Needed: Information Technology 'Call to Action' for Healthy Homes
Recent strong information technology gains give public health departments and agencies across the country the perfect chance to help finish a federal, decade-old "Healthy Homes Call to Action." Fully realized, this goal would provide far safer and healthier home and apartment environments. Now, a parallel "call to action" in public health informatics is needed to help finish the job. It would take advantage of information technology benefits to support federal "healthy home" objectives.
Furthermore, timing for public health informatics couldn't be better. The deadly, not yet fully-understood COVID-19 virus still forces much of the U.S. population to hunker down at home. People are constantly exposed to lead poisoning, radon, carbon monoxide, asbestos, and other dangers. (NOTE: "Home and home" also refer throughout to apartments.)
U.S. Surgeon General's 'Healthy Homes Call to Action'
In 2009, the U.S. Surgeon General issued “A Call to Action" to promote much healthier homes. Though tremendous strides have been made to make home environments much healthier, many recommendations to improve them remain valid to this day.
The report argued that unhealthy conditions in homes and apartments are a major public health hazard. For instance, mold and poor ventilation account for fully 20 percent of asthma cases. Remarkably, radon in homes is the second leading cause of lung cancer. Home fires injure 12,000 Americans and kill 2,500 people every year. According to a U.S. Centers for Disease
Control and Prevention report, carbon monoxide exposure contributes to about 450 deaths and more than 15,000 hospital emergency room visits annually. Further, a whopping 64 percent of the exposures occurred in homes.
Research also shows that carbon monoxide exposures increase in winter. A high proportion of the jump is due to poorly maintained home heating systems, greater use of gasoline-powered generators, indoor use of charcoal grills (never recommended), portable stoves, and space heaters. Over 240,000 U.S. children live in dwellings with unsafe lead exposure. The link between home hazards and public health is indisputable.
Yet, there is good reason to be optimistic the figures can be driven down -- and soon. Thanks to growing advances, mobile applications could be applied to help manage healthy home inspections.
Information Technology Support Dimensions
Mobile applications (cell phones and tablets) can transform crucial collection of home inspection data from current and tedious, one-by-one recording of housing conditions. Instead, collection would be a speedy data sweep, always consistent beyond what human inspectors could ever do. And since public agency budgets are severely constrained and there's no information technology support for healthy homes, creating needed "continuity of care" in healthy building conditions is impossible to attain.
Public health informatics works three ways. As long as only professional inspectors collect data, it can be recorded more efficiently without using paper. It could also be used in follow-up inspections and repairs. Second, informatics inspection systems could be used to train "community workers" to perform inspections. Their work would be shared with remote experts for analysis. Third, the programs may let residents themselves document suspected housing problems, then send them to expert analysts.
As reliable data keeps pouring in, ever-growing cloud-based storage systems would then allow cheap and uniform analysis of home inspection data. This technology would allow "real-time" profiles and home hazards prioritization. Put simply, the worst problems would be tackled first.
For example, technology information systems would certainly show areas needing immediate remedial actions in public housing. Limited resources could be targeted there. Informatics development is a potentially lucrative area for the private sector, as well.
Tenant involvement in healthy homes programs can increase the value of information technology support. For example, organizations like the Metropolitan Tenant Organization of Chicago get thousands of calls per year from tenants regarding housing problems. The calls must now be answered by people manning phones. By contrast, artificial intelligence will allow many questions to be funneled via computerized chatbots.
The wide variety of hazards underscores the need to involve community and residents in healthy home programs that go well beyond mere code enforcement. A “Healthy Homes for Community Health Workers” report by the National Center for Healthy Housing lists so many needs. Major ones are dust mite control, pest control, working fire alarms, household chemical hazards, heating and ventilating problems, working carbon monoxide alarms, safety from falls, lead poisoning, asbestos, and radon. Residents should know about all these hazards.
Unfortunately, the many advantages of using information technology have yet to come into play. Inspectors are still stuck with pen-and-paper and isolated home inspection data collection systems.
The Information Technology "Call to Action' for Healthy Homes
At present, there are few information technology support systems for home and building inspections, and there is no clear dominant application. Thus, standardized protocols are needed for building inspection activities. This means little analysis exists of how effective information technology by municipalities, public housing, and tenant organizations is right now. This hampers guidance of future informatics development.
As a start, the information technology "call to action" to support healthy homes demands development and funding of well-structured pilot projects. Key players are universities, public housing agencies, small communities, and big cities. Partnerships would vary.
Among the most beneficial places to introduce pilot programs are U.S. Housing and Urban Development (HUD) inspection efforts. Over 2 million people live in HUD housing. In 2019, the U.S. Government Accounting Office was highly critical of HUD's Real Estate Assessment Center (REAC) physical inspections.
The report cited misrepresentation of housing conditions, inadequate inspectors training, and no quality control to ensure housing problems are actually fixed. At least in part, many problems could be corrected via information technology support. Informatics applied to a program as big as HUD's REAC could pave the way for eventual adoption by smaller public health agencies, municipalities, and everyone with a keen interest in advancing the public's overall good health.
This opinion piece first appeared in the Online Journal of Public Health Informatics (VOL 11, No 2). See the journal at ojphi.org.
Copyright © 2019 by the authors, below:
Kevin G. Croke, Ph.D., Emeritus Professor, UIC School of Public Health
Edward K. Mensah, Ph.D., UIC Associate Professor
Health Policy and Administration Division
School of Public Health
University of Illinois at Chicago
1603 West Taylor Street (M/C 923)
Chicago, IL 60612
This is an "open access" article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. However, readers may use articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy. Articles can only be used for educational and not-for-profit purposes.
