Lead prevention policy: Where we stand

By Catherine Wheeler

Dust from old lead-based paint is one of the biggest sources of lead exposure for children. Even if paint hasn’t chipped, it can still create dust. Photo by Catherine Wheeler

In the United States today, about half a million children ages 1-5 have high blood lead levels, according to the Centers for Disease Control.

Though the number of children with lead poisoning has gone down in recent years, effective policies to prevent lead poisoning remain minimal.

Current policy primarily focuses on what happens after a child has been lead poisoned rather than focusing on identifying and removing the lead in the environment, said Dr. Bruce Lanphear, a professor of public health at Simon Fraser University in Burnaby, British Columbia. Lanphear’s research focuses on public health and environmental hazard prevention.

Changing the focus to prevention would stop many children from getting sick in the first place, Lanphear said. “We are failing to protect children because we are finding it too late,” he said.

Forty-three states have some sort of lead exposure prevention laws on the books, but the laws vary in comprehensiveness and effectiveness. A few states and cities have model programs that could help. Experts say that prevention should be the national strategy to effectively combat lead poisoning in children. 

Prevention is important

Primary prevention is a strategy to lessen or eliminate hazards before the onset of symptoms, according to an Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control report from January 2012.

Once children are lead-poisoned, there is no way to reverse harm. Therefore resources should be focused on preventing exposure entirely, the report said.

At the time of its passing, the Residential Lead-Based Paint Hazard Reduction Act of 1992 was the most comprehensive national lead policy in the United States, said David Jacobs, chief scientist at the National Center for Healthy Housing, a nonprofit based in Columbia, Maryland. The law focused on childhood lead poisoning as well as worker lead poisoning, specifically targeting lead in paint. But now, he said, the policy needs to be updated.

While primary prevention is the goal, in reality local departments often don’t act until a child’s lead poisoning is discovered through blood tests.

“Primary prevention remains more of a goal than a reality.” Jacobs said.

Housing is the biggest source of lead exposure because there are many sources of lead within homes, such as dust and paint, Jacobs said.

Most states and local laws focus on reactionary strategies, such as what to do once children have been lead poisoned, , according to a policy paper from the Temple University Center for Public Health Law Research. “Research has clearly established that medical treatment for a child with lead poisoning is necessary but has limited effect,” according to the paper.

Though most states have policy aimed at prevention, the laws don’t go far enough in containing the source of the problem, said Katrina Korfmacher, an associate professor at the University of Rochester Medical Center who wrote the paper.


Policy Examples

Several states and cities have effective policies for removing or controlling lead hazards in homes.

Jacobs, a former director of the Office of Lead and Hazard Control and Healthy Homes for the Department of Housing and Urban Development, cited Rochester, New York as a good example of community lead prevention policy.

Rochester’s 2006 The Lead-Based Paint Poisoning Prevention ordinance presumes that homes built before 1978, when lead paint was banned, have lead-based paint on the interior and exterior, according to the law.

Deteriorating paint inside or outside of a unit is subject to inspection. Inspections first consist of a visual assessment. If deteriorated paint is spotted on or in a property built before 1978, it is assumed a lead hazard is present and it must be fixed.

Properties in high-risk areas that don’t reveal deteriorated paint have to conduct a wipe test to see if lead is present in dust. The health department uses data about elevated blood lead cases that have been identified to determine high-risk areas, according to the law.

To clear violations, property owners must fix those hazards. Property owners need a clearance test by a private inspection firm, which includes visual and dust tests, Korfmacher said.

This law also takes into account lead in soil within a home’s dripline, which is where lead paint chips may fall. Korfmacher said in initial soil testing around homes, some results reached the level to be classified as hazardous waste.

In 2005, 621 children in Rochester were screened with blood lead levels above or equal to 10 micrograms per deciliter. In 2015, that number decreased to 170, according to data from the Coalition to Prevent Lead Poisoning, nonprofit advocacy organization based in Rochester.

The National Center for Healthy Housing cites the 1971 Massachusetts lead law as one of the first lead prevention laws as well as a model policy. It requires property owners to remover or cover lead based paint hazards in any unit that has a child under the age of 6 living there. This means that property owners need to be aware of lead hazards and fix issues that arise.

In addition, property owners are held strictly liable for any harm that comes from lead hazards, which means owners are responsible even if they didn’t know there was lead paint in the home. To help with costs, the state set up financial assistance to help fix lead hazards, according to the law.

Jacobs said the Massachusetts policy is proactive in requiring testing before children live in the home.

Lead poisoning and its effects

While policy to prevent lead poisoning is ideal, millions of children are still exposed to lead.

Even though blood levels today are 80 to 90 percent lower than they were in the 1960s and 1970s, lead is still a big issue in the U.S., Lanphear said.

Blood lead levels today are about 10-100 times higher than they were before the Industrial Revolution, Lanphear said. Humans never developed a tolerance for lead, and there is no safe level of exposure, according to the CDC.

Lead exposure in children happens when there is a “confluence of mouthing and mobility,”Lanphear said. When children start putting things in their mouth and learn to crawl or walk, they increase the likelihood of lead exposure. The source of lead exposure can likely be found where the child spends most of his or her time, Lanphear said.

Lead is a toxin that affects multiple parts of the body, Lanphear said. Lead can affect the brain, kidneys and bones. It’s one of the most well-studied toxins.

Some of the most common effects of lead poisoning for children are IQ deficit, diminished academic performance, ADHD and conduct disorders and later criminal behavior, Lanphear said.

As a child’s blood lead levels rise from zero to 100 parts per billion, the child’s IQ drops about six points due to lead poisoning in the blood, he said. “Children who are more heavily exposed to toxins won’t reach the same peak cognitive ability as those who have lower exposures,” Lanphear said.

For adults, high blood lead levels can result in kidney disease and hypertension, he said.

Lanphear said there is no drug to treat lead poisoning. That’s why identifying the problem and preventing it is the best step in reducing blood lead levels.

The largest source of lead varies from place to place, Lanphear said.

He said paint, dust, soil and water are all sources of lead exposure. Korfmacher said dust is an important source to watch out for because even if paint is intact, it can still create dust that children can be exposed to. The dust can go from a child’s hands to his or her mouth, Korfmacher said.

Lanphear said his goal is to train young investigators, policy makers, physicians and parents to look out for all sources of lead, rather than primarily focus on the effects.

Dr. Jennifer Lowry, section chief of toxicology and environmental health at Children’s Mercy Hospital in Kansas City, said children 1-2 years old who use Medicaid must be tested for lead poisoning, but doesn’t always happen in private physicians’ offices.

In Boone County, the health department follows guidelines from the Missouri Department of Health and Senior Services for lead testing, said Kristie Griffitts, a public health nurse in the Columbia/Boone County Department of Public Health and Human Services.

If a child tests at or above 5 micrograms per deciliter, the parents are notified, and Griffitts begins education with them about possible exposure and how to minimize effects. The child is retested every couple of months until his or her blood lead level is below 5 micrograms per deciliter, Griffitts said.

Griffitts said she suggests nutrition changes for the children once they test high for lead. Consuming more calcium, iron and vitamin C can decrease the absorption of lead. She also encourages regular meals and snacks to decrease the chance a child will want to chew on something hazardous.

Engaging a child’s brain can help reduce the effects of lead exposure on a child’s cognitive capabilities, Lowry said.

Boone County tends to have a relatively low number of elevated blood-lead cases, Griffitts said. In 2015, Boone County reported six to seven children tested above five micrograms per deciliter, and two tested above 10, she said.

The next steps

Jacobs said lead should be removed from paint and other products.

Paint companies such as Sherwin-Williams still produce lead-based paint and sell it in countries where it is still legal, Jacobs said. Azko Nobel, the world’s largest paint company, which is based in the Netherlands, removed all lead from its paints, and all paint manufacturers should do the same, he said.

Governmental funding is an important part of creating effective preventative policies.

The recent budget proposal from the Trump administration threatens to eliminate Environmental Protection Agency funding for its lead programs.

The National Safe and Healthy Housing Coalition and National Center for Healthy Housing wrote a letter to Scott Pruitt, the administrator of the EPA, asking him to continue to fund the Lead Risk Reduction Program and keep giving grants to states for lead.

Additionally, the center and coalition recommend policies to remove lead hazards through its Find It, Fix It, Fund It program.

To create lead prevention policy, especially at the local level, Korfmacher said communities first have to recognize what their community’s particular needs and resources are.

“Lead doesn’t go away. It’d be great to get the lead out of all homes,” Korfmacher said. “In the meantime, coming up with a way to address lead hazards facing the children is the focus of today.”



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