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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.

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Lead Poisoning: More than Just a Health Concern

By Linda Kite

Lead poisoning is generally considered a public health success, and for the most part it is. Where we’ve failed to make meaningful and sustainable progress is in very low-income communities of color.  Many people in those communities are tenants living in housing of last resort and facing a myriad of socio-economic issues. For them, lead poisoning is another social determinant standing in the way of improved health and well-being.

Pockets of lead poisoning

In Los Angeles there are pockets of lead poisoning prevalence rates that far outpace the rest of the county and state. There are also poorly performing schools, violence,  higher crime rates that coincide with higher rates of imprisonment, and a cycle of poverty that seems insurmountable. In that context, perhaps it’s not surprising that decades of studies make the correlation between lead poisoning and learning disabilities, behavioral problems, violence, and loss of future income. The data also show that if we spent less than $10,000 per home removing lead-based paint hazards, we’d save public resources and lives.

None of this is pie in the sky abstraction.  It’s concrete and real, especially to communities that have been saddled with these problems for decades. As a society we seem to have accepted that social determinants of health exist and all we can do is document them. But lead poisoning is mainly preventable.  Such simple steps as keeping paint intact, and ensuring that old double-hung windows and old door jams are replaced, are key to preventing poisoning. In some cases backyards have been contaminated with soil from old lead paint or from decades of leaded gasoline, but more often children are poisoned in their homes.

When I started as a community organizer in the field of lead poisoning prevention in 1992, I figured it would be a six-month campaign and I could move on to more complex issues. It is now twenty-two years later ,and while L.A. has made great strides and important legislative reform, we have only scratched the surface.

Doctors and prevention

Doctors play a critical role in preventing lead poisoning. Every child must have a well-child physical at twelve and twenty-four months that includes a blood lead test. The twelve-month test provides a baseline, and the twenty-four month level tells us if there is something extreme going on in the child’s environment that needs to be addressed. While it is not primary prevention to use the child as the lead detector, it is a standard of care.  If the child’s blood lead test is higher than accepted levels (experts use a reference level of 5 micrograms per deciliter to identify children with blood lead levels higher than most), this will trigger other interventions to prevent the child’s lead level from increasing further.

Once exposure has been diagnosed, a housing inspection should occur at the child’s home to identify the source of lead exposure and authorize necessary improvements.   Low-income homeowners can generally find relief with Housing and Urban Development (HUD) funds that municipalities administer.  In many cases, children who have been exposed to lead are also eligible for educational interventions such as speech therapy. The science indicates that if we provide interventions before the age of three, they can help remediate long-term learning or behavioral issues.

The benefits of improved housing conditions transcend the lead poisoning issue and include improved safety as well as self-esteem. Most children who live in housing of last resort are ashamed to invite their friends over, and there is limited capacity to instill civic pride in these same children. This becomes a clear-cut environmental justice issue whose ramifications cost society at large.

Affected child

In one Healthy Homes Collaborative case, a two-year old living in an old Victorian home with her mother, her grandparents and her siblings had an initial blood lead level of 30 micrograms per deciliter. The owner was ordered to abate the hazards and was referred to HUD funding at the city for assistance. He instead decided to do the repairs himself. After six months of improper repair work, the two-year-old’s blood lead level spiked at 173 micrograms per deciliter and she was hospitalized. The child’s mother was told not to return to the home, but she could not afford to go elsewhere.

The affected child is now seven years old and unfortunately is having a terrible time with school, learning and behaving. She is often suspended for hitting other children. The property owner who poisoned her by failing to do proper repairs? He unloaded his assets and filed for bankruptcy; the personal injury case against him was discharged like the rest of the consumer debt. He has since re-acquired the properties and is back doing business as usual.

The affected child will need special education services for the remainder of her school career, which is far more expensive than the original $10,000 it would have cost to repair her home correctly. Loss of IQ as well as her ability to be a productive member of society is an additional cost to her, her family and the general public.

References:

  1. National Toxicology Program. NTP Monograph on Health Effects of Low-Level Lead. June 13, 2012. Office of Health Assessment and Translation Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.
  2. Gould, Elise. Childhood Lead Poisoning: Conservative Estimates of the Social and Economic Benefits of Lead Hazard Control. Environ Health Perspect. Jul 2009; 117(7): 1162–1167.
  3. Grosse, Scott D. 2007. How Much Does IQ Raise Earnings? Implications for Regulatory Impact Analyses. Association of Environmental and Resource Economists (AERE) Newsletter. 27(2): 17–21.
  4. Grosse SD, Matte TD, Schwartz J, Jackson RJ. 2002. Economic gains resulting from the reduction in children’s exposure to lead in the United States. Environ Health Perspect 110:563–569.
  5. CDC’s Healthy Homes and Lead Poisoning Prevention Program.

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