LEAD EXPOSURE AND CHILDREN
In the U.S. today, there are at least 4 million households with children who are exposed to high levels of lead and nearly half a million children have blood lead levels at or above the hazard threshold of 5 micrograms per deciliter. Experts have found that there is no level of lead exposure that is safe for children. Lead exposure early in life has been linked to behavioral and learning disabilities in children, including lower IQ, impaired cognition hyperactivity, slowed growth, hearing problems, anemia, and even violent behaviors later in life. The economic costs are also significant. Childhood lead poisoning has been estimated to cost the U.S. almost $6 million in medical care, as well as an additional $51 billion in lost economic activity.
POLICIES & PRACTICES
On the federal level, lead is classified as a pollutant. The Centers for Disease Control and Prevention (CDC) provides funding for childhood lead poisoning prevention programs. 44 states have adopted laws to address lead hazards (as of 2016). The agency has a goal of eliminating elevated blood lead levels in children by:
- providing primary prevention
- case management
- environmental interventions for families at risk
- coordinating the mitigation of hazards and treatment of children with healthcare providers.
However, there is still a need for local policies and local enforcement to decrease exposure. City leaders across the country have identified lead as an important public health issue. They are investing in preventing lead exposure in the communities they serve, but resources remain scarce. Currently, there is no effective treatment that reverses the cognitive and developmental damage stemming from lead exposure. To protect kids, many cities have implemented both preventive and remediation measures to mitigate the risk of future exposures. City agencies concerned with the long-term health of all residents can target resources toward vulnerable populations to prevent and further limit lead exposure in children. Interventions designed to educate and equip high exposure communities alongside proactively implementing lead abatement initiatives have reduced the negative immediate and downstream effects of lead poisoning and improved health and economic outcomes in communities.
PREVENTING LEAD EXPOSURE
Lead poisoning costs communities a lot of money, both by creating steep health care bills for treatment, and generating productivity losses. Preventing lead exposure for all children born in 2018 could generate $9.6 billion for state and local governments and $84 billion overall in future benefits. Experts recommend removing lead water pipes, eradicating lead-paint hazards from homes, enforcing the EPA’s lead-safe contractor practices, curtailing emissions from airplane fuel, and additional specific, targeted interventions for children with past lead exposure. In Michigan, Centers for Medicare/Medicaid (CMS) authorized the state to use CHIP funds to replace pipes for low income families with children, and Milwaukee passed a law to require full replacement of lead service lines with copper whenever there is a leak or planned replacement. In New York, tenants must be notified of any construction or renovations that could create dust hazards.
EDUCATION AND PUBLIC AWARENESS
Local health departments educate the public about health hazards like lead, including the effects of exposure and how to protect themselves and their families. City and county governments can work to ensure that regulatory protections are in place to mitigate lead hazards and protect residents. Baltimore publishes a list of apartments and houses with recent lead hazard violations that have not been fixed so that residents can easily check if their home is listed. New York City (and many other cities) provide educational resources for both tenants and building owners.
HEALTHY HOMES AND LEAD PAINT ABATEMENT
Since lead paint is a major source of exposure, most city-level lead policies focus on preventing exposure among children by addressing lead paint at home, school, and other places where they spend a lot of time. Although lead was banned in commercial paint decades ago and banned altogether by several state governments shortly thereafter, many older buildings and homes still contain lead paint. When paint is disrupted by construction or if they flake due to age, small pieces of paint can enter the air and can be ingested by children. The United States Department of Housing and Urban Development estimates that 24 million homes in America have lead-based paints that are peeling or chipping.
Cities can offer inspection, abatement and remediation services to assess, and in many cases remove, lead infused paints from homes and reduce paint disruption and chipping. In 2012, Philadelphia passed a law that requires landlords to ensure that property rented to families with children 6 years of age and under is lead safe, and to provide certification to both the tenant and the Department of Public Health. Washington D.C. requires training for contractors remodeling houses built before 1978 to ensure they know how to deal with materials containing lead. Other cities have requirements for registering houses with lead paint and for landlords to immediately remediate lead-paint hazards in apartments with young children. However, while these regulations exist in some cities, it can be challenging to enforce them. Without strict enforcement, families do not always feel empowered to demand that the issue is addressed.
REDUCE RISK OF LEAD CONTAMINATED DRINKING WATER
In many cities, water is delivered to residents through lead reinforced pipes. Water mains and pipes owned and operated by utility companies, as well as pipes within houses and apartment buildings may have lead hazards. If proper corrosion controls are not in place, the parts that make up the distribution system - pipes, solder, brass fixtures, and fittings - can become corroded and lead can contaminate water traveling into homes. To reduce exposure to lead in drinking water, cities can work with local utilities and companies to test lead levels at the source, implement protective standards and guidelines, install certified water filters, and incentivize private properties to replace lead corroded pipes. In D.C., if a property owner replaces a pipe on private property, DC Water will replace the public portion of the pipe at the same time. At a federal level, the EPA has released a toolkit for schools on how to reduce lead in drinking water and ensure compliance with the Lead and Copper Rule, which is designed to minimize exposure to those metals in drinking water.
ENVIRONMENTAL TESTING OF LEAD CONTAMINATION IN SOIL AND WATER
Lead can also be found in soil and free-standing water, particularly in urban areas, near heavy industrial sites, and around older homes. Lead was used in gasoline until it was banned by the federal government in the 1990’s. Before the ban, pollution from cars and airplanes that ran on lead gasoline made its way into the air, water, and soil, and the residual waste is still present today. Children are particularly vulnerable to lead exposure through touching, consuming, or inhaling lead dust particles. This is also an issue for soil used in urban gardening. If the soil used to grow food is contaminated with lead, it can contaminate the produce itself, thus exposing people to lead through food consumption. Cities often test for the presence of lead in soil and water by conducting environmental assessments in communities, especially in high risk areas. Environmental assessments allow cities to determine areas at higher risk, collect critical data for public education purposes, and take proactive steps to eliminate or reduce future exposures.
BLOOD LEVEL TESTING IN CHILDREN
Cities can offer children free or reduced cost testing for lead poisoning (often on an annual or biannual basis).
Consistent with federal law, healthcare providers and health plans that provide services for children on Medicaid can provide blood lead screening and diagnostic and treatment services, as well as refer children with elevated blood lead levels for follow-up services. Cities can develop proactive models and response frameworks that allow them to quickly limit further exposures when children are exposed to lead and/or remove children from the source of the exposure.
RAPID RESPONSE: RELOCATION, REASSESSMENT, EMERGENCY REMEDIATION
Public health agencies are often responsible for coordinating and providing follow-up care for children with lead poisoning. This often includes formal case management to ensure that the child is relocated and reassessed to continue to determine their blood lead level, and that the dangerous environment is remediated. Depending on the circumstance, the response can include further blood tests, a full medical evaluation, and/or a risk assessment of the home. Ideally there is interagency coordination between public health, housing, and environmental agencies to address lead poisoning and create safer environments for children.
In Chicago, as in many big cities, either the local or state health departments provide case management services including counseling about lead hazards and prevention, referrals for home inspections, and referral to other relevant social services and medical care.
As a result of lead poisoning, some children might have permanent developmental, intellectual, or behavioral conditions that require additional services throughout their lives. In these cases, children are usually integrated into already-existing programming for children with intellectual impairments, including special education support and other related services.
- Pew Charitable Trusts: 10 Policies to Prevent and Respond to Childhood Lead Exposure
- EPA: Lead Poisoning Home Checklist
- EPA|USCPSC|HUD: Protect Your Family from Lead in Your Home
- Lead and Copper Rule: A Quick Reference Guide for Schools and Child Care Facilities that are Regulated Under the Safe Drinking Water Act
- 3Ts for Reducing Lead in Drinking Water in Schools
- CDC Childhood Lead Poisoning Prevention Program
- Guidebook to creating a Lead-based Paint Enforcement Bench Book
- State level policies
- Trust for America's Health: Recommendations to Prevent and Mitigate the Effects of Lead Poisoning
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Note: These are highlights of selected activities going on in cities across the country, and are not meant to be comprehensive.