United States
Environmental Protection
           Office of Air and Radiation
                           EPA 402-K-00-002

                           March 2000
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  te Healthy Buildings, Healthy People Draft Final Report serves two
purposes. First, it is a call to action for all of us to work together to
  luence the indoor environment. As such, the report serves as the
?asis for discussion and education among professionals in public policy,
tealth, building sciences, product manufacturing and environmental
 ^search.  Second, it is a blueprint for channeling available resources.
   sady, EPA has undertaken program and budget initiatives focused on
  ildhood asthma, increasing demand for cleaner indoor products for
ise in schools, and creating standards of care for existing buildings.
  ly sustained enterprise fixed upon these goals by those in the public
    private sectors will let us fulfill the Healthy  Buildings, Healthy
'eople (HBHP) vision in the decades ahead.

)bviously, this draft is a work-in-progress. Once again, it is your turn
|is an expert, industry representative, futurist, policy maker or concerned
itizen to reflect on the broad structure of the approach the HBHP study
las taken £
nd provide EPA with your comments. We especially want
 our answi ?rs to four broad questions:

  *   Do tr e vision and goals capture the themes that are essential
     for in iproved indoor environments?
lere opportunities for improvement which remain
dressed in the potential actions?
     Whic i potential actions are most critical for EPA to undertake,
     whidh can others implement, and which can you engage in?

     Are t lere scientific, technological, health, economic, or
     admi listrative issues that have yet to be addressed?

(ur reflec ions on these points are most welcome and will be addressed
  the final publication of the HBHP Report. Please share your written
br oral corr ments with the HBHP staff by May 31, 2000. Contact informa-
lon is pro\ ided in the box to the right.

Please send comments
on this report by
May 31, 2000 to:

Pauline Johnston
U.S. EPA (6609J)
1200 Pennsylvania
Avenue, N.W.
Washington, DC 20460
phone: 202 564-9425
fax; 202 565-2039

Or, to:
Dan Fort, OPPTS
U.S. EPA (7406)
1200 Pennsylvania
Avenue, N.W.
Washington, DC 20460
phone: 202 260-1694
fax: 202 260-0816

This document is
available on the Internet
at http://www.epa.gov/iaq
                                              U.S. EPA Headquarters Library
                                                    Mail code 3201
                                              1200 Pennsylvania Avenue NW
                                                Washington DC  20460

                        The importance of the indoor environment to human health has been high-
                        lighted in numerous environmental risk reports, including the 1997 report of
                        the Presidential and Congressional Commission on Risk Assessment and
                        Risk Management. We spend as much as 90% of our time indoors, where
                        pollutant levels are often higher than those outside. Indoor pollution is
                        estimated to cause thousands of cancer deaths and hundreds of thousands
                        of respiratory health problems each year. In addition, hundreds of thousands I
                        of children have experienced elevated blood lead levels resulting from their
                        exposure to indoor pollutants.

                        The Office of Air and Radiation (OAR) and the Office of Prevention, Pesticides,
                        and Toxic Substances (OPPTS) led a cross-Agency effort to define a strategic
                        vision and potential actions for improving the quality of our indoor environ-
                        ment. As part of this effort, we sought the advice of many outside experts and
                        visionaries. During this collaborative process, we learned a great deal from our
                        stakeholders. For example, we need to further understand indoor sources of
                        pollutants and their health effects, integrate building design and maintenance,
                        encourage federal buildings to be "model" indoor environments, support new
                        product technologies, and educate the public. Also, we need to work closely
                        with other federal agencies; state, local and tribal governments; health and
                        community organizations; and industry and other private groups to improve
                        the nation's health.

                        Based on stakeholder and cross-Agency input, we have developed the
                        vision, goals, guiding principles, and potential actions to improve human
                        health indoors outlined  in this document. Chapter 1 focuses on why human
                        health indoors deserves the scrutiny, concern, and action of policymakers.
                        These reasons are primarily health-related. Health risks associated with
                        indoor environments include asthma, cancer, reproductive and develop-
                        mental effects, and others. Significant gaps still exist in the current state of
                        knowledge about indoor environmental risks and exposures. We also
                        believe that a particular emphasis must be placed on children's health.

 Ihapter 2 presents a draft vision statement and outlines goals, broad strate-
gies, and guiding principles to achieve success in every sector of our society
pver the next 25 to 50 years. In short, our objective is to realize major human
health gains over the next fifty years by upgrading indoor environments. Five
pals or strategies have been set to accomplish this objective: (1) achieve
 lajor health gains and improve professional education; (2) foster a revolution
  the design of new and renovated buildings; (3) stimulate nationwide action
 i enhance health in existing structures; (4) create and use innovative prod-
jtcts, materials, and technologies; and (5) promote health-conscious individual
 ehavior and consumer awareness.  In addition to providing information on
Ictions and strategies that can be taken to protect people indoors, EPA's
jision acknowledges the important  role played by individuals in protecting
 leir own health  and the health of those around them. Chapter 3 lays out
botential actions  that EPA or others  may pursue.

 Appendix A provides an overview of current indoor environmental program
priorities in various offices within EPA. Appendix B examines the roles of the
\gency's partners in indoor environmental protection, including federal,
 ' ate, local, and tribal governmental organizations, as well as stakeholders in
 ne private sector.


               Why Study Human Health Indoors?	1
                  Background  	2
                  Indoor Human Health Risks	4
                  Uncertainties 	8
                  Who is Most at Risk?	9

               Vision and Goals	11
                  Vision  	12
                  Goals to Achieve the Vision 	 13
                  Principles for the Future 	 17

               Potential Actions 	21
                  Overview  	.22
                  Potential Actions for Goal 1 	25
                  Potential Actions for Goal 2 	29
                  Potential Actions for Goal 3 	34
                  Potential Actions for Goal 4 	38
                  Potential Actions for Goal 5 	44

                References	49
                Indoor Environments: Current Program Priorities	51
                    Overview  	52
                    Office of Air and Radiation	55
                    Office of Prevention, Pesticides, and Toxic Substances	58
                    Office of Research and Development	61
                    Office of Solid Waste and Emergency Response	65
                    Office of Enforcement and Compliance Assurance	67
                    Office of Water	68
                    Office of Children's Health Protection	69
                    Office of Administration and Resource Management	72
                    Regional Offices	73

                 Partners in Indoor Environmental Protection	75
                    Other Federal Agencies	76
                    State, Local, and Tribal Agencies  	86
                    Other Stakeholders  	88

                                      BACKGROUND	2
                                      INDOOR HUMAN
                                      HEALTH RISKS..
                                      UNCERTAINTIES ... 8


                        Americans spend about 90 percent of their time indoors, where concentra-
                        tions of pollutants are often much higher than those outside. Risk assess-
                        ments performed for radon, environmental tobacco smoke (ETS), and lead
                        have shown that health risks are substantial. Thousands of chemicals and
                        biological pollutants are found indoors, many of which are known to have
                        significant health impacts both indoors and in other environments.
                        Although much is known and suspected regarding human health risks in
                        the indoor environment, a comprehensive, integrated effort to assess and
                        manage indoor risks has yet to be undertaken.

                        In 1987, the EPA Comparative Risk Project was conducted to examine the
                        relative risk of environmental problems. In 1990, the Relative Risk Reductionl
                        Strategies Committee of EPA's Science Advisory Board conducted a similar,
                        extensive analysis of relative environmental risk. Both resulting reports,
                        Unfinished Business: A Comparative Assessment of Environmental Problems (U.S.
                        EPA 1987) and Reducing Risk: Setting Priorities and Strategies for Environmental
                        Protection (U.S. EPA 1990), ranked indoor  air pollution among the top five
                        environmental risks to public health. In 1997, the report of the Presidential
                        and Congressional Commission on Risk Assessment and Risk Management
                        also found indoor environmental pollution to be one of the greatest risks to
                        human health and advised EPA to address these risks.

                        Americans are concerned about their own health and the health of their
                        children. However, despite efforts by EPA and other private and public
                        groups to conduct research on indoor environmental issues and to commu-
                        nicate the findings of that research, most Americans do not have a clear
                        sense of the significant health risks  of indoor pollution. They also do not
                        know what they can do to reduce risk for asthma, cancer, and other serious
                        diseases caused by indoor pollutant exposure.

  ie following two principles will serve to provide a workable context for
Identifying and addressing priorities for improving the indoor environment:
first, exposure needs to occur within or be aggravated by the building.

  lis principle is relatively straightforward. However, there are diverse
  >es of buildings, including homes, schools, day care facilities, nursing
     ;s, offices, factories, hospitals, hotels, restaurants, retail shops, theaters,
Irenas, and correctional facilities. Impacts on human health and methods
lor reducing exposure to indoor air pollution and the associated risk vary
py building type, use, and activity.

Second, risk reduction must be accomplished through better building
pesign, construction, and operation, improvements in the development
  id use of indoor products, or mitigation of existing exposures within a
building or in its immediate vicinity.

  ns principle excludes some risks that, although they occur indoors, originate
[utside the building and are best mitigated at a distance. For example, risks
 /ould be excluded if the source of the pollutants is industrial discharge (e.g.,
Drinking water contaminated by lead tailings from a mine or air pollutants
 itering the environment from industrial smokestacks1). Risks would be included
 Irhen the pollutant is added indoors (e.g., drinking water contaminants from
bad solder in plumbing in the building or air pollutants emitted from sources
Within the building). Pesticide residues on food from the spraying of crops
 frould be excluded, while pesticides used directly indoors, or that are used near
 :\e home and are tracked indoors, would be considered indoor pollution.


The risks to human
health indoors
include asthma,
cancer, reproductive
and developmental
problems, and other
health effects.

An estimated 17 million Americans suffer from asthma (U.S. EPA 1999). In
addition, about 5,000 deaths occur yearly from asthma— an increase of 33
percent in the last decade (Mannino et al. 1998). Consequently, the social and •
economic costs are large. Among chronic diseases, asthma is the number one
cause of absenteeism from school (Pope et al. 1993). Asthma cost an estimat-
ed $6.2 billion in the United States in 1990, including direct medical and indi- i
rect non-medical costs combined. An update of this figure would fall in the
range of $7 to $9 billion in 1998 dollars (Weiss et al. 1992).

Some groups in this country (e.g., children, certain minorities, seniors, and
low-income, urban populations) are disproportionately affected by asthma.
An estimated 1.8 million people required emergency room services for asth-l
ma in 1995. Mortality rates associated with asthma among African-
Americans, as a whole, are two- to three-fold higher than those among
whites. Mortality  rates for African-American children are five-fold higher
than those for their white peers (Mannino et al. 1998). While research has
not yet explained the rise in the incidence of asthma, nor all the reasons
why individuals first contract it, there is general agreement that controlling
indoor exposures is an important protective measure (NAS 2000).

Recently, the National Academy of Sciences/Institute of Medicine issued a
report on asthma and indoor air quality, confirming that dust mites and other]
allergens, microorganisms, and some chemicals found indoors are triggers
for asthma.  In addition, the report stated there was sufficient evidence
regarding associations between ETS, in preschool-aged children, and house
dust mites and the development of asthma (NAS 2000). ETS may significant- >
ly aggravate symptoms of asthma for 200,000 children and may affect as
many as 1,000,000 children to some extent (U.S. EPA 1992).


A number of indoor contaminants, such as asbestos, radon, tobacco smoke,
and benzene, are known human carcinogens. Other indoor contaminants,

 such as certain chlorinated solvents, polycyclic aromatic hydrocarbons,
 aldehydes, and pesticides, are considered likely to cause cancer in humans.

  ic National Academy of Sciences, in its latest report on radon health
  ience (NAS 1998), concluded that radon is the second leading cause of
[ung cancer in the country. NAS has estimated that about 12 percent of the
    ; cancer deaths in the United States are linked to radon. They calculate
 ie number of lung cancer cases attributable to radon exposure to range
     15,000 to 22,000 annually.

   vironmental tobacco smoke is estimated to  cause an additional 3,000
[iung cancer deaths in nonsmokers each year (U.S. EPA 1992).2 Other forms
 f cancer have also been found to be associated with indoor pollutants
 ?.g., leukemia with benzene; bladder cancer with ETS).


 )uring the period 1991  to 1994, almost 900,000  children had elevated blood
lead levels, which can cause a variety of developmental delays, including
 'fects  on intelligence quotient (IQ); vision, hearing, and stature deficits; and
[earning disabilities (U.S. DHHS  1997a). Several studies indicate that common
 idoor pollutants such as lead and ETS can also impair fetal development. A
 California  report estimates that 9,700 to 18,600 cases of low birth weight in
 ifants are caused each  year by ETS (NCI 1999).

 lany other environmental agents, including a number of chemicals
fcommonly found indoors (e.g., tobacco smoke, some pesticides, lead and
other heavy metals, alcohols, and plastic additives), are suspected of
fausing developmental toxicity in humans (U.S. EPA 1991a, NCI 1999).
 Sndocrine disrupters (e.g., certain pesticides and plasticizers), which affect
    normal function of  sex and thyroid hormones, present a new area of
toncern for reproductive toxicity. Adverse effects on a developing child
  jy result from exposure prior  to conception  in either parent, exposure


during pregnancy, or post-natal exposure. These effects range from low
birth weight to genetic diseases to lower IQs and infertility.

While the proportion of reproductive and developmental effects due to
indoor environmental factors is currently unknown, the impact could be seri- j
ous. Approximately 3 percent of newborn children have one or more signifi-
cant malformations at birth. By age one, about 3 percent more are recognized
to have serious developmental defects. Lifetime health-care costs for children
born each year with birth defects are estimated to be more than $8 billion.

Indoor environments can cause or amplify many other health effects as well.
The American Heart Association estimates that 35,000 to 40,000 cardiovascular
deaths per year among non-smokers can be attributed to ETS exposure (Taylor
et al. 1992). Recent studies have shown that, compared to those who had not
been exposed, ETS was associated with a 20 percent increase in the progression |
of atherosclerosis (hardening of the arteries) (Howard et al. 1998). Carbon
monoxide (CO) poisoning associated with the improper use and maintenance
of fuel-burning appliances kills more than 200 people per year in this country
and results in about 10,000 admissions to hospital emergency rooms for treat-
ment (U.S. CPSC 1997). An additional 600 to 700 accidental deaths from CO
poisoning occur indoors from other sources, including automobiles (Cobb and
Etzel 1991). The agent for Legionnaires' disease, a potentially deadly pneumo-
nia which affects 10,000 to 15,000 people each year, is associated with cooling
systems, whirlpool baths, humidifiers, food market vegetable misters, and
other indoor sources, including residential tap water (EPA et al. 1994; U.S.
DHHS 1997b). Effects associated with toxins from indoor fungi and bacteria
range from short-term irritation to immunosuppression and cancer (EPA et al.

Studies show that symptoms of sick building syndrome (SBS) may be
caused or intensified by indoor environmental problems (U.S. EPA 1991b,
U.S. EPA et al. 1994). The term "sick building syndrome," first employed
  the 1970s, describes a spectrum of specific and non-specific complaints
 sported by a population of building occupants. These symptoms can be
associated with their presence in the building. These complaints may also
 ssult from causes other than SBS, including illness contracted outside the
juilding, acute sensitivity (e.g., allergies), job-related stress or dissatisfac-
ion, and other factors. Data are insufficient to thoroughly evaluate many
BBS problems.


                       Although EPA has estimated the carcinogenic potency of a number of
                       indoor pollutants, the Agency has conducted comprehensive population
                       risk assessments for only a few substances (e.g., radon, ETS, and lead). A
                       comprehensive indoor environments risk assessment should cover all of the |
                       chemical and biological indoor pollutants for which sufficient lexicological
                       and exposure data exist.

                       Most chemicals in commercial use have not been tested for possible health
                       effects. Fewer than one-third of regulated, high-production chemicals,
                       including many found indoors, have undergone even a screening level of
                       testing for adverse effects. Health effects data are particularly critical for
                       indoor exposure  because median indoor concentrations are one to five
                       times the median outdoor concentrations of many hazardous air pollutants.
                       Considering that people spend approximately 90 percent of their time
                       indoors, median  indoor exposures (concentration multiplied by time) may
                       be 10 to 50 times higher than outdoor exposures (U.S. EPA 1998).

                       Significant uncertainties exist in the areas of exposure assessment and control.
                       For example, data are lacking on the rate and frequency of emissions from
                       many sources, such as building materials and consumer products. There is also I
                       a lack of data on the identity of the chemicals emitted, as well as on the cost
                       and performance of solutions to reduce exposures. Since there are no standard
                       methods to quantify emissions, widespread commercial development of new
                       products and materials that emit significantly lower levels of indoor pollutants I
                       has been limited. Significant uncertainties stiil exist regarding how  a change in
                       building design, operation, and maintenance will influence the mix of indoor
                       pollutants, as well as how to measure the concentrations of biological contami-
                       nants present indoors. Exposures in schools, residences, and most other non-
                       occupational indoor environments still remain largely unstudied.

          IS MOST AT RISK?
 Ihildren often experience higher exposures to environmental pollutants than
   ilts because, per pound of body weight, they breathe more air and ingest
 lore material than adults. Children also more readily absorb contaminants.
 Additional exposure pathways resulting from activities such as crawling and
Bucking and gnawing on toys can also elevate risk for children. For example,
   teen 1991 and 1994, almost 900,000 children in this country had unaccept-
    blood lead levels from exposure in their own homes (U.S. DHHS 1997a).
   lority status, income status, and age of housing have all been shown to
 jrrelate with elevated blood lead in children. Children are more susceptible
 • the effects of lead exposure because their brains are still developing,  they
 igest more lead than adults through hand-to-mouth activity, and their devel-
h>ing systems more readily absorb lead than those of adults (U.S. EPA  1996).

 pA estimates that ETS is responsible for between 150,000 and 300,000 lower
 sspiratory tract infections in infants and children under 18 months of age,
 ; well as an increased prevalence of fluid build-up in the middle ear. This is
Istimated to result in between 7,500 and 15,000 hospitalizations each year.
Post-natal ETS exposure has also been implicated in 1,900 to 2,700 cases of
judden infant death syndrome (SIDS) annually (NCI 1999).

 idividuals may be more vulnerable to indoor contaminants because of age,
genetics, nutrition, metabolism, exposure levels, existing diseases, and other
 ictors. For example, older people are at particular risk for adverse effects on
 ie nervous and cardiovascular systems; asthmatics are more vulnerable to
 lergens and respiratory irritants; and people with acquired immune  defi-
      syndrome (AIDS) and other immunodeficiencies are more vulnerable
 i pneumonia, pathogenic yeasts, and other illnesses.

                         When attempting to reduce the "total" impact on human health, knowl-
                         edge of the relative risk from ambient air pollutants that make their way
                         indoors and from pollutants emitted by indoor sources will determine the
                         focus of where the most effective risk reduction can occur.

                         2EPA firmly maintains that the bulk of the scientific evidence demonstrates
                         that secondhand smoke-environmental tobacco smoke, or "ETS"-causes lung
                         cancer and other significant health threats to children and adults. EPA's report]
                         was peer-reviewed by 18 eminent, independent scientists who unanimously
                         endorsed the study's methodology and conclusions. Since EPA's 1993 report
                         estimating the risks posed by ETS, numerous independent health studies have]
                         presented an impressive accumulating body of evidence that confirms and
                         strengthens the EPA findings. It is widely accepted in the scientific and public
                         health communities that secondhand smoke poses significant health risks to
                         children and adults.

                         A U.S. District Court decision has vacated serveral chapters of an EPA
                         scientific risk assessment document that served as the basis for EPA's classifi-
                         cation of secondhand smoke as a Group A carcinogen and estimates that ETS
                         causes 3,000 lung cancer deaths in non-smokers each year. The ruling was
                         largely based on procedural grounds. EPA is appealing this decision. None of
                         the findings concerning the serious respiratory health effects of secondhand
                         smoke in children was challenged.

                                            GOALS TO ACHIEVE
                                            THE VISION 	13
                                            PRINCIPLES FOR
                                            THE FUTURE	17


 •  Leveraging
     Action Through

 •  Encouraging

 •  Market

 •  Research and

 •  Legislation,
     Policy, and

 •  Education and
All across our nation, people live, work, and learn in healthy indoor
environments. The environments inside our buildings help us reach our
full potential for good health and productivity. No one is excluded: we
create healthy buildings at every income level and help all our children
grow up to be healthy adults. We understand the importance of healthy
indoor environments, create a demand for them, and expect them as
thing that everyone deserves. By choosing designs, ventilation syste
materials and products wisely, we are able to create healthy buildings while!
substantially reducing energy use, cutting materials costs, and raising
productivity. The Nation's success in improving human health indoors
serves as a model for better building design and construction, rehabilitation |
and maintenance, and product development around the world.

)ur Objective: To Achieve Major Human Health Gains Over the Next
              SOYears By Upgrading Indoor Environments.

iOAL 1:

 Achieve Major Health Gains and Improve Professional Education

    Known risks from indoor environments are effectively addressed,
    leading to significant health gains in many areas, including:

       Avoidance of excess lung cancer deaths caused by exposure
       to radon, environmental tobacco smoke (ETS), and asbestos.

       Avoidance of excess cancer deaths caused by indoor exposure to
       volatile organic compounds and other chemicals.

       Avoidance of delays in physical and mental development in
       children, lowered IQ levels, shortened attention spans, and
       behavioral problems associated with elevated blood lead levels.

       Avoidance of excess deaths from asthma and other respiratory
       diseases; improved comfort for the estimated 20 to 30 million
       Americans who have asthma, and many of the more than 50
       million who suffer from allergies.

       Significant reductions in the spread of infectious diseases, such
       as tuberculosis, Legionnaires' disease, and influenza.

       Significant reductions in other health effects, including eye, nose
       and throat irritation, headaches, fatigue, loss of coordination, nausea,
       developmental and reproductive damage, and damage to the liver,
       kidneys, and central nervous system.

       Major productivity gains  from improvements in worker and
       student performance.

    The most important risks posed by indoor environments are identified
    and quantified, and risks from interactions of toxins and cumulative
    low-level exposures are clarified.
Achieve Major
Health Gains and

Foster a Revolution
in the Design of
New and

Nationwide Action
to Enhance Health
in Existing

Create and Use
Products, Materials,
and Technologies

Promote Health-
Individual Behavior
and Consumer

  '»  Information about indoor health risks and healthy indoor environments
     is fully integrated into professional curricula and the training and prac-
     tice of health, science, manufacturing, and building professionals.


  Foster a Revolution in the Design of New and Renovated Buildings

  *  The planning and construction of nearly all new buildings is based
     on an integrated design process that looks at whole-building systems
     and seeks out least-cost strategies for simultaneously achieving
     health-enhancing indoor environments, efficiency in the use of energy
     and materials, high functionality, comfort, and productivity.

  »  New buildings with health-enhancing indoor environments and high
     energy efficiency cost no more to own and operate than conventional
     buildings, and often cost less.

  9  Cost-effective building rehabilitation, renovation, and remodeling
     strategies have been developed that address all major identified risks
     in the indoor environment.

  *  Residential and nonresidential rehabilitation, renovation, and remod-
     eling projects are undertaken using integrated design processes and
     achieve large improvements in indoor environmental quality, energy
     efficiency, and productivity.

  ®  The great majority of new and renovated buildings are designed for
     easy maintenance with low-impact products and procedures.


  Stimulate Nationwide Action to Enhance Health in Existing Structures

  «  Guidelines for healthy building operation, maintenance, renovation,
     and remodeling are developed and routinely followed in commercial
     and office buildings.

    Standards of care and livability are developed and routinely followed
    in residential rental buildings.

    Building managers and engineers, maintenance and custodial workers,
    trash handlers, recyclers, renovators, and others who contribute directly
    to maintaining clean, healthy indoor environments have proper training
    and the capability to carry out their work.
 Create and Use Innovative Products, Materials, and Technologies
 »  Building materials and consumer products that pose potential health and
    environmental risks are subject to standardized, life-simulation tests.
 *  An easily understood "green labeling" system has been developed that
    allows consumers to assess health risks and make informed choices
    among building materials and consumer products used indoors.
    Low toxicity, resource-efficient products are widely available in all
    indoor product areas and usually cost no more than conventional

    Low-cost testing kits and sensors for detecting exposure to a wide range
    of indoor pollutants and assessing personal  risks are available to all.

I Promote Health-Conscious Individual Behavior and Consumer Awareness

[ *  Everyone is aware of the importance of indoor environments for
    maintaining and enhancing health. Indoor environmental quality is
    seen as just as important to health as environmental quality outdoors.

    Nearly everyone is familiar with how to access information about
    indoor environments, including information on health effects, envi-
    ronmental impacts, pollution prevention strategies, integrated build-
    ing design, and indoor enviro-friendly products.


*   Information is easily available and useful to the general public (including
    access in multiple languages) and to all relevant constituencies, including j
    building professionals, product manufacturers, and health professionals.

«•   Nearly all involuntary exposure to ETS has ceased, so that it is no
    longer a significant health threat.

»   The great majority of homeowners, tenants, and landlords significantly
    reduce exposure to indoor pollutants and irritants by practicing good
    building maintenance, e.g., controlling moisture problems, exterminating
    cockroaches and other vermin, changing air filters, and testing for radon,
    lead, asbestos, carbon monoxide, and other toxics.

*   More informed consumer product purchasing and use has led to a
    substantial reduction in health risks associated with cleaning, painting,
    lawn and garden care, and other aspects of personal behavior in home


 From the smallest home to the largest office building, we will improve indoor
  wironments through an integrated design process that looks at whole-
 building systems and the leverage points where individual expenditures can
 generate multiple benefits. A whole-systems perspective that evaluates the
 Building, including its site, heating, ventilating, and air conditioning (HVAC)
 bystems, materials, finishes, carpets, paints, appliances, and equipment, is the
 itey to implementing the least-cost design and remodeling.


   will create indoor environments that are healthy for everyone by mak-
ing indoor environments safe for the most vulnerable among us, especially
  tildren. Improving indoor environments is critical to children's health and
|ays the groundwork for healthier generations to come.


  jrne population groups—usually low-income people, and often minorities
  ire exposed to a disproportional amount of environmental hazards both
 idoors and outdoors, at home, and at work. Economically-disadvantaged
 beople often  have fewer chances to improve their housing or workplace
 ponditions. Environmental justice requires that we make extra efforts to
  sure that these groups are equally protected.


 Citizens have a right to know what is in their environment and how it
 Iffects them.  This allows them to make informed choices to protect them-
 slves from environmental health threats. This principle applies to indoor
  ivironments just as much as to outdoor ones. It will become increasingly


relevant as low-emission products and low-cost indoor testing and sensor
technologies are marketed.


Indoor environmental conditions can lead people to under-perform and to
feel less than their best without producing overt symptoms of illness.
Efforts to improve indoor environments should not only prevent illness,
they should aim to enhance health, vitality, and productive activity.


Strategies for improving indoor environments need to be based on scientific
facts. We need a better understanding of people's exposure in various indoor
environments, how those exposures affect health and productivity, and how
they can be minimized by prevention-oriented, least-cost strategies. We also
need to understand how healthy lifestyles and indoor behaviors can best be


Preventing indoor environmental problems from occurring in the first place
is far more cost-effective than remediating problems and treating illnesses
after they occur. The key to stopping the escalation of health care costs is
to "design out" the conditions which cause illness, including unhealthy
environments in homes, schools, and workplaces.


Indoor environmental quality is the sum total of decisions made by an
enormous variety of individuals and institutions, including architects and
builders; bankers and real estate agents; academic scientists and medical
professionals; national, state, and local governments; building owners and
managers; product manufacturers and retailers; janitors and sanitation

 workers; employers and unions; parents; consumers; and others. We can
fmprove indoor environments faster if all these parties become more
  lowledgeable, so that the impetus for change emerges from all sectors.


Improving human health indoors requires a new level of systematic cooper-
ation among disciplines, as well as the many public, private, and voluntary
organizations whose activity affects indoor environments. Partnerships
imong disciplines are critical for whole-systems thinking and integrated
iesign. Partnerships between government and business can bolster research
bfforts and speed the  emergence of profitable solutions. Partnerships among
federal, state, and local governments can accomplish far more than federal
 ction alone. Such creative linkages are key to improving indoor environ-
 lental quality and lowering health risks.


  iproving indoor environments requires better coordination within and
kmong federal government agencies to  align efforts and set clear roles for
bach organization. New efforts will be required within EPA to span internal
boundaries and collaborate more effectively with other agencies.


  ie federal government can lead by example and through implementing
Jtrategies that empower others. Key areas for federal action include
 anstructing facilities that are models of indoor environmental quality and
leveloping criteria and management systems for indoor environmental
buality that provide examples for other agencies. The federal government
tan also enable other stakeholders, using strategies such as supporting
<&D, providing information, stimulating the marketplace through
mrchasing, and setting standards or encouraging efforts to develop
Itandards within the private sector.



Strategies for improving indoor environments can be designed to promote
economic efficiency, spur technological innovation, and benefit business,
while promoting public health at the same time. Choosing designs, materials,
and products wisely will create healthy indoor environments while simultane-1
ously improving efficient use of energy and materials. Energy use can be
reduced through more efficient building envelopes, glazings, and lighting
systems. The need for materials can be reduced by minimum-materials
design, minimum-toxicity components, improved durability, more flexible
building design (so buildings do not have to be replaced when their use
changes), and more extensive recycling and reuse of building materials.
Technologies to use water more efficiently can also play an important role in
areas where water supplies are limited. Money can be saved by downsizing
HVAC equipment, reducing material costs, and cutting operating expenses for I
heating, cooling, and lighting.  Small businesses may require special strategies
to enable them to stay competitive and improve indoor environments.


We need to take into account  the relationship between indoor and outdoor
environments. Designs for healthy buildings should include energy-saving
landscaping and should be tailored to deal with the special problems posed
by regional climates and local conditions. Healthy indoor environments are
easier to achieve when outdoor environmental quality is high, because
what comes in from the outside affects the indoors.

Clear goals and measurements of movement toward them must be set.
Appropriate measurements of success are essential for tracking and
demonstrating progress, evaluating programs, and directing strategies.

                                                  OVERVIEW 	22
                                                  POTENTIAL ACTIONS
                                                  FOR GOAL 1  ......25
                                                  POTENTIAL ACTIONS
                                                  FORGOAL2 	29
                                               Si POTENTIAL ACTIONS
                                                  FORGOAL3  	34
                                                  POTENTIAL ACTIONS
                                                  FORGOAL4  	38
                                                  POTENTIAL ACTIONS
                                                  FOR GOALS  ......44
                                                  REFERENCES  	49

 The following is an
 outline of potential
 actions for the five
 goals identified in
 Chapter 2.
  Achieve Major Health Gains and Improve Professional Education
     A. Develop a risk assessment methodology, perform research, and
        conduct assessments.
     B.  Along with other public health agencies, develop a public health
        metric (or series of merries) as a baseline against which to
        demonstrate health gains.
     C.  Demonstrate specific health gains from good IEQ practices and
        marshal evidence to indicate that the gains are due to actions taken.
     D. Provide information/education to foster understanding and action.
  Foster a Revolution in the Design of New and Renovated Buildings
     A, Quantify the benefits and costs of integrated design and use this
        information to provide incentives to build/renovate buildings
        with integrated building designs.
     B.  Facilitate competitions or industry consortia to develop integrated
        building designs.
     C.  Develop and promote building system performance targets.
     D. Develop university and continuing education curricula.

 Stimulate Nationwide Action to Enhance Health in Existing Buildings
    A. Identify and fill knowledge gaps for the full range of existing
    B, Develop and promote excellent IEQ standards of care.
    C. Develop specific guidance documents for critical junctures in the
       life cycle of existing buildings.
    D. Develop metrics for a performance-based building rating/
       certification program.
    E. Provide information targeted to do-it-yourselfers.
    F.  Develop homeowner/tenant checklists.
 Create and Use Innovative Products, Materials, and Technologies
    A. Further develop the Source Ranking Database.
    B. Document and evaluate state-of-the-art sensors,  test kits, and
       indoor-related prevention and control technologies.
    C. Perform comparative exposure and risk assessments on products
       and materials.
    D. Develop product testing protocols.
    E. Work with stakeholders and outside standard-setting organizations
       to develop voluntary, consensus-based standards and guidelines.
    F.  Provide market incentives to drive manufacturers to develop both
       new  products and new technologies.
    G. Work with interested stakeholders to develop and disseminate
       product labels, instructional materials, enhanced material safety
       data  sheets, and product specifications.
                                                                        P .'!•.".


 Promote Health-Conscious Individual Behavior and Consumer Awareness
     A. Initiate a campaign to educate society's leaders on IEQ.
     B.  Create a healthy children program.
     C.  Ensure consumers are well-informed.
     D. Provide for healthy home care.

 .fundamental requirement for improving human health indoors is a better
 iderstanding of the health risks posed by indoor environments. A comprehen-
   ; assessment of health risks across the wide variety of indoor environments
 /ill require extensive research efforts. Issues needing further research include test
 methods, basic toxicology for agents and mixtures, and the development of bio-
   rkers and appropriate environmental measurements. A sustained, long-term
 fort is needed to identify and quantify the most important indoor health risks.

to demonstrate how healthier buildings lead to healthier people, research is
ilso needed to establish public health baselines against which health gains
 m be measured. Critical to achieving this goal is the quick communication
bf research findings about indoor health risks and how they can be avoided
 i building and public health professionals, product manufacturers, and the
 iblic. Metrics are needed to measure the status and trends of a number of
kealth effects caused by poor indoor environmental quality. This effort will
 squire coordination with other public health agencies with an interest in
 idoor environmental issues. Once metrics are established, they can be used
  demonstrate health gains from appropriate risk management options.

   can improve the indoor environment most rapidly if all parties involved
Become more knowledgeable, so that the impetus for change comes from all

 A. Develop a risk assessment methodology, perform research, and con-
    duct assessments.

    These assessments will determine how potential risks posed  by indoor
    exposures can be predicted accurately, quickly, and cost-effectively.

    1. Address multiple pathways, multiple agents, and non-traditional
       stressors (e.g., thermal, light, and sound).
Achieve Major
Health Gains
and Improve

    2.  Develop a peer-reviewed, high-level cross-Agency research strategy, I
       with buy-in from other agencies as well as non-federal stakeholders,}
       designed to improve public health. This strategy may be developed
       at the level of the White House Committee on Environment and
       Natural Resources and should address:

       « Appropriate test methods to assess the often symptom/complaint-
         related issues associated with indoor environments.

       * Toxicological testing for agents and mixtures, particularly for
         agents other than the traditional developmental/reproductive risks j
         (e.g., immunotoxicity, neurotoxicity, and human performance).

       * Development of biomarkers and appropriate environmental

       * A testing strategy to help address some of the above risks.

    3.  Manage a coordinated effort (government and non-government)
       to perform the necessary exposure, effects assessment, and risk
       management research.

    4.  Complete the EPA portion of the inter-agency research effort.

    5.  Establish an indoor environmental risk assessment methodology
       and databases for ready access.

B.  Along with  other public health agencies, develop a public health
    metric (or series of metrics) as a baseline against which to demon-
    strate health gains.

    Metrics are needed to measure status and trends for asthma and
    allergens, productivity/human performance, irritancy, neurotoxicity,
    reproductive toxkity, infectious disease, cancer, and other health

    1.  Identify health conditions that should be included in the public
       health baseline.
    2.  Ensure:
       « Collection of the necessary public health data to assess the public
         health baseline.
       » Development and acceptance of public health indicators and metrics.
       » A commitment to using the indicators and metrics on a national scale.
C.  Demonstrate specific health gains from good IEQ practices and marshal
    evidence to indicate that the gains are due to actions taken.
    1.  Identify specific actions, and ensure that the actions are implemented,
       documented, and tracked.
    2.  Push aggressively to implement those actions likely to produce the
       largest reduction for each known risk.
    3.  Monitor national status and trends of public health by working
       with other public health agencies.
    4.  Demonstrate the link between improved public health and actions
       taken by assessing  changes to the public health baseline.
D. Provide information/education to foster understanding and action.
    1.  Integrate information about indoor health risks and healthy indoor
       environments into professional curricula and health professional
       training as well as training of building professionals,
       a. Include case studies in the educational curricula of medical
         students (e.g., Second Nature), architects, and engineers.
       b. Educate insurance and real estate agents, building sanitation
         engineers, mortgage lenders, etc.


2.  Develop health issue papers for the public on such known risks as:
   «* Radon
   * Environmental tobacco smoke
   « Lead poisoning
   «f Asthma
 )ramatic improvements in the indoor environments of the next century
 nil be achieved with integrated design and good indoor air quality (IEQ)
 planning and construction when buildings are erected. The design and
bonstruction of new residential and commercial buildings accounts for some
  J'l billion per year in the U.S. economy, with new homes alone accounting
for $182 billion (U.S. DOC 1996,1997). Extensive building renovations offer
pimilar opportunities for improving indoor environments. Once the poor
[stepsister of the building industry, nonresidential rehabilitation is now a
  ajor market. Most of this work requires total building overhaul or major
 enovations, not just remodeling or repair.

 everal dozen buildings have been constructed around the world over the
 bast few years using an integrated design process. They demonstrate that
 iprovements in energy efficiency can complement indoor environmental
 [ipgrades. Often, integrated design actually saves money by downsizing
 jieating, ventilating, and air conditioning (HVAC) equipment, reducing
  sterial costs, and cutting operating expenses for heating, cooling, and
[ighting. New and renovated buildings can also be designed for easy
  aintenance with low-impact, high-efficiency products and procedures.

 everal kinds of initiatives are needed to help integrated design move from
 ; present status of "innovative best practice" to standard practice. Research
  needed to establish the economic costs and benefits of integrated design
 id good IEQ construction, as well as the costs of health care, productivity
 ass, and poor building performance related to inferior IEQ design and
lonstruction. Reliable information of this kind will eventually influence costs
   insurance, mortgages, and health care coverage, creating strong economic
  entives for integrated design,

 Jeeded as well are new tools to provide industry and consumers with the
 \formation they require to make sound building and renovation decisions.
professionals in the design and building industries need to agree on the
llements of good IEQ design and on appropriate ways to measure and
lornpare the features offered by given designs. Collaboration with profes-
tonals and organizations in the design, engineering, construction, building
Foster a Revolution
in the Design of
New and Renovated

                               products, real estate, government, and public health communities is essential
                               to speed change in professional practice, professional curricula, and standards
                               and code setting.

                                 A. Quantify the benefits and costs of integrated design, and use this
                                    information to provide incentives to use integrated designs to build
                                    or renovate structures.

                                    Integrated design simultaneously achieves good indoor environmental
                                    quality, energy efficiency, high functionality, comfort, and productivity.
                                    Building design, construction, and procurement professionals need
                                    sound financial arguments to make healthy indoor environment features
                                    a priority in new buildings.

                                    1. Convene a stakeholder process to define good/superior IEQ for
                                       various buildings types.

                                    2. Collect existing information and perform needed research to quantify]
                                       initial building and lifetime costs of superior IEQ and the savings
                                       from improved health, productivity, and building systems perform-
                                       ance. Focus on energy, productivity, absenteeism, cost of law suits
                                       and worker's compensation, tenant turnover/retention, sale of
                                       homes, rental rates, costs of implementing guidance, and assessment
                                       of the market value for a "healthy building."

                                    3. Use existing data and research results to develop building design
                                       simulation packages that demonstrate the consequences of building
                                       design and product choice on the health, economics, and productivit
                                       of the occupants. Address air quality, air flow, energy consumption,
                                       life cycle effects, and  health/productivity impacts.
                                    4. Promote integrated design cost/benefit information for good decisior
                                       making by:
                                       a. Widely disseminating cost/benefit information to builders,
                                          product manufacturers, commercial realtors, insurance and
                                          mortgage  companies, public health professionals, and consumers
                                          to improve understanding and encourage integrated designs.

      b. Championing insurance industry rate incentives for superior
         IEQ buildings using cost-benefit arguments. Work with consumer
         advocacy organizations and insurance companies or their profes-
         sional organizations to pioneer reduced premium costs for holders
         of health, home, or commercial property insurance policies who
         have created high-quality indoor environments.

       c. Creating primary and secondary mortgage banking instruments
         that result in savings for residential remodeling and  new con-
         struction projects that use integrated design. Use cost-benefit
         arguments that demonstrate savings from improved systems
         performance, lowered taxes, and improved insurance rates and
         work with consumer groups and mortgage bankers to craft
         lower debt-to-equity rates  for residential lending. This program
         may be modeled on or integrated with the Energy Efficient
         Mortgage program.

      d. Working with school districts  to revise how schools allocate
         resources, taking into account the cost of new construction,
         maintenance, and future costs and revising federal and state
         formulas to reflect these factors.

B. Facilitate competitions or industry consortia  to develop integrated-
   building designs.

   Options to be considered:

   1. Establish a consortia of designers, manufacturers, and other
      stakeholders to develop the designs and the building materials
      for high-performance buildings.

   2. Promote juried design competitions, undertaken with other
      stakeholders, that focus the creativity of architects and designers
      on improved indoor environments.

   3. Provide grants to show that integrated designs are feasible.

C. Develop and promote building system performance targets.

   1.  Through a stakeholder process, develop IEQ performance targets
       for new or renovated buildings. Working with established voluntar
       standards-setting organizations to create a unified set of voluntary
       standards, incorporate key lEQ-related variables (maintainability,
       air quality, energy efficiency, air flow, materials selection, and feed-
       back loops for measurement and evaluation). Develop a voluntary
       ratings system that predicts performance.

   2.  Procure a Presidential Executive Order requiring new or renovatedj
       federal buildings to comply with the voluntary standards.

   3.  Establish a Green Codes program where localities lower permitting
       fees, cut taxes, or simplify procedures for buildings that adhere to a
       voluntary IEQ buildings rating system. Work with international code|
       officials and local government organizations responsible for building
       codes to develop model programs. Where possible, integrate Green
       Code efforts with American Institute of Architects (AIA) and other
       existing Green Buildings efforts (Green Buildings Council, Energy
       Star, the Office of Policy (OP) Smart Growth Network, and the
       OP/Office of Solid Waste (OSW)/National Association of Home
       Builders (NAHB) Research Center) to develop a local Green Builder
       program model.

   4.  Create a recognition program for integrated-design buildings.
       Highlight buildings built with whole systems design, including
       schools, office buildings, and low- and moderate- income housing.
       Assist in developing an industry organization or an independent
       authority to establish and oversee a recognition program that directs j
       potential consumers to the benefits offered by the  building's good
       IEQ. Integrate these efforts with existing Green Buildings efforts.

D, Develop university and continuing education curricula.

   Develop curricula and work with state licensing agencies to incorporate
   integrated design standards and continuing education requirements for
   designers, architects, engineers, and health professionals. Begin an EPA
   or third-party certification process for companies and individuals for
   added marketability and develop a mechanism for recognition and
   price differentiation in the marketplace. Develop integrated design
   components for existing professional training programs. Partner with
   state contractor licensing organizations, home builders, remodelers, and
   other industry groups to promote integrated design standards.

 Nationwide Action
 to Enhance Health
 in Existing
The indoor environments of existing structures must also be considered. Each j
year, the inventory of existing buildings grows both older and larger. From
the point of view of human health, therefore, it is important to improve the
indoor environmental quality of existing buildings so that virtually everyone
lives and works in healthy surroundings.

Because industrial environments are unique and, for the most part, well-reg-
ulated, our efforts focus on non-industrial buildings of all types. These non-
industrial buildings range from single-family, owner-occupied structures to
large multi-tenanted residential buildings; from small retail establishments
to large office buildings; from hospitals to prisons  to schools.

Several types of initiatives can combine to improve IEQ in existing buildings.
Guidelines can be developed and promoted for bettering IEQ in routine
remodeling and repairs. Standards of care and livability for healthy building
operation and maintenance can be institutionalized. Research can support the
development of guidance and make outreach programs more effective.
Education and  training programs can ensure that those responsible for man-
aging and maintaining buildings have the ability to perform their work. Better!
measures of building performance arid recognition programs can heighten
awareness of the issue in general and the status of particular buildings.

  A.  Identify and fill knowledge gaps for the full range of existing buildings.

     Buildings of interest cover a wide spectrum and can include residences,
     hospitals, and hotels.

     1.  Develop and carry out a "research" agenda in the following areas:

        »  Current IEQ in non-office  buildings. (EPA has recently completed
           the data collection phase of a baseline study of office buildings.)

        *>  Short- and long-term costs and benefits of good IEQ, including
           such factors as improved health (and health costs), energy, produc-
           tivity, absenteeism, cost of law suits and worker's compensation,
           tenant turnover/retention,  fire susceptibility, equipment life
           expectancy, sale of homes, rental rates, costs of implementing guid-
           ance, and assessment of the market value for a "healthy building."

      »  IEQ diagnostic protocols and detection technologies.

      *  Building ventilation control technologies that are most effective
         from IEQ and energy standpoints.

      »  Building maintenance protocols and their impact on IEQ,
         including cleaning and maintenance products.

      *  Building IEQ remediation protocols.

   2. Target a building with stable historical data and identify stakeholders
      who can study the effectiveness of EPA's guidance in improving IEQ
      and its effect on health, including quantifying effects through health
      insurance claims, sick leave, and productivity gains and losses.

B. Develop and promote excellent IEQ standards of care.

   1. Work with stakeholders to facilitate the creation of integrated IEQ
      standards of care for different building types, taking into account the
      interrelated roles and responsibilities of building owners, managers,
      occupants, and tenants.

   2. Procure a Presidential  Executive Order requiring existing federal
      buildings (both owned and leased) to comply with integrated IEQ
      standards of care.

      Encourage the adoption of IEQ standards of care in mortgage and
      insurance policies and rates, hospital certification, voluntary practice
      guidelines, and building codes.

      Develop a voluntary Building Coalition dedicated to promoting
      the adoption of IEQ standards of care. The Coalition could: develop
      an outreach mechanism/tool to encourage adoption, including the
      development of training outlined  below; create a building recogni-
      tion program; manage the development of the IEQ performance
      index; and serve as the focal point for future progress on IEQ in
      existing buildings.


   5.  With stakeholders, develop training and other tools to educate
       various audiences on IEQ standards of care. Promote adoption by
       institutions that educate architects, engineers, home inspectors,
       and other building professionals, and as continuing education or
       a prerequisite for certification by professional organizations.
       Promote education and training programs to ensure that building
       managers and engineers, maintenance and custodial workers,
       trash handlers, pest management contractors, recyclers, and others '
       who contribute directly to maintaining indoor environments have
       the information and capabilities they need for carrying out their
       work. Ensure that training and other tools reach other IEQ service
       providers and residential audiences.

C. Develop specific guidance documents for critical junctures in the life
   cycle of existing buildings.

   1.  Focus these documents on residences. Improve the indoor environ-|
       ment and educate people about the IEQ effects of decisions when
       certain events occur, such as:

       •  During remodeling

       9  At sale of building/home

       #  At building commissioning and decommissioning

       *  During annual safety inspection

       *  During tenant improvement projects

       t  During building recertification

       »  After flooding/fire/storms

   2.  Develop outreach programs to encourage people to take action.

D. Develop metrics for a performance-based building rating/certification

   1, Facilitate stakeholder development of an IEQ performance metric
      for different building types that utilizes research done under other
      action items elsewhere in this plan (e.g., baseline data on IEQ,
      health effects data, and cost/benefit information).

   2. Facilitate the establishment of a performance-based rating/
      certification program that utilizes an IEQ performance metric
      and baseline data to develop a voluntary performance standard
      or threshold and a verification protocol. Promote this program to
      building owners, insurers, occupants, government officials, and
      consumers with outreach and success stories.

E. Provide information targeted to do-it-yourselfers.

   Work through partnership with major hardware retailers to include
   point-of-purchase displays, print advertising, and promotion of products
   meeting good IEQ standards and homeowner on-line workshops with
   IEQ experts. Focus materials and activities on raising homeowner aware-
   ness of good renovation design for IEQ.

F.  Develop homeowner/tenant checklists.

   Develop instruments mat allow homeowners/tenants to do their own
   IEQ self audits and develop and implement a strategy to disseminate
   these checklists widely.
                                                      U.S. EPA Headquarters Library
                                                             Mail code 3201
                                                      1200 Pennsylvania Avenue NW
                                                         Washington DC 20460


 Create and Use
 Products, Materials,
 and Technologies
The products, materials and technologies that we use inside our buildings are
another potential source of indoor environmental problems. A key component,
for achieving building improvements is the use of building materials, during
construction and renovation, which produce low levels of any potentially
harmful emissions.

Many strategies are available to accelerate the innovation of products,
materials, and technologies. The most fundamental approach is to develop
a reliable emissions testing system, to perform comparative risk assess-
ments, and to develop voluntary, consensus-based guidelines and standards|
to assist in the evaluation of products, materials, and technologies. The
results of standardized testing can be used to develop low-toxiciry products |
that are competitively priced with conventional products and can serve as
a basis for developing information to assist consumers in making informed
choices among products, materials, and technologies used indoors.

Voluntary guidelines and standards for products, materials, and technologies
can take many forms. For example, guidelines or standards might ask a man-
ufacturer  to provide emission levels from a product for comparative purposes
with other similar products, or they may set a level above which a product is
regarded as "unsafe." They may also be set to ensure the appropriate use of
products (e.g., labeling on the use of adequate ventilation or for use by certi-
fied applicators). In addition, certain industry members who perform well in
reducing emission levels may be recognized under a program similar to the
EPA Green Lights or Energy Star programs.

While the first line of defense is to prevent pollution by controlling sources
of indoor pollutants, rapid  progress is also needed  in monitoring and control
technologies. Low cost sensors and test kits, for example, will eventually
make it possible for nearly  everyone to assess their risks indoors.
Improvements are needed in technologies to "clean" air and to increase
ventilation efficiency in buildings.

  A.  Further develop the Source Ranking Database.
                            In consultation with all interested stakeholders, use the database to
                            prioritize those products and materials that may present the greatest

   exposures and risks to human health indoors. This prioritization
   should address both the health risks and potential benefits of the
   products and materials. Continually review and update the database
   as new information becomes available on product formulations and
   emissions, exposure data, and toxicity information.

   1.  Work with all interested stakeholders to collect and compile
       additional existing data to assist in this prioritization.

   2.  Seek input, through stakeholder workshops, on those priority
       consumer products and building materials that, based upon the
       best available data, have the largest relative impact on health in
       indoor environments based on both chemical and biological
       contaminant emissions.

   3.  In the interest of the public's right to know, make summaries of the
       publicly-available chemical formulations in product categories
       available through an EPA web page and prepare chemical exposure
       and toxicity fact sheets for the chemicals and product categories that
       are accessible through this web page.

B. Document and evaluate state-of-the-art sensors, test kits, and indoor-
   related prevention and control technologies.

   1.  Survey, monitor, document, and assess the status and progress
       of technologies based on efficacy, health impacts (e.g., enhanced
       growth of microorganisms, chemical emissions), and cost; identify
       the trends, technical issues, and needs of future development.

   2.  Publish and periodically update this analysis in a database, by
       technology type; use the database as a source of information on
       current technologies and as a measurement tool to assess progress
       in stimulating research and development to improve these devices.

C. Perform comparative exposure and risk assessments on products
   and materials.

   1.  Provide leadership in working with outside stakeholders to establish
       an exposure and health risk assessment methodology for consumer


                                       products and building materials used indoors that would address
                                       the total health impacts of products, including beneficial impacts
                                       (e.g., disinfection).

                                   2.  Develop consensus on the general methods to be used to consider
                                       relevant information, including:

                                       * Data on all routes of exposure (nasal, inhalation, dermal, and
                                         oral) and their comparative importance.

                                       * The effects of indoor sinks and interactions of multiple pollutants]
                                         from multiple sources on indoor exposure levels.

                                       « Both lexicological and sensory health impacts.

                                       • Evaluation of dose-response relationships.

                                D. Develop product testing protocols.

                                   1.  Establish a standardized, consensus-based generalized emissions
                                       testing system with stakeholders, so that the potential exposure
                                       and health risk of most consumer products and building materials
                                       can be assessed. Develop and validate low-toxicity products using
                                       the testing and assessment system.

                                   2.  Assist stakeholders in developing standardized, consensus-based
                                       emissions testing and risk assessment systems specific to their
                                       products or materials and in promoting the concept of low-toxicity |
                                       products and materials.

                                E.  Work with stakeholders  and  outside standard-setting organizations to
                                   develop voluntary, consensus-based standards and guidelines.

                                   1.  Develop standards or guidelines for emissions levels of chemicals
                                       from products and materials used indoors by convening a
                                       dialogue to set consensus-based ground rules that can be used
                                       by organizations outside  the federal government to develop
                                       standards and guidelines.

   2.  Develop guidance on safe levels of pollutants in indoor environments
       to assist in the development of sensor and control technologies.

   3.  Develop standards or guidelines to evaluate the efficacy and
       cost-effectiveness of new technologies used to monitor or control
       pollutants (e.g., sensors and air cleaners).

F.  Provide market incentives to drive manufacturers to develop both
   new products and new technologies.

   The incentives will provide for healthier indoor environments and will
   not compromise other aspects of environmental performance. EPA will
   lead other stakeholders in working with a wide range of consumers to
   direct demand toward healthier indoor products and technologies.

   1.  Focus on creative market incentives such as those derived from
       financing  and insurance mechanisms (e.g., discounts in health
       insurance rates for people who live in homes with healthier
       indoor environments).

   2.  Work with institutional buyers within the federal government and
       elsewhere (e.g., hospitals, schools and universities, and the retail
       sector) to increase demand for cleaner indoor products through
       individual pilot projects focusing on specific products or materials.
       Establish bidding procedures for manufacturers to compete on the
      basis of both price and emissions to ensure lower emissions at rea-
      sonable prices. Develop a database and communications program
      to collect the experience and bid results from participants and to
      communicate information on technical feasibility and cost to spur
      new buyer membership and competition by manufacturers.

   3. Periodically survey the market to gauge the extent to which
      demand rises for cleaner products and the extent to which that
      demand is leading towards improvements in products and tech-

   4.  Provide programmatic grants to product manufacturers and other
       parties to develop low-emitting or low-toxicity products that are
       less problematic from a public health perspective.

   5.  Promote lEQ-friendly products through the development of
       planning and sales software for building contractors. Integrate
       this effort with the Office of Prevention, Pesticides, and Toxic
       Substances' Environmentally Preferable Products program.

   6.  Make low-cost IEQ monitors and control technologies a
       standard feature.

       a. Identify stakeholders to popularize the standard use of basic
         detection systems for home and work and help develop a
         clearinghouse for appropriate sensor and mitigation technologies.

       b. Fund an effort, possibly through programmatic demonstration
         grants, to integrate reliable indoor sensor technologies with
         environmental controls (i.e., "smart" building systems) in
         institutional settings, such as offices, hospitals, schools, and
         prisons as a means to create an awareness of indoor pollutants
         and demand for a healthier indoor environment.

       c. Integrate available and reliable indoor sensor technologies with
         environmental control systems in residential settings to create
         consumer demand for healthier indoor environments.

       d. Initiate a field study to evaluate commercially-available indoor
         pollutant monitors and control devices for both performance
         and practicality.

       e. Assure federal adoption of new systems.

G. Work with interested stakeholders to develop and disseminate product
   labels, instructional materials, enhanced material safety data sheets,
   and product specifications thai will allow for the incorporation of a

broad spectrum of environmental and performance information.
These materials can be used by consumers to select the best products,
materials, and new technologies for use indoors.

1.  Encourage consumers to make informed choices when deciding
   what products, materials, and technologies to purchase for use
   indoors, as well as how they should be used.

2.  Collect background research and conduct individual interviews and
   focus group discussions to develop specific recommendations for the
   type and design of user information to enable consumers to weigh
   environmental impacts indoors, as well as product performance and
   beneficial aspects, in purchasing decisions for both products and
   new technologies.

3.  Develop appropriate user information, which focuses on reducing
   human health risks in the indoor environment and includes informa-
   tion on the beneficial aspects and performance characteristics of the
   products and materials. Convene all interested stakeholder groups,
   including industry, institutional purchasers, and organizations expe-
   rienced in providing user information for priority indoor products,
   technologies, and services.


 Promote Health-
 Individual Behavior
 and Consumer
More health-conscious individual behavior can create healthier indoor
environments. In an ideal situation, nearly everyone sees indoor environ-
mental quality as important for health and most people know how to get
information they need. For individuals to engage in health-conscious
behavior regarding their indoor environment, they must be informed, have
the tools necessary to act, and believe their actions will result in a benefit to
their health, lifestyle, or productivity.

Improving indoor environmental quality and reducing the health risks of
serious indoor environmental problems will require millions of self-initiated
actions by individual home dwellers, building owners and managers, par-
ents, school officials, real estate professionals, and other key target audiences. |
Effective programs to achieve this mission must emphasize communication
and outreach to catalyze and influence actions by the millions of individuals
who make decisions affecting indoor environments.

The following  list of specific, recommended initiatives uses a variety of targeted
approaches for encouraging health-conscious individual behaviors to improve
the indoor environment. As further research into indoor environmental health
risks and mitigation strategies is conducted, new initiatives to encourage
health-conscious individual behaviors will be developed.

  A.  Initiate a campaign to educate society's leaders on IEQ.

     1.  Work with private sector leaders and public policy makers at the
        federal, state, and local levels to demonstrate the significance of
        the indoor environment and the cost-effective benefits of improved]
        conditions in homes, schools, workplaces, and public buildings.

     2.  Develop a highly-targeted campaign aimed at encouraging society's
        leaders to understand the following key facts about indoor environ-
        mental quality:

        * People spend 90 percent of their time indoors.

        • Indoor environmental problems are high risk.

        • There are cost-effective solutions to many IEQ problems.

      * Research is needed to improve our understanding of how to
         prevent IEQ problems.

   3. Reach out to scientists, influential medical centers, high-level health
      officials, state legislators, tribal leaders, private sector executives,
      influential state and local officials, and other key opinion leaders.
      Use a variety of targeted channels ranging from scientific journals
      to the mass media, including articles in popular publications and
      airline flight magazines, speakers at key conventions, and feature
      segments in TV programs and Sunday morning talk shows.
      Conduct these activities in partnership with key stakeholders.

B. Create a healthy children program.

   1. Protect children from asthma by reducing the degree to which
      indoor environmental conditions contribute to the rate and severity
      of asthma in children. Work in close partnership with other federal
      agencies to: integrate prevention messages into existing treatment
      messages; emphasize innovative outreach in homes; use schools to
      deliver proven asthma prevention and management messages to
      children of pre-school and primary school age; track the effective-
      ness of these school interventions; leverage the existing health care
      system to reduce costs by promoting asthma prevention and
      management education; and employ cutting-edge mass media
      approaches to raise parent and child awareness and induce health-
      promoting behavioral changes.

   2. Develop an action campaign to improve the indoor environments of
      children. Form a cross-government team, including EPA representa-
      tives from OPPTS, OAR, and the Office of Children's Health
      Protection (OCHP), to improve the indoor environments of children
      in homes, day care facilities, and schools. Work with stakeholders to
      educate parents, day care providers, child health care providers,
      and school officials on the benefits of reducing children's exposure
      to lead, secondhand smoke, radon, allergens, pesticides, and other
      harmful indoor pollutants. Explore partnerships with health main-


       tenance organizations (HMOs) to encourage participating physicians!
       to include environmental factors in checkups. Explore mechanisms
       for incorporating environmental factor training into medical school
       programs for patient background, screening, and diagnosis.

    3.  Initiate a three- to five-year campaign to reduce minority children's!
       exposure to indoor environmental tobacco smoke using transit and
       other media appropriate to minority audiences. Expand existing
       media campaigns to include TV, radio, print, transit, billboard, and
       other materials targeted specifically to minority populations.

    4.  Educate children on indoor environmental risks by teaming with
       stakeholders to develop curricula, science lessons, teaching modules,
       and other mechanisms for mainstreaming indoor environmental
       subject matter into the Nation's formal education system. Teaching
       children about the importance of the indoor environment to human
       health will help to ensure health-conscious behaviors in two long-
       term ways: 1) by developing an "indoor environmental ethic" so that
       children will ultimately be better managers of their own indoor
       environments  as adults, and 2) when children adopt environmentally-
       conscious behaviors, the adults in their lives often emulate those
       behaviors (e.g., recycling).

C.  Ensure consumers are well-informed.

    1.  Take a comprehensive approach to the real estate sector, which pro-
       vides a critical link to achieving measurable risk reduction on radon,
       carbon monoxide, lead in paint, asbestos, underground storage tanks,|
       and drinking water. Agents, brokers, home inspectors, attorneys,
       mortgage bankers, and other real estate professionals are uniquely
       positioned to assist consumers in making informed decisions about
       correcting environmental problems before they purchase commercial
       and residential properties. Collaborate within EPA to develop and
       implement a cross-Agency strategy and workgroup, integrated public
       information materials, information clearinghouse, web site, one-stop
       environmental real estate hotline, and outreach partnerships with
       each of the major  segments of the real estate professions. Engage

       other federal institutions (e.g., the Department of Housing and
       Urban Development (HUD), the Veteran's Administration (VA),
       Fannie Mae, and Freddie Mac) to coordinate environmental

   2.  Publish "50 Tilings You Can Do to Improve Your Indoor
       Environment." Develop and promote clear and consistent messages
       on indoor environmental concerns and questions frequently asked
       by the public. Prepare and distribute these as concise, easy-to-use
       materials in multiple formats (web page, consumer advice booklet,
       magazine article) which clearly explain what people can do now to
       improve their indoor environments.

   3.  Encourage more informed consumer product purchasing. Engage
       the private sector and other concerned federal agencies in designing
       ways to educate consumers about how to purchase products wisely
       and use them with appropriate care.  Consumers infrequently read
       product labels before using the contents and often disregard impor-
       tant manufacturer's instructions concerning safe use of the product.
       Likewise, product labels lack uniformity in the way safety and use
       instructions are presented. Directions such as "use with adequate
       ventilation" are subject to broad interpretation.

   4.  Initiate a consumer campaign to improve indoor workplace
       environments. With groups like the Occupational Safety and Health
       Administration and organized labor,  develop a comprehensive
       information campaign to educate the public about the straightfor-
       ward, cost-effective actions that can be taken to improve indoor air
       quality in workplaces. Adjuncts to the campaign could include a
       toll-free hotline number, web site, or  other places where building
       occupants, as well as owners and operators, can receive information
       and resource materials.

D. Provide for healthy home care.

   1.  Expand the Master Home Environmentalist Program nationwide.
       A small pilot program that has successfully demonstrated a
       change in behavior, the Master Home Environmentalist Program is
                                                               ?'£/? 3 * POT EN',


   a hands-on, tuition-free program that teaches people about the
   indoor environment in return for their commitment to teach others, t
   Topics include ways to reduce tracking soil containing lead and
   pesticides into the home,, proper vacuuming techniques and how to]
   evaluate the effectiveness of vacuum cleaners, safe methods to
   dispose of household waste, ways to identify and fix problems
   related to moisture indoors, and ways to reduce bioaerosols, dust
   mites, bacteria, and fungi indoors.

2.  Make accurate information available to the public on air cleaning
   and filtration equipment. Working with public and private sector
   stakeholders, ensure that accurate information is available to the
   public so consumers can make wise choices when considering air
   cleaning and filtration equipment. Establish a system to prevent
   false advertising of indoor air cleaning devices, and design a
   means of assessing the safety and effectiveness of new devices.

3.  Establish a humidity control and microbe-resistant building materials]
   education mini-grant program. Emphasize impacts on low-income
   populations in high humidity regions (i.e., the Southeast). The focus
   of the program should be to inform parents and other caretakers that
   the condition of the indoor environment can significantly affect the
   health and well-being of children. Coordinate with existing education)
   programs on humidity-related illnesses such as asthma and
   Legionnaires' disease.

 :obb, N., and R.A. Etzel. 1991. Unintentional
karbon monoxide related deaths in the United
ftates, 1979 through 1988. Journal of the
 American Medical Association 266: 659-663.

 loward, G., L.E. Wagenknecht, G.L. Burke,
 L Diez-Roux, G.W. Evans, P. McGovern,
f. J. Nieto, and G.S. Tell. 1998. Cigarette smoking
 id progression of atherosclerosis, journal of the
   jrican Medical Association 279:119-124 (abst.).

 fannino, D.M., D.M. Homa, C.A. Pertowski,
 L Ashizawa, L.L. Nixon, C.A. Johnson, L.B.  Ball,
 , Jack, and D.S. Kang. 1998. Surveillance for
|sthma- United States, 1960-1995. Morbidity and
 lortality Weekly Report 47(SS-l):l-28.

 Jational Academy of Sciences (NAS). 2000.
 tlearing the Air: Asthma and Indoor Air
pposures.  Prepared by the Committee on the
 ssessment of Asthma and Indoor Air Quality,
 istitute of Medicine.  Washington, DC: National
 Academy Press.

 Jational Academy of Sciences (NAS). 1998.
      Effects of Exposure to Radon  (BEIR VI).
  spared by the Committee on the Biological
fffects of Ionizing Radiation (BEIR VI) of the
 Jational Research Council. Washington, DC:
 Jational Academy Press.

 National Cancer Institute (NCI). 1999.
 lealth Effects of Exposure to Environmental
tobacco Smoke: The Report of the California
Environmental Protection Agency. Smoking
 id Tobacco Control Monograph No. 10.
lethesda, MD: National Cancer Institute,
 lational Institutes of Health, U.S. Department
If Health and  Human Services.
    Publication No. 99-4645.
Pope, A.M., R. Patterson, and H. Burge, eds.
1993. Indoor Allergens: Assessing and
Controlling Adverse Health Effects. Washington,
DC: National Academy Press.

Taylor, A.E. et al. 1992. Environmental Tobacco
Smoke and Cardiovascular Disease: A Position
Paper from the Council on Cardiopulmonary
and Critical Care, American Heart Association.
Circulation 86: 699-702.

Weiss, K.B., P.J. Gergen, and T.A. Hodgson. 1992.
An economic evaluation of asthma in the United
States. N Engl J Med 326: 862-866.

U.S. Consumer Product Safety Commission
(CPSC). 1997. CPSC Urges Annual Fuel-Burning
Appliance Inspection to Prevent Deaths, Fires.
U.S. Consumer Product Safety Commission
Press Release #97-191. Washington, D.C.

U.S. Department of Commerce (DOC). 1997.
Highlights from the Expenditures for Residential
Improvements and Repairs Report. Bureau of the
Census, U.S. Department of Commerce Press
Release, August 4.

U.S. Department of Commerce (DOC). 1996.
(C Series, C-30) Current Construction Reports.
Bureau of the Census,
U.S. Department of Commerce.

U.S. Department of Health and Human Services
(DHHS). 1997a. Update: Blood Lead Levels -
United States, 1991-1994. Morbidity and
Mortality Weekly Report 46/7: 141-146.
(Correction in Volume 46, No. 26).


U.S. Department of Health and Human Services
(DHHS). 1997b. Legionnellosis: Legionnaires'
disease and Pontiac fever. Atlanta, GA: Centers
for Disease Control and Prevention. 06:50:52.

U.S. Department of Housing and Urban
Development (HUD). HUD, CPSC, and DOH
Promote Poison Prevention and Consumer Safety
Drive in Local HUD-assisted Housing
Developments, Press Release, New York, N.Y.

U.S. Environmental Protection Agency (EPA).
1999. Clear Your Home of Asthma Triggers: Your
Children Will Breathe Easier. Washington, DC: U.S.
Environmental Protection Agency. EPA/402-F-99-005.

U.S. Environmental Protection Agency (EPA).
1998. A Comparison of Indoor and Outdoor
Concentrations of Hazardous Air Pollutants.
In: Inside IAQ, Spring/Summer 1998, pp. 1-7.
Prepared by Office of Research and Development,
U.S. Environmental Protection Agency, Research
Triangle Park, NC. EPA/600/N-98/002.

U.S. Environmental Protection Agency (EPA).
1996. Environmental Health Threats to Children.
Washington, DC: U.S. Environmental Protection
Agency. EPA 175-F-96-001.

U.S. Environmental Protection Agency (EPA). 1995.
The Inside Story: A Guide to Indoor Air Quality.
Washington, DC: U.S. Environmental Protection
Agency. EPA 402-K-93-007  (GPO 055-000-00502-8).

U.S. Environmental Protection Agency (EPA).
1992. Respiratory Health Effects of Passive
Smoking: Lung Cancer and Other Disorders.
Washington, DC: U.S. Environmental Protection
Agency. EPA/600/6-90/006F (NTIS PB 93-134419).
U.S. Environmental Protection Agency (EPA).
1991a. Guidelines for Developmental Toxicity
Assessment. Washington, DC: U.S. Environmental
Protection Agency.

U.S. Environmental Protection Agency (EPA).
199 Ib. Indoor Air Facts No. 4 (Revised):
Sick Building Syndrome. Washington, DC: U.S.
Environmental Protection Agency. 402-F-94-004.

U.S. Environmental Protection Agency (EPA).
1990. Reducing Risk: Setting Priorities and
Strategies for Environmental Protection.
Washington, DC: U.S. Environmental Protection
Agency. EPA-SAB-EC-90-021.

U.S. Environmental Protection Agency (EPA). 1987.
Unfinished Business: A Comparative Assessment of
Environmental Problems. Washington, DC: U.S.
Environmental Protection Agency.

U.S. Environmental Protection Agency (EPA),
American Lung Association, U.S. Consumer
Product Safety Commission, and American
Medical Association. 1994. Indoor Air Pollution:
An Introduction for Health Professionals.
Washington, DC: U.S. Government Printing
Office. 1994-523-217/81322.

            OVERVIEW	52






            OFFICE OF WATER	68



            REGIONAL OFFICES	73



            This voluntary dialogue was jointly led by the OPPTS
            and OAR and included representatives of a number of
            other offices within the Agency, as well as all interested
            stakeholders (i.e., industry, unions, public interest
            groups, and other federal agencies). The dialogue
            resulted in industry agreement to test new carpet floor-
            covering materials for total volatile organic compound
            (VOC) emissions and to explore ways to lower VOC
            emissions from carpet products. Most importantly, the
            industry undertook an extensive consumer education
            program, in cooperation with other dialogue partici-
            pants, designed to provide the public with information
            on the role that carpet products play  in indoor air
            quality and ways in which consumers can make
            informed purchase decisions.

            OAR is collaborating with the Office of Ground
            Water and Drinking Water (OGWDW) to develop a
            unique and innovative drinking water rule for radon.
            The cost-effectiveness of reducing radon risk is
            substantially greater for indoor air (from soil gas)
            than from drinking water. Because of this, EPA, in
            proposing a maximum contaminant level (MCL) for
            drinking water (Federal Register, November 2,1999),
            also made available a higher alternative maximum
            contaminant level (AMCL) accompanied by a multi-
            media mitigation program to address risks in indoor
            air. The proposed regulations will provide States flex-
            ibility in how to limit the public's exposure
            to radon.
EPA's Strategic Plan includes pro-
gram priorities aimed directly at
protecting human health indoors,
as well as protecting it as part of
broader environmental protection
programs. EPA's indoor environ-
ments programs address well-
known risks, such as radon, lead,
asbestos, and environmental tobacco
smoke. These programs also provide
tools and guidance on good indoor
environmental practices in resi-
dences, schools, and office buildings.
Other EPA programs are broader in
scope (e.g., providing safer chemicals
and products, reducing exposures to
hazardous waste streams, and
reducing risks to disadvantaged and
disproportionately-exposed  popula-
tions), but have the protection of
human health indoors as a program
component. Although EPA has made
significant progress in reducing risks
from some well-known hazards
indoors, much remains to be done.
EPA's strategic focus revolves
around four main areas: science and
engineering, guidance and policy
development, generating public
action, and measuring results.
The Agency believes that both
regulatory and nonregulatory

                                                              STRATEGIC FOCUS
 Approaches have value. Regulations
 landate behavioral changes by industry
  id others to prevent exposure to toxic sub-
 ^tarices. Nonregulatory processes are often
     to mitigate unexpected risks or to
 litigate risks through voluntary actions.


 ;PA uses the Federal insecticide,  Fungicide,
  id Rodenticide Act (FIFRA) and the Toxic
 [substances Control Act (TSCA) to prevent
  azardous pollutants from unnecessarily
  itering the indoor environment. These
 Itatutes require manufacturers or users to
 submit information to characterize the health
 fisks a substance might pose before it can be
  jnufactured or distributed. EPA can then
   set the manufacturer to take measures to
 sduce exposure to the substance, such as
limiting where and how much of the sub-
Jtance can be used, mandating labeling and
 ise of protective equipment to ensure proper
  2, and requiring training of the people
     use the substance. Regulation can also
further restrict or even ban a substance when
|here is no other way to provide adequate
 protection. EPA works closely with industry
  id other stakeholders to assist them in
 educing risks to workers, communities, and
 le environment by developing pollution
 prevention and waste minimization tools.
 EPA observations of chemical  plant incidents
Measuring Results
* Selecting appropriate
environmental indicators
to measure progress
* Continuous
improvement and
adjustment of strategies
and activities for
achieving risk reduction


Science and
» Targeting the greatest
risk first
* Identifying and filling
research gaps
«> Enhancing
understanding of the
multi-factorial nature of
indoor environmental
* *
Generating Public
* Establishing
partnerships to
communicate guidance
and promote effective,
timely action
* Forging constructive
alliances to leverage
resources and to ensure
statutory authorities are
used effectively
* Designing market-
based incentives to
lower source emissions
and providing the
information necessary to
make informed decisions


Guidance and Policy
* Developing and
refining guidance
using a broad-based
consensus approach
* Preventing indoor
pollution through source
control and building
management and
* Using a continuum
of risk management
approaches to control
risks (information-


                               and subsequent investigations are being brought to the attention of industry to
                               leam from mistakes made and to further upgrade indoor/outdoor plant safety.!

                               APPROACHES FOR EXISTING RISKS:

                               In some cases, products or materials in the indoor environment may present a
                               risk to human health indoors. Besides emissions from products and materials,
                               chemical pollutants can be introduced to the indoor environment from contam-J
                               inated potable water, outdoor air, soil, and other external sources. In some
                               cases (e.g., asbestos, lead, and radon), EPA's approaches to addressing these
                               risks are, in part, specified by statutes.

                               In many cases, however,  EPA's approach has been to obtain nonregulatory,
                               voluntary actions by industry to address risks. The mechanism used for
                               eliciting this voluntary approach has often been stakeholder dialogues. These |
                               dialogues may result in the development of voluntary guidelines and stan-
                               dards based on levels of a pollutant, source emissions, ventilation parameters, I
                               and building or maintenance practices either in lieu of, or in addition to, reg-
                               ulatory action. Other nonregulatory approaches that may be taken include
                               risk communication, training, technical assistance, cooperative partnerships,
                               community activities, and other pollution prevention activities.

                               Discussions of each office's priorities and  activities for protecting human
                               health indoors are provided below.


OAR has recently begun a new initiative on asthma. Its mission is to ensure
that indoor environmental management is an integral part of asthma manage-
ment in the United States. Although both medical treatment and indoor
environmental management are needed to effectively control asthma, the latter]
is not often practiced nor part of the prescription for managing asthma. The
Indoor Environments Program will focus on two primary audiences: the public
health/medical community and children with asthma and the people who
manage their environments. The Program plans to reach these audiences
through several activities:

  *  Health care/managed care summits

  *•  A media campaign

  *•  An in-home education program

  *  School/day care-based education of children

  *  Integration of ETS into tobacco control programs

  «  Improving indoor environments in schools

A number of different specific strategies exist to achieve OAR's priorities.
OAR works with its regional offices, state and local agencies, and private
partners to get local action on indoor environmental issues. OAR stimulates
local action on radon through the State Indoor Radon Grants program, whichj
has resulted in significant risk reduction in homes. A unique feature of the
OAR program's voluntary efforts is a network of cooperative partnerships
with organizations that speak to and. for the public, as well as key eonstituen-l
cies, including county and local environmental health officials, susceptible
minority and disadvantaged populations, schools, real estate and building
professionals, etc. This network allows OAR to leverage the personnel,
expertise, and credibility of these organizations, as well as mobilize hundreds |
of community-based affiliates at the state and local level.

 )AR also takes a proactive approach in providing a broad range of infor-
 nation about indoor air-related risks, as well as the steps to reduce them,
   5ugh the use of public awareness campaigns, guidance document
Bissemination, training course delivery, the operation of several linked
kotlines and clearinghouses, a web site and related outreach efforts. These
     5 reach a broad audience, including homebuilders and buyers, real
 state professionals, health professionals, environmental and public health
|>fficials, facility owners and managers, school administrators and teachers,
 id service providers (such as day care providers, maintenance personnel,
   . pest control companies).


                      Many of OPPTS's priorities for 2005 relate to human health indoors.
                      By 2005, OPPTS expects that:

                        *  Lead poisoning will be significantly reduced from levels in the early
                           1990s, with particular emphasis on children in high-risk groups.

                        •  Of the approximately 3,000 high-volume chemicals in commerce and
                           the 1,000 chemicals expected to enter commerce each year, EPA will
                           significantly increase the introduction and use by industry of safer
                           or "greener" chemicals. Fewer than 100 cases per year will need
                           regulatory management by EPA.

                        *  There will be a significant increase in industry's use of pollution
                           prevention and "green approaches" in the design, development,
                           manufacture, and use of chemicals so that there is increased
                           availability of safer substitutes.

                        *  EPA will annually review about 2,500 Premanufacture Notifications
                           submitted by chemical manufacturers and take appropriate risk
                           management actions to protect human health and the environment.
                           EPA will concentrate on protecting children and workers from
                           potential inhalation and dermal exposures.

                        *  EPA will amend the TSCA Inventory Update Rule (IUR) to collect
                           information needed for risk screening and develop and implement
                           a chemical hazard classification scheme.

                        t  EPA will achieve significant progress in acquiring test data on chemicals
                           entering commerce and high-volume chemicals, including testing for
                           endocrine disruption.

                        *  There will be significant reductions in exposures to toxic fibers,
                           e.g. asbestos.

                        *  Toxicity test data gaps will be identified for household chemicals which
                           result in substantial exposures to consumers and children. Toxicity testing
                           actions will be initiated or completed for 50 percent of these chemicals.
                           Risk management actions will result in significant risk reduction to
                           consumers, and information/education programs will empower them.

     EPA will improve the ability of the public to reduce exposure to specific
     environmental and public health risks by making current, accurate,
     substance-specific information widely and easily accessible.

     EPA will provide chemical data and tools to the public for them to
     understand and analyze environmental data. The data and tools will be
     tailored to suit various needs, such as ranking potential concerns for
     indoor environmental quality and "green design," as well as product
     labels to be easily understood by consumers.

     All pesticides licensed before 1988 will have complete and reviewed
     databases, in accordance with the most current requirements,  to
     support their uses (more recently licensed pesticides will already be
     in full compliance).

     Where necessary, consumer information on labels will be updated and
     clarified to prevent unnecessary indoor use and exposures.

     For nearly all pesticides, risk assessments accounting for all sources of
     exposure, including indoor exposures, will be conducted.

 )PPTS programs are primarily oriented towards prevention rather  than
 emediation. Both the toxics and pesticide programs operate in an environ-
 tent of mandated deadlines and  regulatory requirements. Science and risk
kssessment are integral; harmonization of test methods between toxics and
pesticides, as well as with others both inside and outside EPA, is an impor-
 int operating principle. In addition, tool and data development in  the
 reas of exposure, hazard, risk, and economics are ongoing activities in both
 ie toxics and pesticides offices,

 )PPTS has regulatory programs in place for two critical indoor pollutants,
 sad and asbestos. Activities to address these pollutants include:

 *   Training and certification programs for workers

     State programs and grants

     Information disclosure upon real estate transfer and renovation

     Federally-identified hazard levels


The Consumer Labeling Initiative (CLI) is a voluntary,
cooperative effort to foster pollution prevention,
empower consumer choice, and improve understanding
by presenting clear, consistent, and useful information
on household consumer product labels. Government,
industry, and other groups are working together in the
CLI to make it easier for consumers to find, read, and
understand label information about a product's safe use
and its environmental and health impacts. This infor-
mation will enable consumers to compare products and
safely use the ones they select.

The CLI project has several phases. In 1996, EPA went
directly to individual consumers to learn how they used
pesticide and cleaner labels and what they thought
about existing labels on indoor insecticides, outdoor
house and garden pesticides, and household hard sur-
face cleaners. EPA also invited individuals and groups
to give their ideas about label problems and solutions
and looked for research already done by others.

In 1997 and 1998, some of the companies that make
consumer products conducted a quantitative survey to
help EPA learn from customers about how to make
label information more understandable arid useful. EPA
is also making language on pesticide product labels
simpler and more direct. In addition, EPA will sponsor a
series of workgroups where alternatives will be
explored to address some of the more difficult issues,
such as ways in which to make the list of chemical
ingredients meaningful to consumers.
In addition to its regulatory programs,
OPPTS also has voluntary pollution
prevention activities designed to produce I
safer indoor environments. OPPTS works |
with industry stakeholders to develop
tools and information that can lead to
formulation of safer consumer products
for use in the indoor environment.
Following Executive Order 13101, OPPTS |
works with federal consumers, such as
the General Services Administration, to
provide them with the information they
need to make purchasing decisions that
are better for the environment, both
indoors and out.

OPPTS also has the Pesticide
Environmental Stewardship Program
(PESP). PESP is EPA's overall program
designed to address the use and risks of
pesticides and involves administrative,
regulatory, and legislative changes
designed to encourage the use of safer pes-
ticides. A major element of PESP is the
encouragement of voluntary partnerships
with private industry to promote safer
pesticides and environmental stewardship.

Consumer education is important and
OPPTS is working with partners to clarify
product labeling procedures. OPPTS is
also working with partners to develop
tools to improve the assessment of chemi-
cal safety in consumer products and
building materials.

 )RD produces technical reports, methods, models, and other scientific
 iformation to improve the Agency's understanding of the effects of indoor
Contaminants and their sources, as well as risk management options to
 2duce exposure. In addition, this research provides technical information
 lat is used by OAR and OPPTS to develop guidance documents on indoor
Invironmental quality and understand the relative risks of various indoor
|ontaminants. The data produced by ORD are also used by product manu-
 icturers to evaluate the risks posed by their products and by building
|iwners and operators responsible for protecting tenants from harmful
 evels of indoor contaminants. Specific activities planned by ORD are to:

     Develop information on the effects of both biological and chemical
     contaminants at concentrations found indoors.

 *  Develop methods and models to quantify source emissions.

 «  Produce models describing exposure to indoor contaminants
     particularly to pesticides.

 *  Develop information to aid school and building managers, the  private
     sector, and government officials in determining which control
     approaches (air cleaners, source management, and ventilation system
     design/operation) will have the greatest impact on risk reduction.

 *  Develop information for manufacturers of building materials and
     products that pose the greatest risk, assisting them in preventing and
     reducing emissions through product redesign and process changes.

 )RD is developing basic information, across building types, to support
Development of policy and guidance on the nature, extent, magnitude, and
 esolution of indoor problems. Information needs include data on pollutant
|oncentrations, ventilation system parameters, building characteristics, and
 ccupant perceptions and productivity. This research is needed to identify
ley pollutant sources, exposure scenarios, and commercial and residential
luilding practices that influence indoor environmental exposures and to
letermine how indoor environmental complaints/problems relate to other
 idoor environmental factors, e.g., thermal comfort, odor, lighting, and noise.

ORD, OAR and OPPTS have worked jointly to identify the most critical
uncertainties associated with indoor pollutants and have developed the
following list of key research needs:

  w  Source Characterization/Solutions

        Develop information on and prioritize indoor environmental
        sources, and establish processes to reduce or prevent pollutant
        exposures associated with those sources. The most important
        needs are: (1) prioritizatiori of indoor environmental pollution
        sources in terms of next actions, e.g., additional studies, guidance
        development, industry  dialogues, and pollution prevention; (2)
        development of standardized methods for source emission testing; j
        and (3) understanding of typical and high-end indoor exposures,
        how these exposures relate to indoor pollutant levels, and how
        their relative risks compare to outdoor air problems and environ-
        mental hazards in other media.

        Assess the impact of building practices on indoor environmental
        quality. Develop and compare investigation and mitigation
        techniques, including IEQ and energy performance of ventilation
        systems in large buildings, cost/benefit analyses of IEQ controls,
        and assessment of IEQ guidance utilization.

  «  Health Effects Assessment

        Improve the Agency's understanding of the health effects of indoor
        pollutants, both chemical and biological, by developing data on
        the risks of indoor pollutants, including irritancy, central nervous
        system and sensory effects, and the effects of mixtures.

    Exposure Assessment

       Improve the Agency's understanding of the exposure-time-activity
       pattern factors that contribute to multi-pathway indoor human
       exposures. Characterize and provide an integrated assessment of
       these exposures (inhalation, dietary, and dermal) to indoor con-
       taminants and to the dose within the human body, culminating in
       a first-generation exposure model.

\ *  Risk Assessment

       Improve the Agency's current knowledge of indoor environmental
       risks by assessing risks from exposure to chemical pollutants,
       including organics, nitrogen oxides, carbon monoxide, particulate
       matter,  and microbiologicals.

lurrent ORD indoor environmental research will address several of the high-
pt-priority research needs identified above. The research programs are specifi-
[illy designed to  address scientific uncertainties associated with indoor health
  s, the magnitude of those risks, and the most effective approaches to pre-
  it or reduce these serious risks. Research will be conducted using ORD's
  ints program under the National Center for Environmental Research and
^RD laboratories and centers using in-house research facilities and staff,
 ; follows:
 >urce Characterization/Solutions
  sosure Assessment
lealth Effects Assessment
ask Assessment
National Risk Management Research
Laboratory (NRMRL)
National Exposure Research
Laboratory (NERL)
National Health and Environmental
Effects Research Laboratory
National Center for Environmental
Assessment (NCEA)

ORD completed a study which examines the emissions of formaldehyde
and other organic chemicals from conversion varnishes into the indoor
environment. Conversion varnishes provide sturdy, chemical- and
water-resistant coatings for kitchen and bathroom cabinets and some
furniture. They are made up of two components, a polymer resin and a
catalyst, which are mixed prior to application. The mixture then reacts
to form a continuous film coating on the surface of the wood. The study
showed that the organic solvent portion of the coating is emitted quick-
ly, typical of most coatings. These emissions will occur mostly while the
cabinet is still in the manufacturing plant. The formaldehyde, however,
is emitted by a different mechanism. Rather than showing the emission
behavior typical of most coatings, the formaldehyde is emitted over a
longer period of time. For the coatings tested, the total amount of
formaldehyde emitted was between two and eight times the amount
present in the formulation. This reflects a net production of formalde-
hyde resulting from the chemical reactions that occur during curing and
ageing of the coating. In addition, the formaldehyde emissions do not
decay as quickly as other (evaporative) emissions more typical of coat-
ings. Rather, the emissions level out over time. The coatings continue to
emit significant amounts of formaldehyde even after 42 days, long after
they could be placed in a consumer's home. Modeling showed the
potential for exposures near the irritation threshold for formaldehyde
from this source alone. The next phase of work on this project is to test
promising new alternatives to conversion varnishes to determine
whether they can reduce total emissions and indoor emissions (and
therefore potential for hitman exposure).

  SWER's priorities applicable to protecting indoor
Invironments include:

    Improve indoor workplace safety by reducing the risk of
    industrial chemical accidents. OSWER will develop and
    disseminate alerts and advisories to industrial sectors
    based on an enhanced knowledge acquired from increased
    EPA chemical accident investigations. A joint EPA-OSHA
    Chemical Accident Investigation Team is currently in place
    to investigate major chemical accidents and disseminate
    "lessons learned" to involved industry sectors.

  *  Reduce risk of worker exposure by reducing the most
    persistent, bioaccumulative, and toxic (PBT) chemicals in
    industrial waste streams found at work. By 2005, reduce
    these types of chemicals in waste streams to 50 percent of
    1991 levels. The pollution prevention list will be prepared
    for signature in the summer of 2000.

    Continue to develop and employ innovative strategies for
    promoting indoor cleanup of contaminants by reducing
    the cost of waste management without sacrificing human
    health or environmental protectiveness.

 I *  Continue to provide technical expertise and conduct
    response actions using Comprehensive Environmental
    Restoration Compensation and Liability Act (CERCLA)
    authority. CERCLA authority may be used to respond to
    threats of environmental releases of hazardous substances,
    pollutants, or contaminants that are found within homes
    and offices.

 , *  Expand OSWER's ongoing partnerships with the con-
    struction and remodeling industries to promote the use
    of safe and recycled materials indoors.

 lany of OSWER's principles and strategies are designed to
 pduce risk to humans in the workplace through concepts such as
OSWER, in partnership with
OP and the National
Association of Home Builders
Research Center (NAHB-RC),
is developing a model "green
builder" program, based on
existing programs in such cities
as Austin, TX and Denver, CO.
This program will educate
builders on environmentally-
friendly construction and offer
them marketing incentives for
applying these techniques. The
model, which will be designed
to be easily adopted by local
home builders associations and
governments nationwide, will
be tested by the Greater Atlanta
Home Builders Association as it
develops its own "green
builder" program. OSWER, OP,
and NAHB also jointly spon-
sored the first Green Buildings
conference aimed at main-
stream homebuilders on April
8-9,1999 in Denver, CO.


source reduction. OSWER also seeks to reduce future risk inside plants by
making unsafe processes safe in the future. OSWER strives to employ good
science and technology to make sound environmental policy decisions which
are protective and based on common sense and reality. The Office works
closely with industry and other stakeholders to assist them in reducing risks
to their workers, to their communities, and to the environment by developing
pollution prevention and waste minimization tools and ideas. OSWER works
to ensure that a high level of public participation is achieved and that state
and local involvement exists so that policies and regulations are protective,
equitable, and implementable.

OSWER also develops new technologies through research and promotes
innovative remediation concepts (such as Brownfields) to achieve the timely,
cost effective cleanup of previously contaminated sites and to develop policy
and regulation to prevent future ones from occurring. These cleanup actions
seek to minimize threats from exposure to contamination sources whose
routes can affect indoor environments (e.g., tap water or indoor air). These
pollution prevention strategies, risk management activities, remediation
strategies, and chemical emergency response/process safety work, aimed at
cost-effectively eliminating, reducing, or minimizing emissions and contami-
nation, will result in cleaner and safer environments in which Americans can
reside, work, and enjoy life indoors as well as out.

OSWER also seeks to increase resource efficiency and improve waste manage-1
ment in the construction and demolition industries through the promotion of
environmentally-friendly building or "green building" programs. While
OSWER's primary interest in this field involves expanding recycling and
reuse  of building products, as well as reducing the amount of demolition
debris, the "green building" movement also includes such elements as energy
efficiency, water conservation, and indoor environmental quality. Therefore,
opportunities exist for OSWER, OAR, and other offices to join forces to create
effective, unified "green building" programs that command the respect arid
interest of the building industries and the public. Through such programs,
EPA can further the construction of buildings that protect human health and
environmental quality.

)ECA's priorities applicable to indoor environments issues are:

    Work with media program offices to identify areas to be targeted (e.g.,
    high-risk disproportionately-exposed populations and other priority
    areas of noncompliance).

    Provide the public, especially disproportionately-exposed and under-
    represented populations, with a meaningful opportunity to participate in
    the development and implementation of environmental protection strate-
    gies that involve the National Enforcement and Compliance Program.

    Ensure that all federal and state enforcement programs include a plan
    for encouraging and responding to citizen reports of violations or
    other environmental incidents.

    Develop the tools to identify or target particular areas or populations
    associated with disproportionate exposure and other appropriate factors.

    Work with the Interagency Working Group on Environmental Justice
    to address case and policy issues that develop between agencies.

    Develop joint agency enforcement initiatives (e.g., EPA/OSHA joint
    chemical pollution/worker safety cases).

|)ECA's programs are primarily for the enforcement and implementation of
^gulatory requirements. In the indoor environments area, OECA is currently
 cusing on compliance with asbestos in schools requirements, lead-based
   t disclosure requirements, and illegal use of pesticides in homes.

lowever, through the Office of Environmental Justice's (OEJ)
Environmental Justice Small Grants and Community/University Grants
rograms, OECA has funded numerous local projects dealing with indoor
wironmental issues, such as lead dust, radon, and asthma. In addition, OEJ
as worked closely with OAR to support the Open Airways program and to
bintiy sponsor  a training session on asthma  issues and solutions.


                      Under the Safe Drinking Water Act, EPA sets and enforces standards on
                      public water supplies to prevent human health impact. Human exposures
                      to contaminants brought into the home by drinking water can result from
                      inhalation and dermal exposure, as well as by ingestion via food and
                      drinking. EPA attempts to take all of these exposure routes into account
                      in the risk assessments that are done for regulatory development.

                      Inhalation exposure is the major exposure pathway for the risk posed by
                      radon in drinking water. It is also a very significant exposure pathway for
                      other volatile contaminants found in drinking water, such as chlorinated
                      solvents. Inhalation exposure results from showering, in which a large
                      amount of water is aerated in a small enclosed space, as well as from other
                      indoor water uses.

ie mission of OCHP is to make the protection of children's health a funda-
   al goal of public health and environmental protection in the United States.
 ZHP participates in and develops projects in the following four areas:

1. The President's Task Force on Environmental Health and Safety Risks
   to Children

   The Task Force, comprised of 15 federal departments and agencies,
   first convened in September 1997 and is co-chaired by DHHS
   Secretary Donna Shalala and EPA Administrator Carol Browner. The
   Task Force has identified four priority areas to address: childhood
   cancer, asthma, developmental disorders, and unintentional injuries.

   An Asthma Initiative is aimed at developing a further understanding of
   the role of environmental factors associated with the onset of asthma and
   triggers of asthma attacks. Indoor environment-related recommendations
   for federal action include reducing children's exposure to environmental
   tobacco smoke and other indoor triggers in their homes and establishing
   school-based asthma programs that help reduce or eliminate allergens
   and irritants. A Childhood Lead Poisoning Prevention Strategy lays out
   the steps needed to eliminate childhood lead poisoning in the United
   States including recommendations for increased Federal efforts. The
   strategy focuses primarily on expanding efforts to correct lead paint
   hazards (especially in low income housing), a  major source of lead
   exposure for children.

   An Inventory of Federal Research provides a  summary analysis of
   federal research on children's environmental health and safety risks.
   The inventory is available to all federal agencies, researchers, and the
   public through the Internet (http://www.epa.gov/chehsir).


2.   EPA Regulations and Standards

    OCHP assures that EPA's standards and regulations protect children
    from environmental hazards. In September 1996, the Administrator
    committed the Agency to review five existing regulations to determine
    whether they are protective of children's health. In response to public
    comments and recommendations from the Children's Health Protectionl
    Advisory Committee, EPA identified a total of eight regulations and
    regulatory areas for review (indoor environments was considered to be
    an area of specific focus). EPA reviews of these regulations are underway.|

    In November 1998, EPA published final Guidance for Rule Writers in
    EPA to help the Agency comply with the  President's Executive Order
    to Protect Children. As a result of this Guidance, EPA standards now
    consistently seek out data on hazards, exposures, and dose response
    functions that may indicate disproportionate risk to kids.

3.   Children's Environmental Health Science and Risk Assessments

    On August 10,1998, the Vice President announced the establishment of
    the first federal research centers dedicated solely to studying children's
    environmental health hazards. These unique Centers of Excellence will
    perform targeted research into children's environmental health and trans-
    late their scientific findings into intervention and prevention strategies by
    working directly with communities.  Eight Centers are the recipients of
    grants funded jointly by EPA and DHHS. Six Centers are focusing their
    research on upper respiratory illnesses or asthma.

    EPA has developed a research  strategy on children's environmental
    health that is currently in peer review. The strategy looks at what
    information is needed, what information  is available, and how EPA
    proposes to close that gap.

 4.  Public Outreach and Education

     On May 21,1998, the First Lady announced a new program designed to
     empower local citizens and communities to take steps toward protecting
     their children from environmental health threats, such as lead paint in
     homes and asthma-related pollutants. Eleven communities have been
     chosen for the pilot phase of the Child Health Champion Campaign.
     EPA worked with each community to assess and prioritize its potential
     environmental hazards to children, set community-specific goals for
     selected hazards, and establish Action Plans to meet each of the goals.
     Nine communities are working on mitigating indoor triggers to asthma.

 L national evaluation is being conducted of the pilot campaign to deter-
 mine future plans for its expansion.

   part of the Child Health Champion Campaign, EPA published a
 ^source guide in September 1998 to help communities in their efforts to
      : their children from environmental hazards. The resources described
 >ver indoor and ambient environments, contaminants such as lead and
 ivironmental  tobacco smoke, specific health effects such as asthma, birth
lefects, and childhood cancer, and information relating to environmental
 lucation and community organization.

  IHP has also developed "tips" that are relatively easy and effective
   tgs that parents and others can do to help protect children from
 ivironmental hazards. 'Tips"  include discussions of environmental tobacco
   )ke, carbon monoxide, and radon. A half-hour television program based on
   "tips" was produced through the National Safety Council and aired on
fRAVO and CNBC in June and July 1999. Beginning in March 2000, a series of
 Danish radio programs will be aired nationwide on five topics related to chil-
 ren's environmental health. It is now available on video in both English and


                     The Office of Administration and Resource Management's main goal
                     regarding human health indoors is to provide a safe and healthful
                     environment for EPA's own employees. Because of their expertise within
                     EPA, OARM often works in conjunction with other EPA offices, other
                     federal agencies, and outside organizations on indoor environmental issues.]

                       * As part of the EPA New Headquarters project, OARM performs cham-
                         ber testing, modeling, and specification writing to strive for improved
                         indoor environmental quality. The protocols that have been developed
                         by OARM for office furniture during this process are now being used ii
                         an Environmental Technology Verification (ETV) project with the furni-
                         ture industry that will result in a national furniture testing program.

                       » OARM is also actively working with OPPTS to institutionalize the
                         "Green Cleanser" project and develop language to promote the use
                         of these cleaners in EPA buildings.

                       * With Public Technology, Inc. (PTI), OARM participated in publishing
                         two guides for sustainability in buildings. OARM is continuing to
                         work with the President's Council on Sustainable Development on
                         these and related projects.

                       * With the General  Services Administration (GSA), OARM has developed]
                         guides for the management of asbestos and lead at federal facilities.

                       * OARM's multimedia laboratory uses computer technology to build
                         learning and program support tools that have wide application in the
                         federal, private, and academic communities.

 Region 1 has officially recognized
 two schools in New Hampshire
 as the first successful pilot
 schools in the country to fully
 and successfully implement
 EPA's Tools for Schools Indoor
 Air Action Kit. The Pennichuck
| Junior High School in Nashua
 and the Little Harbor Elementary
 School in Portsmouth began the
 process of implementing the Kit
 in the Fall of 1996 by appointing
 an IAQ Coordinator and forming
| an IAQ Team. To better inform
' team members about indoor air
j quality and how to more fully
I use the guidance, each team was
I given indoor air training by the
I NH Division of Human Health
. Services and an EPA grantee, the
j NH Coalition for Occupational
 Safety and Health (NH COSH).
The EPA Regions support and implement the national programs
discussed earlier in this Appendix. In doing so, these offices
have demonstrated initiative and creativity in working with
very limited resources to address indoor risks in innovative
When available, the Regions use statutory authorities. For
  «» Working with state and tribal partners to develop lead
     programs, per Title IV of the Toxic Substances Control
     Act, for certification and training of lead workers.
  • Working with state and tribal partners to implement
     radon programs using the grant authorities of the Indoor
     Radon Abatement Act to promote voluntary programs for
     radon awareness, testing, and mitigation.
  * Working with state and tribal partners to develop and
     implement asbestos-in-schools management programs,
     per the Asbestos Hazard Emergency Response Act.
  « Working with public water supplies to address the
     requirements of the Safe Drinking Water Act and the
     Lead and Copper Rule.
Of equal, and in some cases more, importance are unique
efforts for outreach, education, and technical assistance for
non-regulatory programs, using a multitude of government,
nonprofit, and other stakeholder partners. Examples include:
  * Through Regional Indoor Air Quality Programs, efforts
     have been tailored to reach out and educate the public on
     a variety of issues using an increasing array of effective
     tools. Depending on geography and climate, such issues
     as toxic mold, asthma and its triggers, CO poisoning,
     indoor use of pesticides, and environmental tobacco
     smoke are being addressed.


IAQ in Schools is being addressed through
large outreach campaigns using EPA's IAQ
Tools for Schools Kit. Leveraging of stake-
holder resources is crucial to these efforts.
Exposure to lead from paint, dust, soil,
and drinking water are addressed with
large outreach and education campaigns,
incorporating many partners.
The National Cooperative Inner-City Asthma
Study (NCICAS) announced results indicat-
ing that exposure to cockroaches was a major
factor related to the exacerbation and per-
haps the causation of asthma in the inner
city.  Region 2 has funded several projects to
reduce the population of cockroaches in
inner-city apartments using Integrated Pest
Management (IPM) techniques. The primary
significance of these projects was to demon-
strate an intelligent, environmentally-sound
method of reducing cockroach burden in
heavily infested inner-city environments, as a
part of reducing exposure to asthma triggers.
 Through a grant with the American Lung Association of Washington, the Master Home
 Environmentalist (MHE) Program promotes human health by increasing awareness of
 home environmental pollutants and encourages actions to reduce exposures. The MHE
 program uses innovative and holistic approaches to identify hazards and ways to make
 homes healthier. The program relies on volunteers to reach out to local communities to
 deliver the latest information about environmental health issues. Volunteers complete
 extensive training in lead, dust, indoor air, household hazardous chemicals, and moisture
 problems in the home. Outreach has been conducted in Galena, AK and Seattle, WA.
 There is a new program beginning in Yakima, WA.

                                        OTHER FEDERAL
                                        AGENCIES 	76
                                        STATE, LOCAL,
                                        AND TRIBAL
                                        AGENCIES 	86
                                        STAKEHOLDERS.... 88


 EPA has worked in conjunction with a number of federal agencies on joint efforts to protect
 human health indoors. A few examples of these activities are:

   With the Consumer Product Safety
   Commission (CPSC):

      •  The Inside Story

      •  Asbestos in the Home

      •  Combustion Appliances and Indoor Air

      •  What You Should Know About Using
         Paint Strippers
      •  Indoor Air Pollution: An Introduction
         for Health Professionals

   With the Department of Health and Human
   Services (DHHS):

      •  Building Air Quality: A Guide for
         Building Owners and Managers

      •  A Citizen's Guide to Radon
      •  Introduction to Indoor Air Quality

   With CPSC and the Department of Housing
   and Urban Development (HUD):
      •  Protect Your Family From Lead in Your

  EPA is working with:

    •   HUD, CPSC, and DHHS on a number
        of projects related to lead-based paint

    •   The General Services Administration ,
        under Executive Order 13101, to
        develop guidance on environmentally-
        preferable products for use in federal

    •   The Department of Energy to
        implement energy-efficiency and
        other improvements at EPA facilities
        to improve laboratory operations and
        to take relevant lessons to a broader
        audience (hospitals, computers, etc.).

    •   The Department of Agriculture to
        develop a list of bio-based products
        that may be preferable for use in the
        indoor environment.

 . number of federal agencies and departments outside EPA have responsibili-
   for protecting human health indoors. The efforts of the Occupational Safety
 id Health Administration (OSHA) in the Department of Labor, the National
  stitute for Occupational Safety and Health (NIOSH) in the Department of
 Jealth and Human Services (DHHS), and the General Services Administration
 "ISA) focus on protecting the health of the workforce.

  "ier agencies and departments focus on reducing exposures and risks to the
  leral population. The Consumer Product Safety Commission (CPSC) is
  sponsible for protecting American families, especially children, from the
|nreasonable risk of injury (including illness) and death from about 15,000
     mer products. The Department of Housing and Urban Development
   JD) provides for safe and healthful housing through programs to reduce


Under the Occupational Safety and Health Act (OSHAct), OSHA develops
and enforces occupational safety and health standards, including those
related to exposures to toxic substances, and has proposed a comprehensive
indoor air quality standard  for workplaces.

Key activities at OSHA include:

  *  Protecting the health and safety of American workers by promulgating]
     mandatory standards and by inspecting workplaces to ensure compli-
     ance with those standards.

  *  Regulating worker exposure to toxic substances and harmful physical
     agents, including asbestos, lead, and noise.

  *  Proceeding with a comprehensive indoor air quality standard that
     would mandate proper operation and maintenance of building sys-
     tems, control of point sources of indoor pollution, control of fumes
     and dusts during renovation and  remodeling activities, and proper
     training of maintenance staff.

  *  Assisting and providing guidance to federal and state compliance offi-
     cials in evaluating indoor environmental quality in non-industrial
     workplaces (including the occurrence of Legionnaires' disease and
     occupational asthma).


The Commission enforces five federal statutes: the Consumer Product
Safety Act, the Flammable Fabrics Act,  the Poison Prevention Packaging
Act, the Federal Hazardous Substances Act, and the Refrigerator Safety Act. I
CPSC's mission is to:
  *  Protect the public against unreasonable risks.

  *•  Assist consumers in evaluating comparative safety.

  •  Develop uniform safety standards so as to minimize conflicting state
     and local regulations.

  *  Promote research and investigation into causes and prevention of
     product-related deaths, illnesses, and injuries.

 IPSC uses a variety of approaches to identify product hazards, including
   internationally-recognized hospital emergency room reporting system
  d a toll-free hotline. The Agency assesses these hazards using a. risk-based
Ipproach grounded in the best scientific data. Once the hazards are
Issessed, CPSC uses a wide range of tools to correct them, including:

  *  Voluntary standards and guidelines

  *  Product recalls and corrective actions

  #  Mandatory rulemaking (e.g., performance standards, bans, and labeling)

  *  Consumer education

pecause CPSC is a federal agency, its product safety work and uniform
 afety guidance and standards ensure businesses a level playing field for
[bmestic and imported consumer products. CPSC evaluates and acts on
     h hazards associated with  the use of products in the following areas:
   (e.g., cigarette lighters and upholstered furniture), mechanical (e.g.,
Jhildren's products, household/structural products, power tools and
 ^uipment, and sports and recreational products), electrical (e.g., lights),
    chemical (e.g., fuel-burning appliances). Some specific CPSC activities
 slating to human health indoors include:

     Evaluating carbon monoxide (CO) detectors to protect against CO
     poisoning and submitting recommendations for changes to the
     Underwriters Laboratories standard for CO detectors.

     Developing voluntary standards to limit combustion pollutant emissions
     from kerosene heaters, unvented gas space heaters, and camping heaters.

     Working with the gas water heater industry to develop an effective
     voluntary standard to address the ignition, of flammable vapors.
                                                                                  P o /';


»  Reducing consumer exposures to lead and protecting against ehildhoc
   lead poisoning by investigating the release of lead from imported vinyl j
   mirublinds and requesting the industry cease using lead as a stabilizer
   in these products.

*  Conducting a study of leaded paint and developing a strategy for use
   by state agencies for identifying and controlling leaded paint.

*  Assessing the potential toxicity of fire-retardant chemicals.

#  Identifying the potential for emissions of bioaerosols from portable
   humidifiers and developing guidelines for cleaning and maintaining
   these humidifiers to reduce bioaerosol emissions.

«•  Investigating and analyzing monitoring data on biological pollutants
   in homes, as part of the Harvard Six-City Study.

»  Assessing the impact of selected residential heating, ventilating, and
   air-conditioning systems and control technologies on indoor air quality, j

*  Evaluating carpet systems to determine if the chemicals they emit into I
   the air might be responsible for the health complaints reported by

*  Measuring and assessing the risk of indoor air pollutant emissions
   from wood-burning stoves.

*  Promulgating several regulations requiring child-resistant packaging
   for medicines and household chemicals to reduce the number of
   deaths to children under the age of five from accidental ingestion.

^  Assessing the potential for noise-induced hearing loss from consumer

*  Developing and disseminating consumer information booklets on
   asbestos, formaldehyde, biological pollutants, lead, combustion
   pollutants, and carbon monoxide detectors.


Jnder the Energy Organization Act, the Atomic Energy Act, and the Energy
Conservation and Production Act, DOE:

    Conducts research on the health effects of ionizing radiation,
    including radon.

    Establishes guidance for energy-efficient buildings and promotes their use.

    Evaluates the impact of energy conservation standards on habitability.

   research at DOE includes:

 «  Developing, testing, and evaluating energy-efficient and cost-effective
    techniques to maintain indoor environmental quality.

 *  Developing methods and protocols for measuring emissions from key
    building materials and products.

 0  Determining the relationship between organic pollutants in large
    buildings and residences and energy-conservation methods.

 *  Developing methods to model and measure infiltration and interzonal
    airflows and assess ventilation of U.S. housing and associated energy use.

 «  Assessing the potential to improve productivity of office workers by
    providing better indoor environments (in conjunction with the
    National Institute for Occupational Safety and Health).

 *  Supporting the American Society of Heating, Refrigerating, and Air
    Conditioning Engineers (ASHRAE) in developing effective ventilation
    and indoor air quality standards.

 •  Developing practical measurement techniques for ventilation rates
    and efficiencies.

 *  Minimizing or eliminating the adverse energy impacts of radon
    mitigation technologies.

 *  Developing an understanding of any cellular and molecular effects of radon.



                     Under the Public Health Services Act (PHSA), DHHS performs research and
                     other activities on the cause, diagnosis, treatment, control, and prevention of j
                     disease related to indoor pollution. These activities include:

                      is   Identifying pollutants and other environmental conditions responsible
                          for human disease and adverse effects on humans.

                      *   Evaluating the health costs of pollutants (with EPA and others).

                     There are a number of institutes and agencies within DHHS that are
                     doing work to protect human health indoors. The National Institute for
                     Occupational Safety and Health (N1OSH) within the Centers for Disease
                     Control and Prevention (CDC) answers inquiries on indoor environmental
                     quality in non-industrial workplaces (e.g., offices) and performs site invest!-]
                     gations to solve environmental problems in these workplaces.

                     Other activities at CDC include:

                      *   Providing information to state health departments and members of  the
                          public concerning the health effects of indoor environmental pollutants.]

                      «   Developing reliable tests for tobacco smoke exposure.

                      *   Providing assistance to state and local health departments in conducting
                          screening and surveillance activities in order to minimize the adverse
                          effects of environmental lead contamination.

                      *i   Providing assistance to states to address asthma including a variety of
                          training and program development efforts, transfer of best practices,
                          and modes for surveillance.

                     The Agency for Toxic Substances  and Disease Registry (ATSDR) within
                     DHHS provides assistance and advice on indoor environmental contami-
                     nant exposures related to hazardous waste sites.

                     Several institutes within the National Institutes of Health (NIH) are
                     also doing work to protect human health indoors, especially in the area
                     of asthma.


    1 has been actively involved in a number of key indoor environmental
 sues. Through the National Manufactured Housing Construction and
 ifety Standards Act, HUD has provided for safe and healthful conditions
  manufactured housing. Standards for formaldehyde emissions from
pressed wood products have been promulgated under this Act. In addition,
 IUD is working to improve the air distribution systems in these types of

  rough the Residential Lead-Based Paint Hazard Reduction Act, HUD
 orks to reduce lead exposures in U.S. housing. Key activities in this area
Jave included:

 * Demonstrating lead hazard abatement strategies and preparing a
    workable plan for abatement in public housing.

 » Surveying public awareness of lead-based paint hazards to determine
    the impact on  hazard disclosure on real estate transactions.

 « Evaluating the effectiveness and cost of the methods used by HUD
    grantees to reduce hazards in privately-owned housing occupied by
    low-income households,

 * Studying the effectiveness of educating families on special lead-dust
    cleaning practices.

 # Developing model provisions for state and local housing codes that
    incorporate best hazard control practices.

 » Research on lead paint identification, evaluation, and control methods.

 1UD also determines HUD/FHA and Public and Indian housing policies
   radon  issues.

finally, conducting general or targeted community awareness of education
programs on environmental health and safety hazards under their "Healthy
 lomes" Initiative, HUD considers allergens and asthma, asbestos, combus-


tion products, insect and rodent pests, mold and moisture, pesticide
residues, and radon key targets for intervention.


GSA provides indoor environmental quality guidelines for federal (GSA-
owned) buildings and leased space. Key activities include:

  «  Providing information to consumers who purchase office furniture
     from the Federal Supply Service schedule.

  *  Coordinating radon testing and mitigation in GSA-controlled buildings|

  *  Funding indoor air quality research  by the National Institute for
     Occupational Safety and Health in GSA buildings.

  *  Providing an indoor environmental  quality program that has:

        An ongoing component that includes responding promptly to
        concerns and, when possible, correcting problems discovered.

        A pro-active component that includes conducting indoor environ-
        mental assessments as part of a survey program.

GSA also coordinates the development, printing, and distribution of indoor envi-i
ronmental publications for federal agencies and provides several publications onj
indoor environmental quality through the Consumer Information Catalog.

 r\e focus of studies at NIST has been on the relationship between ventilation
 id contaminant levels in buildings. Activities at NIST include:
    Developing models to account for air movement and contaminant
    dispersal in buildings.
 *  Developing an understanding of factors affecting the mixing of carbon
    monoxide in buildings as it relates to the location of detectors.
    Performing simulation studies of approaches to the ventilation of
    residential buildings.
I *  Developing test methods and procedures for studying air change char-
    acteristics, pollutant levels, and their relationship in large buildings.
 *  Developing a practical guide to procedures for assessing ventilation
    rates in commercial buildings.
 *  Developing test methods for lead in paint (in cooperation with HUD
    and EPA).
 *  Maintaining national radium and radon measurement standards.

                             The quality and structure of state, local, and tribal indoor environmental
                             programs vary significantly from state to state. Some states have strong or
                             moderately strong indoor environmental programs, while others have
                             essentially no programs at all.

                             State, local, and tribal programs provide public information, problem assess- ]
                             ment, and response, but often these activities are divided among several
                             agencies, particularly at the state level, as a reflection of the multifaceted
                             nature of indoor environmental issues. Some states, like California, Florida,
                             and Vermont, have interagency indoor environmental groups to coordinate
                             activities across state agencies. The strongest state programs are those which
                             have been mandated by state legislation. In these states, much of what has
                             been achieved has been through voluntary compliance. Many state and local!
                             governments do have some regulatory authority in specific areas (e.g.,
                             asbestos, lead, radon, and environmental tobacco smoke). A substantial
                             component of many state programs is to assist local governments and tribes
                             to address indoor environmental issues at the local and tribal level.

                             State-level indoor environmental programs are often hampered by the
                             lack of a routine funding mechanism, with the exception of state radon
                             programs which can receive federal funding. Agencies sometimes respond
                             to problems identified through publicity or public outcry. Such response is
                             frequently reactive and crisis-driven. In some states, there is no organized
                             structure in place to educate or empower the public about their indoor
                             environment, and funding may decrease when the issue drops out of the
                             media spotlight.

                             Like state government, local health and/or environmental offices often have
                             no established indoor environmental programs. They may create a mecha-
                             nism to respond to a current crisis, routine public inquiries, or public outcry.

                             The scarcity of local government programs is being offset by grassroots
                             coalitions and non-profit organizations, extension educators, and local
                             professional organizations working independently and in cooperation with
                             each other and federal, state, and local officials on public outreach and
                             program implementation. Some funding and training for indoor em'ironmental j

 tivities is available for and utilized by local governments, local health and
nvironment officials, and non-profit organizations. More limited funding may
  available for local indoor environmental needs on a competitive or ad hoc
asis from federal and/or state agencies.

sine tribal governments have established radon and indoor environmental
  agrarns receiving federal funding. The close-knit nature of tribal councils and
lie high regard of elders has proven effective in implementing grassroots envi-
pnmental programs and allowed for good coordination of environmental pro-
 am activities. Economic and cultural issues make some environmental issues
particular challenge. Involvement of the tribal council and elders assures
 Bareness of cultural sensitivities and increases the opportunity for success.

ie strongest indoor environmental programs were found in states where
here was a funding mechanism, upper management support of the program,
id/or full time staff dedicated to indoor environmental efforts. However,
/en states with strong programs generally face constraints which prevent
 em from doing the kind of proactive outreach which would prevent indoor
ivironmental problems and crises or have serious gaps in their programs.
   example, some statewide/regional programs cover such a large geo-
  phic area that individual city or county assistance could be more effective.
ime states have a strong indoor environmental quality program in schools,
it do not address homes at all. In other states, efforts for lead or pesticides
 ay be targeted to specific audiences due to staff limitations (e.g., integrated
est management irt schools, lead awareness to real estate professionals).
Bsticides programs are frequently housed in state agriculture departments,
[hich will follow up on indoor environmental concerns regarding pesticides
jiisuse if contacted.


                       Many different entities in the private sector impact the state of human
                       health indoors. A few of the key stakeholder groups that have a role in
                       protecting human health indoors, and their potential roles in solving indoor
                       environmental problems, are discussed below.


                       Consumer, environmental, health, and other professionals are knowledgeablej
                       of the symptoms and effects produced by environmental pollutants and can
                       advise the public on possible mitigation of environmental exposures. They
                       use diverse approaches to protecting human health indoors, including devel-1
                       oping information and education programs to educate the public about
                       indoor environmental quality, conducting research to identify problems and
                       recommend solutions, and participating in the policy-making process.


                       Manufacturers can ensure good indoor environments by designing products
                       and materials that eliminate or reduce exposures to toxic chemicals, pesticides, ]
                       and other pollutants to safe levels. These include consumer and commercial
                       products, building materials, office equipment, and furniture. Manufacturers
                       can also label  their products so that they will be properly used and main-
                       tained. If a supplier provides raw materials (e.g. chemicals) to be formulated
                       further into a  product, the supplier can provide the formulator with sufficient
                       health and safety information to allow the formulator to determine if the raw
                       material can be safely used in the intended application. Manufacturers and
                       suppliers can  conduct research and adopt test procedures (e.g. emission test
                       procedures) and standards to ensure that the products and materials that they
                       sell are safe for use in indoor environments.


 puilders and architects can work to design and build structures that elimi-
  ite indoor environmental problems or enhance indoor environments. By
      ig about the quality of the indoor environment in the design stage, in
 snstruction practices, and in remodeling, builders and architects can have
  substantial impact on the health and safety of the building occupants.
 guilders and architects can help achieve safe indoor environments by
 2lecting building materials that will not release harmful levels of toxic
 lemicals into occupied indoor environments (either when the materials are
 lew or as they age) and by designing buildings to be in compliance with
 tdoor air quality ventilation standards. During the remodeling of occupied
 luildings, builders and architects can help protect the safety of tenants by
  slating them from pollutants generated during construction work.


 luilding owners, managers, and engineers ensure good indoor environmental
 [uality by properly operating and maintaining buildings. Building owners,
  anagers, and engineers can foster a good indoor environment by adopting
 [entilation maintenance procedures to eliminate and prevent contamination
 id ensure an adequate supply of clean air to occupants; using zone ventila-
 lon or local exhaust for indoor sources; developing specific procedures for
 [se of cleaning solvents, paints, pesticides, and other products and materials
 /ithin the building; and abiding by recognized standards of care for building
  dntenance. Their role includes establishing a process to educate building
 ccupants about their roles in maintaining good indoor environmental quality
 id encouraging an active exchange of information about indoor environmen-
 il problems. They can develop and adopt formal protocols to investigate
 idoor environmental complaints from occupants, thereby encouraging an
Itmosphere of trust.


Diagnostic and mitigation firms respond to hazards and complaints in problem]
buildings. They may work closely with building owners, managers, and engi-
neers or individual homeowners to investigate indoor environmental quality
issues. Professionals in these firms span a broad range of occupations, including
industrial hygienists, mechanical (ventilation) engineers and technicians, mk
biologists, architects, chemists, air pollution scientists, industrial engineers, risk!
assessment personnel, abatement personnel, and others. The services of most of|
these firms include evaluations of ventilation systems, measurement of indoor
pollutants, and characterization of the sources of pollutants in buildings.
Through these efforts, they can be instrumental in turning a problem building
into a healthy building.


The real estate industry has begun addressing a variety of indoor environ-
mental issues in the past few years as a result of both client demand and
legal requirements. The real estate industry, discovering a need to know
more about radon, lead, asbestos, the safe application  of pesticides, and
underground storage tanks, is partnering with government and industry
organizations to provide the necessary training to its members to facilitate
transactions and improve customer service.


Unions can protect human health indoors by ensuring a clean and healthy
indoor environment for their members. They can work with building owners,!
managers, and engineers to ensure that employees are afforded an optimum
work environment. If problems occur, they can come to the aid of employees
who feel that they have been improperly exposed to pollutants in their work-|
places and can work with building designers, owners, managers, and engi-
neers in the design and operation of healthy workplaces.


Itandard-setting organizations (e.g., building code organizations, the
  merican Society for Testing and Materials (ASTM), the American National
|tandards Institute (ANSI), the American Society of Hearing, Refrigerating,
  id Air-Conditioning Engineers (ASHRAE), Underwriters Laboratory (UL),
    International, and the American Conference of Governmental Industrial
 lygienists (ACGIH)) can play an important role in protecting human health
  indoor environments. Depending on the organization, they can provide a
 ange of services. One important service of some standard-setting organiza-
tons is to foster healthy indoor environments by developing or enhancing,
providing for efficient use of, and, and in some cases, enforcing model build-
 ig codes. Other services standard-setting organizations may provide are
 string uniform methods of testing, establishing levels of accepted practice,
Ir developing and maintaining consensus standards. Some may provide
 ertification opportunities, laboratory testing and toxicological assessments
 slated to certification, and conformity assessments and compliance monitor-
 ig. Education and training services may also be provided. Standard-setting
Irganizations can help product manufacturers, code writers, designers,
  .aiders, enforcement officials, and others perform their functions in a more
Iffective and efficient manner. Standard-setting organizations can also play
|n important role providing the public with some assurance that their homes,
  iools, and workplaces, and the products that go into them, are safe.


 lany research organizations work to protect human health indoors. Some
\i these organizations address policy issues, such as providing critical
Inalyses of the potential risks for pollutants indoors, addressing land use
|nd building design issues, or setting future strategies for protecting indoor
 ivironments. Scientific research organizations address a wide range of
 sues related to indoor environments, including proper building design
 id operation, health and comfort impacts of poor indoor environments,
  sasurements of indoor pollutants and the characterization of emissions


from products and materials used indoors, and exposure mitigation (e.g.,
ventilation, air cleaning, source control, and individual behaviors). Becausel
research in indoor environments is relatively new, these organizations play]
a key role in determining future areas of concern for indoor environments.


Individuals are the strongest force in protecting human health indoors.
Consumers protect their own health and the health of those around them by
properly maintaining their homes and making informed choices about con-
sumer goods and services. Building occupants (e.g., office workers) do the
same by properly using products and equipment within the building. With
knoxvledge, individuals can take many actions to avoid personal exposures.
The value of individual behavior cannot be minimized in our efforts to develop
and implement a nationwide strategy to improve indoor environments.