Home Rx: The Health Benefits of Home Performance

This report was developed based upon funding from the Alliance for Sustainable Energy, LLC, Managing and Operating Contractor for the National Renewable Energy Laboratory for the U.S. Department of Energy (DOE). This report is being disseminated by DOE. As such, this document was prepared in compliance with Section 515 of the Treasury and General Government Appropriations Act for Fiscal Year 2001 (Public Law 106-554) and information quality guidelines issued by DOE. Though this report does not constitute “influential” information, as that term is defined in DOE’s information quality guidelines or the Office of Management and Budget’s Information Quality Bulletin for Peer Review, the report was reviewed both internally and externally prior to publication. This report has benefitted from review by the National Renewable Energy Laboratory and DOE’s Building Technologies Office. Prepared by: National Center for Healthy Housing (NCHH) Columbia, Maryland Jonathan Wilson, NCHH David Jacobs, NCHH Amanda Reddy, NCHH Ellen Tohn, Tohn Environmental Strategies Jonathan Cohen, DOE Ely Jacobsohn, DOE

Executive Summary Background:

The home performance industry supports whole-house solutions to improve home energy use and enhance indoor air quality and environmental conditions. Numerous studies have evaluated the effects of a range of residential energy efficiency and green renovation work on indoor environmental quality and occupant health. However, there has not been a systematic review of such studies to summarize current knowledge and identify research gaps.



The purpose of this review is to address the question: what are the occupant health and indoor environmental outcomes resulting from energy efficiency or home performance upgrades, and how indoor environmental conditions can affect health? Home performance upgrades—defined as the systematic approach to improving the comfort, health, safety, energy efficiency, and durability of a home—ranges from work supported by many utilities and the Department of Energy’s Weatherization Assistance Program (e.g., air sealing, insulation, lighting, properly functioning heating/cooling systems, assuring adequate ventilation) to additional work supported by DOE’s Home Performance with ENERGY STAR (HPwES) and green renovations (e.g., ventilation upgrades, moisture control, window replacement, and allergen-reduction repairs). In all home repair and home performance work, there is some potential for unintended consequences and negative health outcomes due to improper design, inadequate installations, insufficient maintenance, and/or equipment failures. This review does not investigate the health outcomes related to these risks, nor does it assess the prevalence of home performance work that does not meet current industry best practices and standards.

Use and Audience

The results of this review can help guide future research, formulate work practices and work specifications, and delineate the opportunities for the home performance and energy efficiency sector to engage with those interested in population health and specific housing-related health risks. The primary audiences for this white paper are energy efficiency and home performance programs and funders, federal agency program staff and leadership, state and local energy efficiency and home performance program administrators, utilities, regulators, and home performance contractor networks. Healthcare stakeholders may also find the research of interest as they explore potential collaborations with energy efficiency, home performance, and green renovation partners. 

1. Base energy efficiency work, such as work done under DOE’s Weatherization Assistance Program, can also create healthier living environments. Health-related outcomes include improved general health, reductions in some asthma symptoms, fewer cases of hypertension and upper respiratory risks, and some improvements in indoor air quality contaminants. One New Zealand study showed significant healthcare savings when uninsulated homes received energy upgrades. 2. Enhanced energy efficiency upgrades have been shown to reduce indoor air contaminants linked to chronic illnesses, control environmental contaminants (dust mites, mold/moisture) that can trigger respiratory symptoms, and improve symptoms of asthma and other respiratory health conditions. The studies also found reductions in other indoor air pollutants and reported improvements in blood pressure and fatigue. One small study of low-income clients also showed a reduction in healthcare costs among U.S. residents. The enhanced practices most closely match common practices in the home performance industry. 3. Green new construction research includes four studies that have documented observed reductions in healthcare utilization. Multiple studies of green renovation and new construction also found reductions in indoor air pollutants, other asthma triggers such as pests and mold, and, ultimately, asthma symptoms. Although green building and maintenance practices are more extensive than the activities of most home performance contractors, this research offers information to frame the potential benefits of energy efficiency/home performance when coupled with other home renovations. 4. Studies of enhanced ventilation strategies have documented reduced indoor air quality contaminants that have been linked with chronic illnesses or respiratory risks; fewer respiratory risks among people with asthma; and reduced allergens. These studies offer promise for positive health benefits when whole house ventilation is incorporated into home performance measures. 5. Several stand-alone home services/upgrades have been shown to improve occupant health and could be incorporated into home performance work specifications. These include: in-room HEPA (high-efficiency particulate air) air cleaners, replacement of gas stoves with electric stoves, and upgrades from older wood stoves to cleaner burning models. These upgrades help to reduce respiratory risks by reducing air contaminants (e.g., nitrogen dioxide; fine particulate matter). Additional studies are needed to build upon existing research that demonstrates improved indoor air quality and reported health symptoms to also document reductions in healthcare utilization -- the extent to which a given group uses particular healthcare services in a specified period, and/or costs. 

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