FLASHBACK FRIDAY – Ellen Tohn – Tohn Environmental Strategies Health and Home Performance: A Game Changer – Original Air Date: Episode 457 | 4-21-17

ellentohnAir Date: 8-17-2018|Episode 513

This week we flashback to Ellen Tohn of Tohn Environmental Strategies. Ms. Tohn is an environmental health consultant with over 30 years of experience. She is a nationally recognized expert in housing based environmental health threats, green and healthy housing, and indoor air quality. Ms. Tohn works with housing developers, owners and managers to create green and healthy housing and developed the nationally recognized “One Touch” approach.  She has assisted health advocates catalyze policy solutions; designed energy efficiency programs incorporating health protections; and managed environmental health research studies.

Ms. Tohn served as an advisor on health issues to the US Green Building Council’s LEED program, Enterprise Green Communities, Delos Living, EPA, Department of Energy, Local Initiatives Support Corporation (LISC), and numerous green building programs. Ms. Tohn is a nationally recognized trainer, providing professional development to over 7,000 individuals.  She received her BA from Cornell University and a Masters from the Massachusetts Institute of Technology (MIT). Ms. Tohn is also an Assistant Professor of Practice at the Brown School of Public Health. Home Performance professionals are becoming much more focused on indoor air quality and that focus is a game changer for their industry and possibly the IAQ world.


00:00 Ellen: Hello, Ellen, do we have you on the line?

00:02 Joe: You do, Joe, happy to be here.

00:05 Ellen: Great, welcome. Great to have you. I’ve been wanting to talk to you here for quite a while. We met many years back, and I just haven’t been able to hook up, but now we’ve got you here. And one of the reasons is the Northeast Indoor Air Quality & Energy Conference sponsored by Maine’s Indoor Air Quality Council is coming up soon. I saw you on the list there and I thought, “Let’s get her on the show.” And we can promote that as well as talk a little to listeners about health and home performance and indoor air quality. I’m just curious, there’s been a pretty big change in the government here recently, and I’m wondering… You do a lot of work for companies and organizations, I guess, that deal with indoor air quality and home health issues, what do you see as the future of these kind of programs in the United States?

00:58 Joe: Well, I think it’s an interesting inflection point. We’re at a time where we’re, from a government investment, federal government investment standpoint, that picture’s a little bit bleak. EPA, preliminary budget veered out of the lead program and the radon programs and the whole indoor air environments division. So I think you have at this moment maybe a little less investment in that at the federal level. At the same time, I think what we’re kind of feeling and seeing in the marketplace is, in a variety of sectors, a lot of interest and new understanding about how important where you live is to your health. And so, we’re seeing energy efficiency programs start; and we can jump into this a little bit more later, Joe. But energy efficiency programs, really kind of think about indoor air quality and health. We’re seeing the health world has changed its whole way that they think about healthcare to not just being sick care, what I would say, treating people when they’re sick, but really to prevention things. So the ethos in the whole public health world is where you live, work and play and learn, is very… It’s gonna define how healthy you are.


02:18 Joe: And so, think about that. Where you live, where you work, and where you learn; all of those are indoor environments. And so I think there’s a pretty strong recognition that those environments are super important to how healthy people are. And there’s… I think one of the things that we’re talking a ton about in this country right now is health. We are talking about how to keep people healthier at a cost that’s less than we have been paying. So I think you’ve got this duality which is a part of federal government, maybe dis-investing, consumers caring more, energy programs caring more, healthcare delivery… A ton are coming around to a recognition of this, and I’d say the third big force that I think is really interesting is around technology. We’re starting to see, and I’m sure you’ve had guests on about this that know way more about it than I do, but new, more affordable and valid ways to start to measure what’s going on inside indoor environments in a way that can tell regular consumers and homeowners or home performance contractors what’s really going on in an indoor environment and not have those be really complicated, expensive research tools that are really in the hands of a few.


03:38 Joe: So I think all of those things, and then we’ve definitely seen green building standards take off, and they have a ton of health elements in them, and new standards that are even focused on well-being in general, like the well-being standard. So I think you got a variety of forces that are not totally exactly aligned at this moment.


03:58 Ellen: And one of those forces you mentioned is the Home Performance Group and they are… We’ve had a few shows about this, but they are getting much more interested in and focused on indoor environmental quality issues. I’m wondering, is that something that came about because of a necessity, they kind of had to change the focus a little bit, or how did that get started?


04:25 Joe: I’m not sure I have the perfect answer on this, but my sense of it is, and I was just down at the Home Performance Conference in Nashville, giving a couple of talks and participating and sitting in, in a panel of a variety of home performance contractors who are using health as part of their marketing. One of them is even called Home Docs, a company in LA. And they literally wear scrubs. That’s their company uniform. I think that when you are in the home performance business, and we offer this integrated home performance set of services, all this stuff that we know around mechanicals and envelope improvement and indoor air quality, some of this is stuff people don’t understand or might not really, the value proposition doesn’t always resonate with them. Actually gonna share some… You and I were chatting a little before we came online to the group, but some data I found really interesting, and I think it’s sort of relevant to this, which is that when we’re trying to deal with customers and consumers around fixing up their home, the Shelton Group has done some terrific market research on this that I recently had a chance to hear about. And what people say is that, they take two-thirds of folks that they survey and they’ve been surveying thousands of people for 10 years or more, so they’ve got really good data, are concerned about the indoor quality in a home. They have some anxiety about that. Which is really a startling number, right?


06:02 Ellen: Sure.


06:03 Joe: And 84% of people think that energy efficient homes are healthier. And when you ask them, which of the things that are going on in your home bother you, about 80% include the following two statements: “The air inside my home is too humid in the summer,” or, “I experience nasal allergy symptoms when I’m inside my home.” So there’s something about the air that doesn’t feel comfortable to them, and they think that they’re having some asthma, or respiratory or nasal thing. So I think what the home performance industry is tapping into, is that we’ve got a bunch of people who’ve got asthma and respiratory problems, so on average about 10% of folks, somewhere between 8% and 12%, depending on where you live, have asthma. That percentage is bigger if you count allergies and other respiratory problems. And people are connecting that sometimes to their home environment, they’re worried about their indoor air quality in their home, and I think they have this instinct that home performance contractors could do something about it. That’s that 84% think energy-efficient homes are healthier.


07:18 Joe: So, I think home performance contractors that are trying to sell business and listening to their customers are hearing that, “This is something I care about. I think you can do something about it.” And one of the things the data also tells us that’s very strong for consumers is, one of the things that motivates us is we wanna get control of our environment. “I don’t want my house to feel cold or hot. I want to be able to control the temperature. I want the air to feel good, smell good, and I wanna protect my family.”


07:49 Joe: Particularly when you… If the decision maker… Young moms often can be the decision makers in some of those sales situations. They really wanna make sure that that new born they’re bringing home is gonna be in a safe, protected environment from an air quality and temperature standpoint. So I think there’s both customers saying, “I think something’s going on here,” and their recognition then that home performance could maybe do something about it. And then I think that some recognition from home performance contractors that, “Hey, you know what? Maybe we could be selling a little more on this point, because it does matter.” And the other thing to say about this, this market research data’s pretty interesting. The other thing they ask people is, “Could you explain terms to your mother or your brother? Not do you understand them, but do you understand them well enough to explain it to somebody?” And only a quarter of people say they can explain the term “indoor air quality.” So I think we do have a communications problem. We’re concerned, we think home performance can do something about it, but the customer doesn’t really know what we’re talking about.


09:00 Ellen: Well, that gives me a lead into another question. You’re mentioning home performance contractors a lot, and we’re gonna talk more about the Occupant Health Benefits of Residential Energy Efficiency, the document. And if I recall correctly, somewhere in there it talked about the fact that consumers call a mechanical contractor an HVAC contractor. Do they even know… How many people know what home performance contractors are and what they do?


09:37 Joe: I don’t think very many. I think it may vary. Like in New York State, someone’s done a better job of getting that messaging out, but I don’t think people know what home performance contractors do. I think it’s not a bad term. It’s a decent term of art, but I don’t think they know. There is… What do you think?


10:01 Ellen: Well, I think when you talk about energy… I don’t even know what they call them, energy raters, or… What did they used to go by? Energy…


10:11 Joe: Well, they’re HERS raters, but they’re like energy auditors, which I think is what a lot of people think of them as.


10:17 Ellen: Energy auditors, yeah. I think people recognized that for a while, and then they changed over to home performance, which, I agree, better describes what they do, but I compare that to the way a lot of the indoor air quality people are now calling it “indoor environmental quality,” and I wonder if people are confused by that from time to time.


10:37 Joe: Yeah, I think so. It’s interesting looking at this market research data. One of the things that the market researchers conclude in talking about the way utilities talk about home performance or energy upgrades, is that customers, they don’t know what the heck we’re talking about most of the time. If you ask, terms you could confidently explain to a friend, energy efficiency gets the best, energy efficient home is 38%, but IAQ is only 28%. HVAC, only 20% of people even could describe that term. And home performance is down at 14%, I’m just looking at the data here.


11:11 Ellen: Okay, I see.


11:13 Joe: Only 14% of people say they could explain home performance versus energy efficient home. An efficient home, 38%… Three times as many people say they can explain that a green home… Almost 30%, almost three times as many. So home performance, a good term, but nobody knows what it means.


11:36 Ellen: And then I have a text, and I think you just answered it, was that 25% of consumers know what IAQ is. I think you said 28% feel like they could explain what it is.


11:49 Joe: It’s 28%. Yeah. So the market research question was terms, and can you confidently and correctly explain the following term to a friend? So only 28% said they could confidently and correctly explain indoor air quality to a friend.


12:08 Ellen: The number you threw out, and I wanna make sure I got it right, because I find this fascinating. 80% of people felt that air was maybe too humid in the summer or that they had allergies more often in their indoor environment. Did I get that right?


12:27 Joe: Yeah. Let me give you the exact question, ’cause I kinda summarized it in the way I said it. So, 86% of people acknowledged at least one indicator of a lack of comfort when asked specific questions. Basically, 9 out of 10 people, that’s around the 86%. So, a lot of people said at least one of the following things was occurring in their home. And there are one, two, three, four, five, six, seven, eight, nine. There are 10 of them. Two of them were the ones I read you. “The air inside my home is too humid in the summer, I sometimes experience nasal allergy symptoms when I’m in my house.”


13:09 Ellen: Okay.


13:09 Joe: The other ones, the 86% said had at least one of these 10, and two of the ones were the ones I read you. I’ll read you the other ones, which is, “I wish my home had more natural light, during the summer my windows let in more heat than I’d like, I wish I had more control over my home’s temperature, I wish my home were better insulated against outside noise, the windows in my home give out a harsh glare in the afternoon, and sometimes I have a hard time reading or doing tasks because the lighting is not very good,” and the last one was, “It’s drafty and cold in my house in the winter.” So, what I just said plus that too humid and the nasal allergy symptoms, 86% of people said at least one of those things is happening in my house. So, what’s interesting about this, of those 10, two of them kind of relate to indoor air quality being too humid, and the nasal allergies. But a bunch of them relate to home performance in general, right?


14:10 Ellen: Right.


14:12 Joe: Too cold, my temperature is not good, it’s drafty, the temperature could be better insulated, ’cause of noise, the windows, I’m too hot in the summer. And then the other thing… It’s really about comfort and lighting. Comfort, lighting and, I would say, indoor air quality are the three things that come out of that.


14:31 Ellen: Before I go into the document on Occupant Health Benefits of Residential Energy, I was on your website and I noticed a program you called the One Touch program, and I wonder if you could tell listeners a little bit about what that is.


14:46 Joe: Yeah, great. I’m super excited about this program that we’ve been rolling out around the country. So, One Touch really is a pretty simple idea, it starts with the notion that we have these energy efficiency programs for homes and we have home visiting programs where we go to people’s homes for health reasons, early childhood interventions, or lead remediation programs, asthma home visiting or trip and fall stuff, and then we have housing repair programs. And, a lot of what I’m talking about here are actually programs geared a little more for low-income families, and these programs are all totally siloed because of the way their money comes, and they don’t really connect with each other. And what One Touch does is we work in a local community, or… I’m actually calling you from Vermont today. We do quite a bit of work in Vermont. We’re working statewide. We connect all those programs. We have a really great statewide coalition in Vermont, a Burlington coalition, Omaha, Nebraska has a coalition like this. I’ll be going out to Kansas City next week, to work with someone who’s been on your show quite a bit, Kevin Kennedy, to bring a One Touch program out to them.


15:53 Joe: And what we do is connect those programs so that everybody going into a house, whether you’re a home performance contractor, a utility energy efficiency program, a weatherization program, a housing rehab program, a general contractor, you’re doing a lead job, we ask about 15 questions that touch on these health housing and energy needs. And depending on what the client tells us, we do what we were normally gonna do and then we connect you with other programs that can kind of fill in the gaps for the other services you need. A good example, in Vermont, we’ve done about 1,400 homes, every weatherization long-term energy efficiency job in Vermont gets a One Touch, we call it a One Touch check-up, and we find about a quarter of the households need something else, and we’re very connected with the health department and other non-profits providing housing rehab services, or lead, as I said, or asthma education, or even smoking cessation. Which you and I know when we think about indoor air quality, that’s a big indoor air quality source if people are smoking a lot in their home.


16:57 Joe: So, we sometimes… We’re doing a home performance job, we’re doing a weatherization job, and we’re doing all our things, we’re improving ventilation, we say, “Hey, does anyone here smoke? Are you interested in getting connected with a quit line?” And we get quite a few people saying yes to that answer and then we connect them with services around smoking cessation, or we connect them with other services they need for… Let’s say you’re doing a home performance job, or a utility energy efficiency job and there’s a roof leak and you can’t insulate the attic, so we wanna connect you with a program that can give you a lower interest loan or a grant to do that, or connect you with a… You’re worried about your asthma symptoms and asthma problems, we can connect you with an asthma education program that could do with some really good coaching on that. So, it’s really easy to roll out in a community, it brings people together, folks love that they get connected with other resources in their community, and it has led to some really interesting collaborations where we’re not just referring, but we’re actually building programs into each other so that energy efficiency gets built into lead hazard control jobs automatically, and a bunch of other examples.


18:15 Joe: So, it’s been great. And what I love about these is they kind of sustainable and you get some really terrific coalitions involved, and we’re starting to see in some of those coalitions, a little more active participation from folks from the healthcare sector, where, and we can talk about this more later, where maybe we will have healthcare partners subsidizing small parts of some of what we do in the home performance and energy efficiency area in homes.


18:46 Ellen: And that, in part, I…


18:47 Joe: So that’s One Touch.


18:51 Ellen: In part, I assume the health care people get involved because they’re trying… They’re focusing more on prevention as opposed to treating the symptoms.


19:01 Joe: Well, it’s interesting. It’s really both. One is that healthcare might get involved, as you say, because we can make sure when we do energy efficiency jobs, that we make the home environment safer, but we’re actually also seeing it with sick patients. So, in Vermont, where there’s early efforts underway to be connecting a regional hospital in the southwestern part of the state with folks who can do energy efficiency and a NeighborWorks program that does housing rehab where if they’ve got patients that have really been struggling with asthma, and they haven’t been able to get their asthma under control, someone is sent from the hospital out to their home to take a look, and if they think there are home conditions that really could be fixed, that would make their asthma better, then that’s gonna trigger a visit by either an energy auditor who’s been trained to also look at healthy homes, kinds of triggers and asthma triggers, then we’re gonna try and get that house fixed through a combination of resources. And the hospital’s got a little bit of skin in that game, in subsidizing a little bit of those home repairs, or putting money into a loan fund that will allow people to get that work done and take in a lower, no-cost loan.


20:21 Ellen: It sounds like an interesting approach to an issue within the industry. A lot of things are kind of in silos. The lead-based paint guys have to have a lead license to do an assessment. The asbestos guys, the same thing. The radon people… And it sounds like a good way to help try and connect all those different groups that can help people with their indoor environment.


20:48 Joe: Yeah, yeah, and I think the other thing, honestly, Joe, is in the same community, people have been working on things that they just don’t even know the other resources are out there. So we’re never gonna be able to get our clients or families that we’re working with the services they need if we don’t even know what they are. So, I think people have… ‘Cause sometimes you go in a house to do the thing that you’re there for, and you see something else and you go, “I really wish I could help ’em on this.” And this is a system that helps, that allows you to do it. So, you do a common check-up, then we have a really nice software. So, the family needs something, we just check that off and an email’s sent to the organization that can help them with the information they need, so they can connect right up with that family. So, trying to use accessible technology, not make us too crazy.


21:33 Ellen: Interesting. And you mentioned earlier, the low-cost sensors that are available now. Are you building them into that program at all?


21:46 Joe: We have not done that yet. One of the things for this year is really to test out some of them. Lawrence Berkeley Lab and Iain Walker just did a look… Iain and also Brett Singer just did a look at how well they’re doing. And so, I’m waiting to see some of those results as they kind of test them out for their validity. Some of them are giving us some results that are kinda a little all over the map. So I think we’re in an experimentation phase. I’m not… I’d like to be doing more of that. I’m not quite there yet.


22:20 Ellen: Okay. I’m glad I asked, because that’s something we’ve talked quite a bit about. We had the people who developed the spec from CMU on, we had the food bot guy on. So, it’s a very interesting topic.


22:34 Joe: Yeah. You might, just trying to encourage you, but Brett and Lawrence Berkeley is doing some good field testing, so it might be an interesting… People can reach out. I don’t think they’ve published anything. They’ve shared some data, but I think it’s a really fruitful area for thinking about… The only thing I think about is I worry that we’re gonna get so obsessed with those kind of data that we’re gonna miss the forest through the trees. You’re gonna worry about little counts of particles… I mean, I care about particles, but you’re gonna forget about dampness and moisture; still one of the biggest enemies that we’re fighting, and stuff you can see.


23:12 Ellen: Good point.


23:12 Joe: The stuff that you can see, we gotta do that. So, let’s not get so focused on these other things that we… We know if you live in a damp environment, even if we don’t have mold, 30% to 50% increased risk of a whole variety of respiratory problems. So, we’ve gotta get people to really understand dampness and pests, and the crap, literally pooping crap they leave behind are all significant asthma triggers that we can see and that we can fix for.


23:44 Ellen: Those are the kind of things you looked at in this document too, Occupant Health Benefits of Residential Energy Efficiency. Let’s go back to the foundation. What led to the development of that document?


24:00 Joe: Yeah, so E4TheFuture is a new national non-profit that recently was formed after Conservation Services Group was acquired by Clear Results and some of the founders, Steve Cowell and others from CSG used that as an opportunity to create a national non-profit, which is really around energy equity environment and employment that they’re trying to advance. They have been very much interested in promoting energy efficiency and a clean energy economy, and I’ve known Steve for many years, and he said, “I keep hearing about this health stuff. I don’t really understand that. I can say to people there are health benefits for energy efficiency, but I don’t have the sentence after that. So can you help us understand it?” So, originally, we wrote this document to help E4TheFuture themselves to really understand internally what the health benefits were of energy efficiency, and as we delved into it more, it really became clear that we could document a pretty credible story here that if you do energy efficiency well in a residential sector, we can improve home environments.


25:18 Joe: We can help create healthier environments for people, can be healthier, that we wanted to expand the study a little and give it a little more outward-facing, let more people see it, and add two other pieces, which is, “Okay, so if that’s true,” and we can get into some of the nuts and bolts of that, “If that’s true, who’s out there doing energy efficiency with an intention around health, or where they’re expanding the energy efficiency work to be a Weatherization Plus Health or Energy Efficiency Plus Health, they’re doing a little more.” So we profiled a few local programs. And then the third thing we end up looking up was, if there really are these health co-benefits of energy efficiency work, a lot of this work is funded and regulated by utilities who have very strict cost-effectiveness tests and ways that they design their programs, and some states do consider what they call non-energy benefits or non-energy impacts, and if there really are these health benefits, how do we value them and how can that be taken account of in a regulatory context? So we’ve profiled some of how people have monetized the health benefits, put a real value on it, so that in utility program design, it’s taken into account and recognized, so we could… It covers some interesting stuff that’s happening in Massachusetts right now.


26:46 Joe: So, that’s really… And E4TheFuture is now really interested in thinking about how we can continue to tell this story. And this document was a companion, came out really concurrent with a similar report from the Department of Energy that looked at not just the health benefits of energy efficiency, but more broadly at home performance and green renovation. And I led the E4TheFuture one and was on the team that did the DOE report, which was led by the National Center for Healthy Housing. So both reports are terrific.


27:18 Ellen: What’s that report called?


27:21 Joe: That was… I knew you were gonna ask me that.




27:24 Ellen: I tell you what we’ll do…


[overlapping conversation]


27:25 Joe: I have it. I got it right here. Home Rx…


27:29 Ellen: Home Rx.


27:30 Joe: The Health Benefits of Home Performance.


27:31 Ellen: Okay. Alright.


27:32 Joe: Yep. If you Google “Home Rx: The Health Benefits of Home Performance,” it’s a literature review of the current literature, both of these did not do new research, we just looked at existing research, and they’re really wonderfully companion documents.


27:47 Ellen: It looked like to me that the Home Rx was kind of the foundation on which you built when E4 put together the Occupant Health Benefits of Residential Energy Efficiency. So a lot of the research on what types of research projects had occurred that correlated health effects and energy, they had already started to work on and discover.


28:14 Joe: Yes, exactly right. We did a big, big literature search for the DOE project, and identified a whole bunch of studies and looked at all of them. We had about 300 articles that we looked at in detail, and we sort of got it down to 50 that we thought were the most powerful. So you’re right, we used that work and then for E, and that work is… That report organizes the research by type of activity, energy efficiency, home energy efficiency plus home performance, and standalone IAQ kind of work, like room air ventilators and things like that, air cleaners. The E4TheFuture, we just focused on energy efficiency. We took a little different tack. We looked at it by type of health outcome. So what do we know about what you can do to improve respiratory asthma and respiratory health, and what do we know about energy efficiency in terms of how it improves other health conditions? So, absolutely using the same study, just sliced it a slightly a different way, but for sure.


29:23 Ellen: I wanna get into a little more detail about this document, Occupant Health Benefits of Residential Energy Efficiency. Ellen, I guess, first, to what extent do energy efficiency programs and practices help to improve the health of occupants by reducing things like asthma risk, respiratory symptoms and other health risks linked to home conditions? Is there pretty good proof now, that energy efficiency programs, I guess, done right, help with health?


29:57 Joe: Yeah, I think two things, Joe, the thing you said last is super important, which is done right. Alright. We can all think of in our own minds, or maybe had to go back to a job where the work wasn’t done well, and we tighten our belts and we end up with extra moisture problems and a variety of things. So if we’re doing the work right, I think we have some pretty good evidence now. So our report looked… When we just looked at energy efficiency, we had 12 studies that we thought… So we looked, as we said, over 300, we found 12 studies we felt really good about, and two that were just on ventilation and standalone, and they all documented some improvement in either occupant health or indoor environmental conditions. And when we break it out, we saw… I will say that we have… More of the research focuses on the homes of lower-income families because those tend to be government-sponsored or utility-sponsored programs that have put in some budgets for evaluation or where folks have gone and done the research. So what we saw is that… I’m just looking here at my data to say it exactly right.


31:23 Joe: So if we just focus on asthma for a second, as I said before, about between 8% and 12% of folks have asthma. If you’re in a lower-income population, for example, the folks getting served by DOE’s weatherization program, in that case 16% of the adults in that household had asthma. So it could be up to one in five households. And we know that about 40% of diagnosed asthma is associated with some home condition, moisture, temperature variation, pests, stuff like that. So not totally surprising, but what we did find is that after energy efficiency, occupants can experience fewer asthma symptoms and related emergency department use. So the one big study of the DOE’s weatherization program found 12% fewer asthma ED, emergency department visits amongst the asthmatics after the weatherization work was done. They also asked people to rate their health on a scale of one to five, from excellent to poor, and saw a 48% decline in poor health.


32:42 Joe: So really significant improvement there where people said, “I just feel better.” They sound mushy, those scales, one to five, rate your health, but the public health community is… Those are pretty well-validated scales. How people rate their own health is very, very predictive of chronic illness and other healthcare expenses. So self-reports about health are good indicators of what’s going on. So, we definitely saw fewer asthma symptoms in a couple of studies, fewer ED visits, and those… And we also, just focusing on asthma, we also saw those improvements get better when people added a little bit more of what I would call home repair and client education. So for example, there’s a terrific study in Washington State, we had asthmatics, and normally for asthmatics, we’ll send a community health worker to their home and do some education, like three visit community health worker, about taking your asthma meds, reducing your home triggers of moisture, pests, burning incense, candles, spraying air fresheners, all those kinds of things that can be irritants. And then for half the group, we added… We also did energy… I shouldn’t say “we.” [chuckle] Also, energy efficiency weatherization work was done where they also pulled up some carpeting and really did a pretty good job in ventilation, and in that case, we saw another 23% reduction in asthma that was out of control.


34:17 Joe: You’re not gonna cure asthma, but what you want people to have is not have bad symptoms that prevent them from sleeping or going to work or going to school. So, when we added that energy efficiency with a little bit of home repair, we definitely saw more improvements. So we see these improvements for respiratory health in asthma. We see them most strongly in lower-income households or people who have pre-existing conditions. I’m not gonna see as much improvement as asthma, if people didn’t have asthma to begin with. So when you focus those studies on people with asthma, we tend to see improvements. And also sinus infections, colds, throat irritation, a variety of the studies asked those kinds of questions and we saw improvements when they asked those questions. The other kinds of health benefits that we did ask about, headache… A variety of the studies asked about headaches or hypertension, high blood pressure, mental health, overall health, and again, saw improvements in all of those categories as well.


35:20 Joe: To not be too long-winded, but some of the studies also measured stuff. They measured moisture, VOCs, formaldehyde, radon, and we saw generally improvements in VOCs and moisture problems, because most of these are energy efficiency programs that are adding some ventilation, typically compliant with like an ASHRAE 62.2-2010 standard, and we saw improvements. There are two areas where we saw some areas of caution. So let me stop there, ’cause I feel like I’m talking for… I can get into the costs.


35:53 Ellen: Okay. No, well… Let’s get the caution real quick. I believe one was radon, and what was the other?


36:00 Joe: Formaldehyde.


36:02 Ellen: Formaldehyde.


36:02 Joe: We definitely saw a couple of studies where, after the work, radon went down in some homes, but we saw some of the studies reported some situations where radon levels did increase. The interesting thing to say about that is, I’m actually involved in two studies that are funded by DOE, and one is actually a combination of HUD, DOE and EPA funds, where we’re… These build on a small study I did in Maine where we tracked what happened to radon levels after weatherization and energy efficiency. These studies are now saying, “Hey, let’s take some… Let’s do some precautionary measures during our energy efficiency, particularly working in a home that might have a dirt floor, or a crawl space or an open sump. Right? Because I am… Well, I’m tightening this house up and I’m reducing the stack effect, so I should be pulling less out of the ground.” If I’ve got a big significant source, I wanna minimize the entry point for those soil gases. So the University of Chicago and the National Center for Healthy Housing are leading these studies that I’m participating in, and we’re looking at how radon might change after weatherization, in one case, doing these precautionary measures and the other making sure that it’s weatherization, energy efficiency that complies with ASHRAE 62.2, the 2010 standard.


37:33 Joe: And I think we’ll have those results in a year or so, because we’re testing, we’re doing the work, we’re testing right after the work was done, and we’re testing at a one-year follow-up. So too early to give results, but there’s a lot of interest in better understanding this and seeing the extent to which following an ASHRAE 62.2-2010 standard would help prevent us from doing harm, which nobody wants to do. Some early work by the University of Illinois, Paul Francisco, Champaign Urbana, did show with an ASHRAE 62.2-2010, that saw some actual… Were able to see some reductions in radon, post-energy efficiencies. So, it was a small study, and we’re looking to do bigger numbers and get a better handle on this.


38:22 Joe: Okay. Cliff, you have a follow-up?


38:24 Cliff: I do, I do. But it’s probably a couple of minutes back. Ellen, one of the things that you talked about was this added work that was done in the homes, following the energy efficiency improvements, such as removal of the carpet, and so on and so forth. And that that had additional improvement. Are you finding that this additional improvement holds over time, or are you going back to those houses and find out that it’s not holding? My question is really more related to the deep cleaning and cleanliness and particulate and so on and so forth that’s also known to exacerbate asthma and respiratory issues.


39:19 Joe: Yeah, yeah, great question. And the answer is, these studies really pretty much usually end at a one-year follow-up. So I don’t really have data beyond one year. But we see the improvements, some of them persisting six months to one year. So if you put in a new carpet, and you raise a good point, right? And no one ever vacuums that carpet, then, in this case, they’ve pulled the carpet and they put in smooth and resilient floorings, with that expectation in mind, which is… I always like to say, Cliff, behavior change, and I’m gonna bely my New England roots, behavior change is wicked hard, but engineering control, much better. So if I can get rid of something, that turning on a bath switch versus it… I turn on a light switch and it stays on automatically, the bath exhaust fan, the nice quiet new fans that we have, that are really good. So we’ve been generally taking carpet out because we don’t trust people to vacuum, and put smooth and resilient flooring down. So I think if we had the allergen loads reasonably low at one year, that’s a pretty good reason to hope that it would persist, but we generally haven’t followed people much longer than that.


40:43 Ellen: Ellen, let me ask you this. You’ve got… You’re gathering good information that home energy upgrades, at least done properly, will help with health. But my question is how do we get that built into the energy efficiency programs out there, because I don’t know that, at this point, anyway, I hear a lot of complaints about the programs, that they don’t necessarily look at a whole home or home performance. It’s, “Let’s get the low-hanging fruit, and then move on to the next one.” How do you get the whole… The money behind it, I guess, geared more towards whole home improvement and home performance?


41:30 Joe: Well, I think it depends on who’s sponsoring the program. If I’m a utility, I really care about therms of kilowatts saved, right?


41:39 Ellen: Right.


41:40 Joe: I don’t know that I… I’m not rewarded by doing the other stuff. So I think we’re gonna have to see, to really… Here’s the thing that’s frustrating, right? I’ve got an energy auditor, who I can train, with the new BPI Healthy Homes Evaluator Credential, which will help train him or her do a pretty good assessment around health. So I’ve got somebody in there and that’s the most expensive thing. Getting somebody there, getting a contractor to do an assessment, it’s expensive. And so I don’t wanna miss that chance and I can definitely feel, I feel confident that we can train those people to be pretty good on the health side. But the utilities are not necessarily, not really what they’re driven to do. So I think we’re gonna need some collaboration with our health partners.


42:28 Joe: We are having several utility programs where I think we need to be thinking about, is how utility and straight up energy programs can collaborate with health sector partners, where there could be some shared cost savings where maybe the health sector will pay for some part of that assessment of the home because, particularly in the homes of people who are costing them a boatload of money. If I can… If an ER visit is at least a thousand bucks, if I can avoid some of those, it’s a pretty good investment to help subsidize the home assessment. Then the question is, if I find stuff, who pays to get it fixed? The energy efficiency work, I’ve just made my case that I think it can improve health.


43:15 Ellen: I think we’re gonna still have the energy sector pay for that. But if there were these add-on things, as Cliff said, pulling carpet and putting smooth flooring down or dealing with some moisture problems that are really not connected to the energy work, then we can… We have to be exploring, whether in some cases that’s on the occupant to do. Look, if your family and your kids are struggling with asthma, you wanna do everything you can to make your kids feel better and you feel better. And probably no one has ever told you that having a home performance contractor come in could be part of the solution. So one thing is, we could get the health sector to feel more confident in recommending that and I think on the energy funded side of things we’ve gotta develop some new models where we can see, in what situations does it make sense for the health sector to be part of the payer? Part of the funding stream to support it. An interesting model’s going on in Washington State, the Opportunities Council out there, Community Action Agency, developed Weatherization Plus Health years and years ago. I’ve known those guys for a long time, John Davies.


44:32 Joe: And they now actually have state dollars that are going to do weatherization energy efficiency in low income homes and they’ve allocated a bunch of money for healthy homes. And they’re gonna be doing that work and then tracking… And they’re getting referrals from community health centers, so we’re gonna get referrals for energy jobs from community health centers for asthmatics where we think the house has got something to do with it. We’re gonna give them a weatherization energy efficiency, plus healthy homes, the state’s gonna pay for all of that and they’re gonna track what happens in their Medicaid costs. Because they did an early study that showed some reductions in Medicaid costs after weatherization and Weatherization Plus Health. But it’s a super small study, it can be highly influenced by one or two people’s Medicaid costs. So, so that’s, I think, that’s an effort to engage Medicaid programs and energy programs together to say, “Is there a new service we can deliver? Because we have an interesting national workforce.” We have the energy efficiency workforce and the home performance workforce that is trained and what the healthcare system likes is to write prescriptions. And so the question is, can we be part of the pharmacy? We stock part of the pharmacy.


45:52 Ellen: Interesting. Cliff, do you have a follow-up?


45:56 Cliff: I do. Ellen, one of the things that Joe and I have learned over the course of doing this show, probably, I think, more in the last year than anytime prior to that was, how important the area is where we sleep and what’s immediately in contact with us and the breathing zone and so on and so forth. And, I guess, that we know that many of the asthma attacks that people will get and so on and so forth, that there’s a strong connection with dust mites and there’s probably some things they could do that are pretty inexpensive, like changing the pillows and encapsulating the mattresses and stuff like that. And I’m not sure whether even that’s considered, but that could really make a pretty significant difference at a very low cost.


46:47 Joe: Yeah, yeah, I know, that’s totally right. When we do these community health worker visits for asthma that’s part of what they talk about. How to better control the environment where you’re spending a lot of time. And so, I think, that’s an interesting question, which is, if we’re gonna have energy efficiency folks add on some health, a lot of those folks, Cliff, are more mechanical [chuckle], they’re more technical. And part of what has to happen with the client is an educational engagement. Here’s things that, in addition to, “I’m gonna make it warm and I’m gonna improve the ventilation and I’m gonna add some filters, I’m gonna make sure your filters are better, I’m gonna get some air changes going here,” and so on. “But here’s some things that you can do and here’s some things you should stop doing.”


47:38 Joe: We had a case of a… Kevin always talks… I think it was Kevin or some other pediatrician of mine, we, someone had an asthmatic kid and they were worried about what was triggering their asthma attacks and they thought it was germs in the air. So, they’d just go out and spray a ton of Lysol in the air which… And other things which were just becoming respiratory irritants. So, sometimes people’s instincts about what to do are not correct. And so I think that mattress covers, dust mite covers, mattress covers, getting rid of plush bed… Furry creatures is good, not sleeping with your dog if you’re allergic to your dog, which is hard behavior to change, and then I think getting rid of the carpet in bedrooms and do those kind of combined things. We’ve seen some pretty good results from those things, so I totally agree.


48:35 Ellen: I want to mention a document that was linked to within the Occupant Health Benefits of Residential Energy Efficiency, and that’s the Healthy Indoor Environment Protocols for Home Energy Upgrades. Any comments on that, Ellen? I just want to make sure I mention it because it’s a great document and I want to make sure we get a link to that document in Cliff’s blog.


49:01 Joe: Yeah, I think it’s the perfect document, and significantly underappreciated. This is something that I worked on with EPA. Many of you know Terry Brennan, worked on it, too. And it really says when you’re doing energy efficiency, doing a home energy upgrade or renovations, here are some inner air quality things that you could think about, sort of minimum protections and other expanded actions that you might want to consider. And I think it’s a really good tool kit, super digestible, that I would encourage home performance contractors to take a look at, or anybody that’s really working in the space of fixing up homes.


49:38 Ellen: And I wanted to get my indoor environmental professionals more aware of and using that document more. And I also wanted to mention before you go, you were working on another document for, I believe it was Renovation in Schools?


49:57 Joe: Yeah, I’m doing a wonderful project with the Maine Indoor Air Quality Council, we’ll be talking about it at their conference, that is a guidance document to help schools that are doing renovations or again, energy upgrades. It’s an indoor air quality planner and what’s terrific about this is it’s really a spreadsheet, an Excel spreadsheet, and you click on the attributes of the job that are gonna be happening, we’re doing window replacements, we’re replacing the mechanicals, changing out flooring, and based on that it auto-generates the indoor air quality specs that you should be taking into account, so you don’t have to look through a whole big guidance document.


50:39 Joe: So it customizes those to your job. And I sent you, Joe, a couple documents that you could post on your website or however, make them accessible to people, but I think it gives some really tailored guidance and can help people doing jobs. Just make sure you’re not missing something that’s gonna come back to bite you later.


Z-Man’s Blog:

“Health and Home Performance: A Game Changer”

Ellen Tohn, a nationally recognized expert in housing based environmental health threats, green and healthy housing and indoor air quality, was today’s guest on IAQradio.

Nuggets mined from today’s episode:

Federal government is cutting back spending on IEQ programs.

Today’s consumers care more about energy efficiency and IAQ. They have a new understanding about what’s important indoors: it’s about where we live, work, play and learn.

Consumers want to keep healthy and save energy.

Sensor technology is becoming more affordable.

There are Green building standards, now there is a wellbeing standard. https://www.wellcertified.com/our-standard

Multiple forces are at work focusing on parts of the energy efficiency and health challenges. Assets in IEQ, energy efficiency and health are not well aligned.

Takeaways from Home Performance event Nashville.

Click to access Natl17_eBrochure_3.17.17_2.pdf

  • http://energydocs.net/faq.php an innovative home performance firm CA whose uniforms are medical scrubs.
  • When surveyed 86% of people have at least 1 point of indoor discomfort: air is too humid, experience nasal irritation/allergies in home, poor lighting, less harsh glare,
  • 2/3’s of people surveyed have anxiety over IAQ.
  • 84% of people surveyed think energy efficient homes are healthier.
  • Only 28% people surveyed understand terms well enough to explain them to others.
  • 8%-12% have asthma (number goes up when allergies and respiratory symptoms are included)
  • Clients care and instinctively believe that Home Performance Contractors can fix their problems. Clients want to have protect their families, control of their environment, want air that is clean and smells good. These Clients will willingly buy/spend more.
  • Home Performance is a good term, most homeowners think they are HVAC contractors. Some Home Performance firms focus on the juicy low hanging work and move on to the next project without a holistic approach.

One Touch is an e-referral program that connects health, energy, and housing home visiting and repair programs to cost-effectively improve health outcomes and reduce home energy use. Government and non-profits partners that “touch” homes use a common home Check Up tool and e-referral system to identify conditions triggering referrals or changes to the services delivered. The program is geared to low income families. 25% of homes worked on need something else (smoking cessation, asthma coaching, low interest loans or grants. The involvement of healthcare makes the homes safer. Connecting regional hospitals and expanding care of sick patients to include improving conditions in homes as preventative healthcare. Occupants need to understand the impact of moisture, pests and pets.

There is higher incidence of asthma in low income housing. Improving energy efficiency when done right, makes homes healthier. Research focused on low income housing found lower incidences of asthma symptoms, fewer emergency room visits, self-health ratings improved after energy efficiency work done. The work is funded by government and energy companies. The primary interest of energy companies is energy efficiency, kilowatts saved. Additional steps such as carpet removal and replacement with smooth hard surface floor and deep cleaning improves results.

“Behavior change is wicked hard. Engineering controls are much better.” Behavior change such as smoking cessation, convincing people not to sleep with animals they are allergic to is wicked hard. Engineering controls such as automated switches are more reliable than reliance upon occupant remembering to turn on bathroom exhaust fan.

BPI Home Evaluators need to collaborate with health partners.

Clients need to know: what they can do and what they can stop doing, such as misting products to kill airborne germs that are irritants and can exacerbate asthma.



Occupant Health Benefits of Residential Energy Efficiency




Ellen Tohn’s contact information:  http://www.tohnenvironmental.com/