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Committee on the Effect of Climate Change on Indoor Air Quality and Public Health Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by a contract between the National Academy of Sciences and the US Environmental Protection Agency via award No. EP-D-09-071. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-20941-0 International Standard Book Number-10: 0-309-20941-2 Additional copies of this report are available from the National Academies Press, 500 Fifth Street N.W., Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover credit: Thermal image of a residence in New Haven. © Tyrone Turner/ National Geographic Society/Corbis. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2011. Climate Change, the Indoor Environment, and Health. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON THE EFFECT OF CLIMATE CHANGE ON INDOOR AIR QUALITY AND PUBLIC HEALTH JOHN D. SPENGLER (Chair), Akira Yamaguchi Professor of Environmental Health and Human Habitation, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts JOHN L. ADGATE, Professor and Chair, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado ANTONIO J. BUSALACCHI, JR., Director and Professor, Earth System Science Interdisciplinary Center, University of Maryland, College Park, Maryland GINGER L. CHEW, Epidemiologist, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia ANDREW HAINES, Professor of Public Health and Primary Care, London School of Hygiene and Tropical Medicine, London, UK STEVEN M. HOLLAND, Chief, Laboratory of Clinical Infectious Diseases; Chief, Immunopathogenesis Section, LCID; Tenured Investigator, Immunopathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland VIVIAN E. LOFTNESS, University Professor, School of Architecture, Carnegie Mellon University, Pittsburgh, Pennsylvania LINDA A. MCCAULEY, Dean, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia WILLIAM W. NAZAROFF, Daniel Tellep Distinguished Professor, Vice-Chair for Academic Affairs, Department of Civil and Environmental Engineering, University of California, Berkeley, California EILEEN STOREY, Surveillance Branch Chief, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia Program Staff DAVID A. BUTLER, Senior Program Officer; Study Director LAUREN N. SAVAGLIO, Research Associate TIA S. CARTER, Senior Program Assistant RACHEL S. BRIKS, Program Assistant VICTORIA WITTIG, Christine Mirzayan Science and Technology Policy Fellow HOPE HARE, Administrative Assistant NORMAN GROSSBLATT, Senior Editor ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice v

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Reviewers This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of the independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following for their review of the report: Patricia Butterfield, Dean and Professor, Washington State University, Spokane Peyton Eggleston, Professor Emeritus, Pediatrics, Johns Hopkins Children’s Center Kristine M. Gebbie, Joan Hansen Grabe Dean (acting), Hunter- Bellevue School of Nursing, Hunter College, City University of New York; Professor, Flinders University School of Nursing and Midwifery Peggy L. Jenkins, Manager, Indoor Exposure Assessment Section, Research Division, California Air Resources Board Patrick Kinney, Associate Professor of Public Health, Division of Environmental Health Sciences, Columbia University, School of Public Health vii

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viii REVIEWERS Donald Milton, Professor and Director, Maryland Institute for Applied Environmental Health, University of Maryland Andrew K. Persily, Leader, Indoor Air Quality and Ventilation Group, Building Environment Division, Building and Fire Research Laboratory, National Institute of Standards and Technology Thomas J. Wilbanks, Corporate Fellow, Oak Ridge National Laboratory Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Richard B. Johnston, As- sociate Dean for Research Development, Professor of Pediatrics, University of Colorado Denver School of Medicine, and Lynn R. Goldman, Dean, The George Washington University School of Public Health and Health Services. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests with the authoring committee and the institution.

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Acknowledgments This report could not have been prepared without the guidance and expertise of numerous persons. Although it is not possible to mention by name all those who contributed to the committee’s work, the commit- tee wants to express its gratitude to a number of them for their special contributions. Sincere thanks go to all the participants at the public meetings con- vened on June 7 and July 14, 2010. The intent of the workshops was to gather information regarding issues related to climate change and public health. The speakers, who are listed in Appendix A, gave generously of their time and expertise to help to inform and guide the committee’s work. Many of them also provided additional information in response to the committee’s myriad questions. The committee extends special thanks to the dedicated and hard- working staff of the Institute of Medicine’s Board on Population Health and Public Health Practice, who supported and facilitated its work. Board Director Rose Marie Martinez helped to ensure that this report met the highest standards of quality. Finally, the committee members would like to thank the chair, John D. Spengler, for his outstanding work, leadership, and dedication to this project. ix

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Contents SUMMARY 1 Framework and Organization, 2 Report Synopsis, 3 Results, 7 References, 15 1 INTRODUCTION 17 Why the Effect of Climate Change on the Indoor Environment and Health Constitutes an Important Issue, 17 Statement of Task, 19 The Committee’s Approach to Its Task, 19 Methodologic Approach, 20 Recent National Academy of Sciences Reports Addressing Climate Change, 26 Organization of the Report, 29 References, 31 2 BACKGROUND 33 Elements of Climate-Change Research Relevant to Buildings and Public Health, 33 Adverse Exposures Associated with Climate-Change–Induced Alterations in the Indoor Environment, 37 Time Spent in the Indoor Environment, 41 xi

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xii CONTENTS Climate Change and Vulnerable Populations, 43 Conclusions, 48 References, 48 3 GOVERNMENT AND PRIVATE-SECTOR INVOLVEMENT IN CLIMATE CHANGE, INDOOR ENVIRONMENT, AND HEALTH ISSUES 53 Federal Government Agencies and Departments, 53 Government Housing and Health Data Collection, 60 State and Local Governments, 67 Intergovernmental Panel on Climate Change, 69 Private Sector, 70 Observations, 72 References, 72 4 AIR QUALITY 79 Introduction, 79 Indoor Sources of Pollutants, 80 Outdoor Sources, 98 Indoor Air Quality in Developing Countries, 111 Conclusions, 114 References, 117 5 DAMPNESS, MOISTURE, AND FLOODING 133 Introduction, 133 Climate Change and Indoor Dampness and Flooding, 134 Indoor Dampness, 135 Dampness and Health, 135 Specific Dampness-Related Contaminants, 141 Summary Comments, 146 Conclusions, 147 References, 148 6 INFECTIOUS AGENTS AND PESTS 155 Infectious Agents, 156 Pests, 163 Conclusions, 174 References, 176 7 THERMAL STRESS 185 Introduction, 185 Management of the Indoor Thermal Environment, 185 Effects of Heat Exposure, 188

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xiii CONTENTS Effects of Cold Exposure, 197 Climate-Change Adaptation and Mitigation Measures, 198 Conclusions, 201 References, 202 8 BUILDING VENTILATION, WEATHERIZATION, AND ENERGY USE 209 Energy Use in Buildings, 209 Building Weatherization, 210 Energy-Efficiency Programs for Buildings, 213 Energy Star, 215 Product-Labeling and Building-Certification Programs, 217 Health Issues Related to Weatherization, 224 Synthesis, 231 Conclusions, 232 References, 232 9 KEY FINDINGS, GUIDING PRINCIPLES, AND PRIORITY ISSUES FOR ACTION 239 Overview of the Committee’s Work, 239 Key Findings, 240 Guiding Principles, 243 Priority Issues for Action and Recommendations, 245 References, 254 APPENDIXES A Public Meeting Agendas 257 B Environmental Protection Agency Contractor Reports on Climate-Change, Indoor-Environment, and Health Topics 263 C Biographic Sketches of Committee Members and Staff 267

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