June 15, 2016 - Updates

Best Practices Catalogue


Click HERE to download the Best Practices Guide, which includes examples of healthy home training, assessment tools, outreach activities, and funding opportunities,many of which are customized materials specifically for tribes.


June 9, 2016 - Updates

May 2014 Updates for Tribal Housing Professionals

From your partners at Tribal Healthy Homes Network…

Work with us to build a housing program that incorporates comprehensive mold and moisture strategies, including how to become certified in mold remediation. Learn about best practices dealing with mold and moisture, proactive investigations, and resident engagement to protect the health of your residents by minimizing mold in the home.

THHNW can coordinate a half-day on-site mold workshop for your housing staff (and other departments who may benefit from this knowledge – eg. community health workers, air quality staff). We bring a Certified Microbial Investigator and an Indoor Air Specialist to provide hands-on training:

  • Accurately Identify Signs and Sources of Mold and Moisture Damage.
  • Learn to Use Tools to Identify Evidence of Damage: Visual Inspections, Moisture Meters and Thermal Temperature Gun.
  • Select and Install Ventilation Improvements to Minimize Future Property Damage and Health Effects.
  • Obtain Materials for Educating Residents about Mold Prevention.

Costs for this workshop range $800-$1,200, depending on travel for the trainers. The training focus can be customized as needed. Contact Gillian Mittelstaedt (gmittelstaedt@thhnw.org) or Rachel Koller (rkoller@thhnw.org) at THHNW for more information.

Some relevant mold in housing resources:

  • Mold Guidance for Tenants and Landlords from the Northwest Clean Air Agency. Many landlords and tenants do not understand why mold problems start and how to safely clean them up when they do. This document is designed to eliminate the confusion with simple guidance followed by detailed examples to help prevent the most common problems NW Clean Air Agency has observed responding to hundreds of complaints.
  • Mold outreach activity: We all need reminding about where excess moisture comes from in our homes! Laminate this one-page mold flyer showing many ways residents can control moisture in a home. Place the flyer in every household, in a visible place such as the back of a kitchen cabinet door.

From your partners at US Environmental Protection Agency Region X…

  • May is Asthma Awareness Month. This is a great time to connect with your clinic, air quality, or environmental health staff as they may be doing outreach to asthma patients this month – for example, educating them on how to reduce triggers like mold, dust, pests in their homes. For resident outreach materials, contact Erin McTigue at EPA (mctigue.erin@epa.gov).
June 9, 2016 - Updates

January 2014 Updates for Tribal Housing Professionals

From your partners at Tribal Healthy Homes Northwest…

  • We’re happy to announce the release of our Quick Tour of Key Healthy Home Resources. It’s an interactive guide to key and free resources that help you build safe and healthy tribal housing. In the Guide, you’ll find tribal-specific FUNDING opportunities, TRAINING opportunities, TOOLS to ASSESS housing conditions, and finally, OUTREACH materials for educating residents.
  • Getting ready to build or renovate homes in your community? Want to know what products are durable, affordable AND healthy? Take a look at our Healthy Home Procurement Guide: “Top 10 Affordable and Healthy Building Materials You Can Begin Using Today”.


From your partners at US Environmental Protection Agency, Region X…

  • Tribes can get free radon test kits from EPA! This January is Radon Action Month. Radon is a natural colorless, odorless radioactive gas, and is the leading cause of lung cancer among non-smokers, but testing for radon and reducing elevated levels when they are found can make your home healthier and safer. Free test kits are available from the Tribal Air Monitoring Support Center (TAMS). Contact Erin McTigue for more information and to order free, easy to use kits at mctigue.erin@epa.gov or 206 553 1254.   More info at http://www.epa.gov/radon/.
  • Are there “standards” for healthy housing?  Up until recently, there weren’t uniform standards, but a recent project by national healthy housing organizations has worked to change that. The National Healthy Housing Standard report was published in June 2013.  For tribal housing staff, the document offers value in that it can serve as a standard of care for any property owner to follow to ensure the health and safety of residents. It covers topics like ventilation, moisture, pest management, indoor air quality, and more.  http://www.nchh.org/Policy/NationalHealthyHousingStandard.aspx
June 9, 2016 - Updates

Better Fuel with Wood Banking in Tribal Communities

Public health professionals who work in cold climates, rural or low-income communities know that wood heat is central to the home energy equation. There are cleaner, greener alternatives, but none match the trifecta that wood heat offers: affordability, reliability and comfort. But those in public and environmental health also know that combustion of biomass produces a complex suite of contaminants. In the literature, these contaminants are strongly associated with upper and lower respiratory diseases (infectious and chronic in nature), and adverse cardiovascular events, such as premature stroke and heart attack. Less well understood, but possibly more insidious is the carcinogenic, mutagenic and immune-suppression effects of woodsmoke, for which the research shows a strong correlation. In short, wood heat poses a complex public health threat, meaning we must approach the challenge with respect, innovation and patience.

As practitioners, our goal is to find interventions that are evidence-based, low-cost and sustainable. These are hard to come by. The default intervention, for the last two decades, has been to replace an aging woodstove with a new, certified stove. Change-out programs have an evidence-base, but are expensive. And research has shown that emissions reductions are not necessarily sustained, as the device ages, or is inadequately maintained. Another device-based intervention is fuel conversion. But while natural gas and propane contribute to the collective good (improved air quality, fewer public health and climate change impacts), the ledger for households doesn’t balance: the up-front investment is high, many parts of Alaska and the rural west are outside service areas, and fluctuations in monthly heating bills are a deterrent.

These realities, along with the long cultural history of fire use, point us towards one of the few variables we can reasonably manage: the fuel itself – more accurately – the moisture content of the firewood.

Wet wood, it turns out, is a pivotal factor in combustion chemistry, and both the toxicity and volume of gaseous and particulate emissions are tied to moisture content (Bølling, 2009, Hall and DeAngelis, 1980; Burnet et al., 1986; McDonald et al., 2000). But the reality for consumers is that wet wood is also “a waste”. Green firewood (60-70% moisture content) produces about 5,000 BTUs of energy per pound, versus an average of 7,700 BTUs produced by properly seasoned firewood (15-20% moisture content). And when the effective available heat is low, more wood (meaning more money) will be needed to produce the same amount of heat. Most families who rely on wood heat are well aware that cured wood produces a hotter, longer-burning, and cleaner fire. So from a public health standpoint, awareness is not our principal concern. Rather, it is the barriers we need to address. These barriers include lack of access to a consistent firewood supply, inadequate places to store, dry and cure wood, and inefficient fire-building practices, such as the use of household waste.

These barriers are not unique to Alaska, but are seen throughout the west, in many of the tribal communities that Tribal Healthy Homes Northwest works with. Through our field research and demonstration projects, we collaborate with dozens of tribes to address woodsmoke, but only recently did we learn about a new, innovative approach, called “Wood Banking”. The concept is simple: you deposit your wet wood, and you withdraw the same quantity of dry wood. The logistics may not be so simple. In our initial research, we’ve learned that you need an accessible, secure location. You need to build a structure large enough to house and protect a large volume of wood. You may not need a full-time operator, but you need someone on-site at least weekly. And you need the initial investment of time or money, in order to either purchase or spend a year curing a large volume of wood.

Still, the potential benefits are intriguing. A cooperative could be formed, for example, in which a small annual fee enables a household to participate (their investment offset by having dry, more efficient wood, and having to purchase fewer cords each season). The fees would help pay for an on-site operator. This operator could be anyone, but in our experience, there are many independent firewood suppliers with both a truck and a desire for added income. That person could be paid, for example, to operate the wood bank each Saturday from 8am – 12pm, using a forklift to help people load and unload their wood. During the week, for those who need help, the operator would pick up a load of wet wood from a person’s home, make the exchange, and return with the dried wood.

Some climates and communities will not be a fit for this approach. In much of the biomass-rich western US, however, and in some regions of Alaska, the model may prove viable. Public policies are guiding us towards more intensive interventions and the use of green heat technologies, but until these are adoptable on a larger scale, this approach should be considered. For a low-technology, low-cost intervention, the potential improvements to ambient and indoor air quality could be significant.

June 9, 2016 - Updates

The Epidemic of Asthma and the News isn’t Good for Washington

The Center for Disease Control just released their National Surveillance of Asthma Report, with data from 2001 to 2010. We are losing ground to this disease and the statistics aren’t good.

What does the CDC report tell us? Here are a few chief observations, based on my perspective of working both in the field and at the policy-level, with certain at-risk asthma populations:

  • The epidemic of asthma continues. The percentage of persons with asthma continued to rise in the ten-year period, increasing an average of 2.9% per year. To put it in perspective, in 2001, we could fill 290 NFL football stadiums, the size of CenturyLink field, with asthma patients. We can now fill 367 stadiums, each holding 70,000 people. If you are a person of color in those stadiums, you are 2-3 times more likely to end up in the emergency room. Although overall mortality rates from asthma declined, a black person is still more than twice as likely to die from the disease.
  • The disparity of asthma continues. In black, Hispanic and native communities, the average increases were double that of white populations. New cases of asthma were being diagnosed at twice the rate (1.4% vs. 3.2%) in some of these at-risk populations. The race and ethnicity data illustrate that asthma continues to be, as I call it, a “marker of access” in our country. Rates continue to rise in those populations with the least access: access to primary health care, access to safe, hazard-free housing, and access to toxin-free ambient air.
  • The reactive approach to asthma continues. Our principal public health response continues to be disease “control”. We rely on patient education, pharmacological control and trigger reduction as our three pillars. In theory, these evidence-based practices should have demonstrated better results. In practice, however, the number of persons with at least one asthma attack increased 2.6% per year from 11.0 million in 2003 to 13.9 million in 2010. More people in those 367 stadiums now experience annual asthma attacks, than they did ten years ago.
  • While these controls may be effective for individual patients, from a population-based perspective, we are still missing the mark. Only a third of those surveyed (34%) reported receiving an asthma action plan. Only half (48%–51%) reported receiving advice on environmental control at home, school, or work. Only half (49%) of children and adults with persistent asthma use controller medications*
  • The enormous household and societal-level costs to control asthma attacks – and the understandable urgency – continues to draw our resources and attention away from Primary Prevention – in which we find the mechanisms that induce disease onset. From the state and tribal perspective in which I work, I would argue that until we focus on primary prevention, we are chasing our tail – and frankly, not even catching it.
  • The disease is epidemic in Washington State. More than a half million Washingtonians have asthma.

Nearly 120,000 of these people are children – one of the highest rates in the US. More than 5,000 people with asthma are hospitalized each year and 100 of those die from asthma.