Integrating Energy Efficiency and Healthy Homes

Why unhealthy homes cause unhealthy occupants.

July 01, 2011
July/August 2011
A version of this article appears in the July/August 2011 issue of Home Energy Magazine.
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Energy efficiency professionals understand that energy retrofits deliver more than technical solutions to functional problems. In this, they’ve been ahead of the curve for years. The rest of the world is finally catching on to the fact that weatherization saves energy and money, and makes homes more comfortable for residents.

At the same time, “green” buildings are currently enjoying the media spotlight. Essential green building elements, including materials sourcing and construction methods, do have less negative impact on the environment at large and on the microenvironment within the building itself. And the basics of energy efficiency, such as good insulation and HVAC systems, are intrinsically green.

The indoor environment—where people spend about 90% of their time—is now being scrutinized for its impact on occupants’ health. Some health hazards, like those posed by lead paint, are well documented and regulated. Others are unaddressed, unrecognized, or unknown. Chemicals in products are being catalogued in the European Union, but not in the United States. In this country, there are no standards, and no overall rating system, for indoor air quality (IAQ). There are exposure limits for CO, nitrogen dioxide, and particulate matter in outdoor air, but in general, there are no exposure limits for indoor air. The Occupational Safety and Health Administration (OSHA) has time-rated permissible exposure limits; however, these are not applicable to residential settings. A recent call for data issued by the Lawrence Berkeley National Laboratory underscored the need for a better understanding of these conditions.

Recognition of the relationship between a safe, nontoxic environment and health has caused the government to reexamine traditional models of providing housing services through a variety of different service providers, each with its own particular area of expertise. Government agencies that develop and manage publicly funded housing have recognized the inefficiencies caused by these silos of funding and service delivery. Meanwhile, homeowners who want to provide the best environment for their families are creating a new market for green and healthy services.

In this article, we discuss ways in which green and healthy standards can be integrated into homes. We also recommend ways that energy efficiency professionals can contribute their expertise to the topic at hand.

An Emerging Consensus

The relationship between housing conditions and health has been recognized for nearly 200 years, but interventions to correct unsafe conditions have traditionally been single treatments. This method is especially suitable for interventions that require particular expertise or certification, such as lead abatement. It also results in issue-specific programs, funded by a variety of sources, and often based on particular health outcomes. The logic of addressing multiple structural deficiencies in a single visit to a home is compelling. Service co-delivery can be more cost effective than intervening on a hazard-by-hazard basis. An integrated approach may also be more effective because it recognizes and reflects the real-life interdependencies that cause unsafe conditions.

Momentum for a more holistic way of addressing housing deficiencies was jump-started in 2009 with the publication of the U.S. Surgeon General’s Call to Action to Promote Healthy Homes. The Healthy Homes Working Group was established by the U.S. Department of Housing and Urban Development (HUD), which brought together a comprehensive roster of agencies to work on a U.S. standard for healthy housing. These agencies included the U.S. Department of Human Services, the Centers for Disease Control (CDC), EPA, DOE, the U.S. Department of Agriculture, the National Institute of Science and Technology, the National Institute of Environmental Health Sciences, and the Office of the Surgeon General. HUD’s Office of Healthy Homes and Lead Hazard Control (OHHLHC), which was established to eliminate lead-based paint hazards in residential buildings, has also been tasked with leading the nation in addressing other hazards.

The Green and Healthy Homes Initiative (GHHI) was established by the Coalition to End Childhood Lead Poisoning in 2008 and was launched as a national partnership in January 2009 with the Council on Foundations, White House Office of Recovery, HUD, CDC, The Annie E. Casey Foundation, and 14 project sites. Work to analyze assets, opportunities, resources, and challenges to combining green and healthy services is currently under way.


A drain pipe leaks raw sewage into the basement. (CNT Energy)

An Emerging Definition

Perhaps not surprisingly, the definition of green and healthy is still a work in progress. NCHH and HUD include energy efficiency as a major component of the “green” in green and healthy. What other components should be included depends on local conditions and policy. Green evaluations could include testing combustion products for safety; testing for the presence of pests and vermin; testing for excessive moisture and the presence of mold; air quality testing; and testing for the presence of lead, radon, or asbestos, among other things. HUD’s working definition of green and healthy homes is homes that are energy efficient and free of major health and safety hazards. However, this definition is general enough to be considered subjective and can be subject to considerable variation.

Homeowners want greener and healthier homes for a variety of reasons. Their motives range from wanting to reduce toxic chemicals and products that exacerbate their allergies to wanting to live a more environmentally sustainable lifestyle. While housing and public health agencies pursue greener and healthier public housing, experts note that even newer, more expensive homes may pose hazards. For example, many new condominiums in Chicago constructed with split-face concrete bricks have been subject to serious mold contamination. Energy auditors need to be ready to help clients to eliminate these hazards.

Enter the Energy Efficiency Professionals

Energy efficiency professionals already have much of the expertise needed to integrate green and healthy practices into their work. Energy auditors are already evaluating the structure of homes, how the residents use the home, and how effectively the mechanical systems work. The criteria that determine whether a home is green and healthy—whether it is energy efficient and free of major health and safety hazards—are the same basic criteria that the energy audit is designed to achieve. Framing energy efficiency work in the context of green and healthy also gives professionals an additional opportunity to engage homeowners, who may be more inclined to pay for energy efficiency work if they understand that it will make their home healthier.


The relationship between housing conditions and health has been recognized for nearly 200 years,
but interventions to correct unsafe conditions have traditionally been single treatments.


What should a comprehensive green and healthy home evaluation include?

Testing for combustion safety. A standard BPI protocol in home energy efficiency work tests appliances that use natural gas to ensure proper functioning and venting. Homes should also be protected by CO and smoke detectors.

Controlling pests and vermin. Pest droppings and dander can exacerbate asthma and allergies. These biological agents can enter the home through the same cracks and gaps that should be eliminated as part of the air-sealing work.

Reducing conditions that cause moisture and mold. While mold and moisture are easily identified with a visual inspection, determining the source of the moisture that causes mold can require an expert knowledge of building science, which is expected of energy auditors.

Other green and healthy standards, as listed below, require special training and certification.

Testing for radon. Energy efficiency professionals can obtain certification in radon testing and can offer that testing as an additional service. Radon levels vary with the geographic area, so the prevalence of radon in the area should be considered. Do-it-yourself tests are also available to homeowners, but these are less accurate as they are often not used correctly.

Testing for lead. Lead contamination in a home can have negative effects on children and nursing mothers, including learning problems and delayed growth. While the potential for lead contamination can be identified, it is necessary to collect dust samples and submit them for laboratory analysis to confirm the presence of lead.

Testing for asbestos. Asbestos is most commonly found in deteriorating, damaged, or disturbed insulation, fireproofing, acoustical materials, and floor tiles. As with lead, visual inspection is not sufficient to definitely identify materials that contain asbestos, and a licensed professional must take samples of suspect materials for analysis. Asbestos becomes an acute problem when the products it is used in, such as floor tiles or pipe insulation, are deteriorating or damaged (which allows for the release of hazardous particles in the air) and in need of repair or replacement. Breathing high levels of asbestos has been known to increase the risk of lung cancer and mesothelioma.

Auditors working with government-regulated and subsidized housing may have heard about the importance of co-delivering energy efficiency and healthy-home services. HUD is providing funds to state and local governments to develop cost-effective ways of reducing home-based health hazards and of enforcing lead-based paint regulations. Codelivering services not only could reduce the time and money spent per unit but also could increase the well-being of occupants. The benefits of healthier housing are estimated to potentially save billions in healthcare costs.

On-the-Ground Implementation: CNT Energy’s Energy Savers Program

Chicago is one of the sites that the GHHI established as learning networks in 2010. Since then, Chicago nonprofits and government agencies have been designing methods to codeliver energy efficiency and health hazard remediation services. This would be beneficial because the cost savings would enable these agencies to provide assistance to more Chicago families while improving the city’s housing stock. And the clients themselves would probably prefer a more integrated model of service. Such a model would reduce the bureaucratic challenge of working with multiple agencies and would streamline the home improvement process.

CNT Energy’s Energy Savers program provides such an integrated delivery model. The Center for Neighborhood Technology (CNT) is an organization known for its work to promote urban sustainability. CNT Energy, a division of CNT, set up its Energy Savers program, which is designed as a one-stop shop of energy efficiency consultation, financing, and retrofit services to multifamily building owners in Chicago. The Energy Savers staff believe that health and safety hazard identification should be incorporated into the energy audit. Accordingly, they made this requirement part of the Energy Savers program. The first step taken to incorporate health and safety into the audit was to develop procedures for collecting data on health and safety hazards, based on visual assessments. CNT Energy’s protocol is modeled after methods developed by the National Center for Healthy Housing. It contains a clear set of definitions and assessment procedures for each health and safety hazard. The energy auditing staff, who are part of the Energy Savers program, revised their existing field energy audit form to include a page for the visual health and safety assessment.

This assessment form is used to document the presence of indicators of health and safety hazards. For example, an energy auditor can identify potential lead-based paint hazards by noting the age of the building and the condition of the interior and exterior paint. If a building was constructed before 1978 and the paint is worn, there’s a good chance that some level of lead contamination exists; these are valid indicators, supported by both EPA and the Centers for Disease Control.

However, CNT Energy does not necessarily require that all of the identified health and safety hazards be resolved before any energy efficiency improvements can be implemented. There are two reasons for this protocol. One is that one goal of the effort is simply to collect data pertaining to health and safety hazards. CNT Energy will use these data both locally and nationally to help paint a clearer picture of local housing conditions. The data will also be used in consultation with partnering organizations to develop standards and discuss protocols for green and healthy housing remediation services.

learn more

To learn more about the Surgeon General’s promotion of healthy homes, see The Surgeon General’s Call to Action to Promote Healthy Homes. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General, 2009.

For HUD’s definition of a green and healthy home, see U.S. Department of Housing and Urban Development’s Leading Our Nation to Healthier Homes: Healthy Homes Strategic Plan, Washington, DC: U.S. Department of Housing and Urban Development, 2009.

To learn more about the National Center for Healthy Housing, go to;

To learn more about the Green and Healthy Housing Initiative, go to

Another reason for this hands-off approach is to understand the realities of how property owners manage their buildings. For example, many Chicago’s buildings are vintage structures that almost certainly contain some lead paint. However, remediation is expensive and disruptive, and property owners can be reluctant to have it done, even when funding to subsidize the costs is available. Furthermore, requiring owners to repair or replace conditions that do not affect energy efficiency could discourage them from participating in energy efficiency programs—so no improvements to the building would be made at all.

This new focus on green and healthy indicators does help provide a context for improvements in building stock. For instance, federal law requires that buildings and homes have CO and smoke detectors, but it is common to find them missing or inoperable. Documenting the presence (or absence) of CO and smoke detectors, how many there are, and if they are in working order gives auditors an opportunity to tell property owners about this value-added safety measure. Auditors can also point out low-cost improvements that property owners can make. These include reducing the temperature in the water heater to 120°F and fixing downspouts or gutters that can lead to mold growth. Finally, auditors may be able to provide outreach and education to residents, who also have a role in maintaining the building.

Strategies for the Independent Energy Auditor

Auditors working in the private sector don’t necessarily need to pursue additional training and certification to become healthy home experts. Their professional evaluation of a house as a system and their commitment to ensuring that the home is safe for residents are in sync with helping to promote healthy home standards.

Many energy auditors are already qualified to address health and safety condition hazards, but all examiners should be familiar with the standards and should know where to refer clients as necessary. Retrofits should not exacerbate existing health and safety hazards, or cause new ones. Auditors who have become experts on the chemicals used in household products can provide a value-added service to clients who are concerned about exposure.

Training is available for those who want to learn more about healthand safety hazards. The National Center for Healthy Housing provides training for auditors related to healthy-home evaluations and certifications, as well as a clearinghouse of additional resources. The center also provides online assessment tools, including a good visual survey that can be used as a starting point for data collection.

Green and healthy housing makes sense. Unsafe conditions can be found in any home, regardless of income level. Through its work, the energy efficiency community can be a valuable partner in the worthy goal of improving our nation’s housing and health.

ChaNell Marshall is the Green and Healthy Homes Coordinator for the Chicago GHHI, a collaboration of public, private and philanthropic partners. Marjorie Isaacson is the Director of QA/QC at CNT Energy, a division of the Center for Neighborhood Technology in Chicago.

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