eca conference session 4: palak raval nelson
TRANSCRIPT
ASTHMA TASKFORCE: PHILADELPHIA HEALTH
DEPARTMENT – LEAD AND HEALTHY HOMES PROJECT
ENVIRONMENTAL HEALTH SERVICES (EHS) MISSION STATEMENT
To maintain environments, prevent disease, and promote public health through education and regulation. EHS monitors, assesses, inspects, and educates the public about vectors, food safety, lead & healthy homes, and environmental engineering.
Environmental Health Services
Vector Control
Food Protection
Environmental
Engineering
Lead & Healthy Homes Program
Pb
Child Asthma Hospitalization Philadelphia (2000-2012)
CHILD ASTHMA HOSPITALIZATION RATE PER 1000,000 <18 YEARS (PHILADELPHIA 2010)
Asthma Related ER Visits Children < 18 yrs. Philadelphia, P A
2009 10,55502010 9,958
PDPH Syndromic Surveillance System
PA Health Care Cost Containment Council 2010
• Americans spend up to 90% of their time indoors• Indoor concentrations of most pollutants are higher than outdoor
Indoor Environment and Asthma
The Healthy Homes Healthy Kids Program City of Philadelphia Department of Public Health
HEALTHY HOMES HEALTHY KIDS PROGRAM
• Collaboration with St. Christopher’s Hospital forchildren with severe asthma
• Integrates clinical, environmental and educational strategies to successfully mitigate and manage a child’s asthma, prevent lead poisoning and address other health and safety hazards
• Close collaboration family, medical team and HHHK team to address housing conditions and behavior.
• Services are provided in English and Spanish in anappropriate cultural framework.
1. Reduce Environmental Health and Safety Hazards• Repair Leaks• Remove mold and repair water damage• Rip up old carpeting and refinish floors• Replace leaded windows where children can reach• Vector Control Unit services (Integrated Pest Management)• Energy Audit and Weatherization
2. Help Families Engage in Healthier Behavior• Personalized Environmental Action Plan & Motivational Interviews• Issues include: clutter, tobacco smoke, stop use of perfumes, candles,
noxious cleaning and pest control supplies
3. Partner with Clinical Team• Biweekly calls for information sharing• Ensure child and caregiver understand and use medication as prescribed
HEALTHY HOMES HEALTHY KIDS: WHAT WE DO
HEALTHY HOMES HEALTHY KIDS % OF PROPERTIES WITH HEALTH AND SAFETY HAZARDS
(January 2013 – December 2014) N=160
AVERAGE COST PER UNIT OF HEALTHY HOMES HEALTHY KIDS INTERVENTION
Activity/Personnel Cost
Remediation $ 3000Integrated Pest Management $ 150Staffing $ 110Client supplies $ 200Total Cost For HHHK Services per unit
$3500
Weatherization (selected homes only)
$1200
HEALTHY HOMES HEALTH KIDS CHILD HEALTH OUTCOMES
Outcome Pre 6-9 months
post
Difference
% improvemen
tHospital visits in last 6 months
1.8 0.6 1.2(p<0.0001)
67%
ER visits in last 6 months
3.7 1.6 2.1*(p<0.0001)
57%
Doctor visits in last 6 months
3.8 2.2 1.6(p=0.002)
42%
Missed school days in last 1 month
3.3 3.6 -0.3(p=0.69)
--
Albuterol use in last 2 weeks
9.3 6.7 2.7(p=0.09)
--
Revised 6.2.1593 families surveyed based on per and post test questionnaires
LESSONS LEARNED FROM THE HEALTHY HOMES HEALTHY KIDS PROGRAM
It works! It is a cost effective intervention. Must address both housing condition and
residents’ behavior. Important to involve child’s medical
providers. Important to allow residents to determine
their Healthy Homes priorities. Must be culturally appropriate and language
accessible. More evidence-based research needed on
reducing second hand smoke in private homes of low income residents.
HEALTHY HOMES HEALTHY KIDS CHALLENGES Funding is needed to support program
expansion. Homeowners need resources to improve
housing. Landlords should be required to adhere
to their legal responsibilities under the Philadelphia law.
Retaliatory evictions are illegal and tenants need adequate representation.
Next Steps-Goals to Help Philadelphia’s Children Partnerships
with community organizations, health care providers, government agencies, health insurers, housing organizations, landlord associations and legal services.
Sustainable Funding for services and home repairs to reduce
the health and safety hazards in homes and support families’ healthy behavioral changes.
Next Steps-Goals to Help Philadelphia’s Children Data & Information
to develop a robust understanding of housing quality in Philadelphia, to understand the prevalence of health and safety housing issues and the impact on children’s health and to evaluate the effectiveness of interventions.
Legal Services and Other Support to ensure families have the legal services along with
have the information, resources, support, access to health care they need to reduce the health and safety hazards in their homes.
Enhanced Enforcement of the Health Code, Property Maintenance Code, Lead
Disclosure and Notification Law and other laws as needed to help improve the housing conditions of children.
