Damp Indoor Spaces and Health (2004) / Chapter Skim
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7 The Public Health Response
7 The Public Health Response
Pages 311-332
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From page 311... ...
; • Sufficient evidence of an association exists between signs of mold and upper respiratory tract symptoms, cough, wheeze, asthma symptoms in sensitized persons and hypersensitivity pneumonitis in susceptible persons (Chapter 5)
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The authors estimated the cost of asthma associated with moisture in buildings in 1996 at 137.5 million Finnish markkaa, which translates to about U.S.$6.06 per person.1 The corresponding per capita cost associated with mold in buildings was about U.S.$3.20. Such estimates are necessarily based on simplifying assumptions and are subject to substantial uncertainty, but they highlight the fact that the effect of indoor dampness on health has an economic dimension and that cost-effectiveness 1The calculation is based on a July 1996 population estimate of 5,105,230 and a January 1996 exchange rate of 4.4425 markkaa per U.S.
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. BARRIERS TO THE ADOPTION OF DAMPNESS PREVENTION AND REDUCTION MEASURES Chapter 6 identifies many technical measures and practices that could prevent or reduce problematic indoor dampness.
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PUBLIC HEALTH APPROACHES TO DAMP INDOOR ENVIRONMENTS If excessive indoor dampness is a public health problem, then an appropriate public health goal should be to prevent or reduce the incidence of potentially problematic damp indoor environments, that is, environments that may be associated with undesirable health effects, particularly in vulnerable populations. However, there are serious challenges associated with achieving that goal.
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At least seven areas of endeavor deserve discussion with relation to the agents and exposures examined in this report:2 • Assessment and monitoring of indoor environments at risk for problematic dampness. • Modification of regulations, building codes, and building-related contracts to promote healthy indoor environments; and enforcement of existing rules.
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As noted in Chapter 2, a primary challenge in formulating a publichealth strategy in response to indoor dampness is that there is no generally accepted definition of dampness or what constitutes a "dampness problem" and no generally-accepted metric for characterizing dampness. Studies of specific populations conducted as part of research projects (summarized in Table 2-1)
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The program includes review, inspection, or evaluation of the "potential for exposure to microbiological airborne particles, including, but not limited to, fungi, mold and bacteria"; moisture incursion; and a number of other building and maintenance factors related to indoor air quality. Boards of education are required to perform an evaluation before January 1, 2008, and every 5 years thereafter of every school building that is or has been constructed, extended, renovated, or replaced on or after January 1, 2003.
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Some official entities have introduced code provisions that specifically address building dampness. In 2002, the California Occupational Safety and Health Standards Board promulgated the following new section in its "General Industry Safety Orders": (g)
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For example, a provision of Connecticut Public Act 03-220 allows the state commissioner of education to approve applications for grants in excess of $100,000 for projects to remedy a "certified school indoor air quality emergency" (as determined by the state Department of Public Health) without seeking legislative approval.
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Guidelines are typically easier to develop than regulations or other more formal instruments but can still have great effect if they earn status as professional standards of care. Prevention is a foundation principle in public health, and the committee believes that there is a need to develop and disseminate guidelines on building design, construction, operation, and maintenance for prevention of problematic damp indoor environments.
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Because the prevention of problematic dampness is just one of a set of interrelated factors that can affect the indoor environment and the health of its occupants, consideration should also be given to developing the guidelines in the context of a wider set of principles that guide the creation and maintenance of healthy buildings. Public-Health-Oriented Research and Demonstration Prevention and control of building dampness are hampered by the lack of evidence regarding the effectiveness of various interventions.
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For the high-intensity group, community health workers provided home assessments of several potential allergens associated with asthma and other risk factors (including dust, house dust mites, cockroaches, environmental tobacco smoke, rodents, and pesticides) , followup education on how to prevent their occurrence or limit their effects, and in some circumstances active interventions to change the indoor environment.
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And, as documented in Chapter 6, there is universal agreement that prompt remediation of water intrusion, leaks, spills, and standing water substantially reduces the potential for growth of dampness-related microbial agents and dampness-related degradation of building materials and furnishings. The committee recommends that carefully designed and controlled longitudinal research be undertaken to assess the effects of population-based housing interventions on dampness and to identify effective and efficient strategies.
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, and HUD and the U.S. Department of Agriculture (Healthy Homes Partnership, 2003)
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The committee is aware that guidance to physicians on the recognition and management of health effects related to indoor mold exposure was being developed when this report was completed, but there were no publicly available documents for its review. Public health professionals, particularly those who work in environmental health, will increasingly be required to assist in drafting recommendations for the prevention of excessive building dampness and the implementation of interventions to eliminate microbial contamination in affected buildings.
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At least two collaborative approaches seem reasonable for introducing or furthering the prevention and control of damp indoor environments. The first is to integrate, or better integrate, dampness considerations into current efforts.
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Findings • Excessive indoor dampness is a public-health problem: dampness is prevalent in residential housing in a wide array of climates; sufficient evidence of an association exists between signs of dampness and upper respiratory tract symptoms, cough, wheeze, and asthma symptoms in sensitized persons; and sufficient evidence of an association exists between signs of mold and upper respiratory tract symptoms, cough, wheeze, asthma symptoms in sensitized persons and hypersensitivity pneumonitis in susceptible persons. • In the absence of a generally accepted definition of dampness or what constitutes a "dampness problem," the advice offered in remediation guidelines developed by government and well-established professional asso
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Recommendations and Research Needs • CDC, other public-health-related, and building-management-related funders should provide new or continuing support for research and demonstration projects that address the potential and relative benefit of various strategies for the prevention or reduction of damp indoor environments, including data acquisition through assessment and monitoring, building code modification or enhanced enforcement, contract language changes, economic and other incentives, and education and training. These projects should include assessments of the economic effects of preventing building dampness and repairing damp buildings and should evaluate the savings generated from reductions in morbidity and gains in the useful life of structures and their components associated with such interventions.
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• CDC and other public-health-related funders should provide new or continuing support for research and demonstration projects that: -- Develop communication instruments to disseminate information derived from the scientific evidence base regarding indoor dampness, mold and other dampness-related exposures, and health outcomes to address public concerns about the risk from dampness-related exposures, indoor conditions, and causes of ill health. -- Foster education and training for clinicians and public-health professionals on the potential health implications of damp indoor environments.
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2000. Health and productivity gains from better indoor environments and their relationship with building energy efficiency.
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2002. Guidelines on Assessment and Remediation of Fungi in Indoor Environments.
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Office of Air and Radia tion, Indoor Environments Division. Washington, DC: EPA.
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