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3 Government and Private-Sector Involvement in Climate Change, Indoor Environment, and Health Issues Several government and private-sector bodies are involved in various issues of climate change, indoor environment, and health. This chapter identifies them and summarizes their work in those issues. It also lists some major sources of data on the characteristics of buildings, the indoor envi- ronment, and public health and discusses how they might inform questions about the intersection between them. FEDERAL GOVERNMENT AGENCIES AND DEPARTMENTS The 2010 National Research Council report Informing an Effective Response to Climate Change lists 19 US federal executive and legislative branch bodies that are involved in or affected by decisions about climate change (NRC, 2010). This section lists the entities that are most directly involved in issues related to the intersection between climate change, the indoor environment, and health and identifies some of their work. Chapter 8 provides additional detail on programs related to building weatherization and energy efficiency. US Environmental Protection Agency The US Environmental Protection Agency (EPA)—the sponsor of the present study—conducts and coordinates research on a broad array of is- sues associated with climate change. Its purview includes both the outdoors 53

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54 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH and some indoor environments.1 The bulk of EPA’s efforts are directed toward research on and regulation of greenhouse gases, but the agency’s Indoor Environments Division addresses climate-change questions as part of its objective to protect the public’s health by promoting healthier indoor environments. One major initiative is the ENERGY STAR voluntary building- certification program, which promotes the use of low-energy–demand designs, construction, and appliances. EPA cites lower greenhouse-gas emis- sions as one the benefits of certified homes (EPA, 2010e). The voluntary Indoor airPLUS standard allows builders who have already met ENERGY STAR requirements to apply an additional label to structures that have met criteria that include resistance to outdoor water intrusion, mitigation of op- portunities for indoor dampness, a heating, ventilating, and air-condition- ing (HVAC) system that meets American Society of Heating, Refrigerating, and Air-Conditioning Engineers standards for ventilation, and low-emission building materials (EPA, 2009b). In late 2010, the agency released a draft of voluntary Healthy Indoor Environment Protocols for Home Energy Upgrades for public comment (EPA, 2010b). The protocols were developed in conjunction with the De- partment of Energy (DOE) Workforce Guidelines for Home Energy Up- grades (DOE, 2011) and focus on potential health effects of weatherization and other retrofits intended to promote energy efficiency. They touch on such issues as moisture, emissions from building materials, and ventilation and offer guidance on exposure assessment, mitigation, and adaptation strategies. EPA specifically addresses the subject of the present report in an In- door Air Quality and Climate Readiness Web site that in late 2010 in- cluded weatherization and indoor air-quality briefing material and links to more general indoor environmental-health information (EPA, 2010d). Several other information and education programs indirectly address build- ing problems and exposures that have been associated with climate change and the indoor environment and with remediation of their adverse effects. The Agency’s Tools for Schools program, for example, seeks to “prevent and solve the majority of indoor air problems with minimal cost and involvement” (EPA, 2009a, p. i).2 As was the case with Indoor airPLUS, actions address outdoor-water intrusion, indoor dampness, proper ventila- tion, well-maintained HVAC systems, and low-emission building materials. 1 Workplace environmental problems are under the jurisdiction of the Occupational Safety and Health Administration. This report touches on issues in offices but does not address in- dustrial environments, which may also be adversely affected by climate change (Nilsson and Kjellstrom, 2010). 2 These topics are also dealt with in the 2006 National Academies report Green Schools: Attributes for Health and Learning (NRC, 2006).

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55 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT A cooperative agreement program announced in late 2010 disseminated $2.4 million to local government, educational institutions, and nonprofit organizations for “demonstration, training, education, and/or outreach projects that seek to reduce exposure to indoor air pollutants” and that would yield measurable results (EPA, 2010c). EPA’s Environmental Technology Verification (ETV) Program was initi- ated in 1995 to evaluate environmental technologies and make them readily available for the mass market for the benefit of the general public (EPA, 2011a). One of its main goals is to standardize testing among different companies and products. One such standardization was of the accuracy of technology that tests building pressure to determine whether contaminants in buildings are due to vapor intrusion or to other product emissions (ETV, 2010). Another initiative investigates microorganism-resistant building ma- terial for mold resistance, emissions of volatile organic compounds (VOCs) and aldehydes, and moisture content (RTI International, 2008). EPA also partners with other federal agencies to conduct research. In collaboration with the Department of Housing and Urban Development (HUD), EPA conducted a national survey that measured allergens, includ- ing mold, and pesticides in homes (Stout et al., 2009). The data have since been used to examine the indoor environment and potential health risks to occupants. It also cochairs the Federal Interagency Committee on Indoor Air Quality with four other federal agencies.3 This committee coordinates research and facilitates communication on indoor-air topics, including ex- cessive dampness, mold, ventilation, emissions from building materials, and “green buildings.” National Institutes of Health The National Institutes of Health (NIH) is the principal biomedical research arm of the Department of Health and Human Services (HHS). It conducts and sponsors investigations on a broad array of health topics and fosters both basic and applied research. Climate-change–related work at NIH falls principally under the aegis of the National Institute of Envi- ronmental Health Sciences (NIEHS), which holds primary responsibility for conducting and funding environmental health research. In 2010, that institute released the results of an effort by the Interagency Working Group 3 The committee’s Web site notes that “the CIAQ is co-chaired by EPA, the Consumer Prod- uct Safety Commission, the Department of Energy, the National Institute for Occupational Safety and Health, and the Occupational Safety and Health Administration. Other federal departments and agencies participate as members” (EPA, 2010a).

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56 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH on Climate Change and Health4 (NIEHS, 2010). The stated purpose of A Human Health Perspective on Climate Change was to (p. iv) identify research needs for all aspects of the research-to-decision making pathway that will help us understand and mitigate the health effects of climate change, as well as ensure that we choose the healthiest and most efficient approaches to climate change adaptation. Among the research needs identified were studies addressing the health effects of indoor dust on asthma exacerbation, including changes in dust composition resulting from climate change (p. 15); how changes in temper- ature and precipitation affect exposure to toxic chemicals (p. 19); the effects of climate change on outbreak incidence, geographic range, and growth cycles of insect pests and pathogens that cause human disease (p. 27); risk factors for illness and death associated with acute exposure to extreme heat events and chronic exposure to increased average temperatures; and the health benefits of the use of environmental design principles to reduce the high thermal mass of urban areas (p. 31). The report also called for research aimed at anticipating, detecting, and responding to climate-change–induced and –exacerbated health problems and identifying vulnerable populations. In July 2010, NIH announced that it would operationalize those recom- mendations by providing research funding through a program intended to “examine the differential risk factors of populations that lead to or are associated with increased vulnerability to exposures, diseases and other adverse health outcomes related to climate change” (NIH, 2010). NIEHS collaborates with EPA to support several Children’s Environ- mental Health Research Centers, which conduct and support studies of the effects of environmental exposures. As noted later in this chapter, it cooperated with the Department of Housing and Urban Development’s Of- fice of Lead Hazard Control to conduct the National Survey of Lead and Allergens in Housing. The study gathered data on indoor allergen exposure that allowed NIEHS to “assess the magnitude of levels of indoor allergens in the United States housing stock” and “evaluate differences in population exposure to allergens based on factors such as region/geography, ethnicity, socioeconomic status, and housing type” (NIEHS, 2011). 4 The working group comprised representatives of the Centers for Disease Control and Prevention, HHS’s Office of the Secretary, EPA, the National Aeronautics and Space Adminis- tration, NIEHS, NIH’s Fogarty International Center, the National Oceanic and Atmospheric Administration, the Department of State, the US Department of Agriculture, and the US Global Change Research Program.

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57 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC), which also falls under the aegis of HHS, takes a public-health approach to climate- change–related work that includes (CDC, 2009b) • T racking data on environmental conditions, disease risks, and dis- ease occurrence related to climate change. • E xpanding capacity for modeling and forecasting health effects that may be climate-related. • E nhancing the science base to understand the relationship between climate change and health outcomes better. • I dentifying locations and population groups at greatest risk for specific health threats, such as heat waves. • C ommunicating the health-related aspects of climate change, in- cluding risks and ways to reduce them, to the public, decision- makers, and health-care providers. One component of the work is the Climate-Ready States and Cities Initiative. The initiative is intended to support health-department efforts to assess, plan for, and build capacity to respond to climate-change–related health effects (CDC, 2010a). Eight states5 and two cities6 were awarded grants totaling $5.25 million in 2010 to pursue projects. Many of them listed issues related to the indoor environment, such as heat-stress morbid- ity and mortality, as subjects to focus on, but indoor environmental quality does not appear to be among the concerns being addressed. CDC’s National Center for Environmental Health (NCEH) seeks to improve the nation’s health status by avoiding diseases and disability caused by noncommunicable environmental factors (CDC, 2011a). It assigns high priority to vulnerable populations—specifically, children, the elderly, and people who have disabilities. NCEH’s activities include lead-poisoning prevention and environmental-health workforce development and capacity- building. Its climate-change–related work includes prevention of carbon monoxide (CO) poisoning from home electricity generators during power outages. CDC also collects surveillance data on diseases related to environmen- tal changes via its National Environmental Public Health Tracking Network (CDC, 2010b). The network includes monitoring of home contaminants— as of 2010, lead and CO. Although it was not designed to investigate climate-change effects, the director of CDC’s Division of Environmental 5 Arizona, Maine, Massachusetts, Michigan, Minnesota, New York, North Carolina, and Oregon. 6 New York City and San Francisco.

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58 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH Hazards and Health Effects asserted in 2007 that it would be “an excellent tool” for such purposes (Late, 2007). CDC has also provided funding for research projects on such topics as adverse exposures and health problems related to extreme weather events (Brandt et al., 2006; CDC, 2006). National Institute for Occupational Safety and Health CDC’s National Institute for Occupational Safety and Health (NIOSH) examines the health consequences of occupational environments. NIOSH has conducted extensive research to evaluate the effects of indoor environ- ments on occupant health and to characterize the factors that contribute to poor health outcomes. No specific research focuses on climate change and occupational-health issues, but the institute has investigated adverse respiratory health effects resulting from damp or water-damaged occupa- tional environments (Cox-Ganser et al., 2005, 2009; Park et al., 2006) and has developed tools to assess indoor moisture to guide preventive actions. Investigators also examine the products of indoor chemistry7 and their health effects (Anderson et al., 2010) and seek to determine the mechanisms by which indoor molds stimulate allergic responses (Green et al., 2009). NIOSH conducts research into the effects of “green” jobs on health, rec- ognizing the new exposures and conditions associated with jobs designed to support activities that lead to energy efficiency and less environmental effect. More generally, the potential for increased heat stress in indoor occu- pational environments has been flagged as a health and productivity issue in other countries (Kjellstrom et al., 2009a,b). Department of Energy DOE research activities include energy efficiency, clean-energy technol- ogy, and greenhouse-gas emission reduction. The department’s Building Technologies Program does not identify climate change as a motivating fac- tor but conducts work that addresses the topic through programs that seek to reduce energy demands and promote good indoor air quality. Research and development initiatives include support of revisions of ventilation and building codes; improvement of exposure-assessment, ventilation, filter- ing, and air-cleaning technologies; source reduction of VOCs; and better 7 Indoor chemistry refers to the oxidation-reduction, acid-base, hydrolysis, decomposition, and other reactions that occur in indoors as a result of the interaction between various chemi- cals in the air, furnishing, floor and wall coverings, cleaning supplies and other constituents of the indoor environment.

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59 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT understanding of the effects of energy-efficiency measures on health and productivity (DOE, 2010). Much of the work is conducted by the Indoor Environment Division of DOE’s Lawrence Berkeley National Laboratory (LBNL, 2010). DOE’s extensive work in weatherization and energy effi- ciency in buildings is addressed in Chapter 8. Department of Housing and Urban Development HUD’s climate-change–related work focuses on the built environment and sustainable building practices—specifically measures to reduce energy consumption (HUD, 2010d). Among its efforts are Sustainable Communi- ties Regional Planning Grants, which include predisaster mitigation plans and climate-change–impact assessments among the eligible activities (HUD, 2010b). HUD’s Sustainable Communities Initiative promotes green building design and construction, but, although it mentions improved public health as a benefit of the program, that is not its focus (HUD, 2010c). HUD also cooperates with DOE on the implementation of its Weath- erization Assistance Program (WAP), identifying low-income properties (public housing, assisted housing, and others given special status under the enabling legislation) that are eligible for weatherization funds. A 2009 Memorandum of Understanding between the agencies streamlined the pro- cess for evaluating candidate properties for the program. HUD estimates that approximately 3 million housing units are potentially eligible for as- sistance (HUD, 2010a). Federal Emergency Management Agency FEMA, a part of the US Department of Homeland Security (DHS), has responsibility within the federal government to “build, sustain, and improve [the nation’s] capability to prepare for, protect against, respond to, recover from, and mitigate all hazards” (FEMA, 2010c). This includes providing guidance on identifying and remediating problematic dampness and mold (FEMA, 2003), and responding to flood (FEMA, 2010a) and hurricane (FEMA, 2010b) damage. FEMA also collects and disseminates disaster epidemiology data and cooperates with agencies at all levels of government including Department of Homeland Security and Office for Interoperability and Compatibility in developing technical standards and specifications, and prioritizing emergency development. The agency’s Fiscal Years 2011–2014 strategic plan states that “chal- lenges posed by climate change, such as more intense storms, frequent heavy precipitation, heat waves, drought, extreme flooding, and higher sea levels, have the potential to change significantly the types and magnitudes of hazards faced by communities and the emergency management profes-

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60 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH sionals serving them” (FEMA, 2011). It has taken and is continuing to take several steps to respond to these challenges. These include a research effort initiated in 2009 to evaluate the potential effect of climate change on flood risk, and hence flood insurance (Lehmann, 2009). US Global Change Research Program The US Global Change Research Program (USGCRP) serves as the coordinating body for federal research on climate change and its effects on society (USGCRP, 2011). It comprises EPA, the Agency for Interna- tional Development, the US Departments of Agriculture, the Department of Commerce,8 the Department of Defense, DOE, HHS, the Department of State, the Department of the Interior, the Department of Transportation, the National Aeronautics and Space Administration, the National Science Foundation, and the Smithsonian Institution. The USGCRP has produced a series of reviews of scientific evidence, including a 2009 assessment of the state of scientific knowledge regarding global climate-change ef- fects in the United States (USGCRP, 2009). The program maintains an Interagency Crosscutting Group on Climate Change and Human Health (CCHHG), but the present committee could not identify any work that it has published that explicitly addresses indoor environmental quality or building-related issues. GOVERNMENT HOUSING AND HEALTH DATA COLLECTION Various agencies and organizations conduct or sponsor studies that collect pieces of information useful in assessing the relationships between buildings, the environment, and health. Each of the existing surveillance systems noted below is designed to achieve specific goals related to build- ings or public health, through, for example, monitoring of trends in pesti- cide use in homes, assessing the household costs of energy use, or examining changes in how people live and work in their buildings. The text below briefly summarizes the information that they collect and identifies poten- tial opportunities and limitations in using them to assess potential effects of climate change on the indoor environment and occupant health. A thorough examination of methods and variables—a task beyond the scope of the present committee—would be needed to draw detailed conclusions concerning how to implement such a survey. 8 Including the National Oceanic and Atmospheric Administration.

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61 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT Housing and Building Surveys American Housing Survey The American Housing Survey (AHS) is conducted by the Census Bureau for HUD and includes apartments, single-family homes, mobile homes, housing characteristics, equipment, corresponding costs, and com- munity characteristics, such as income and recent migration. The AHS is conducted in odd-numbered years and surveys the same housing units each time for comparison purposes. Every 6 years, specific data are collected on almost 50 metropolitan areas throughout the United States (US Census Bureau, 2008). A substantial problem with the AHS from the standpoint of gathering information on the effects of climate change on indoor environments is that it is administered to the same housing unit every other year, whether or not the same residents live in the unit. Because the US population is rela- tively mobile, comparisons within this survey can be inconsistent (Acevedo- Garcia et al., 2004). Furthermore, renovations of a housing unit could have changed in ways that are material to the consideration of indoor environ- mental quality—for example, the purchase of a window air-conditioning unit or installation of new double-pane windows. A change of occupants of a housing unit would also mean changes in how the unit is used, which could influence and possibly confound variables used to evaluate indoor environmental quality. American Healthy Homes Survey EPA and HUD collected questionnaire and environmental data on a stratified, nationally representative sample of 1,131 US residences in 2005–2006 (Stout et al., 2009). Exposure measurements in the homes included pesticides, allergens, fungi, lead, and arsenic (Stout et al., 2009). The study built on a previous effort by HUD and NIEHS that measured lead and allergens in homes (Arbes et al., 2003; Cohn et al., 2004, 2006; Thorne et al., 2005). A future data collection planned to take place before 2020 will assess progress toward the Healthy People 2020 goals regard- ing environmental exposures in noninstitutional US homes (Department of Health and Human Services, 2009). Residential Energy Consumption Survey The US Energy Information Administration conducts the Residential Energy Consumption Survey (RECS), a probability-sample survey that col- lects energy-related data on occupied primary housing units (Energy Infor-

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62 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH mation Administration, 2009). The first RECS was conducted in 1978; the most recent, in 2005, collected data on 4,381 households in housing units statistically selected to represent the 111 million housing units in the United States. Another wave of collection started in January 2011; its results are to be posted in late 2011 and early 2012 (Energy Information Administra- tion, 2009). The collected data include physical characteristics, heating and cooling equipment, demographic characteristics of residents, and types of fuels used. Data are collected via three methods: in-person interviews with residents, in-person or telephone interviews with rental agents for units some or all of whose energy costs were included in the rent, and mail-in questionnaires from utility companies and suppliers. Large Analysis and Review of European Housing and Health Status In 2002–2003, the World Health Organization conducted the Large Analysis and Review of European Housing and Health Status (LARES), a cross-sectional survey to improve knowledge of the effects of housing on residents’ physical well-being and mental health (Bonnefoy et al., 2007). Eight cities representing northern, southern, eastern, and western Europe participated. The sample in each city was randomly generated from resident registries, the local tax registry, or the national health insurance registry. LARES used three survey instruments: an inhabitant questionnaire that described residents’ perceptions of their dwellings, a health questionnaire for inhabitants to report their health status (and that of children less than 12 years old), and a visual inspection by a trained surveyor (Bonnefoy et al., 2007). No physical measurements—such as temperature, humidity, and chemical or biologic exposures—were recorded. Teams of two technicians visited 3,373 dwellings and collected data on the health status of 8,519 inhabitants (Bonnefoy et al., 2007). LARES focused on such subjects as indoor air quality, noise effects, indoor dampness, and domestic accidents (WHO, 2011). The study examines indoor air environments and their con- nection to the building, but the data were centered on occupant perceptions of indoor air quality rather than on measurements, and climate-change– related factors were not assessed (WHO, 2011). Health and Environment Surveys National Health and Nutrition Examination Survey The National Health and Nutrition Examination Survey (NHANES) is the most detailed large-scale survey of health status in the United States, with questionnaire, mental-health assessment, physical examination, labo- ratory, and some environmental data collected at home. The survey is na-

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63 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT tional in scope and samples a representative population; it includes targeted “oversampling” to obtain sufficient data on various minority populations at different times. The primary purpose of NHANES is to generate data that can be analyzed at a national level. However, coding schemes are available for researchers that provide information about subjects’ locations by latitude and longitude, census tract and block, county, and state. The survey could be enhanced in a number of ways to assess the effects of climate change. As Chapter 4 notes, there are outdoor air pollutants such as particulate matter and ozone whose levels may be affected by climate change, and outdoor levels influence indoor levels. One approach would be to collect valid, nationally representative air-toxics exposure data that could be linked in time and space to human health outcomes data. Previous important work in this field has been limited to community-level studies or the use of historical NHANES human health data linked to geographically interpolated air-toxics exposure data. The latter method has scientific value and has been used to support analyses of both NHANES and US National Health Interview Survey (NHIS) data. However, it has limitations, and there is a need for improved data collection. NHANES also has the ability to measure concentrations of a wide va- riety of specific chemicals in blood and urine, and it does this for a number of environmental analytes of interest—such as lead, mercury, and organo- chlorines. In the past, blood concentrations of VOCs were also measured. It is therefore a primary source of national-level environmental-health data on the United States. NHANES has already conducted environmental sam- pling in homes during one cycle (2005–2006), and this could be repeated and expanded. Data collected included dust concentrations of dust mite, cockroach, dog, cat, rat, mouse, Alternaria, and Aspergillus allergens and serum concentrations of IgE antibodies to these antigens (Gergen et al., 2009; Visness et al., 2009). A summary of the NHANES environmental- health data is published in CDC’s National Report on Human Exposure to Environmental Chemicals (CDC, 2011b) and in numerous peer-reviewed journal articles. NHANES also has the ability to perform direct air toxin exposure monitoring of individual participants for short periods (24–48 hours), but this data collection requires more extended efforts and costs than local environmental monitoring. Data on VOCs in the breathing zone of participants were collected from 2005 to 2010 (CDC, 2009a). National Health Interview Survey NHIS is a multistage probability-sample survey conducted by CDC’s National Center for Health Statistics (CDC, 2009c). It reaches 75,000– 100,000 persons in the United States each year and collects a wide ar-

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68 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH regarding environmental and public-health considerations for buildings. Its Specification 01350 establishes goals and provides guidelines for en- ergy and material use in buildings; indoor air quality, including nontoxic performance standards for cleaning and maintenance products; and other occupant health and sustainability considerations (CalRecycle, 2011). Specification 01350 includes provisions for evaluating VOC emissions from indoor sources. The testing is intended to limit health effects of exposure to VOCs and occurs at multiple stages during construction. It evaluates emission data on large-surface-area materials by using standard exposure scenarios for estimating VOC emissions and area-specific air flow rates. Specific VOCs are considered as separate pollutants to estimate possible health effects on building occupants more accurately. That means of measuring VOCs and indoor air quality has since been incorporated into sections of the draft International Green Construction Code and is influencing other green-building certification and labeling schemes (Levin, 2010). Levin’s 2010 EPA white paper addresses Specification 01350 in greater detail. The state’s Green Building Standards Code (CalGreen) is intended to improve public health and safety through planning and design, energy efficiency, water efficiency and conservation, material conservation and resource efficiency, and environmental quality measures (California Build- ing Standards Commission, 2010). The codes apply to state-regulated and owned buildings and structures, including public elementary and secondary schools and California State University buildings, as well as other buildings such as low-rise residential buildings and acute care hospitals and clinics (California Building Standards Commission, 2010). Among its provisions are mandatory measures that require low-emitting materials and coatings (based on Specification 01350 and other limits) and voluntary measures regarding indoor air quality. The California Environmental Protection Agency’s Air Resources Board has regulatory authority to evaluate and control air toxics under the state’s 1983 Toxic Air Contaminant Identification and Control Act (Cal/EPA ARB, 2009). In 2009, that authority was used to promulgate an airborne toxic control measure to reduce formaldehyde emissions from composite wood products used in home construction, finishing, and furniture (Cal/ EPA ARB, 2011). City Initiatives Many larger cities have or are developing climate-action plans, typically centered on infrastructure protection in coastal areas. Almost all public- health departments have plans in place to deal with heat-wave emergencies. Two of the more comprehensive efforts are summarized briefly below.

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69 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT In 2008, New York City used a grant from the Rockefeller Founda- tion to establish a Panel on Climate Change as part of a larger effort to establish a long-term sustainability plan. The panel released a report in 2010 that took a risk-management approach to adaptation questions. It included a series of climate-change–related considerations that the authors believed should be taken in account in revising infrastructure design and performance standards, such as those for buildings (NYC Panel on Climate Change, 2010). Four primary hazards were identified—coastal flooding and storm surge, inland flooding, heat waves, and extreme wind events—all of which are also addressed in the city’s natural-hazard mitigation plan (NYC Office of Emergency Management, 2009). Chicago’s Climate Change Action Plan includes the promotion of build- ing design, construction, and operation practices that enhance energy effi- ciency and human health outcomes. The city requires that new government buildings conform to LEED Silver certification standards (Chicago Climate Task Force, 2008). The urban heat-island effect is a concern for the city, which experienced an extreme heat event in 1995 that resulted in more than 400 deaths in excess of the number otherwise expected (CDC, 1995; Kaiser et al., 2007). The action plan mentions that steps will be taken to identify at-risk populations and promote innovation to ameliorate heat islands, but it offers no specifics. A private-sector initiative, the Chicago Community Loan Fund, provides low- and middle-income housing financing and en- courages the use of energy-efficient building standards and nontoxic and low-emission materials in the design and construction of affordable housing (Chicago Community Loan Fund, undated). INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE The Intergovernmental Panel on Climate Change was created under the auspices of the UN Environment Programme and the World Meteo- rological Organization to review and assess research and information on climate change to enhance worldwide understanding of the topic (IPCC, 2010). Discussion of indoor air quality issues in its fourth report, which was published in 2007, focused on indoor biomass combustion and its ad- verse effects on human health (Metz et al., 2007). The report called indoor air pollution “a key environmental and public health peril for countless of the world’s poorest, most vulnerable people” and advocated the adoption of cleaner-burning cooking stoves both to prevent health problems and to limit greenhouse-gas emissions. For developed countries, it noted that “the diffusion of new technologies for energy use and/or savings in residential and commercial buildings contributes to an improved quality of life and in- creases the value of buildings” (Metz et al., 2007). A fifth report was under development in early 2011. It will emphasize socioeconomic vulnerability to

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70 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH the effects of climate change and implications of sustainable development and risk management (IPCC, 2010). PRIVATE SECTOR The private sector plays a considerable role in issues of climate change, the indoor environment, and health. A few examples are listed below. White papers commissioned by EPA in support of the present study provided detailed information on industry and professional-organization initiatives regarding building materials and product-testing regimens (Levin, 2010), green-building rating systems (Srebric, 2010), and energy-conservation codes for commercial and residential buildings (Mudarri, 2010). All those are discussed elsewhere in this report. American Society of Heating, Refrigerating and Air-Conditioning Engineers The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) is a professional organization that serves to advance the science of sustainable heating, ventilating, refrigeration, and air con- ditioning (ASHRAE, 2011). Its membership is drawn from private-sector, academic, and government professionals. ASHRAE has considerable in- volvement in indoor air-quality issues, in particular through standards11 that it and the American National Standards Institute (ANSI) have devel- oped for proper ventilation of commercial and residential buildings and the maintenance of thermal comfort in buildings. The standards, although voluntary and advisory, have been adopted into many building codes. The organization has also published the Indoor Air Quality Guide, which offers design and construction strategies to improve indoor air quality that go be- yond those specified in codes and standards (ASHRAE, 2009b). ASHRAE’s involvement in climate-change issues includes its GreenGuide—which pro- vides information on sources of green design, construction, and operation practices (2010)—and a 2009 climate-change position document focused on reducing building emissions of greenhouse gases (2009a). 11 Standard 62: Ventilation for Acceptable Indoor Air Quality and Standard 55: Thermal Environmental Conditions for Human Occupancy. A third document addressing how ven- tilation, the thermal environment, and other building characteristics jointly influence indoor environmental quality—Guideline 10: Interactions Affecting the Achievement of Acceptable Indoor Environments—was under development in early 2011.

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71 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT LEED LEED (Leadership in Energy and Environmental Design)—a compo- nent of the US Green Building Council, a building-trades association—pro- mulgates voluntary certification standards for buildings that emphasize the reduction of climate-change effects. The standards include consideration of indoor air quality, but they focus primarily on increasing buildings’ water and energy efficiency and decreasing their greenhouse-gas emissions and other aspects of their environmental footprint. Chapter 8 addresses LEED standards in greater detail. Insurance Industry A 2008 Ernst & Young study identified potential climate change as the greatest strategic risk facing the property and casualty insurance industry (Ernst & Young, 2008). Segments of the industry have been heavily in- volved in climate-change issues, particularly those related to reinsurance12 (Nutter, 2010). The firm Swiss Re has published reports on the topic, ad- dressing primarily the vulnerability of buildings and other infrastructure to catastrophic weather events (Swiss Re, 2002, 2010). Munich Re maintains NatCatSERVICE, which it characterizes as the most comprehensive global- loss database and which tracks the incidence of hurricanes, heat waves, flash floods, and other extreme weather events as part of a larger effort in cataloging natural catastrophes (Munich Re, 2003). There is a small litera- ture on the effect of climate change on the insurance industry’s business (Mills, 2005, 2007). American Red Cross American Red Cross emergency response and disaster preparedness programs offer relief and development assistance to millions of people annually who are affected by natural disasters. Their emergency response programs provide financial assistance to stimulate the local economy; relief supplies such as food, shelter materials, and hygiene kits; and trained volun- teers who assess needs and implement critical relief services (ARC, 2011). The Red Cross works closely with FEMA to assist the US government agen- cies and community organizations in planning, coordinating, and providing mass care services for communities influenced by disasters (ARC, 2010). 12 Reinsurance, simply put, is insurance that insurance companies take out to protect them- selves against the risk of unusually large or numerous payouts on policies that they write. Reinsurance can become important when catastrophic events occur, especially if there is an anomalous number of them during a relatively short period.

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72 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH Disaster epidemiology data developed by Red Cross/Red Crescent societies are used by government and other bodies for policy and plan- ning purposes. Internationally, the Red Cross/Red Crescent Climate Centre concentrates on the humanitarian effects of climate change and extreme weather events. The Centre’s mission is to educate and advocate for di- saster risk reduction and climate adaptation; analyze relevant weather forecast data on all timescales; and incorporate understanding of climate risks into Red Cross/Red Crescent strategies, plans and procedures (RC/ RCCC, 2011). OBSERVATIONS The preceding sections illustrate a fundamental problem. Multiple parts of government and the private sector have a stake in issues of climate change, indoor environmental quality, and public health, but no one body has assumed or attempted to assume the lead responsibility. As a result, there is a lack of leadership in identifying potential hazards, formulating solutions, and setting research and policy priorities. The present report cannot solve that problem. Its aim is instead to high- light important issues for decision-makers and the scientific community. In approaching that aim, it seeks to draw special attention to • W ays in which the information needed to make informed decisions is lacking. • W ays in which initiatives aimed at reducing climate-change risks have the potential to inadvertently exacerbate problems in the in- door environment. • H ow it may be possible to achieve a healthier indoor environment at lower cost, with lower emissions, or both than is currently the case. REFERENCES Acevedo-Garcia D, Osypuk TL, Werbel RE, Meara ER, Cutler DM, Berkman LF. 2004. Does housing mobility policy improve health? Housing Policy Debate 15(1):49-98. Anderson SE, Jackson LG, Franko J, Wells JR. 2010. Evaluation of dicarbonyls generated in a simulated indoor air environment using an in vitro exposure system. Toxicological Sciences 115(2):453-461. Arbes SJ, Cohn RD, Yin M, Muilenberg ML, Burge HA, Friedman W, Zeldin DC. 2003. House dust mite allergen in US beds: Results from the First National Survey of Lead and Allergens in Housing. The Journal of Allergy and Clinical Immunology 111(2):408-414. ARC (American Red Cross). 2010. FEMA, Red Cross to share mass care responsibility for U.S. emergencies. http://www.redcross.org/portal/site/en/menuitem.1a019a978f421296 e81ec89e43181aa0/?vgnextoid=988d4c642b2db210VgnVCM10000089f0870aRCRD (accessed April 17, 2011).

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73 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT ARC. 2011. Emergency disaster response and preparedness. http://www.redcross.org/portal/ site/en/menuitem.d229a5f06620c6052b1ecfbf43181aa0/?vgnextoid=cc0795e5ded8e110 VgnVCM10000089f0870aRCRD&vgnextchannel=5002af3fbac3b110VgnVCM100000 89f0870aRCRD (accessed April 17, 2011). ASHRAE (American Society of Heating, Refrigerating and Air Conditioning Engineers). 2009a. ASHRAE position document on climate change. http://www.ashrae.org/File%20 Library/docLib/Public/20060823_2006710123326_347.pdf (accessed February 21, 2011). ASHRAE. 2009b. Indoor air quality guide—Best practices for design, construction, and com- missioning. Atlanta, GA: ASHRAE. ASHRAE. 2010. ASHRAE GreenGuide: The design, construction, and operation of sustain- able buildings. Atlanta, GA: ASHRAE. ASHRAE. 2011. About us. http://www.ashrae.org/aboutus/ (accessed February 21, 2011). Bonnefoy X, Braubach M, Davidson M, Robbel N. 2007. A pan-European housing and health survey: Description and evaluation of methods and approaches. International Journal of Environment and Pollution 30(3/4):363-383. Brandt M, Brown C, Burkhart J, Burton N, Cox-Ganser J, Damon S, Falk H, Fridkin S, Garbe P, McGeehin M, Morgan J, Page E, Rao C, Redd S, Sinks T, Trout D, Wallingford K, Warnock D, Weissman D. 2006. Mold prevention strategies and possible health effects in the aftermath of hurricanes and major floods. MMWR 55(RR08):1-27. Cal/EPA (California Environmental Protection Agency). 2009. ARB mission and goals. http:// www.arb.ca.gov/html/mission.htm (accessed May 1, 2011). Cal/EPA ARB (Air Resources Board). 2009. Consumer products and services—California’s air toxics program. http://www.arb.ca.gov/html/brochure/airtoxic.htm (accessed April 28, 2011). Cal/EPA ARB. 2011. Air quality monitoring network. http://www.arb.ca.gov/aqd/aqmoninca. htm (accessed March 15, 2011). California Building Standards Commission. 2010. 2010 California Green Building Standards Code: California Code of Regulations, Title 24, Part 11. Sacramento, CA. CalRecycle (California Department of Resources Recycling and Recovery). 2011. Sustainable (Green) Building Section 01350. http://www.calrecycle.ca.gov/greenbuilding/specs/sec- tion01350/ (accessed February 22, 2011). CDC (Centers for Disease Control and Prevention). 1995. Heat-related mortality—Chicago, July 1995. MMWR Morbidity and Mortality Weekly Report 44:577-579. CDC. 2006. Health concerns associated with mold in water-damaged homes after Hurricanes Katrina and Rita—New Orleans area, Louisiana, October 2005. MMWR 55(02):41-44. CDC. 2007. The National Environmental Public Health Tracking Program: Healthy informed communities 2007. http://www.cdc.gov/nceh/tracking/pdfs/aag07.pdf (accessed January 31, 2011). CDC. 2009a. About the National Health Nutrition and Examination Survey. http://www.cdc. gov/nchs/nhanes/about_nhanes.htm (accessed March 15, 2011). CDC. 2009b. CDC policy on climate change and public health. http://www.cdc.gov/ climatechange/pubs/Climate_Change_Policy.pdf (accessed October 27, 2010). CDC. 2009c. About the National Health Interview Survey. http://www.cdc.gov/nchs/nhis/ about_nhis.htm (accessed March 15, 2011). CDC. 2010a. CDC’s climate-ready states & cities initiative. http://www.cdc.gov/climatechange/ climate_ready.htm (accessed October 27, 2010). CDC. 2010b. National environmental public health tracking. http://cdc.gov/nceh/tracking/pib. htm. (accessed September 16, 2010).

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74 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH CDC. 2010c. Health risks in the United States. Behavioral risk factor surveillance system: At a glance 2010. http://www.cdc.gov/chronicdisease/resources/publications/AAG/brfss.htm (accessed March 15, 2011). CDC. 2011a. National Center for Environmental Health. http://www.cdc.gov/nceh/ (accessed February 27, 2011). CDC. 2011b. National report on human exposure to environmental chemicals. http://www. cdc.gov/exposurereport/ (accessed March 15, 2011). CDC. 2011c. Biosense. http://www.cdc.gov/biosense/ (accessed July 15, 2011). Chen H, Zeng D, Yan P. 2010. Infectious disease informatics: Syndromic surveillance for public health and bio-defense. New York: Springer Science & Business Media, LLC. Chicago Climate Task Force. 2008. Chicago climate action plan—our city, our future. http:// www.chicagoclimateaction.org/filebin/pdf/finalreport/CCAPREPORTFINALv2.pdf (ac- cessed November 30, 2010). Chicago Community Loan Fund (undated). Building for sustainability creating energy-efficient and environmentally friendly affordable housing in Chicago. http://www.swaraj.org/ shikshantar/chicagogreen.pdf (accessed November 30, 2010). Cohn RD, Arbes SJ, Yin M, Jaramillo R, Zeldin DC. 2004. National prevalence and exposure risk for mouse allergen in US households. The Journal of Allergy Clinical Immunology 113(6):1167-1171. Cohn RD, Arbes SJ, Jaramillo R, Reid LH, Zeldin DC. 2006. National prevalence and expo- sure risk for cockroach allergen in U.S. households. Environmental Health Perspectives 114(4):522-526. Cox-Ganser JM, White S, Jones R, Hilsbos K, Storey E, Enright P, Rao CY, Kreiss K. 2005. Respiratory morbidity in office workers in a water-damaged building. Environmental Health Perspectives 113(4):485-490. Cox-Ganser JM, Rao CY, Park JH, Schumpert JC, Kreiss K. 2009. Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants. Indoor Air 19(4):280-290. Department of Health and Human Services. 2009. Healthy People 2020: The road ahead. http://www.healthypeople.gov/hp2020 (accessed January 10, 2011). DOE (US Department of Energy). 2010. Indoor air quality R&D. http://www1.eere.energy. gov/buildings/indoor_air.html (accessed November 30, 2010). DOE. 2011. Residential retrofit guidelines. http://www1.eere.energy.gov/wip/retrofit_guide- lines.html (accessed February 27, 2011). Energy Information Administration. 2009. Residential Energy Consumption Survey (RECS). http://www.eia.doe.gov/emeu/recs (accessed January 11, 2011). English PB, Sinclair AH, Ross Z, Anderson H, Boothe V, Davis C, Ebi K, Kagey B, Malecki K, Schultz R, Simms E. 2009. Environmental health indicators of climate change for the United States: Findings from the State Environmental Health Indicator Collaborative. Environmental Health Perspectives 117(11):1673-1681. EPA (Environmental Protection Agency). 2009a. Indoor air quality tools for schools. Refer- ence guide. http://www.epa.gov/iaq/schools/pdfs/kit/reference_guide.pdf (accessed Octo- ber 29, 2010). EPA. 2009b. Indoor airPLUS construction specifications. http://www.epa.gov/indoorairplus/ pdfs/construction_specifications.pdf (accessed October 29, 2010). EPA. 2010a. Federal interagency committee on indoor air quality. http://www.epa.gov/iaq/ ciaq/ (accessed November 17, 2010). EPA. 2010b. Healthy indoor environment protocols for home energy upgrades. http://www. epa.gov/iaq (accessed November 18, 2010). EPA. 2010c. Indoor air quality. http://www.epa.gov/iaq (accessed September 15, 2010).

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75 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT EPA. 2010d. Indoor air quality and climate readiness. http://www.epa.gov/iaq/climate readiness/ (accessed November 17, 2010). EPA. 2010e. Join the fight against climate change: Take the Energy Star pledge: Energy Star. http://www.energystar.gov/index.cfm?fuseaction=globalwarming.showPledgeHome (ac- cessed October 29, 2010). EPA. 2011a. Environmental technology verification program: Basic information. http://www. epa.gov/nrmrl/std/etv/basic.html (accessed February 27, 2011). EPA. 2011b. National air toxics assessments. http://www.epa.gov/ttn/atw/natamain/ (accessed March 15, 2011). Ernst & Young. 2008. Strategic business risk—Insurance. http://aaiard.com/11_2008/2008_ Strategic_Business_Risk_-_Insurance.2.pdf (accessed February 20, 2011). ETV (Environmental Technology Verification Program). 2010. Quality assurance project plan for verification of building pressure control for the assessment of vapor intrusion. Columbus, OH: Battelle. FEMA (Federal Energy Management Agency). 2003. Dealing with mold & mildew in your flood damaged home. http://www.fema.gov/pdf/reg-x/mold_mildew.pdf. FEMA. 2010a. Flood response. http://www.fema.gov/hazard/midwestfloods.shtm (accessed April 26, 2011). FEMA. 2010b. Hurricane. http://www.fema.gov/hazard/hurricane/index.shtm (accessed April 26, 2011). FEMA. 2010c. Protecting your home and property from flood damage. Mitigation ideas for reducing flood loss. http://www.fema.gov/library/file?type=originalAccessibleFormat File&file=protecting_home_book_508compliant.pdf&fileid=c37fe0c0-615f-11e0-b6f6- 001cc4568fb6 (accessed April 26, 2011). FEMA. 2011. FEMA Strategic Plan Fiscal Years 2011-2014; FEMA P-806 / February 2011. http://www.fema.gov/txt/about/strategic_plan11.txt (accessed April 17, 2011). Gergen PJ, Arbes SJ Jr, Calatroni A, Mitchell HE, Zeldin DC. 2009. Total IgE levels and asthma prevalence in the US population: Results from the National Health and Nutrition Examination Survey 2005-2006. Journal of Allergy and Clinical Immunology 124(3): 447-453. Green BJ, Tovey ER, Beezhold DH, Perzanowksi MS, Acosta LM, Divjan AI, Chew GL. 2009. Surveillance of fungal allergic sensitization using the fluorescent halogen immunoassay. Journal de Mycologie Medicale 19(4):253-261. HUD (US Department of Housing and Urban Development). 2010a. Fact sheet—HUD-DOE weatherization partnership. Streamlining weatherization assistance in affordable hous- ing. http://portal.hud.gov/hudportal/documents/huddoc?id=factsheet_doe_weatherize_3. pdf (accessed April 26, 2011). HUD. 2010b. Notice of funding availability (NOFA) for HUD’s fiscal year 2010 sustainable communities regional planning grant program. http://www.hud.gov/offices/adm/grants/ nofa10/scrpgsec.pdf (accessed October 28, 2010). HUD. 2010c. Sustainable communities regional planning grants. http://portal.hud.gov/portal/ page/portal/HUD/program_offices/sustainable_housing_communities/Sustainable%20 Communities%20Regional%20Planning%20Grants (accessed September 30, 2010). HUD. 2010d. Sustainable housing and communities. http://portal.hud.gov/portal/page/portal/ HUD/program_offices/sustainable_housing_communities (accessed September 18, 2010). Interagency Climate Change Adaptation Task Force. 2010. Progress report of the Interagency Climate Change Adaptation Task Force: Recommended actions in support of a national climate change adaptation strategy. Washington, DC: The White House Council on Environmental Quality. IPCC (Intergovernmental Panel on Climate Change). 2010. Organization. http://www.ipcc.ch/ organization/organization.shtml (accessed January 25, 2011).

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76 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH Josseran L, Fouillet A, Caillère N, Brun-Ney D, Ilef D, Brucker G, Medeiros H, Astagneau P. 2010. Assessment of a syndromic surveillance system based on morbidity data: Results from the Oscour network during a heat wave. PLoS One 5(8):e11984. Kaiser R, Le Tertre A, Schwartz J, Gotway CA, Daley WR, Rubin CH. 2007. The effect of the 1995 heat wave in Chicago on all-cause and cause-specific mortality. American Journal of Public Health 97(Suppl 1):S158-S162. Kjellstrom T, Holmer I, Lemke B. 2009a. Workplace heat stress, health and productivity—an increasing challenge for low and middle-income countries during climate change. Global Health Action 2:2-6. Kjellstrom T, Kovats RS, Lloyd SJ, Holt T, Tol RS. 2009b. The direct impact of climate change on regional labour productivity. Archives of Environmental & Occupational Health 64(4):217-227. Landrigan PJ, Trasande L, Thorpe LE, Gwynn C, Lioy PJ, D’Alton ME, et al. 2006. The National Children’s Study: A 21-year prospective study of 100,000 American children. Pediatrics 118(5):2172-2186. Late M. 2007. U.S. environmental public health tracking programs gain success: Partners working on nationwide network. Nation’s Health 37(5):21. LBNL (Lawrence Berkeley National Laboratory). 2010. Indoor environment division. http:// eetd.lbl.gov/IEP/IEP.html/ (accessed November 30, 2010). Lehmann E. 2009. FEMA launches effort to measure impact of climate change on flood insur- ance. New York Times, June 11, 2009. Levin H. 2010. National programs to assess IEQ effects of building material and products. Washington, DC: EPA Indoor Environments Division. http://www.epa.gov/iaq/pdfs/hal_ levin_paper.pdf (accessed February 18, 2011). Metz B, Davidson OR, Bosch PR, Dave R, Meyer LA. 2007. Contribution of working group III to the fourth assessment report of the Intergovernmental Panel on Climate Change, 2007. New York: Cambridge University Press. Mills E. 2005. Insurance in a climate of change. Science. 309:1040-1044. Mills E. 2007. Synergisms between climate change mitigation and adaptation: An insurance perspective. Mitigation and Adaptation Strategies in Global Change. 12:809-842. Mudarri D. 2010. Building codes and indoor air quality. Washington, DC: EPA Indoor En- vironments Division. Munich Re. 2003. NatCatSERVICE® A guide to the Munich Re database for natural catas- trophes. Munich, Germany: Münchener Rückversicherungs-Gesellschaft. NIEHS (National Institute of Environmental Health Sciences). 2008. NIEHS Exposure Biol- ogy Program: A component of the NIH Genes, Environment and Health Initiative (GEI). http://www.niehs.nih.gov/health/docs/expbio-gei-fact.pdf (accessed January 11, 2011). NIEHS. 2010. A human health perspective on climate change. http://www.niehs.nih.gov/ health/docs/climatereport2010.pdf (accessed November 22, 2010). NIEHS. 2011. National Survey of Lead and Allergens in Housing (NSLAH). http://www. niehs.nih.gov/research/clinical/join/studies/riskassess/nslah.cfm (accessed May 1, 2011). NIH (National Institutes of Health). 2010. Climate change and health: Assessing and modeling population vulnerability to climate. http://grants.nih.gov/grants/guide/pa-files/PAR-10- 235.html (accessed November 22, 2010). Nilsson M, Kjellstrom T. 2010. Climate change impacts on working people: How to develop prevention policies. Global Health Action 3:5774 - DOI: 10.3402/gha.v3i0.5774. NRC (National Research Council). 2006. Green schools: Attributes for health and learning. Washington, DC: The National Academies Press. NRC. 2010. Informing an effective response to climate change. Washington, DC: The Na- tional Academies Press.

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77 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT Nutter F. 2010. Climate change and the built environment. Presentation before the Committee on the Effect of Climate Change on Indoor Air Quality and Public Health, June 7, 2010, by Frank Nutter, President, Reinsurance Association of America. NYC Office of Emergency Management. 2009. The 2009 New York City natural hazard mitigation plan. http://nyc.gov/html/oem/html/about/planning_hazard_mitigation.shtml (accessed November 30, 2010). NYC Panel on Climate Change. 2010. CLIMATE PROTECTION LEVELS: Incorporating Climate Change into Design and Performance Standards, W Solecki, L Patrick, M Brady, K Grady and A Maroko, authors. In Climate change adaptation in New York City: Building a risk management response. Annals of the New York Academy of Sciences 1196(1):293-352. Park J, Cox-Ganser J, Rao C, Kreiss K. 2006. Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building. Indoor Air 16:192-203. Pew Center on Global Climate Change (Pew). 2011a. Climate action plans. http://www.pew- climate.org/sites/default/modules/usmap/pdf.php?file=5900 (accessed February 20. 2011). Pew. 2011b. U.S. climate policy maps. http://www.pewclimate.org/what_s_being_done/in_the_ states/state_action_maps.cfm (accessed February 20. 2011). RC/RCCC (Red Cross/Red Crescent Climate Centre). 2011. About us. http://www.climatecentre. org/ (accessed April 17, 2011). RTI International. 2008. Test/QA plan for mold-resistant building material testing. Research Triangle Park, North Carolina. Srebric J. 2010. Opportunities for green building (GB) grating systems to improve indoor air quality credits and to address changing climatic conditions. Washington, DC: EPA Indoor Environments Division. http://www.epa.gov/iaq/pdfs/jelena_draft_paper_11-4-10. pdf (accessed February 18, 2011). Stout DM II, Bradham KD, Egeghy PP, Jones PA, Croghan CW, Ashley PA, Pinzer E, Friedman W, Brinkman MC, Nishioka MG, Cox DC. 2009. American Healthy Homes Survey: A national study of residential pesticides measured from floor wipes. Environmental Science & Technology 43(12):4294-4300. Swiss Re. 2002. Opportunities and risks of climate change. http://stephenschneider.stanford. edu/Publications/PDF_Papers/SwissReClimateChange.pdf (accessed February 20, 2011). Swiss Re. 2010. Weathering climate change: Insurance solutions for more resilient com- munities. http://media.swissre.com/documents/pub_climate_adaption_en.pdf (accessed February 20, 2011). Thorne PS, Kulhankova K, Yin M, Cohn R, Arbes SJJ, Zeldin DC. 2005. Endotoxin exposure is a risk factor for asthma: The national survey of endotoxin in United States housing. American Journal of Respiratory and Critical Care Medicine 172(11):1371-1377. US Census Bureau. 2008. American Housing Survey. http://www.census.gov/hhes/www/ housing/ahs/ahs.html (accessed January 11, 2011). USGCRP (US Global Change Research Program). 2009. Global climate change impacts in the U.S. http://downloads.globalchange.gov/usimpacts/pdfs/climate-impacts-report.pdf (accessed February 22, 2011). USGCRP. 2011. Program overview. http://globalchange.gov/about (accessed February 22, 2011). Visness CM, London SJ, Daniels JL, Kaufman JS, Yeatts KB, Siega-Riz AM, Liu AH, Calatroni A, Zeldin DC. 2009. Association of obesity with IgE levels and allergy symptoms in children and adolescents: Results from the National Health and Nutrition Examination Survey 2005-2006. Journal of Allergy and Clinical Immunology 123(5):1163-1169.

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78 CLIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTH WHO (World Health Organization). 2011. Housing and health. http://www.euro.who.int/ en/what-we-do/health-topics/environmental-health/Housing-and-health/activities/the- large-analysis-and-review-of-european-housing-and-health-status-lares-project (accessed February 8, 2011). Yan P, Chen H, Zeng D. 2008 Syndromic surveillance stystems—public health and biodefense. Annual Review of Information Science and Technology 48:1-96.