and environmental-health workforce development and capacity-building. Its climate-change–related work includes prevention of carbon monoxide (CO) poisoning from home electricity generators during power outages.
CDC also collects surveillance data on diseases related to environmental changes via its National Environmental Public Health Tracking Network (CDC, 2010b). The network includes monitoring of home contaminants—as of 2010, lead and CO. Although it was not designed to investigate climate-change effects, the director of CDC’s Division of Environmental
5 Arizona, Maine, Massachusetts, Michigan, Minnesota, New York, North Carolina, and Oregon.
6 New York City and San Francisco.
Hazards and Health Effects asserted in 2007 that it would be “an excellent tool” for such purposes (Late, 2007).
CDC has also provided funding for research projects on such topics as adverse exposures and health problems related to extreme weather events (Brandt et al., 2006; CDC, 2006).
National Institute for Occupational Safety and Health
CDC’s National Institute for Occupational Safety and Health (NIOSH) examines the health consequences of occupational environments. NIOSH has conducted extensive research to evaluate the effects of indoor environments on occupant health and to characterize the factors that contribute to poor health outcomes. No specific research focuses on climate change and occupational-health issues, but the institute has investigated adverse respiratory health effects resulting from damp or water-damaged occupational environments (Cox-Ganser et al., 2005, 2009; Park et al., 2006) and has developed tools to assess indoor moisture to guide preventive actions. Investigators also examine the products of indoor chemistry7 and their health effects (Anderson et al., 2010) and seek to determine the mechanisms by which indoor molds stimulate allergic responses (Green et al., 2009). NIOSH conducts research into the effects of “green” jobs on health, recognizing the new exposures and conditions associated with jobs designed to support activities that lead to energy efficiency and less environmental effect.
More generally, the potential for increased heat stress in indoor occupational environments has been flagged as a health and productivity issue in other countries (Kjellstrom et al., 2009a,b).
Department of Energy
DOE research activities include energy efficiency, clean-energy technology, and greenhouse-gas emission reduction. The department’s Building Technologies Program does not identify climate change as a motivating factor but conducts work that addresses the topic through programs that seek to reduce energy demands and promote good indoor air quality. Research and development initiatives include support of revisions of ventilation and building codes; improvement of exposure-assessment, ventilation, filtering, and air-cleaning technologies; source reduction of VOCs; and better
7 Indoor chemistry refers to the oxidation-reduction, acid-base, hydrolysis, decomposition, and other reactions that occur in indoors as a result of the interaction between various chemicals in the air, furnishing, floor and wall coverings, cleaning supplies and other constituents of the indoor environment.
understanding of the effects of energy-efficiency measures on health and productivity (DOE, 2010). Much of the work is conducted by the Indoor Environment Division of DOE’s Lawrence Berkeley National Laboratory (LBNL, 2010). DOE’s extensive work in weatherization and energy efficiency in buildings is addressed in Chapter 8.
Department of Housing and Urban Development
HUD’s climate-change–related work focuses on the built environment and sustainable building practices—specifically measures to reduce energy consumption (HUD, 2010d). Among its efforts are Sustainable Communities Regional Planning Grants, which include predisaster mitigation plans and climate-change–impact assessments among the eligible activities (HUD, 2010b). HUD’s Sustainable Communities Initiative promotes green building design and construction, but, although it mentions improved public health as a benefit of the program, that is not its focus (HUD, 2010c).
HUD also cooperates with DOE on the implementation of its Weatherization Assistance Program (WAP), identifying low-income properties (public housing, assisted housing, and others given special status under the enabling legislation) that are eligible for weatherization funds. A 2009 Memorandum of Understanding between the agencies streamlined the process for evaluating candidate properties for the program. HUD estimates that approximately 3 million housing units are potentially eligible for assistance (HUD, 2010a).
Federal Emergency Management Agency
FEMA, a part of the US Department of Homeland Security (DHS), has responsibility within the federal government to “build, sustain, and improve [the nation’s] capability to prepare for, protect against, respond to, recover from, and mitigate all hazards” (FEMA, 2010c). This includes providing guidance on identifying and remediating problematic dampness and mold (FEMA, 2003), and responding to flood (FEMA, 2010a) and hurricane (FEMA, 2010b) damage. FEMA also collects and disseminates disaster epidemiology data and cooperates with agencies at all levels of government including Department of Homeland Security and Office for Interoperability and Compatibility in developing technical standards and specifications, and prioritizing emergency development.
The agency’s Fiscal Years 2011–2014 strategic plan states that “challenges posed by climate change, such as more intense storms, frequent heavy precipitation, heat waves, drought, extreme flooding, and higher sea levels, have the potential to change significantly the types and magnitudes of hazards faced by communities and the emergency management profes-
sionals serving them” (FEMA, 2011). It has taken and is continuing to take several steps to respond to these challenges. These include a research effort initiated in 2009 to evaluate the potential effect of climate change on flood risk, and hence flood insurance (Lehmann, 2009).
US Global Change Research Program
The US Global Change Research Program (USGCRP) serves as the coordinating body for federal research on climate change and its effects on society (USGCRP, 2011). It comprises EPA, the Agency for International Development, the US Departments of Agriculture, the Department of Commerce,8 the Department of Defense, DOE, HHS, the Department of State, the Department of the Interior, the Department of Transportation, the National Aeronautics and Space Administration, the National Science Foundation, and the Smithsonian Institution. The USGCRP has produced a series of reviews of scientific evidence, including a 2009 assessment of the state of scientific knowledge regarding global climate-change effects in the United States (USGCRP, 2009). The program maintains an Interagency Crosscutting Group on Climate Change and Human Health (CCHHG), but the present committee could not identify any work that it has published that explicitly addresses indoor environmental quality or building-related issues.
Various agencies and organizations conduct or sponsor studies that collect pieces of information useful in assessing the relationships between buildings, the environment, and health. Each of the existing surveillance systems noted below is designed to achieve specific goals related to buildings or public health, through, for example, monitoring of trends in pesticide use in homes, assessing the household costs of energy use, or examining changes in how people live and work in their buildings. The text below briefly summarizes the information that they collect and identifies potential opportunities and limitations in using them to assess potential effects of climate change on the indoor environment and occupant health. A thorough examination of methods and variables—a task beyond the scope of the present committee—would be needed to draw detailed conclusions concerning how to implement such a survey.
8 Including the National Oceanic and Atmospheric Administration.
Housing and Building Surveys
American Housing Survey
The American Housing Survey (AHS) is conducted by the Census Bureau for HUD and includes apartments, single-family homes, mobile homes, housing characteristics, equipment, corresponding costs, and community characteristics, such as income and recent migration. The AHS is conducted in odd-numbered years and surveys the same housing units each time for comparison purposes. Every 6 years, specific data are collected on almost 50 metropolitan areas throughout the United States (US Census Bureau, 2008).
A substantial problem with the AHS from the standpoint of gathering information on the effects of climate change on indoor environments is that it is administered to the same housing unit every other year, whether or not the same residents live in the unit. Because the US population is relatively mobile, comparisons within this survey can be inconsistent (Acevedo-Garcia et al., 2004). Furthermore, renovations of a housing unit could have changed in ways that are material to the consideration of indoor environmental quality—for example, the purchase of a window air-conditioning unit or installation of new double-pane windows. A change of occupants of a housing unit would also mean changes in how the unit is used, which could influence and possibly confound variables used to evaluate indoor environmental quality.
American Healthy Homes Survey
EPA and HUD collected questionnaire and environmental data on a stratified, nationally representative sample of 1,131 US residences in 2005–2006 (Stout et al., 2009). Exposure measurements in the homes included pesticides, allergens, fungi, lead, and arsenic (Stout et al., 2009). The study built on a previous effort by HUD and NIEHS that measured lead and allergens in homes (Arbes et al., 2003; Cohn et al., 2004, 2006; Thorne et al., 2005). A future data collection planned to take place before 2020 will assess progress toward the Healthy People 2020 goals regarding environmental exposures in noninstitutional US homes (Department of Health and Human Services, 2009).
Residential Energy Consumption Survey
The US Energy Information Administration conducts the Residential Energy Consumption Survey (RECS), a probability-sample survey that collects energy-related data on occupied primary housing units (Energy Infor-
mation Administration, 2009). The first RECS was conducted in 1978; the most recent, in 2005, collected data on 4,381 households in housing units statistically selected to represent the 111 million housing units in the United States. Another wave of collection started in January 2011; its results are to be posted in late 2011 and early 2012 (Energy Information Administration, 2009). The collected data include physical characteristics, heating and cooling equipment, demographic characteristics of residents, and types of fuels used. Data are collected via three methods: in-person interviews with residents, in-person or telephone interviews with rental agents for units some or all of whose energy costs were included in the rent, and mail-in questionnaires from utility companies and suppliers.
Large Analysis and Review of European Housing and Health Status
In 2002–2003, the World Health Organization conducted the Large Analysis and Review of European Housing and Health Status (LARES), a cross-sectional survey to improve knowledge of the effects of housing on residents’ physical well-being and mental health (Bonnefoy et al., 2007). Eight cities representing northern, southern, eastern, and western Europe participated. The sample in each city was randomly generated from resident registries, the local tax registry, or the national health insurance registry. LARES used three survey instruments: an inhabitant questionnaire that described residents’ perceptions of their dwellings, a health questionnaire for inhabitants to report their health status (and that of children less than 12 years old), and a visual inspection by a trained surveyor (Bonnefoy et al., 2007). No physical measurements—such as temperature, humidity, and chemical or biologic exposures—were recorded. Teams of two technicians visited 3,373 dwellings and collected data on the health status of 8,519 inhabitants (Bonnefoy et al., 2007). LARES focused on such subjects as indoor air quality, noise effects, indoor dampness, and domestic accidents (WHO, 2011). The study examines indoor air environments and their connection to the building, but the data were centered on occupant perceptions of indoor air quality rather than on measurements, and climate-change–related factors were not assessed (WHO, 2011).
Health and Environment Surveys
National Health and Nutrition Examination Survey
The National Health and Nutrition Examination Survey (NHANES) is the most detailed large-scale survey of health status in the United States, with questionnaire, mental-health assessment, physical examination, laboratory, and some environmental data collected at home. The survey is na-
tional in scope and samples a representative population; it includes targeted “oversampling” to obtain sufficient data on various minority populations at different times.
The primary purpose of NHANES is to generate data that can be analyzed at a national level. However, coding schemes are available for researchers that provide information about subjects’ locations by latitude and longitude, census tract and block, county, and state.
The survey could be enhanced in a number of ways to assess the effects of climate change. As Chapter 4 notes, there are outdoor air pollutants such as particulate matter and ozone whose levels may be affected by climate change, and outdoor levels influence indoor levels. One approach would be to collect valid, nationally representative air-toxics exposure data that could be linked in time and space to human health outcomes data. Previous important work in this field has been limited to community-level studies or the use of historical NHANES human health data linked to geographically interpolated air-toxics exposure data. The latter method has scientific value and has been used to support analyses of both NHANES and US National Health Interview Survey (NHIS) data. However, it has limitations, and there is a need for improved data collection.
NHANES also has the ability to measure concentrations of a wide variety of specific chemicals in blood and urine, and it does this for a number of environmental analytes of interest—such as lead, mercury, and organochlorines. In the past, blood concentrations of VOCs were also measured. It is therefore a primary source of national-level environmental-health data on the United States. NHANES has already conducted environmental sampling in homes during one cycle (2005–2006), and this could be repeated and expanded. Data collected included dust concentrations of dust mite, cockroach, dog, cat, rat, mouse, Alternaria, and Aspergillus allergens and serum concentrations of IgE antibodies to these antigens (Gergen et al., 2009; Visness et al., 2009). A summary of the NHANES environmental-health data is published in CDC’s National Report on Human Exposure to Environmental Chemicals (CDC, 2011b) and in numerous peer-reviewed journal articles. NHANES also has the ability to perform direct air toxin exposure monitoring of individual participants for short periods (24–48 hours), but this data collection requires more extended efforts and costs than local environmental monitoring. Data on VOCs in the breathing zone of participants were collected from 2005 to 2010 (CDC, 2009a).
National Health Interview Survey
NHIS is a multistage probability-sample survey conducted by CDC’s National Center for Health Statistics (CDC, 2009c). It reaches 75,000–100,000 persons in the United States each year and collects a wide ar-
ray of sociodemographic and health information through direct visits to households. NHIS is considered the principal source of data on US asthma prevalence. Modular units collect data on subjects of special interest and could be designed to evaluate climate-change effects on health.
Behavioral Risk Factor Surveillance System
CDC’s Behavioral Risk Factor Surveillance System (BRFSS) is a state-based data-collection effort that uses telephone surveys to obtain information (CDC, 2010c). It has been in operation since 1985 and conducts more than 400,000 interviews each year. As the name suggest, BRFSS focuses on how people conduct their daily lives and how this influences their health. It has several potential advantages as an instrument for amassing climate-change and health information. The survey is already being used to examine data at geographic region, state, and local levels, and its Selected Metropolitan/Micropolitan Area Risk Trends (SMART) database allows breakouts of information on more than 200 metropolitan and micropolitan statistical areas. BRFSS also allows states to add questions to suit local needs or to assess the effects of particular events, such as hurricanes.
National Environmental Public Health Tracking Program
The National Environmental Public Health Tracking Program, developed by CDC, is coordinating a national system to track environmental hazards and related diseases (CDC, 2007). The program updates traditional surveillance systems with geographic information systems (GIS). Many of the data arise from state and local health-department grantees. In addition, CDC has collaborated with several other federal agencies and professional organizations to provide data for the program. The National Environmental Public Health Tracking Network promotes information-system standards to integrate local, state, and national databases on environmental hazards, environmental exposures, and health effects, including outdoor and indoor air exposures.
Other Data Sources
Calculating past exposures and modeling trends in outdoor air pollution would require the use of other existing databases. EPA and various state agencies have historical databases of air-quality measurements and exposure assessments, including the EPA National Air Toxics Assessments (EPA, 2011b) and the California Air Quality Resources Board air quality monitoring databases (Cal/EPA ARB, 2011a).
Existing health surveys are not, for the most part, designed to assess
major time-limited events, such as hurricanes and heat waves. Syndromic surveillance9 systems may prove useful for assessing health effects of these events, but not all are structured to do so.10 In 2010, CDC initiated a redesign of BioSense—which was created in 2003 to “establish an integrated national public health surveillance system for early detection and rapid assessment of potential bioterrorism-related illness” (CDC, 2011c)—to imbed it more firmly in state and local public-health systems and make it more responsive to local needs for information.
Synthesis—Surveillance Systems to Track Climate-Change Effects on Indoor Environmental Quality and Health
To track the effects of climate change on indoor environmental quality and health, it will be important to gather information over time and in specific geographic regions to assess variations and the different effects associated with them. Environmental and building factors of interest include
- Outdoor temperature, humidity, and rainfall.
- Outdoor air quality, including levels of hazardous air pollutants and particulates.
- Building type or use—single-family residence, multihousing unit, school, office, or commercial space.
- Building and indoor environmental characteristics, including presence, type, and condition of HVAC system; air-exchange rate; building age, location, and setting (urban, suburban, or rural); temperature, humidity, allergens, and chemical contamination; and mitigation strategies implemented.
Health outcomes of interest include
- Asthma—prevalence and severity.
- Allergies—prevalence and severity.
- Vectorborne illness.
- Waterborne illnesses.
- Reproductive outcomes.
9 Syndromic surveillance “is concerned with continuous monitoring of public health-related information sources and early detection of adverse disease events” (Yan et al., 2008). These include epidemics and bioterrorism incidents.
10 Chen et al. (2010) describe syndromic surveillance systems that have been used for onetime special and large-scale events; Josseran et al. (2010) relate the use of a system in France to monitor the effects of a heat wave.
- Heat stress.
- Excess mortality during periods of excessive heat or extreme weather events.
A 2009 report from the State Environmental Health Indicators Collaborative (SEHIC) listed several environmental-health indicators that are currently tracked, need validation, or need to be tracked (English et al., 2009). They included wildfires, pollen, temperature and humidity, drought, harmful algal blooms, and respiratory and allergic disease related to air quality. In addition, a report from the Interagency Climate Change Adaptation Task Force (ICCATF)—under the auspices of the White House Council on Environmental Quality—set a policy goal of coordinating capabilities of the federal government to support climate-change adaptation (2010). The ICCATF recommended that “agencies should work individually, collaboratively, and with the Task Force to ensure that resources are allocated to maximize their impact and avoid unnecessary duplication” (2010). Therefore, merely adding health-related indicators to housing surveys or adding housing-related indicators to health surveys could improve the tracking of climate-change effects but might result in redundancy. Because of the aforementioned limitations of surveillance systems and the lack of a consistent timeframe for measurement of the indicators (for example, some surveys are repeated every year and some sporadically, and some surveys ask about exposure or health outcomes in the preceding 3 months and some about them in the preceding year), combining datasets can be complicated at best and misleading at worst.
The ideal surveillance for assessing climate-change effects of indoor environment exposures and related health effects would be a national study with this clear focus. A model would be the National Children’s Study (NCS), which will be prospective (that is, allow clear identification of trends in a given population), large (100,000 children), and representative of the population and will incorporate objective measurements of environmental exposures (including biomarkers) and health outcomes (Landrigan et al., 2006). An expansion of the NCS to include health outcomes of other members living in the household could be rather expensive, but it would leverage the existing environmental measurements from the home and enable followup of middle-age and older adults who could also be at risk for the effects of climate change.
Another option, albeit more limited, is the use of information technology in buildings and in assessment of health outcomes. Data loggers can easily track temperature and humidity, and recent advances have led to real-time measurement devices for environmental exposure (such as chemical and particles) and biomarker monitoring that can be coupled with accelerometers to track exposures when study participants wear them
(NIEHS, 2008). Substantial cost savings can be realized by bypassing the requirement of trained technicians to set up bulky equipment in the home, work, or school environment. In addition, the source apportionment of exposures could be refined while the ability to link biologically relevant exposures to health outcomes was improved The passive collection of data in buildings and from surveillance of participants at multiple times is possible only with improved information technology. However, the data gained will inevitably lead to better surveillance of climate-change–related exposures and health effects.
State and local government climate-change initiatives generally focus on greenhouse-gas emissions, energy efficiency, and preservation of infrastructure—including the public-health infrastructure—in the event of extreme weather or flooding. Among the ones that include consideration of the indoor environment and public health, the issues that are most often addressed are extreme heat and problems that disproportionately affect the elderly, low-income, and other vulnerable populations. Exposures in the indoor environment and health-related adaptation and mitigation efforts for buildings either are not addressed or are mentioned only in passing. A few examples are provided below.
Separately, there are isolated efforts on the state and local levels to address indoor environmental health concerns. Although they were not motivated by climate-change concerns, they address exposures that might be exacerbated by changing outdoor conditions. One, a California standard on emissions from building materials, is summarized below. A 2010 white paper by Levin provides details on that standard and voluntary standards in the United States that address emissions from building materials and products that may affect indoor environmental quality. The 2004 Institute of Medicine report Damp Indoor Spaces and Health compares the guidance on mold remediation offered by federal, local government, and private sources available at the time of its publication.
The Pew Center on Global Climate Change reported that 36 states had comprehensive climate action plans in February 2011 and two more had plans under development (Pew, 2011a). They vary widely in scope and focus, but their building-sector initiatives typically include green-building standards, residential and commercial energy-conservation codes, and appliance-efficiency standards (Pew, 2011b).
California is among the states that offer specific regulatory guidance
regarding environmental and public-health considerations for buildings. Its Specification 01350 establishes goals and provides guidelines for energy and material use in buildings; indoor air quality, including nontoxic performance standards for cleaning and maintenance products; and other occupant health and sustainability considerations (CalRecycle, 2011).
Specification 01350 includes provisions for evaluating VOC emissions from indoor sources. The testing is intended to limit health effects of exposure to VOCs and occurs at multiple stages during construction. It evaluates emission data on large-surface-area materials by using standard exposure scenarios for estimating VOC emissions and area-specific air flow rates. Specific VOCs are considered as separate pollutants to estimate possible health effects on building occupants more accurately. That means of measuring VOCs and indoor air quality has since been incorporated into sections of the draft International Green Construction Code and is influencing other green-building certification and labeling schemes (Levin, 2010). Levin’s 2010 EPA white paper addresses Specification 01350 in greater detail.
The state’s Green Building Standards Code (CalGreen) is intended to improve public health and safety through planning and design, energy efficiency, water efficiency and conservation, material conservation and resource efficiency, and environmental quality measures (California Building Standards Commission, 2010). The codes apply to state-regulated and owned buildings and structures, including public elementary and secondary schools and California State University buildings, as well as other buildings such as low-rise residential buildings and acute care hospitals and clinics (California Building Standards Commission, 2010). Among its provisions are mandatory measures that require low-emitting materials and coatings (based on Specification 01350 and other limits) and voluntary measures regarding indoor air quality.
The California Environmental Protection Agency’s Air Resources Board has regulatory authority to evaluate and control air toxics under the state’s 1983 Toxic Air Contaminant Identification and Control Act (Cal/EPA ARB, 2009). In 2009, that authority was used to promulgate an airborne toxic control measure to reduce formaldehyde emissions from composite wood products used in home construction, finishing, and furniture (Cal/EPA ARB, 2011).
Many larger cities have or are developing climate-action plans, typically centered on infrastructure protection in coastal areas. Almost all public-health departments have plans in place to deal with heat-wave emergencies. Two of the more comprehensive efforts are summarized briefly below.
In 2008, New York City used a grant from the Rockefeller Foundation to establish a Panel on Climate Change as part of a larger effort to establish a long-term sustainability plan. The panel released a report in 2010 that took a risk-management approach to adaptation questions. It included a series of climate-change–related considerations that the authors believed should be taken in account in revising infrastructure design and performance standards, such as those for buildings (NYC Panel on Climate Change, 2010). Four primary hazards were identified—coastal flooding and storm surge, inland flooding, heat waves, and extreme wind events—all of which are also addressed in the city’s natural-hazard mitigation plan (NYC Office of Emergency Management, 2009).
Chicago’s Climate Change Action Plan includes the promotion of building design, construction, and operation practices that enhance energy efficiency and human health outcomes. The city requires that new government buildings conform to LEED Silver certification standards (Chicago Climate Task Force, 2008). The urban heat-island effect is a concern for the city, which experienced an extreme heat event in 1995 that resulted in more than 400 deaths in excess of the number otherwise expected (CDC, 1995; Kaiser et al., 2007). The action plan mentions that steps will be taken to identify at-risk populations and promote innovation to ameliorate heat islands, but it offers no specifics. A private-sector initiative, the Chicago Community Loan Fund, provides low- and middle-income housing financing and encourages the use of energy-efficient building standards and nontoxic and low-emission materials in the design and construction of affordable housing (Chicago Community Loan Fund, undated).
The Intergovernmental Panel on Climate Change was created under the auspices of the UN Environment Programme and the World Meteorological Organization to review and assess research and information on climate change to enhance worldwide understanding of the topic (IPCC, 2010). Discussion of indoor air quality issues in its fourth report, which was published in 2007, focused on indoor biomass combustion and its adverse effects on human health (Metz et al., 2007). The report called indoor air pollution “a key environmental and public health peril for countless of the world’s poorest, most vulnerable people” and advocated the adoption of cleaner-burning cooking stoves both to prevent health problems and to limit greenhouse-gas emissions. For developed countries, it noted that “the diffusion of new technologies for energy use and/or savings in residential and commercial buildings contributes to an improved quality of life and increases the value of buildings” (Metz et al., 2007). A fifth report was under development in early 2011. It will emphasize socioeconomic vulnerability to
the effects of climate change and implications of sustainable development and risk management (IPCC, 2010).
The private sector plays a considerable role in issues of climate change, the indoor environment, and health. A few examples are listed below. White papers commissioned by EPA in support of the present study provided detailed information on industry and professional-organization initiatives regarding building materials and product-testing regimens (Levin, 2010), green-building rating systems (Srebric, 2010), and energy-conservation codes for commercial and residential buildings (Mudarri, 2010). All those are discussed elsewhere in this report.
American Society of Heating, Refrigerating and Air-Conditioning Engineers
The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) is a professional organization that serves to advance the science of sustainable heating, ventilating, refrigeration, and air conditioning (ASHRAE, 2011). Its membership is drawn from private-sector, academic, and government professionals. ASHRAE has considerable involvement in indoor air-quality issues, in particular through standards11 that it and the American National Standards Institute (ANSI) have developed for proper ventilation of commercial and residential buildings and the maintenance of thermal comfort in buildings. The standards, although voluntary and advisory, have been adopted into many building codes. The organization has also published the Indoor Air Quality Guide, which offers design and construction strategies to improve indoor air quality that go beyond those specified in codes and standards (ASHRAE, 2009b). ASHRAE’s involvement in climate-change issues includes its GreenGuide—which provides information on sources of green design, construction, and operation practices (2010)—and a 2009 climate-change position document focused on reducing building emissions of greenhouse gases (2009a).
11Standard 62: Ventilation for Acceptable Indoor Air Quality and Standard 55: Thermal Environmental Conditions for Human Occupancy. A third document addressing how ventilation, the thermal environment, and other building characteristics jointly influence indoor environmental quality—Guideline 10: Interactions Affecting the Achievement of Acceptable Indoor Environments—was under development in early 2011.
LEED (Leadership in Energy and Environmental Design)—a component of the US Green Building Council, a building-trades association—promulgates voluntary certification standards for buildings that emphasize the reduction of climate-change effects. The standards include consideration of indoor air quality, but they focus primarily on increasing buildings’ water and energy efficiency and decreasing their greenhouse-gas emissions and other aspects of their environmental footprint. Chapter 8 addresses LEED standards in greater detail.
A 2008 Ernst & Young study identified potential climate change as the greatest strategic risk facing the property and casualty insurance industry (Ernst & Young, 2008). Segments of the industry have been heavily involved in climate-change issues, particularly those related to reinsurance12 (Nutter, 2010). The firm Swiss Re has published reports on the topic, addressing primarily the vulnerability of buildings and other infrastructure to catastrophic weather events (Swiss Re, 2002, 2010). Munich Re maintains NatCatSERVICE, which it characterizes as the most comprehensive global-loss database and which tracks the incidence of hurricanes, heat waves, flash floods, and other extreme weather events as part of a larger effort in cataloging natural catastrophes (Munich Re, 2003). There is a small literature on the effect of climate change on the insurance industry’s business (Mills, 2005, 2007).
American Red Cross
American Red Cross emergency response and disaster preparedness programs offer relief and development assistance to millions of people annually who are affected by natural disasters. Their emergency response programs provide financial assistance to stimulate the local economy; relief supplies such as food, shelter materials, and hygiene kits; and trained volunteers who assess needs and implement critical relief services (ARC, 2011). The Red Cross works closely with FEMA to assist the US government agencies and community organizations in planning, coordinating, and providing mass care services for communities influenced by disasters (ARC, 2010).
12 Reinsurance, simply put, is insurance that insurance companies take out to protect themselves against the risk of unusually large or numerous payouts on policies that they write. Reinsurance can become important when catastrophic events occur, especially if there is an anomalous number of them during a relatively short period.
Disaster epidemiology data developed by Red Cross/Red Crescent societies are used by government and other bodies for policy and planning purposes. Internationally, the Red Cross/Red Crescent Climate Centre concentrates on the humanitarian effects of climate change and extreme weather events. The Centre’s mission is to educate and advocate for disaster risk reduction and climate adaptation; analyze relevant weather forecast data on all timescales; and incorporate understanding of climate risks into Red Cross/Red Crescent strategies, plans and procedures (RC/RCCC, 2011).
The preceding sections illustrate a fundamental problem. Multiple parts of government and the private sector have a stake in issues of climate change, indoor environmental quality, and public health, but no one body has assumed or attempted to assume the lead responsibility. As a result, there is a lack of leadership in identifying potential hazards, formulating solutions, and setting research and policy priorities.
The present report cannot solve that problem. Its aim is instead to highlight important issues for decision-makers and the scientific community. In approaching that aim, it seeks to draw special attention to
- Ways in which the information needed to make informed decisions is lacking.
- Ways in which initiatives aimed at reducing climate-change risks have the potential to inadvertently exacerbate problems in the indoor environment.
- How it may be possible to achieve a healthier indoor environment at lower cost, with lower emissions, or both than is currently the case.
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