New York State Healthy Neighborhoods Program: Saving Lives, Saving Money

Studies confirm that the program improves asthma outcomes for low-income New Yorkers

ALBANY, N.Y. (January 27, 2017) – A longstanding program run by the New York State Department of Health (NYSDOH) is helping people with asthma achieve better health, while also saving money and improving household conditions, according to three newly published studies by the NYSDOH and the National Center for Healthy Housing (NCHH) in Columbia, MD.

Research looking at the New York State Healthy Neighborhoods Program (HNP) shows the program helps improve health outcomes for people with asthma while lowering the overall cost of their care and helping them eliminate or reduce household hazards that impact health and safety.

The research was featured on the cover of the March/April issue of the Journal of Public Health Management and Practice, posted online on January 27. The articles were co-authored by Marta Gomez, MS, a research scientist at NYSDOH, and staff at NCHH.

"This research provides clear and compelling evidence that our Healthy Neighborhoods Program is making a significant impact on health and health care costs," said Commissioner of Health Dr. Howard Zucker. "By working directly with local health officials and people at risk for asthma, the Department is directly improving the health of New Yorkers."

Poor housing conditions have a direct impact on the health and safety of residents, especially for people with asthma, a disease exacerbated by environmental factors. The HNP provides in-home assessments and interventions to reduce residential health and safety hazards in selected at-risk communities in New York State. The program is implemented by county health departments, which send staff such as sanitarians, public health nurses, and health educators to dwellings to look for hazards and provide interventions that improve living conditions. Program participants receive education, referrals for services, and low-cost materials such as smoke detectors, cleaning supplies, pest control baits, and, for people with asthma, mattress covers.

Researchers looked at data collected during HNP home visits between October 2007 and June 2011. The first article evaluates the impact of the HNP on asthma outcomes in 1,465 adults and children. Participants with poorly controlled asthma were reached in three different ways: they were identified by their managed care plans as having poorly controlled asthma, referred to the HNP by outside programs or providers, or identified during door-to-door canvassing in high-risk areas.

Results showed that after HNP staff visited the homes, there were significant improvements in the physical conditions of the home, as well as better self-management of asthma, improved health care access, and a decrease in asthma morbidity outcomes, including a decrease in the number of asthma attacks and hospitalizations due to asthma.

For instance, in the group that was referred by managed care plans, the study found that before the HNP intervention, only 19 percent of people with poorly controlled asthma knew their personal asthma triggers, six percent knew how to avoid their triggers, and 17 percent used a peak flow meter to manage their asthma. At a return visit three to six months later, 100 percent knew their triggers and how to avoid them, and 85 percent were using a peak flow meter to help manage their symptoms. The children also missed fewer days of school or daycare after the HNP visit. In the three months leading up to the first HNP visit, the children with poorly controlled asthma had missed 5.8 days of school or daycare. But after the intervention, they had missed only two days in the previous three months.

"This evaluation, and others before it, offer a practical and cost-effective solution for increasing access to critical public health services," said Amanda Reddy, Director of Strategy and Impact for the NCHH and a study co-author. "Other states struggling with issues like asthma, childhood lead poisoning, or other housing-related illnesses and injuries should look to the New York State Healthy Neighborhoods Program as a model for improving health by investing in housing-based services."

The second article analyzing the cost-benefits of the program showed that the HNP's environmental asthma interventions actually save money. The study looked at 791 households with 448 children and 551 adults where a household member had had an asthma attack in the previous three months or one or more medical encounters in the previous year for an asthma attack or worsening symptoms.

Although the costs for prescription medications went up after the intervention (which reflects improved use of medications to control asthma), the reduction in hospitalizations produced an overall cost savings to Medicaid managed care. For every in-home asthma visit, which cost an average of $302, there was a per person savings of $1,083. For every $1 invested, the HNP produced a benefit of $3.58.

The third article evaluated the impact of the HNP on 6,436 dwellings that received an initial visit followed by a return visit. The majority of residents were low-income renters and lived in buildings built before 1950.

HNP staff did a visual assessment to identify potential health and safety hazards in the homes. At the initial visit, 68 percent of the homes were missing a carbon monoxide detector, 40 percent were missing smoke detectors, and 39 percent had residents who smoked in the home. Other conditions found in homes included ineffective cleaning, rodents, and peeling paint that could contain lead.

Within six months, the HNP intervention was able to produce significant improvements in fire safety, indoor air quality, tobacco control, pest control, mold, moisture, and other environmental health and safety hazards. Among the most remarkable findings, the number of homes without a working smoke detector decreased by 64 percent and without a carbon monoxide detector decreased by 76 percent. Among homes with rodent infestations, 64 percent no longer had the problem by the return visit. Many homes also had improvements in removing blocked exits, cockroaches, water leaks, electrical hazards, and mold.

Since 1985, the HNP has been performing home assessments in targeted communities. The HNP addresses the need to control asthma and decrease health and safety hazards in the home. It follows guidelines developed by an expert panel convened by the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Over the years, the target areas have changed and the data collection methods have improved. In the past five years, the HNP visited 31,000 homes with 85,000 residents, and provided the asthma intervention to 11,000 adults and children with asthma. These assessments capture both environmental information and self-reported heath information creating a data set about the health effects of housing hazards that is unmatched in scope.