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Lead Hazard Control and Healthy Homes
By David Jacobs, PhD, CIH, Chief Led by the new Secretary of Housing and Urban
Scientist, National Center for Healthy Development, this Task Force will recommend
Housing and Sarah Goodwin, Policy new strategies, regulations, incentives and other
actions that promise to conquer these avoidable
Analyst, National Center for Healthy
problems. With strategic leadership and
Housing
concerted action, the Task Force can eliminate
Administering Agency: HUD’s Office of Lead childhood lead poisoning as a major public health
Hazard Control and Healthy Homes (OLHCHH) problem and ensure that all American families
Year Started: Lead Hazard Control, 1992; have healthy homes.
Healthy Homes Initiative, 1999 The draft executive order was written by the
Population Targeted: Low-income and very National Center for Healthy Housing and is
low-income families who reside in worst-quality available here: https://twitter.com/Day1Project/
private housing where children under six years of status/1338593971069734913?s=20.
age reside or are likely to reside. HUD published an important revision to its
FY20 Funding: $360 Million, including $50 Lead Safe Housing rule on January 13, 2017
million for the Healthy Homes Initiative that conforms its definition of elevated blood
lead level to that of the Centers for Disease
Children spend as much as 90% of their time Control and Prevention (CDC). The revision also
indoors, and toxic substances can reach more establishes more comprehensive testing and
concentrated levels indoors than they do outside. evaluation procedures for the assisted housing
Older, dilapidated housing with lead-based paint, where such children reside and certain reporting
and the settled interior dust and exterior bare requirements. See: https://portal.hud.gov/
soil it generates, are the biggest sources of lead hudportal/HUD?src=/program_offices/healthy_
exposure for children. Often these units have homes/enforcement/lshr.
a combination of health dangers that include
dust mites, molds, and pests that can trigger The National Safe and Healthy Housing Coalition
asthma; carcinogens, such as asbestos, radon, tracks appropriations for these two programs
and pesticides; and other deadly toxins such as and regularly circulates sign-on letters. See:
carbon monoxide. www.nchh.org and: http://www.nchh.org/Policy/
National-Policy/Federal-Appropriations.aspx.
RECENT DEVELOPMENTS In addition, healthy housing fact sheets are
now available for all 50 states and five major
The Biden Administration is considering an
territories (https://nchh.org/who-we-are/nchh-
executive order: “Ensuring Healthy Homes:
publications/fact-sheets/state-hh-fact-sheets/).
Eliminating Lead and Other Housing Hazards.”
The urgent need for homes that support good A major new lead poisoning report is now
health has never been clearer: the COVID-19 available: (https://nchh.org/information-and-
pandemic has meant more time in our evidence/healthy-housing-policy/10-policies/).
residences, bringing healthy housing to the
fore as a national priority. This Executive Order
establishes a cabinet-level Presidential Task
Force on Lead Poisoning Prevention and Healthy
Housing to coordinate the nation’s response to
lead paint and other housing-related diseases
and injuries under the Biden Administration.
NATIONAL LOW INCOME HOUSING COALITION 6–1HISTORY AND PURPOSE plan and is permitted to target investment
of grant funds based on factors such as the
Lead Hazard Control presence of a lead-poisoned child and location in
The “Residential Lead-Based Paint Hazard a high-risk neighborhood. The programs’ funds
Reduction Act,” or Title X of the “Housing and are awarded via competitive Notices of Fund
Community Development Act of 1992,” was Availability.
enacted to focus the nation on making housing
safe for children by preventing exposure to lead- ISSUE SUMMARY
based paint hazards (the statute defines this as Recent research confirms that housing policy
deteriorated lead-based paint, lead contaminated has a profound impact on public health, and for
settled house dust, and lead contaminated bare any public health agenda to be effective, it must
soil). The law authorized the HUD Lead Hazard include a housing component. The statistics and
Control Grants Program and related programs at key findings regarding the long-term effects of
the Environmental Protection Agency (EPA) and housing-related health hazards are alarming.
CDC to provide grants to local jurisdictions to At least 270,000 children aged one to five in the
identify and control lead-based paint hazards in U.S. have elevated blood lead levels above the
privately owned, low-income, owner-occupied, current CDC reference value of 5 micrograms
and rental housing and conduct training and per deciliter. Childhood exposure to lead can
public health surveillance and other duties. In have lifelong consequences including decreased
2003, Congress created Lead Hazard Reduction cognitive function, developmental delays,
Demonstration Grants to target additional lead behavior problems, and, at very high levels can
hazard control grants to the nation’s highest-risk cause seizures, coma, and even death. Asthma
cities. Both programs and enforcement of related is one of the most common chronic conditions
regulations are housed in HUD’s OLHCHH. among children in the U.S.; over 24 million
Healthy Homes Initiative people in the U.S. have asthma, including 7.5% of
children under 18.
The Healthy Homes Initiative was established
by Congress in 1999 to protect children and The burden of housing-related health hazards
their families from residential health and falls disproportionately on the most vulnerable
safety hazards. The goal of this program is children and communities, contributing greatly
a comprehensive, integrated approach to to U.S. health disparities. African American
housing hazards through grants that create children are twice as likely to have asthma and
and demonstrate effective, low-cost methods of are six times more likely to die from it than white
addressing mold, lead, allergens, asthma, carbon children. Households with annual incomes less
monoxide, home safety, pesticides, radon and than $30,000 are twice as likely as others to have
other housing-related health and safety hazards. lead hazards in their homes. Children of low-
These grant programs are housed in HUD’s income families are eight times more likely to
OLHCHH. be lead-poisoned than those of higher-income
families, and African American children are
The beneficiaries of both the lead and healthy
five times more likely than whites to be lead-
homes programs are low-income households and
poisoned. Children poisoned by lead are seven
the broader public through education campaigns.
times more likely to drop out of school, and six
Assisted rental units served must be affirmatively
times more likely to end up in the juvenile justice
marketed for at least three years for families
system.
with children under age six. Ninety percent of
owner-occupied units served must house or be There are even bigger consequences when
regularly visited by a child under age six. Because dealing with the cumulative effects of multiple
the funds do not cover all housing eligible under hazards. Inadequate ventilation increases the
federal policy, each grantee develops its local concentration of lethal indoor air pollutants, such
6–2 2021 ADVOCATES’ GUIDEas radon and carbon monoxide, and exacerbates PROGRAM SUMMARY
moisture and humidity problems. Moisture
causes paint deterioration, which puts children Healthy Homes Initiative
at risk of exposure to leaded dust and paint chips. The Healthy Homes Demonstration Grant
Moisture also encourages the growth of mold, Program develops, demonstrates, and promotes
mildew, dust mites, and microbes that contribute cost-effective, preventive measures for
to asthma and other respiratory diseases and identifying and correcting residential health
structural rot, which is related to injuries. and safety hazards. HUD awards Healthy
Asthma is exacerbated by allergic reaction to Homes Demonstration grants to nonprofits, for-
certain triggers such as dust, mold, pests (such profit firms located in the U.S., state and local
as cockroaches, rats, and mice), cold air, and governments, federally recognized Indian Tribes,
dry heat. Use of common pesticides to control and colleges and universities.
infestations can contaminate homes. Thus, a
Lead Hazard Control Grants
‘whole-house’ approach is critical, including
thorough visual assessments, air tests, and The typical award of $3 million addresses
remediation activities. hazards in several hundred homes and provides
needed outreach and capacity-building services.
Additionally, solutions and opportunities
Grants are awarded to states, counties, and cities
may arise through existing weatherization,
for lead hazard control in privately-owned, low-
rehabilitation, maintenance, and home repair
income housing. At least 65% of the grant must
work. Because improperly disturbing lead-based
be used for direct activities such as abatement,
paint may cause lead poisoning, it is necessary
interim control, clearance, and risk assessment
to use lead-safe work practices and comply with
(and to a limited extent other healthy housing
the EPA’s renovation, repair, and painting rule
issues). Grantees are required to partner with
(and for federally assisted housing, HUD’s Lead
community groups, typically by awarding sub-
Safe Housing rule, which was updated in Jan
grants, and to provide a match of 10% to 25%
2017). Many weatherization treatments have
from local or Community Development Block
healthy homes benefits. For example, window
Grant (CDBG) funds. More than $1 billion has
replacement can help with lead poisoning
been awarded since the program started in 1993.
prevention, and roof repair and insulation may
help reduce moisture intrusion and prevent mold. Lead Hazard Reduction Demonstration Grants
Improving ventilation to ameliorate the ill effects This program targets funds for lead hazard
of tightening a building can help ensure no harm control to the nation’s highest-risk cities as
from energy-efficiency measures. Healthy Homes defined by the prevalence of lead poisoning and
and weatherization/building performance are the number of pre-1940 rental housing units.
described in a new report from the Department Grants may be as high as $3 million, but 80%
of Energy and the National Center for Healthy of the funds must be spent on direct activities,
Housing: https://www.energystar.gov/campaign/ and HUD requires a 25% local match from local
improvements/professionals/resources_library/ or CDBG funds. High-risk cities can receive
health_and_home_performance. demonstration grants in addition to basic lead
The World Health Organization released new hazard control grants. HUD now allows a portion
International Housing and Health Guidelines of the lead grants to be used for other healthy
in December 2018. See: http://www.who.int/ homes issues.
sustainable-development/publications/housing- Healthy Homes and Lead Technical Studies
health-guidelines/en/. Grants
These grants develop and improve cost-
effective methods for evaluating and controlling
residential health and safety hazards through
NATIONAL LOW INCOME HOUSING COALITION 6–3a separate competition open to academic • FY21 funding for EPA includes approximately
and nonprofit institutions, state and local $13 million for programmatic lead work,
governments, tribes, and for-profit and non-profit about $60 million in grants to states for lead
organizations. paint and lead in drinking water activities,
and about $24.6 million for radon and indoor
OTHER FEDERAL AGENCIES air quality.
The CDC Childhood Lead Poisoning Prevention
Program, National Asthma Control Program,
FORECAST FOR 2021
Environmental Public Health Tracking Network, The FY21 appropriation includes between $360
and the EPA provide complementary programs million for HUD’s Lead and Healthy Homes
to HUD’s OLHCHH. The EPA provides training Program. This funding level falls below the
and licensing programs and laboratory quality National Safe and Healthy Housing Coalition
control programs; CDC-funded programs provide proposal of $606 million, but is a welcome
surveillance data, education, and outreach on increase of funding of this program. Please see
housing related diseases and injuries; and HUD- this link for updates https://nchh.org/information-
funded programs remediate homes to remove the and-evidence/healthy-housing-policy/national/
health hazards. current-nchh-work/federal-appropriations/.
For more information on healthy homes work at
TIPS FOR LOCAL SUCCESS
these and other federal agencies, see https://nchh.
org/who-we-are/nchh-publications/fact-sheets/ Many communities have improved the quality
agency-fact-sheets/. of their housing stock through the development
of better codes, such as the National Healthy
CDC Childhood Lead Poisoning Prevention
Housing Standard, and proactive code
Program
enforcement programs, instead of a complaint-
CDC’s Childhood Lead Poisoning Prevention driven process. For example, many housing
Program provides funding to state and local codes prohibit peeling paint, standing water,
health departments to determine the extent of chronic moisture, roof and plumbing leaks, and
childhood lead poisoning by screening children pest infestation. The International Residential
for elevated blood lead levels, helping to ensure Code requires carbon monoxide detectors
that lead-poisoned infants and children receive in new homes with fuel-burning appliances
medical and environmental follow-up, and or attached garages. Efforts are underway to
developing neighborhood-based efforts to require carbon monoxide detectors in existing
prevent childhood lead poisoning (not all states housing and radon-resistant new construction
receive these grants). and to prohibit lead hazards and excessive
moisture that leads to mold. Increasing public
FUNDING awareness and concern about other housing-
FY21 funding: related hazards is fueling new attention to state
and local regulation of healthy homes issues.
• HUD Office of Lead Hazard Control and
Many communities have also urged strong
Healthy Homes: $360 million, including $50
collaboration between departments of housing,
million for the Healthy Homes Initiative.
health, and environment; effective utilization of
• CDC Childhood Lead Poisoning Prevention CDC surveillance data to guide HUD programs to
Program: $37 million (Senate). families and areas of greatest need; enforcement
of EPA requirements; and state Medicaid
• CDC National Asthma Control Program: $30
reimbursement for environmental health
million.
services in the homes of lead-exposed children
• CDC National Environmental Public Health and people with asthma. For example, the State
Tracking Network: $34 million. of Michigan recently succeeded in obtaining
6–4 2021 ADVOCATES’ GUIDEa Children Health Insurance Amendment to hazards, including lead-based paint problems.
conduct lead paint and lead drinking water pipe This also requires full funding for allied
mitigation totaling $160 million. Other states HUD programs, such as the Community
such as Ohio and Maryland have also succeeded Development Block Grants, Public and Indian
in such amendments. Housing, Section 8 Housing Choice Vouchers,
and others.
WHAT TO SAY TO LEGISLATORS
• Fully fund healthy homes programs within
Advocates should contact their members of CDC’s National Center for Environmental
Congress, ask to speak to the person who deals Health, including the Childhood Lead
with housing policy, and deliver the message that Poisoning Prevention Program, the
funding is needed to correct health and safety National Asthma Control Program, and
hazards and lead hazards in homes. Healthy the Environmental Public Health Tracking
homes interventions prevent injury, neurological Network.
and respiratory diseases, cancer, and even death
• Fully fund lead and healthy homes activities
from toxins such as carbon monoxide and radon.
at EPA.
And addressing these hazards provides economic
benefits, too; for example:
FOR MORE INFORMATION
• Removing leaded drinking water service
National Center for Healthy Housing, 410-992-
lines from the homes of children born in
0712, http://www.nchh.org/.
2018 alone would protect more than 350,000
children and yield $2.7 billion in future National Safe and Healthy Housing Coalition,
benefits, or about $1.33 per dollar invested. www.nshhcoalition.org.
• Eradicating lead paint hazards from older HUD’s Office of Lead Hazard Control and Healthy
homes of children from low-income families Homes, https://www.hud.gov/lead
would provide at least $3.5 billion in future CDC’s Healthy Homes and Lead Poisoning
benefits, or approximately $1.39 per dollar Prevention Program, http://www.cdc.gov/nceh/
invested, and protect more than 311,000 lead/.
children born in 2018 alone.
• For every $1 spent on home-based asthma
control, there is a return on investment of
$5.30 to $14.
Advocates should use the Healthy Housing Fact
Sheets for each state and five major territories at:
https://nchh.org/who-we-are/nchh-publications/
fact-sheets/state-hh-fact-sheets/ and the Healthy
Housing Agency Fact Sheets at https://nchh.
org/who-we-are/nchh-publications/fact-sheets/
agency-fact-sheets/.
Advocates should also inform legislators of the
following ways through which they can lend
support for reducing housing-related health
problems:
• Fully fund HUD’s Lead Hazard Control and
Healthy Homes Program through which
communities can fix homes with health
NATIONAL LOW INCOME HOUSING COALITION 6–5You can also read
