PU501 Unit 10 Childhood Asthma Housing Issue Paper Example

Mold, Mice and Missed School: A Public Health Issue Paper Arguing That a Composite City Should Pair Proactive Rental Inspection With Asthma Home Visits to Cut Children's Emergency Visits in Its Oldest Rental Neighborhoods, Recommendation for the City Council

[Student Name]

Purdue University Global

PU501: Fundamentals of Public Health and Health Systems

Unit 10 Public Health Issue Paper

[Instructor Name]

[Date]

The city, its neighborhoods and every figure are composite and bracketed for the writer's own data; the research cited is real.

Executive Summary

Problem: asthma emergency visits among children in [Eastgate] and [Riverside Flats] run at [214] per [10,000] children a year, against [83] citywide. Most of these children live in rental housing built before [1960], where moisture, mold, cockroaches and mice, all known asthma triggers, are common. Recommendation: adopt a proactive rental inspection ordinance, starting in those two neighborhoods, and pair it with community health worker home visits for children with asthma, funded through Medicaid managed care plans and a small repair fund. First-year city cost: about [$780,000].

The Problem

Population: [4,900] children in the two neighborhoods; [14] percent have diagnosed asthma, against [9] percent citywide. Burden: [1,050] emergency visits over three years, from hospital discharge data, and an estimated [11,000] school days missed. Housing: of [612] code complaints in the two neighborhoods last year, [71] percent involved moisture, mold or pests. Complaints come mostly from tenants willing to risk conflict with a landlord, so the true count is higher. The problem is a population one. Treating each child's asthma in the clinic helps that child, but the triggers sit in the buildings, and they reach every child who lives there. The children are treated in the clinic and sent home to the same mold that sent them in.

Evidence

Housing has long been recognized as a determinant of health, with moisture, pests and poor ventilation linked to asthma and other respiratory illness (Krieger & Higgins, 2002; Breysse et al., 2004). In a randomized trial among low-income households with a child with asthma, community health workers who made several home visits, assessed triggers and provided supplies and education produced greater improvements in caregiver quality of life and greater reductions in urgent care use than a single visit (Krieger et al., 2005). Home visits change what families can control; they cannot repair a leaking roof or a building-wide pest problem, which belongs to the owner and the code.

Criteria

Each option is judged on the same four criteria: reach to the children at risk; strength of evidence; cost to the city; and risk of displacing tenants through rent increases or retaliation.

Option 1: Strengthen Complaint-Based Code Enforcement

Add [two] inspectors and shorten response times. Reach: limited to tenants who complain. Evidence: indirect. Cost: [$190,000] a year. Displacement risk: high for complainants, who may face retaliation.

Option 2: Proactive Rental Inspection

Inspect every rental unit on a cycle, such as every [four] years, starting in the two neighborhoods, with fees charged to owners. Reach: all units, not only those with complaints. Evidence: moderate; inspection finds conditions, and repairs remove triggers. Cost: [$520,000] a year at start-up, partly offset by fees. Displacement risk: moderate if owners pass costs to tenants.

Option 3: Community Health Worker Asthma Home Visits

Visits for children with asthma, with supplies and referrals, paid by Medicaid managed care plans where they cover the service. Reach: children already diagnosed. Evidence: strong for family-level outcomes. Cost to the city: low if plans pay. Displacement risk: low.

What Families and Owners Said

Before writing this paper, the health department held two listening sessions with the neighborhood tenant association and one with a small landlords' group. Parents described calling the landlord repeatedly about leaks and pests, using bleach on mold themselves and missing work when a child's attack meant another night in the emergency department. Several said they had not complained to the city because they feared a rent increase or a nonrenewal. Small owners, many of whom own two or three old buildings, said they wanted to make repairs but lacked the money for roofs and plumbing, and that larger owners with many units were the worst offenders. Both groups supported inspection if it was fair and came with help for repairs.

Why Not Home Visits Alone

Home visits are attractive because they are popular and largely paid by Medicaid plans. But the trial evidence shows that visits change what families can control, such as cleaning, bedding covers and pest traps, while the most serious triggers in these neighborhoods come from leaking roofs, broken plumbing and building-wide infestations. Without an owner obligation enforced by the city, visiting workers would document problems they cannot fix, and families would be left with the same building. The combination matters because each option covers the other's blind spot.

Recommendation

Combine Options 2 and 3. Proactive inspection finds and fixes the conditions owners control; home visits address what families control and identify units for inspection. Begin in the two neighborhoods for two years, with a [$100,000] repair fund for small owners who cannot afford repairs, and an anti-retaliation provision. The city council's housing committee would adopt the ordinance; the health department would run the home visiting partnership with the Medicaid plans.

Drawing on the Course

Assessment found the problem in discharge and code data; policy development gives the council the ordinance; assurance comes through inspection and home visits. The relevant essential services are legal action, partnerships and equitable access. Legal authority exists in the city's police power over housing, which state law delegates.

Equity

The two neighborhoods are home to most of the city's Black and Latino children living in rental housing, and their asthma burden reflects decades of disinvestment in the housing stock. A citywide complaint system treats every neighborhood the same, which in practice protects the tenants most able to complain. Starting proactive inspection where the burden is greatest directs public effort toward the children who carry it, rather than distributing it evenly regardless of need.

Implementation and Evaluation

Year one: adopt the ordinance, hire inspectors, sign agreements with two Medicaid plans and begin visits. Measures: asthma emergency visits per [10,000] children in the two neighborhoods, share of inspected units with moisture or pest violations corrected within [60] days and tenant displacement complaints. Review at two years before expanding citywide.

Risks and Responses

Owners may raise rents; the repair fund and phased fees limit the pressure. Tenants may fear inspection; inspectors will work with community organizations and explain anti-retaliation rights.

Conclusion

Asthma in these neighborhoods is a housing problem that shows up in emergency departments. Pairing inspection with home visits addresses both the building and the family, and the council has the authority to start now.

References

Breysse, P., Farr, N., Galke, W., Lanphear, B., Morley, R., & Bergofsky, L. (2004). The relationship between housing and health: Children at risk. Environmental Health Perspectives, 112(15), 1583-1588. https://doi.org/10.1289/ehp.7157

Krieger, J., & Higgins, D. L. (2002). Housing and health: Time again for public health action. American Journal of Public Health, 92(5), 758-768. https://doi.org/10.2105/AJPH.92.5.758

Krieger, J. W., Takaro, T. K., Song, L., & Weaver, M. (2005). The Seattle-King County Healthy Homes Project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public Health, 95(4), 652-659. https://doi.org/10.2105/AJPH.2004.042994