Baltimore’s Transition to
Healthy Homes
Structuring a comprehensive,
community-based healthy homes
effort
Genevieve Birkby, MPH, MA
Baltimore City Health Department
Healthy Homes & Communities
Division
Overview
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Describe Baltimore’s transition to
healthy homes
Convey opportunities, resources &
barriers
Discuss expansion to communitybased initiatives which support healthy
housing
Baltimore
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87 square miles; 650,000 people
55,000 children under 6
65% African American
Median family income – $37,000
Limited affordable, healthy housing
Goal - Clean, Green, Healthy
Healthy Homes & Communities
Division
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Created in May 2006
Deputy Commissioner, Dr. Madeleine Shea
Mission:
The Baltimore City Health Department -- in
collaboration with community, city, state and
national partners -- will improve the health and well
being of children and their families by developing
and targeting resources to make Baltimore homes
lead safe, reduce home-based asthma triggers,
reduce carbon monoxide poisoning, and decrease
preventable home injuries.
Baltimore’s Housing
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50 years old on average (US is 30 yrs)
75% of rental units estimated to have lead
Studies of low income housing show:
24% leaking roofs
 53% peeling paint
 38% mouse droppings
 31% roaches present
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Lead Exposure in Baltimore
2500
2000
1500
1000
500
0
2000 2001 2002 2003 2004 2005 2006 2007
The number of lead-poisoned children under age 6 in
Baltimore decreased from 2,189 in the year 2000 to 626 in
2007.
Why Transition from Lead to HH?
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Declining lead cases
Unmet needs in asthma prevention
and control, and injury prevention
Staff capacity in inspections, health
education and case management
Opportunity to expand public health
services and impact
New funding and partnership
opportunities
Healthy Homes Demonstration
Project
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CDC-funded; piloted in 2007
Goal to develop, implement and
evaluate a model to expand an urban
childhood lead poisoning prevention
program into a comprehensive healthy
housing program
100 initial home assessments
50 three-month follow up assessments
HH Demonstration Project
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Significant staff training (healthy
homes 101; IPM; fire safety; CO etc.)
Developed forms, assessments and
protocols
Identified relevant healthy housing
resources
Evaluation, evaluation, evaluation
Population Demographics
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Mean income = $576/month
Average household size = 4.9 people
Population - Renters
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56% live in rental properties
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65% of renters have a written lease
Average monthly rent is $328
Population - Asthma
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40% of households have someone with
asthma or other respiratory problem
32% have child with asthma
Results: What did we find?
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Kitchens without a trash can: 28%
Households reporting any pest
problem: 79.5%
44% with no working smoke alarms
Asthma reported: 43%
No working heat: 17%
Indoor smoking: 36%
Lessons Learned: HH Pilot
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One-size fits all approach?
Need to weigh “comprehensive”
assessment with “actionable” interventions
Priority intervention areas?
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Asthma? IPM?
Staff
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Training
Morale
How? Resources & Opportunities
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City Agencies – (DHCD, HABC, FD, PD, Health
Programs, Quasi Orgs, School System)
State Agencies (DHMH, MDE, DHCD)
Universities (public health, nursing, psychiatry,
urban planning, community law, social work,
forestry, etc.)
Primary Care Providers
Federal Agencies (CDC, HUD, EPA)
Community Based Orgs (Coalition to End
Childhood Lead Poisoning, community groups, etc)
National Advocacy and Training Orgs (NCHH,
AHH)
How? Resources & Opportunities
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City-wide initiatives
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Baltimore City Sustainability Commission
Mayor’s Cleaner, Greener Initiative
Food Policy Task Force
Barriers to Transition
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Taking programs to scale
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Requires increased staff, training and
supplies
Lack of public investment in housing
for low-income families
Families “in crisis” – social issues
beyond housing
Resource constraints
Current Division Structure
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Four Bureaus
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Lead Inspections &
Enforcement
LAAP (Lead
Abatement Action
Program)
Asthma
Community
Planning &
Initiatives
Lead Inspections & Enforcement
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Registered sanitarians inspect all
homes of children with elevated blood
lead levels with a healthy homes
approach.
Issue violation notices to those homes
with lead hazards
2009: Bed bug response
Lead Inspections & Enforcement
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Case management for children with an
EBL or with significant lead risks
Provide integrated healthy homes
assessment and risk-specific advice
Link families to resources needed to
improve the health and safety of their
housing
Lead Abatement Action Program
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Health intervention program geared towards
interim control treatments of lead poisoning
hazards in the home.
Have completed lead hazard intervention
work in over 2,500 units throughout the City.
Asthma
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Home visiting asthma programs
 Enroll children ages 2- 18 who have
moderate to severe asthma
 Home visits from nurses and trained
community health workers to assess
medical and environmental needs.
 Utilize a healthy homes approach.
Community Planning & Initiatives
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Community-based initiatives and
evaluation
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Outreach and training
Lead Safe Work Practices Initiative
Promotores program
Community Environmental Health
Planning Initiative
Safe Pest Management for Health
Initiative
Expansion to the Community
Healthy Homes
Healthy Homes and Communities
Community Approaches
Response to both identified priorities
and emerging needs
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Promotores program – need for better
engagement with the Latino community
Safe Pest Management for Health
Bed bugs!
New and creative approaches (MICA)
Asthma community education groups
Community Approaches
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Support other city-wide initiatives
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Weatherization + health
Baltimore City Sustainability Commission
Redline Project
Safe Pest Management for Health
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Baltimore Housing, BCPSS
Augment our IPM response within the
division
35 site assessments
Recommendations for city IPM
contracts
Bed bug subsidization program
Peer education in public housing
Weatherization
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Broad-based partnership
Housing; CECLP; MD Rehab.,
Civicworks, Rebuilding Baltimore
Together
Weatherization + healthy housing
Future Directions
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Healthy housing will continue to evolve
Tailor according to your community’s
needs – don’t take on too much
Consider creative approaches and
non-traditional partners