EUROPE DANIEL GEHRT, MARCO HAFNER, LUCY HOCKING, EVANGELOS GKOUSIS, PAMINA SMITH, JACK POLLARD Poor indoor climate, its impact on child health, and the wider societal costs For more information on this publication, visit www.rand.org/t/RR3256 Published by the RAND Corporation, Santa Monica, Calif., and Cambridge, UK © Copyright 2019 RAND Corporation R® is a registered trademark. RAND Europe is a not-for-profit organisation whose mission is to help improve policy and decision making through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. 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Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org www.rand.org/randeurope Preface This report presents the findings of a project that has combined five different analyses: • A rapid evidence assessment (REA) concerning the impact of poor indoor climate on child health; • An analysis of statistical datasets concerning the prevalence of various indoor climate-related hazards in the EU and the number of children exposed to them; • A regression analysis concerning the associations between poor indoor climate and child health; • An estimation of the burden of disease (in terms of health and educational impacts) of children who are exposed to damp and mould in their homes; • A modelling of the economic benefits associated with reducing children’s exposure to selected aspects of poor indoor climate, more specifically (a) damp and mould in their homes and (b) poor ventilation in schools. The report will be of interest to policy-makers in the fields of public health, housing and education, and at the same time to a much broader spectrum of readers, including house owners, tenants, as well as private sector agents, in particular in the construction, renovation and property management domains. VELUX Group commissioned RAND Europe to carry out this research project. RAND Europe had full editorial control and independence of the analyses performed and presented in this report. This work informs the public good and should not be taken as a commercial endorsement. RAND Europe is an independent, not-for-profit policy research organisation that aims to improve policy and decision making in the public interest through research and analysis. This report has been peer- reviewed in accordance with RAND’s quality assurance standards. For more information about RAND Europe or this document, please contact Daniel Gehrt ([email protected]) at: RAND Europe Westbrook Centre, Milton Road Cambridge CB4 1YG United Kingdom Tel. +44 1223 353 329 iii Table of contents Preface ............................................................................................................................................. iii Table of contents ............................................................................................................................. iv Figures ............................................................................................................................................. vi Tables ............................................................................................................................................. vii Abbreviations and acronyms ............................................................................................................ ix Executive summary .......................................................................................................................... xi Background .................................................................................................................................. xi Objectives and research questions ................................................................................................. xi Study design ................................................................................................................................ xii Specific indoor climate hazards covered ....................................................................................... xiii The prevalence of various indoor climate hazards and their impact on child health ..................... xiv The economic and educational impacts of health conditions identified ....................................... xvi Quantifying the burden of poor indoor climate........................................................................... xvi Implications for key stakeholders .............................................................................................. xviii Acknowledgements ........................................................................................................................ xxi 1. Introduction ................................................................................................................................ 1 1.1 Background ............................................................................................................................ 1 1.2 Objectives and research questions ........................................................................................... 2 1.3 Study design ........................................................................................................................... 3 1.4 Specific indoor climate hazards covered .................................................................................. 6 1.5 Structure of this report ........................................................................................................... 7 2. Poor indoor climate and children: A review of the literature ........................................................ 8 2.1 Method and search strategy .................................................................................................... 8 2.2 The health effects of poor indoor climate on children ........................................................... 11 2.3 The impact of health conditions linked to indoor climate hazards on parents’ economic outcomes ..................................................................................................................................... 21 2.4 The impact of health conditions linked to indoor climate hazards on children’s academic achievement ................................................................................................................................. 24 2.5 Important points to be considered when interpreting the evidence ....................................... 28 3. Quantifying the burden of poor indoor climate on children and their parents ........................... 30 3.1 Data sources ......................................................................................................................... 31 3.2 Statistical methods ............................................................................................................... 34 3.3 Empirical results ................................................................................................................... 36 3.4 The potential burden associated with poor indoor climate .................................................... 50 iv 4. The potential economic implications associated with exposure to poor indoor climate at home and in schools across EU countries.................................................................................................. 52 4.1 The macroeconomic model .................................................................................................. 53 4.2 The economic implications associated with reducing children’s exposure to residential damp 54 4.3 The economic implications associated with improving ventilation rates in schools ............... 58 4.4 Modelling the economic effects of improved indoor air quality in schools ............................ 60 4.5 The economic implications associated with higher ventilation rates across schools: results .... 62 5. Summary and implications for key stakeholders ........................................................................ 69 5.1 Summary of key findings ...................................................................................................... 69 5.2 Implications for key stakeholders .......................................................................................... 70 References ....................................................................................................................................... 73 Appendix A. The REA search protocol and the inclusion/exclusion criteria .................................... 82 A.1. The search protocol .............................................................................................................. 82 A.2. Inclusion and exclusion criteria ............................................................................................. 86 Appendix B. Details on the statistical methods ............................................................................... 88 Appendix