Health at risk for Sonoma County tenants in poor living conditions
The effect of squalid housing on people's health is difficult to determine in Sonoma County because there is no study, stockpile of data or government agency that tracks illness in connection with living environments.
Though doctors and scientists are building consensus through research, the connection remains largely anecdotal, witnessed by physicians or reported by tenants' rights advocates on a case-by-case basis, The Press Democrat found as part of a yearlong investigation into substandard housing in the county.
Sonoma County's lead health agency, a $247 million department overseeing public health and welfare initiatives for nearly 500,000 residents, does not keep track of housing violations that state officials say can present dire health and safety threats for people who live in slum conditions. County health officials also rarely get involved with investigations into substandard housing allegations.
The county's Department of Health Services is charged with inspecting restaurants to ensure food is safe, for intervening in mental health and psychiatric crisis and for preventing the spread of infectious diseases, among other mandates.
But county public health officials say they have little role in overseeing housing stock and ensuring its safety. They also have no data on how squalid housing affects the health of local renters.
“We are not the enforcement agency,” said Karen Milman, the county's public health officer, who pointed out that county and city code inspectors are in charge of state health and safety investigations on housing. “But we'll come in and write a letter if we're asked.”
Milman said health department officials sometimes write letters of support for open code enforcement investigations, but their input is not used as a primary tool to assist tenants or force landlords to make repairs in housing units that are found to be substandard. Milman said health officials get involved in roughly 10 substandard housing cases per year.
By comparison, city and county agencies last year were handling more than 250 unresolved cases on substandard housing.
“We get involved when we're asked, but not everyone always complains, so our hands are a little tied on this,” she said, referring to instances in which health officials join code enforcement officials on routine inspections.
Few if any local governments around the United States track the health effects of substandard housing because of the expense, patient privacy issues and the difficult of coordinating with medical providers.
Milman said she was aware of just one jurisdiction, King County in Washington, that had done such work.
“That was a clinical trial, so they had specific asthma research funding,” Milman said. “I'm certainly concerned about the effect substandard housing can have on someone's health, but it's hard to quantify the magnitude of the problem.”
Slum housing conditions - including mold, vermin and insect infestations, faulty plumbing and shoddy electrical wiring - can risk tenants' physical safety and contribute to lasting health problems - especially in the young and the old, according to peer-reviewed studies and U.S. experts in public and environmental health. Such conditions also can lead to mental health problems, including depression, stress and anxiety, the experts say.
One of the most pressing repercussions is respiratory illness, health experts said. In Sonoma County, more than 18 percent of the population has been diagnosed with asthma, higher than the statewide average of 14 percent, according to county health data.
Medical research has not concluded that mold and other housing problems cause asthma. But the chronic disease has a range of environmental triggers, including outdoor pollens, air pollution and cigarette smoke, as well as indoor mold, which can make the disease worse.
Asthma researchers also are beginning to establish a link with cockroaches and rodents in housing.
“The evidence is really strong and clear,” said James Krieger, a Seattle-based doctor and leading health researcher on the matter. “Problems in the home, with mold and cockroaches … trigger asthma, and kids are more at risk because their bodies are so small.”
Krieger, the former King County chief of chronic disease and injury prevention, found in a 2010 study published in the journal Pediatric Allergy, Immunology and Pulmonology that 40 percent of the asthma risk for low-income children and nonwhite children is attributable to residential allergens associated with substandard housing conditions.
“If you're a poor person of color, you're more likely to be exposed to these asthma sensitizers found in homes,” Krieger wrote.