Sometimes home inspectors are asked, “What did you do before you became a home inspector?” My answer is that I was a New Jersey public health officer for 11 years. Although I left my official public health career in 1986, I am reminded every time I inspect a home that home inspectors play a vital role in protecting health. The purpose of this article is to examine that role.
MOISTURE CONTROL AND DISEASE
Inspecting for water problems occupies much of our time on the job. We understand the damaging effects water can have on a structure and its equipment, and we know our clients expect us to identify water problems present in a home. Water problems can lead to health problems, and health issues rank at the top of homebuyers’ concerns.
For example, consider standing water due to poor lot drainage, sagging or blocked gutters, abandoned pools, etc. Water that collects near a home can allow mosquitoes to breed. Every year, there are outbreaks of West Nile fever and Eastern equine encephalitis in the U.S., viruses spread by mosquitoes. The Center for Disease Control and Prevention (CDC) reports that in 2008 there were 1,356 cases of West Nile virus in the U.S., with 45 deaths. Every state reported cases of West Nile virus.1 The CDC also reported that mosquito-borne encephalitis cases average between 150-3,000 per year in the U.S.2 As home inspectors, we report exterior conditions that can cause standing water and, as a result, help to prevent the spread of mosquito-borne illness.
But water problems are not limited to standing water. Interior moisture conditions may be of equal or greater concern. How many times have we heard customers say a family member is allergic to mold? Healthful homes are essential to buyers, and it is imperative to them that there are no mold problems in the homes they buy. Although home inspectors are not required to test for mold, we report the conditions that cause it and its presence. In addition, some of us offer testing. The National Academy of Science reports that toxin-producing molds can grow indoors in damp conditions. Damp interiors also may lead to bacterial growth that causes toxic or inflammatory effects, and there is sufficient evidence of an association between damp indoor environments and some respiratory health problems.3
Home inspectors report faulty gutters, negative grade, building envelope leaks, improper termination of dryer vents, inadequate venting of attics, lack of vapor barriers, condensation conditions, plumbing leaks and other defects that lead to moisture accumulation. I believe home inspectors are leaders in the fight against health problems caused by damp indoor conditions and standing water.
Plumbing is included in the ASHI Standards of Practice. The stated purpose of The National Standard Plumbing Code is “To provide practices and performance criteria for the protection of health and safety through proper design of plumbing systems.”4
Sanitary plumbing has probably saved more lives than any technological improvement in human history, especially considering the millions who have perished from fecal contamination of drinking water. Typhoid fever, cholera, bacterial and amoebic dysentery are among the notorious illnesses caused by drinking sewage-contaminated water. Home inspectors inspect plumbing systems looking for lack of air gaps, physical cross connections, surface discharges of plumbing drainage, some even extending their inspections to unsanitary private water supplies, etc. The CDC reports that in 2005-06, there were 20 documented cases of waterborne disease in the U.S. from contaminated drinking water that caused 612 cases of illness, with 4 deaths.5 More importantly, consider that 1.8 million people worldwide die each year from diarrheal disease caused by contaminated drinking water.6 One can readily appreciate the blessing of modern plumbing.
INDOOR AIR AND HEALTH
Nothing could be more important to our clients than the air they breathe. The CDC reports an estimated 15,000 emergency room visits and 500 deaths per year from non-intentional exposure to carbon monoxide.7 We inspect furnaces, boilers, hot water heaters, fireplaces and chimneys, and one of the critical concerns we have is proper exhausting of combustion products to prevent carbon monoxide gas from poisoning our customers. All of us have seen blocked chimneys, connecting pipes that have separated, back drafting, etc. Who knows how many folks we have protected against CO poisoning by simply doing our jobs? Home inspectors are on the front line of carbon monoxide poisoning prevention.
Also, many of us provide radon testing as part of our home inspections. The National Cancer Institute recognizes radon gas as the second leading cause of lung cancer in the U.S. and estimates 15,000 to 22,000 deaths per year from radon.8 And in New Jersey, where I work, 75-80 percent of all radon testing is done as part of the home inspection process. Arguably, there is no industry that has done as much as the home inspection industry to help lower household radon levels. No one ever will know how many lung cancers have been and will be prevented by radon testing during home inspections.
And, most of us report possible asbestos, whether old steam pipe wraps, vermiculite in the attic, etc. Some of us have inspected older homes where pure asbestos was used as attic insulation. Lung diseases such as asbestosis, mesothelioma and lung cancer are caused by exposure to asbestos fibers. Although we may or may not offer asbestos testing services, most home inspectors cite “possible asbestos” in their reports and will recommend testing and/or professional removal, thus helping our customers avoid exposure to asbestos.
Additionally, many of us work in areas where fuel oil is used for home heating, and fuel oil often is stored in inside tanks or worse, is stored underground. The horror stories about contamination from oil leaks are legion, but do we think about the health effects of breathing the vapors from fuel oil that may be leaking inside the home? How often have we walked into a basement and smelled fuel oil? The Wisconsin Department of Health Services reports that high levels of fuel oil vapors can “cause headaches, nausea, light-headedness, poor coordination, increased blood pressure and difficulty concentrating” and “long-term exposure to benzene, the most toxic component of fuel oil, is known to cause leukemia.”9
Then there is “sick building syndrome” and “building-related illness.” These health conditions are addressed in an EPA document titled “Indoor Air Facts No. 4 (Revised) Sick Building Syndrome.”10 Home inspectors, if they choose, can play a role in tracking down the causes of these problems, but more importantly, we help prevent these conditions from developing in the first place by doing what we normally do on our inspections.
SANITATION AND DISEASE
Do you dread those jobs where you encounter unsanitary conditions? I mean those inspections that ruin our appetites and make us want to run to a shower. In addition to being unpleasant, unsanitary conditions in a home are a potential health problem, and home inspectors can play a role in correcting these conditions.
Unsanitary conditions are conducive to pest infestation, and infestation can lead to disease. For example, we’ve all been in homes with rodent problems, and we understand the damage that rodents can do to electrical wiring, etc. But rodents also can transmit disease via their ticks and mites, and from their urine and feces. Cockroaches are another pest that can transmit disease. Gastroenteritis and allergic reactions can be caused by roaches. Unsanitary conditions also can lead to infestations of body lice. Unsanitary conditions and pest infestations require professional correction and are reported by home inspectors.
Another potential source of disease is bird and bat droppings in attics. Fungal diseases, including the lung infection histoplasmosis, can be caused by large accumulations of bat and bird droppings and professional cleanup is needed to avoid exposures. Home inspectors need to be aware of and report those conditions. Additionally, although bats are beneficial, it is important to remember that bats often carry the rabies virus, and inspectors and homeowners should avoid contact with them.
The very first section of the International Residential Code has the following statement:
“The purpose of this code is to provide minimum requirements to safeguard life or limb, health and public welfare.”11 Although most home inspectors do not cite the code formally in their reports, code requirements as they relate to safety are the basis for many of the problems we cite. ASHI Standards of Practice and Code of Ethics requires members to report those systems or components judged to be unsafe.12
All home inspectors pay close attention to staircases, porches, decks, balconies, etc. The Home Safety Council reports that in 2004, there were 5,961 deaths from falls in the home and that there were an average 1.5 million injuries per year from falls in the home from 1997-2001.13 How many of our customers are healthy today because their home inspector disclosed a serious safety problem with a staircase, porch, deck or balcony?
Scalding hot water is a serious concern, particularly for the very young and the elderly. The Consumer Product Safety Commission reports that each year approximately 3,800 injuries and 34 deaths are caused by scalding hot water in the home.14 Home inspectors cite that problem frequently.
Lack of safety glass is a problem. How often do we see old storm doors, sliders, shower doors and other glass windows or doors that are in critical locations and are not safety glass? Douglas Hansen’s article in the May 2007 issue of the ASHI Reporter, titled “Safety Glazing,” is an excellent resource on safety glass.15
Other safety-related inspection items include the lack of or leaking or overrated faulty temperature and pressure relief valves, lack of GFI protection, faulty wiring, trip hazards, doors that swing over steps, camouflaged steps, lack of adequate lighting in critical areas, missing railings, window sashes that “guillotine,” and the list goes on and on. The subject of home safety problems could fill a book. Every safety problem that is repaired because we discovered it during a home inspection protects our customers against the potentially life-changing effects of serious injury.
How many people are impacted by home inspections? National Association of Realtors (NAR) data from 1999-2008 indicates an approximate average of 5.8 million existing home sales per year.16 A 2001 joint survey by ASHI and NAR reported that 77 percent of all home sales included a home inspection.17 That percentage may be higher today. But using the 77 percent figure and assuming the average number of existing home sales, it would mean an approximate average of 4.5 million home inspections per year. If one
assumes three people per household, it would mean approximately 13.5 million people a year move into homes evaluated by home inspectors. It is clear that the collective work of home inspectors can have an impact on the lives of millions of people.
The purpose of this article is not to list every health or safety problem that we encounter as home inspectors. For example, lead poisoning was not included, but is an important issue. The author’s purpose is simply to inform the reader that home inspectors play a vital, if unheralded, role in protecting their customer’s health by identifying conditions during home inspections that can lead to disease or to injury.
1 Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount08_detailed.htm.
2 Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/ncidod/dvbid/Arbor/arbofact.htm.
3 Institute of Medicine (U.S.), Damp Indoor Spaces and Health, Committee on Damp Indoor Spaces and Health, Board of Health Promotion and Disease Prevention, 2004, p.7.
4 National Association of Plumbing-Heating-Cooling Contractors, National Standard Plumbing Code, 2006, iii.
5 Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report Surveillance Summaries, Sept. 12, 2008, 57 (SS09); 39-62.
6 World Health Organization International Network to Promote Household Water Treatment and Safe Storage, Combating Waterborne Disease at the Household Level, 2007, p7.
7 Centers for Disease Control and Prevention (CDC), Carbon Monoxide-Related Deaths-United States 1999-2004. Morbidity and Mortality Weekly Report, December 21, 2007/56(50); 1309-1312.
8 National Cancer Institute Fact Sheet. Radon and Cancer: Questions and Answers.
9 Wisconsin Department of Health Services. Fuel Oil Fact Sheet. Revised October 24, 2008.
10 United States Environmental Protection Agency (EPA), Indoor Air Facts No. 4 (revised) Sick Building Syndrome (updated Feb. 20, 2008).
11 International Code Council, Inc., International Residential Code for One- and Two-Family Dwellings, 2000, Section R101.3.
12 American Society of Home Inspectors, Des Plaines, Ill., Standards of Practice, Section 2.2.C1.
13 Home Safety Council, Washington, D.C., 2004
14 Consumer Product Safety Commission, Tap Water Scolds, Document #5098.
15 Douglas Hansen, Safety Glazing, ASHI Reporter, May 2007.
16 National Association of Realtors (NAR), Existing Home Sales, United States & Each Region, Annual 1989 to current; Monthly 1999-current (Seasonally Adjusted Rate).
17 American Society of Home Inspectors, Des Plaines, Ill., NAR & ASHI 2001 Home Inspection Study.