House Calls

ANCHORAGE - Who needs home delivery when you can get all the news you need on-line? Or an early-morning coffee klatch when you can join a chat room? Or house calls when, say telemedicine advocates, diagnoses are faster and more informed when patients and physicians connect more as easily over Skype? It's a 21st century fact of life. Hello touch screen, goodbye human touch.

Not everywhere. Consider the pioneering work being done by the Alaska Native Tribal Health Consortium in southeast Alaska. Founded in 1997, it's charged with providing health and medical care to some 150,000 Alaskan villagers and American Indians. It's huge, with a 150-bed hospital in Anchorage - staffed by 250 physicians and 700 nurses - and a network of clinics and tribal partners across the state. It's got every reason, every incentive to go big, to be impersonal.

But it's not. In fact, the Consortium and its partners still make "house calls." For a very good reason. Look at the numbers. "Compared to the general US infant population," it advised HUD in a successful 2013 application for a Healthy Homes Technical Studies Grant, "the hospitalization rate for pneumonia in Native Alaskan infants is five times higher." For Native Alaskans living in southwest higher, it added, it's seven times higher. "Local health care providers identify respiratory conditions as the primary health problem facing children."

Visit a typical southeast Alaska home and you'll understand why. With "average high temperatures are at or below freezing for six months of the year, Alaska Natives often keep their homes warm by sealing them up tightly, blocking ventilation systems with clothing or other household items," a HUDUser (https://www.huduser.gov/portal/casestudies/study-08012016-1.html) case study recently reported. "The sealed houses create closed areas that concentrate contaminants from cooking and heating with a wood stove, as well as retain visible and invisible pollutants released from materials brought in from outside. The poor home ventilation can lead to asthma, pneumonia, and respiratory syncytial virus and other infections, as well as headaches, eye and throat irritation, worsened allergies, heart disease, and cancer."

ANTHC's campaign to reduce, even eliminate starts by knocking on doors. "Just like people," says A.J. Salkoski, director of the Consortium's project, "houses have to breathe." If the air circulates and the ventilation's good, dangerous particulates go out and fresh air comes in. The air doesn't get trapped, toxins don't linger, moisture doesn't pool and mold and mildew don't get a foothold. The house is "healthy" and its occupants more likely to be the same. If we are what we eat, we're also what we breather. Good ventilation is critical to good respiratory health.

Which is why ANTHC environmental health and engineering teams make "house calls." Once they cross a threshold, it's the house and not the household that gets the physical, with Consortium staff looking for inoperative heating and ventilation systems, leaking wood stoves or too few or blocked vents. And then, collaborate with tribal housing entities like the Association of Village Council Presidents Regional Housing Authority and Bristol Bay Regional Housing Authority; they fix the identified problems, usually for less than $5,000 per house.

That small investment appears to yield big dividends. Again, consider some preliminary numbers. From the first three years of the four-year study. Preliminary data from more than 60 homes in eight villages report "decreases of 21 percent in particulates, 26 percent in carbon dioxide, and 68 percent in volatile organic compounds." Which, in turn, has led to reports from participating families of "a 50 percent reduction in clinic visits for children and 27 percent fewer school days missed." Seven hospitalizations were reported by the families in the two weeks before the home improvements were made. But none in the two weeks following them. Final results are expected to be published shortly in Indoor Air (http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-0668).

Preliminary? Sure. Impressive? Absolutely. So much so that the Consortium's was one of just four organizations nationwide to be named in 2015 by HUD Secretary Julián Castro and the National Environmental Health Association as the first-ever winners of the HUD Secretary's Healthy Homes Award for excellence in promoting resident health through housing interventions. Or, as Secretary Castro explains, for "leading the way in creating healthy environments for families to thrive."

"Why worry," you ask, "about something happening in eight tiny southeast Alaska villages?" On average, we spend 87 percent of each day inside a building, the National Human Activity Pattern Survey found, and another 6 percent in a car. That's 156 hours during which you'll breathe in and breathe out more than 56,000 times. And it will all be indoor air. Better be good air, huh? Which is why what's happening in those eight, isolated Alaskan villages matters to you. And maybe what they and ANTHC are doing you ought to do with your house, your office, your car. Your family's health and future depend on it. For more, visit EPA's Inside Story: A Guide to Indoor Air Quality (www.epa.gov/iaq/pubs/insidestory.html).

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