Creating Healthy and Energy-Efficient Housing

What Does the Research Tell Us?

August 29, 2012
September/October 2012
A version of this article appears in the September/October 2012 issue of Home Energy Magazine.
Click here to read more articles about Program Design

During the next decade, over a million homes are expected to undergo energy upgrades. Government programs and property owners will fund this work. Key actors will include DOE’s Weatherization and Better Buildings programs; HUD’s Rehabilitation and Repair Home Loan and HOME programs; utility-supported programs; homeowners who employ home performance contractors; and property owners who are making sound financial decisions. Done well, these energy upgrades offer an unprecedented opportunity to improve health conditions for millions of Americans at a time when our health care costs are skyrocketing, exceeding $7,000 a year per capita (OECD, 2010).

Chipping paint can be a source of lead poisoning, a common problem in older residences with deferred maintenance.

This furnace filter is no longer functional due to built-up dust particles; this can cause premature equipment failure in the heating unit.

The presence of a smoke detector does not assure its utility for fire prevention; testing often reveals missing batteries.

For low-income Americans, who suffer disproportionately from various ailments, energy upgrades offer a unique opportunity to reduce fuel costs, make homes warmer for those in heating climates and cooler for those in cooling climates, and implement basic health and safety measures. Collectively these actions will increase the chance that families will suffer less from breathing problems, have improved nutrition because they have additional money for food, and spend less time in the hospital. And these health benefits need not be confined to the low-income sector. The way in which we define and execute energy upgrades will determine whether Americans will enjoy the health benefits that are possible if the work is performed with health considerations in mind—or miss out on those benefits if it is not. Fortunately, almost all of the agencies and contractors that are deeply involved in energy retrofits understand the potential pitfalls and recognize the opportunities.

In 2011, EPA released its Healthy Indoor Environment Protocols for Home Energy Upgrades (U.S. EPA, 2011). These are the minimum health guidelines that contractors performing energy upgrades should follow so that they don’t make health conditions worse. The protocols also identify actions that go beyond the minimum. When DOE’s Weatherization Assistance Program (WAP) updated its Health and Safety Program Guidance in 2011, it worked with EPA to ensure that the two guidance documents are generally consistent. The policies set forth in these documents have drawn the interest of researchers who are studying the health benefits of comprehensive energy upgrades and are learning more about precautions that contractors must follow to avoid creating health hazards. The good news is that energy upgrade work, even before contractors modify their practices, can improve occupants’ health.

Reducing Fuel Costs in Heating Climates Produces Health Benefits

Research on the Low-Income Heating and Energy Assistance Program (LIHEAP) has shown that helping low-income families to pay their fuel bills can reduce unscheduled hospital admissions and the health risks experienced by underweight children (Frank et al., 2006). It is reasonable to expect that energy upgrades in the homes of low-income Americans will also produce these health benefits, because these upgrades reduce low-income clients’ fuel bills. According to DOE, weatherization and other low-income energy upgrade programs reduce client heating bills by roughly 30% in the first year, and these savings are expected to continue over the long term because the home will continue to use less energy (U.S. DOE, 2012).

Comprehensive Energy Upgrades Improve Comfort and Safety, and Reduce Contaminants

Here are the details.

Improving comfort. Making homes more comfortable helps to minimize the use of unhealthy heating equipment, such as ovens and unvented space heaters. Data from New York City show that in neighborhoods where families rely most heavily on supplemental heating sources, there are more emergency responses by the fire department related to potential CO exposure (see Figure 1) (Kass, 2012; FDNY, 2010). These data demonstrate how reducing supplemental sources of heat would increase safety in the home and reduce the potential for CO poisoning.

Improving safety. Installing smoke and carbon monoxide alarms—a typical measure in weatherization programs—helps to reduce the risk of death from fire by 50% and the risk of fire-related injuries by 80% (Aherns, 2011).

Improving ventilation and reducing exposure to contaminants. Weatherization and other comprehensive energy upgrade programs test for CO gas during energy audits and address high levels of CO by repairing or replacing appliances. In heating climates, 20% of heating systems and 30% of water heaters require tuning, repair, or replacement as part of an energy upgrade (Skumatz and Gardner, 2005). Nationally over 60% of heating systems are fueled by gas, propane, or wood, all of which can produce CO, and in some instances small particles that can irritate the respiratory system (U.S. Census Bureau, 2011). Energy upgrades that improve ventilation by complying with ASHRAE 62.2 will ensure that more homes exhaust moisture in bathrooms and kitchens and have clean, fresh air if systems designed to pull in fresh air (that is, heat recovery ventilators or energy recovery ventilators) are installed. Research conducted by the California Air Resources Board has shown that the air in homes with enhanced ventilation contains less formaldehyde, a known carcinogen and respiratory irritant (Offerman, 2009).

Reducing asthma attacks. According to the Centers for Disease Control, one in eight Americans (13% or 39 million people) will be diagnosed with asthma during his or her lifetime (CDC, 2010). Moisture, mold, pest allergens from mice and cockroaches, changes in temperature, and environmental tobacco smoke have been shown to trigger asthma attacks (Institute of Medicine, 2004). Building dampness is associated with a 30–50% increase in a number of respiratory and asthma-related health problems, including upper respiratory tract ailments, coughing and wheezing, and asthma (Fisk, Lei-Gomez, and Mendell, 2007).

Combining rodent exclusion with air sealing by installing corrosion-proof metal screening in holes before foaming is a low-cost strategy that can prevent mice from entering a home. This will help the 7–18% of the population that has an allergic reaction to mice and improve the 35% of U.S. homes that show evidence of mice allergens (Arbes et al., 2005; Salo et al., 2008; Wilson et al., 2010). It will also improve the durability of the air sealing by preventing mice from chewing through the newly installed expanding foam.

Supplemental Heat and CO Incidents CO Incidents with > 1 ppm per 1,000 buildings

Figure 1. The vertical axis represents the number of CO incidents in each neighborhood where FDNY measured at least 1 ppm at the scene, per 1,000 buildings. The horizontal axis represents the estimated number of households in an area that needed to use a secondary source of heat in addition to their primary source, divided by the number of households in the area and expressed as percentage.

Supplemental Heat and CO Incidents CO Incidents with > 1 ppm per 1,000 buildings

Figure 2. The Watts to Well-Being study showed an improvement in general health after weatherization work. A greater percentage of residents rated their health as excellent, very good or good after weatherization work. There was a corresponding decline in the percentage rating their health as fair or poor after the energy upgrade.

Research Shows That Weatherization Improves Health

Several studies have shown health benefits from energy upgrades conducted in single-family homes. One evaluation of WAP found that clients reported feeling healthier following energy upgrade work than clients who had not yet received weatherization services (Brown et al., 1994). A study of low-income households in New Zealand with at least one person reporting respiratory problems showed that insulating existing houses led to significantly warmer, drier indoor environments and resulted in improved self-rated health and self-reported wheezing. The study also documented reductions in the number of days off school and work due to illness, fewer visits to medical care providers, and fewer hospital admissions for respiratory conditions (Howden-Chapman et al., 2007). It is important to note that this study tracked homes that had little to no insulation prior to the energy upgrades; the authors report that about one-third of homes in New Zealand have no insulation.

A recently completed study, Watts to Well Being, conducted by the National Center for Healthy Housing with Tohn Environmental Strategies, tracked the health of 248 adults and 75 children before and after energy retrofits in their low-income single- and multifamily homes in Boston, Chicago, and New York City. (The authors report some of the preliminary findings below, and anticipate publishing the full study results in the near future.) The weatherization work included air sealing; insulation; heating system repairs and replacements, as needed; window replacement, primarily in New York; repairs to address leaks and moisture problems; and health and safety measures (for example, CO testing and repairs; and bath and dryer ventilation). The study did not focus on occupants with breathing problems; rather, it documented changes in building conditions and occupant health experienced by typical weatherization families. Occupants were asked about their health status before and after the energy work was completed; average follow-up time was nine months.

In general, residents reported improved comfort. The percentage of homes reporting uncomfortable temperatures in the winter dropped from 55% before the energy work was done to 39% at follow-up. Similarly, the percentage of homes reporting uncomfortable summer temperatures dropped from 65% to 45%. Both sets of changes were statistically significant. Fifty-two percent of homes reported moisture and leaks before weatherization while only 42% reported such problems after the energy upgrade. These improvements are consistent with those observed in the New Zealand study (Howden-Chapman et al., 2007).

Improvements in general health, hypertension, and sinusitis were documented in the Watts to Well Being study. The interviewer and the interviewee at follow-up were both blinded to the general health responses provided at baseline to minimize bias. The average general health score for adults improved 0.29 on a 5-point scale and was statistically significant. The general health improvements were greatest for those who initially self-identified as being in fair or poor health. As shown in Figure 2, there was a substantial increase in the percentage of adults rating their health as either excellent, very good, or good and a decline in the percentage rating their health as fair or poor. Among adults, the study observed an 18% net decline in hypertension rates and a 5% net improvement in sinusitis.

For asthma, 20% of adults had a reduction in the use of rescue medication, but at the same time reported more coughing and wheezing as well as more difficulties sleeping due to asthma. The New Zealand study observed improvements in all of these asthma symptoms following comprehensive energy- and moisture-control work in the homes of asthmatics; the energy work in the Watts study did not include comprehensive moisture and asthma trigger control. Several studies have shown that it typically takes a multifaceted asthma intervention—one that addresses all housing-based hazards, such as moisture, mold, dust, and pests—to produce consistent improvements in respiratory health (Krieger et al., 2010).

What the Health Studies Tell Us

The cumulative research tells us that comprehensive energy retrofits performed by professionals can improve occupant health. Health gains result from reductions in energy bills for low-income Americans, as evidenced by the research involving LIHEAP. Low-income residents in both the New Zealand study and the Watts study reported general health improvements, with particular improvements for those in poor or fair health. Both the New Zealand and Watts studies also show reductions in sinusitis. When energy work includes moisture improvements in the homes of asthmatics, there are documented improvements in dampness and concomitant improvements in respiratory health (Howden-Chapman et al., 2007). When extensive moisture controls are not part of the energy upgrade work, there are fewer improvements in dampness (only 10% homes showed improvement) and more mixed results in respiratory health.

“This study of the data showed us the importance of participating in practical research. We are committed to finding solutions to health problems that can be addressed through home retrofits and to improving occupant health.”

Next Steps

Over the last 30 years, energy professionals have honed their skills to deliver healthier and more energy-efficient homes. Modern energy upgrade work improves health. Practices such as testing for combustion gases, installing smoke and CO alarms, removing unvented space heaters, blocking pest entry with enhanced air sealing, following lead-safe work practices, and enhancing ventilation all contribute to improved health.

The road map is clear. Energy professionals and programs have enormous potential to help reduce housing-based health risks. Critical next steps are discussed below.

Promote the Health Benefits of Well-Performed Energy Upgrades. Programs and contractors can talk to consumers and policy makers about the health benefits of energy upgrades, and can encourage them to support continued and enhanced funding for programs, particularly programs that meet the needs of low-income families. Contractors and private sector programs should explore marketing and outreach strategies that promote these health benefits to consumers, many of whom care more about their health than they care about energy efficiency. A national survey of potential green consumers found that health-related concerns are strong consumer purchase motivators for green products, including products that increase energy efficiency. Further, green consumers were 3 times more likely to suffer from asthma and other breathing problems than the overall population (Shelton, 2012).

Support and Promote High-Quality Energy Upgrade Programs. DOE’s WAP is committed to continuous improvement for energy efficiency, health, and safety. WAP’s recent Health and Safety Guidance (WAP 11-06) and the Standard Work Force Specifications are evidence of this commitment (see “Weatherization and Health: The Next Step for WAP,” HE March/April ’12, p. 30 and “Raising the Bar for Home Performance,” HE Mar/April ’11, p. 52). Both clearly specify minimum guidelines to improve occupant health and reduce health care costs. State weatherization programs should take advantage of this new guidance to make best use of health and safety funds. EPA’s new Healthy Indoor Environment Protocols for Home Energy Upgrades also present guidelines that contractors and programs (including utility, state, and private programs) can and should follow. Energy programs working with utilities and property owners can use these protocols to enhance their service delivery and their products.

Support Collaborations to Integrate Health Protections with Energy Upgrades. The Weatherization Plus Health Initiative, sponsored by DOE and the National Association of State Community Service Programs and profiled earlier this year in “Weatherization Plus Health: The Next Step for WAP” (HE Mar/Apr ’12, p. 30), offers tools and models to support the enhanced partnerships that will help deliver healthier housing as part of energy upgrades. Energy contractors can help serve their customers and clients by understanding how the house affects occupants’ health and by addressing problems that fall within their scope of work, and by serving as a connector to resources and professionals that can help clients solve problems that fall outside the boundaries of an energy job.

Conduct More Research on Energy Upgrades, Focusing on Ventilation and Radon. There are limited data on potential changes in radon exposure following energy upgrades. Radon is the second-leading cause of lung cancer, so it is important to understand how energy practices might affect exposure to radon. The forthcoming National Evaluation of the Weatherization Program should provide important information on this topic, as will several smaller studies that are now under way. One such study, by the Maine Indoor Air Quality Council, showed an increase in radon levels in some homes following energy upgrades. Approximately half of the homes had radon levels below the EPA action threshold of 4 picocuries per liter (pCi/l) both before and after the energy upgrades. Increases were more likely in homes with dirt floors and open sump pumps (MIAQC and Tohn, 2012). Research documenting the changes in indoor air quality following improved building tightness and ventilation will help to inform programs grappling with the complexities of compliance with ASHRAE’s new ventilation standards.

Anne Evens, director of CNT Energy in Chicago, and a contributor to this article, concludes, “This study of the data showed us the importance of participating in practical research. We are committed to finding solutions to health problems that can be addressed through home retrofits and to improving occupant health. A better understanding of radon change is next on our list.”

This work was funded by a grant from HUD (MDLHH0190-08). Project partners and article authors and contributors include Ellen Tohn, Tohn Environmental Strategies; Jonathan Wilson and David Jacobs, National Center for Healthy Housing; Anne Evens and Marjorie Issacson, CNT Energy; Yianice Hernandez, Enterprise Community Partners; and John Wells, Boston anti-poverty agency ABCD.

This article was sponsored by DOE’s Weatherization Assistance Program, through the Oak Ridge National Laboratory.

  • 1
  • NEXT
  • LAST
Click here to view this article on a single page.
© Home Energy Magazine 2023, all rights reserved. For permission to reprint, please send an e-mail to
Discuss this article in the HVAC and Weatherization groups on Home Energy Pros!

Add a new article comment!

Enter your comments in the box below:

(Please note that all comments are subject to review prior to posting.)


While we will do our best to monitor all comments and blog posts for accuracy and relevancy, Home Energy is not responsible for content posted by our readers or third parties. Home Energy reserves the right to edit or remove comments or blog posts that do not meet our community guidelines.

Related Articles
SPONSORED CONTENT What is Home Performance? Learn about the largest association dedicated to home performance and weatherization contractors. Learn more! Watch Video