Healthy Housing Reference Manual

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U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Environmental Health

U.S. Department of Housing and Urban Development

Original Printing 1976, Reprinted 1988,
Updated and Revised 2006

Suggested citation: Centers for Disease Control and Prevention and U.S. Department of Housing and Urban Development. Healthy housing reference manual. Atlanta: US Department of Health and Human Services; 2006.

Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, the U.S. Department of Health and Human Services, or the U.S. Department of Housing and Urban Development.

Disclaimer: Links to other federal and nonfederal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or HUD, and none should be inferred. CDC and HUD are not responsible for the content of the individual organization Web pages found at these links.


We acknowledge the suggestions, assistance, and review of numerous individuals and organizations that went into the original and current versions of this manual. The revisions to this manual were made by a team of environmental health, housing, and public health professionals led by Professor Joe Beck, Dr. Darryl Barnett, Dr. Gary Brown, Dr. Carolyn Harvey, Professor Worley Johnson, Dr. Steve Konkel, and Professor Charles Treser.

Individuals from the following organizations were involved in the various drafts of this manual:

  • Department of Housing and Urban Development (HUD), Healthy Homes and Lead Hazard Control,
  • U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH)
  • National Healthy Homes Training Center and Network
  • National Association of Housing and Redevelopment Officials
  • Department of Building, Housing and Zoning; Allentown, Pennsylvania
  • Code Enforcement Associates; East Orange, New Jersey
  • Eastern Kentucky University; Richmond, Kentucky
  • University of Washington; Seattle, Washington
  • Battelle Memorial Institute; Columbus, Ohio

Specifically, our gratitude goes to the following reviewers:

Dr. David Jacobs, Martin Nee, and Dr. Peter Ashley, HUD; Pat Bohan, East Central University; James Larue, The House Mender Inc.; Ellen Tohn, ERT Associates; Dr. Stephen Margolis, Emory University; and Joseph Ponessa and Rebecca Morley, Healthy Homes Training Center.

A special thank-you for assistance from Carolyn Case-Compton, Habitat for Humanity, 123 East Main Street, Morehead, Kentucky. Pictures of a home under construction are courtesy of Habitat for Humanity and John King, home builder and instructor, Rowan County Technical College, Morehead, Kentucky; and Don W. Johnson, building photographer of Habitat for Humanity

In addition, a special thank you to the Environmental Health Services Branch and the following staff: CAPT Craig Shepherd and CAPT Michael Herring, Commissioned Corps, U.S. Public Health Service, for their research and review during the editing of this manual. Special thanks also to Pamela S. Wigington and Teresa M. Sims for their hard work preparing this manual for Web publication.


Housing quality is key to the public’s health. Translating that simple axiom into action is the topic of this book. In the 30 years since the first edition was published, the nation’s understanding of how specific housing conditions are related to disease and injury has matured and deepened. This new edition will enable public health and housing professionals to grasp our shared responsibility to ensure that our housing stock is safe, decent, affordable, and healthy for our citizens, especially those who are particularly vulnerable and who spend more time in the home, such as children and the elderly.

The Centers for Disease Control and Prevention and the U.S. Department of Housing and Urban Development (HUD) have worked together with many others to discover the ways to eliminate substandard housing conditions that harm health. For example, the advances in combating water borne diseases was possible, in part, through standardization of indoor plumbing and sewage, and the institution of federal, state and local regulations and codes. Childhood lead poisoning has been dramatically reduced, in part, through the elimination of residential lead-based paint hazards. Other advances have been made to protect people from carbon monoxide poisoning, falls, safety hazards, electrocution, and many other risks.

However, more must be done to control existing conditions and to understand emerging threats that remain poorly understood. For example, nearly 18 million Americans live with the health threat of contaminated drinking water supplies, especially in rural areas where on-site wastewater systems are prevalent. Despite progress, thousands of children still face the threat of lead poisoning from residential lead paint hazards. The increase in asthma in recent decades and its relationship to housing conditions such as excess moisture, mold, settled dust allergens and ventilation remains the subject of intense research. The impact of energy conservation measures on the home environment is still unfolding. Simple affordable construction techniques and materials that minimize moisture problems and indoor air pollution, improve ventilation, and promote durability and efficiency continue to be uncovered.

A properly constructed and maintained home is nearly timeless in its usefulness. A home is often the biggest single investment people make. This manual will help to ensure that the investment is a sound one that promotes healthy and safe living.

Home rehabilitation has increased significantly in the last few years and HUD has prepared a nine-part series, The Rehab Guide, that can assist both residents and contractors in the rehabilitation process. For additional information, go to

Page last reviewed: October 1, 2009