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The Home Environment & Better Health

Hello and welcome to this week's live stream. Today I am talking to you about The Home Environment and Better Health. Why am I doing this? Well, I think the home environment has a huge impact on how you feel about life in general and about whether or not you suffer from any adverse health symptoms. We're going to be talking today about some key pieces of research that have emerged in 2019, and I'm going to be drilling down into these research papers to pull out some of the facts and figures as well as some of the conclusions that I'm hoping you can use and incorporate into your own thinking about the indoor living environment and how it impacts on your health.

So what I want to talk about first off is something called The Indoor Generation Report. And The Indoor Generation Report was published in 2018, and it came out at the end of 2018 by a company called velux.com. And one of the really interesting things about this report is that it focused on this area, which is really important to me and too many of you, which is about healthy buildings, indoor climate and energy efficiency. And the reason that this report is really important is that all of us spend possibly up to 90% of our time indoors. And the indoor air can be up to five times more polluted than outside. And often children's bedrooms are the most polluted in the house. And there are many reasons for this.

Oftentimes they are overly heated, under ventilated, and usually there is the presence of a lot of porous bedding and blankets and that sort of thing. And it's very interesting when we do indoor air quality inspections, we often find that the children's bedrooms are in fact more heavily contaminated. And it's interesting that world research confirms that anecdotal observation that we have noticed.

Interestingly, the velux.com paper shows that asthma risk is increased up to 40% by the presence of mould and dampness. And up to 77% of people aren't even aware that the indoor air can be more polluted than the outdoor air. And for copyright reasons I can't show you the video that Velux.com have produced. This beautiful video I urge you to look at on YouTube and it's a short video and it encapsulates a lot of the topics that we're talking about today. And this link will also be in the show notes at the bottom of this live stream. And I want to focus on some of the risk factors and can we identify these and and use these?

We're really talking about this topic of Sick Building Syndrome, sometimes abbreviated as SBS. Sick Building Syndrome really focuses on the nonspecific building related symptoms which occur when individuals spend time in that particular building. Now these include, and these are typical building specific Sick Building Syndrome symptoms and they're usually classified as affecting the eye, nose, throat, skin symptoms with the result of often fatigue and headache in individuals that experience this. There's three ways of categorizing sick building syndrome and they are: general symptoms, mucosal symptoms, and then skin or dermal symptoms. The first paper that I want to highlight came out as I said in 2019, I'm going to put all the links below, I've put the DOI number down the bottom of this slide and you can see that this is from Science and the Total Environment.

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And this is a fantastic publication because it has looked at a lot of the home environment factors which are correlated with health. What the researchers did is that they polled parents from daycare centers and they polled 36,541 individuals across China, across six different cities. They gave them a questionnaire which focused on the health status of the children and the parents and there were a lot of questions about the home environment. I've pulled up just a couple of the questions because the article has got some wonderful, wonderful detail about a lot of other questions that were asked as well, but the ones that impact on you and that you can actually takeaway and use when you are evaluating your own living or work environments that could impact on your health, are typical questions such as the size of the home, the location of the home, etc.

Is it in an urban area, a rural area? When was it constructed? Is it a new home construction? Is it five or 10 or 20 years old or is it perhaps much older than that? What type of mechanical ventilation or natural ventilation is present in the property? Do you use an exhaust fan? Is there an exhaust fan eve installed at the property? Do you use this in the kitchen and bathroom? What type of window openings do you have? When do you open them? Do you have presence of vermin, mice or rats or even cockroaches? And do individuals burn incense indoors or even smoke cigarettes? Which hopefully they don't. And so these researchers as well have gone on to drill down into the water damage and mould arena and they have come up with something called the dampness and mould index, and they have evaluated four variables. They have looked at how this can help individuals explain or rank their experience of mould and dampness.

They evaluated four variables, and these are:

1. damp stains with a ranking of never at zero or yes for one. And you'll see how these numbers add up in a moment.

2. Whether or not the individuals can see mould spots inside their home,

3. whether or not they have experienced actual water damage in the past years or in the last 12 months and,

4. whether or not they experienced the perception of mouldy odour.

And you will then end up with a numerical grade for the experience of dampness and mould between zero and six. And obviously if you experience mouldy odour weekly, you have had water damage in the last 12 months and you can see mould spots and damp stains, you're going to have a ranking of six (6) and that's pretty serious! So I think that this is an excellent way of simply defining one's experience of dampness and mould. And this pops out of this excellent Chinese paper.

Now, what was some of their results? Well, these researchers are quite active and they've been continuing to publish in this arena of better health indoors and its correlation with building specific features. And from their 2017 article, which again is linked in the show notes, they discovered that increasing ambient temperature is associated with more self-reported water damage, which is interesting because there is ... you would think that that would lead to a more humid conditions, but they discovered that relative humidity was not necessarily a good correlate with the experience of mould and water damage. But rain obviously is associated with the experience of water damage and damp spots. So the more rainy the area, the more impact that has on the building and the higher the probability of water intrusion entering into your property and resulting in the observation of mould.

So that is very self evident. But again it's interesting to poll people across cities in another country and see how that impacts on their self reported perception of mould and water damage. Again, as I mentioned, relative humidity was not associated with the observation of indoor dampness and mould and older buildings obviously had more dampness and mould. And we see this across Australia as well. A very interesting result was also reported in their paper and they discovered that manual workers or those in blue collar jobs had less reported water damage than those individuals who had managerial or professional occupations. So that is an interesting observation about how people respond perhaps [differently] to their indoor living environment.

Now there are some other results I want to highlight from this article, and they discovered that the medical symptoms were much more prevalent among women than men. So there is a gender bias which has been reported as well in other literatures regarding inflammation and allergy.

They discovered that redecoration or renovation of the home is associated with the experience of rhinitis, eye, skin headache, and fatigue.

And new furniture is positively associated with eye, throat, skin and fatigue. And gas cooking is associated with eye, throat, headache and fatigue.

And again, you might not be aware, but whenever you use your gas cooker [stovetop], the process of cooking generates/admits fine particles into the air. And it's very important to use the extractor fan whenever you are cooking because this can be an invisible and unexpected byproduct of the kitchen environment being used as it is intended. So this is related to extraction of hidden pollutants.

Now, similarly biomass cooking is prevalent certainly in China and this is associated with eye, throat and headache. We would experience, this is the use of a barbecue in many respects here in Australia, but that's a problem, and burning incense is definitely associated with the experience of eye, throat, skin headache and fatigue symptoms. There are some other results as well.

They found that those who have cats in the home environment, definitely seen an association of eye symptoms whereas this was not seen for those who have dogs. And dog owners also experience far less fatigue.

Now living near a major road is associated with rhinitis, eye, throat, skin and fatigue. And daily cleaning and mechanical ventilation in the kitchen or in the bathroom are protective. So these are some of the things that you can incorporate into your daily life, which lead to improved outcomes for you and your family.

And living in an old building and in less urbanized areas appears to be protective, but there is some conflicting conclusions even by the same authors regarding the age of a building, but generally an older building will have less new building elements in it that can off gas and obviously living in less urbanized areas, particularly in China, is protective to the individuals.

Now exposure to indoor dampness and mould. The key takeaway here should be moisture reduction and it's very important to avoid risky building practices and to make sure that adequate attention is applied to maintaining a building or minimizing the risk of moisture intrusion or accumulation by carrying out effective maintenance.

Now, I now want to move on to the European experience. So again, a marvelous paper came out, again a couple of months ago in 2019. This was published in the European Respiratory Journal. I'm going to talk about some of the important issues that are highlighted in this research. But the Germans have also discovered that there are 84 million Europeans living in buildings that directly impact on their respiratory health and lead to asthma and COPD. And that is a huge number because remember that water damage is one of the most common causes of a building defect. And we see that in Australia all the time.

So the key question in this research is: is dampness, mould and mould odor associated with the onset and remission of respiratory symptoms, asthma and rhinitis among adults? What the scientists did is that they offered individuals a questionnaire at baseline and then again at 10 years and they gave this to 11 and a half thousand people. So this is an excellent study that looked at a different question to the episodic experience of adverse health. For example, like with the thunderstorm asthma event in Australia a few years ago, where this was a one-off phenomena and people's asthma or respiratory system was impacted on heavily. So this European research I'm about to talk about is looking at the longterm trends of living in buildings with different features and characteristics. So that's what I'm focusing on today.

Now again, because this live stream is generally about water damage and mould and the experience and how to deal with this phenomena. The scientists in this European paper looked at and posed the question in the last 12 months, have water leaks or water damage indoors on walls, floors or ceilings being experienced? It's defined as general water damage. Has there been general dampness experienced in the property? And the key criteria for observing this was was there discoloration on floor coverings? So this is floor dampness and this really should be extended to include rising damp, which affects the floor and they were also looking for the presence of visible mould affecting walls, floors or ceilings. And they were looking at whether or not there were mould odours being experienced in one or more rooms.

And from this then they could develop their own metric using yes or no responses to these questions to then flag fall whether or not there is a problem in that particular area and relate it to rhinitis or sinusitis and these other adverse unwanted illnesses.

Now what they discovered was that at baseline, remember this study was done at baseline and then 10 years later with the same group of individuals and they found that at baseline water damage, floor dampness, mould and mould odour are all positively associated with the onset of respiratory symptoms and asthma.

Now dampness at home and at followups, so that's 10 years later experiencing dampness meaning they are now also residing in an environment which has this dampness is definitely associated with onset of respiratory symptoms, asthma and rhinitis. Dampness at work during followup is associated with the onset of respiratory symptoms, asthma and rhinitis. Combined dampness at home and at work increased the risk of respiratory symptoms and rhinitis and decreased remission. And mould odour is enhanced by poor ventilation

The key takeaway also is that dampness and indoor mould can decrease remission of respiratory symptoms and allergic rhinitis. And this is pretty self explanatory, but it's important to focus on the fact that these scientists were looking at whether or not the living environment leads to a positive outcome for these individuals. And so their conclusion was that living in these environments decreases the likelihood that those symptoms will go away. And that's pretty serious.

So where do we go from here? Well, what are the indoor climates of the future going to look like? Well, certainly everyone who works in building design and emerging areas of architecture and the interplay of building scientists and indoor building professionals and indoor air quality experts, that more daylight would be a beneficial thing to have inside homes. We need to be looking at different types of insulation, and we need to be looking at mechanical ventilation systems which adapt to the changing climate conditions that we find ourself in. Buildings need to be designed that are truly energy efficient and not just tight, and that this needs to link in with the mechanical refrigeration or heating and cooling system.

This topic of window fenestration impacts on not only the thickness of the window glass but your windows and the window frames need to be sympathetic to the climate and to the building components that have been used in the construction of the property, and renewable energy and the use of solar panels and often growing walls or growing elements within buildings need to be incorporated as well and considered how that impacts on the long and short term implications for amenity.

And we need to be considering this emerging area of biomimicry which is copying aspects of the biological systems or processes which have a good tight relationship between form and function, and how that type of thinking can impact on changes in building design. And that will be a topic of a live stream down the track. We also need to be incorporating environmental justice principles into building design and moving towards healthy homes.

So to recap, there are two pieces of research that have come out, published this year by the Chinese and by the Europeans that have focused a lot on whether or not people's respiratory health gets worse or is improved by different environmental interventions, including well known ones like ventilation. But also this aspect of how you measure water damage and mould is particularly important. And you can use a lot of these criteria in your own discussions with stakeholders to get across the point that you are in fact having a range of different impacts on your amenity and experience in the property and that they can be defined into different categories. And so that's the key message I want to leave you with. In any case, thanks for watching and I'll see you next week. Bye for now.

Dr. Cameron Jones

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