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When It Comes to Lead Poisoning, Prevention Is Key

Three people working to improve the prevention of lead poisoning in children share successes and challenges they see and what more is needed to protect the human capital of tomorrow.

Decades after the United States banned lead paint and leaded gasoline, children are still suffering from lead poisoning, and the risk of it here, in the region served by the Cleveland Fed, is higher than in similar regions of the country.

“Individuals’ health outcomes are largely determined by where they live; the idea is that one’s life expectancy is linked more to zip codes than genetic codes,” says Mary Helen Petrus, assistant vice president of the Bank’s Community Development Department.

“We’re at heightened risk in this region [the Fourth Federal Reserve District comprises Ohio, western Pennsylvania, the northern panhandle of West Virginia, and eastern Kentucky] because so much of our housing stock is wood frame and old—built prior to 1978 when lead-based paint was banned,” Petrus continues.

Lead is in the environment also because of the region’s industrial past, adds Lisa Nelson, a Cleveland Fed community development advisor. “By virtue of having the old industry, there’s a lot of lead in our soil,” she explains.

Recent concerns made evident by media reports about lead poisoning crises within the Fourth District—specifically in Cleveland—and outside of it, namely in Flint, Michigan, motivated the Cleveland Fed to in 2016 publish a brief that examines impact studies and remediation efforts both locally and nationally. The Bank also convened a forum to stress the importance of lead poisoning prevention to the economic vitality of the region.

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Ten presentations delivered during the Cleveland Fed’s forum “Addressing the Impacts of Lead: Moving Toward Prevention” are available online.

“This issue has been a concern within our region for decades, particularly in the most distressed areas,” Nelson says. “Research has documented the negative impact of lead exposure on kids’ educational outcomes and on their ability to reach their full potential in life. Nothing has been found that can fully mitigate the effects of lead on children once they are poisoned.”

That reality makes efforts to prevent lead exposure essential. Such efforts are most effective if the various experts who touch families’ lives, from pediatricians and public health experts to community developers and educators, work together to increase prevention, Nelson says.

To that end, the Cleveland Fed’s November 2016 forum, “Addressing the Impacts of Lead: Moving Toward Prevention,” sought to encourage the sharing of best practices and research among academia, nonprofits, government agencies, and healthcare providers. Roughly 60 stakeholders in Cuyahoga County attended.

The lead poisoning of children today has serious implications for the human capital of tomorrow. “Decades’ worth of research has linked lead poisoning with reductions in IQ, poor educational outcomes, behavioral challenges, attention disorders, and criminal activity,” reads the conclusion of Nelson’s August 2016 report, “Lead Poisoning and the Children of Cuyahoga County.”

The report continues, “The costs associated with lead-exposed children estimated by economists, physicians, public health experts and others may differ, but there is considerable consensus that the societal and economic costs associated with lead-poisoned children are substantial.”

While lead poisoning may seem an intractable issue, there are models of mitigation that have shown success, Petrus and Nelson say.

Recently, Forefront asked 3 of the forum’s speakers to discuss promising approaches to lead poisoning prevention. An edited transcript of our conversation follows.

Coulton: It’s most prevalent in housing, both single-family and multifamily housing, that’s suffered disinvestment and a lack of upkeep and maintenance. Here in Cleveland, the current pattern of lead poisoning very much tracks the redlined areas from the 1930s and 1940s—the same areas affected more recently by rampant foreclosures and subprime mortgages, where homes were left empty. That’s where it’s concentrated here. Nationally, in newer cities, the patterns are different. And in Flint, Michigan, we know water was the source of lead.

O’Leary: We know with our city being the age it is and the construction type it has—largely wood frame housing and most of it constructed before 1978 [when lead paint was banned]—that this is going to be an issue throughout every neighborhood in the city, but the higher concentrations of elevated blood-lead levels tend to be in areas of the city where there are other maintenance issues. What we’re doing is pulling in information about where elevated blood levels are highest, and that’s where we will begin to focus our rental property inspection program when we get it started later this year. Previously, we’ve inspected rental properties on more of a complaint-driven basis and based on orders from our housing court; we’ve been planning for some time [to] implement a systematic rental inspection program. Rentals are a business, and the landlords should be appropriately maintaining the rental units in a way that’s safe for tenants.

Coulton: Our research points to single-family and 1- to 4-unit properties as most important to monitor. Being sure to track where it’s happening is important. There’s a good possibility a child will end up being in that unit again in the future.

O’Leary: Landlords have a business enterprise, and often the margins are very tight; we don’t want to have any more vacant properties than we already have. We are concerned about our efforts leading to displacement and vacancy, but not at the expense of people living in unsafe housing. The landlords are responsible for maintaining their properties up to code. That is the bottom line. But we have to be practical and acknowledge that some landlords will need access to financial resources so that they don’t allow their properties to become vacant. We want to provide direction to those landlords as to where they can find resources to correct violations. That way, we have safe places for people to live.

Korfmacher: The community partnership that we have in Rochester is the most critical thing. We have this beautifully simple but elegant system of rental inspections that is very efficient and cost-effective. We have a holistic collaboration of the county health department, the city housing department, and community groups, and that helps us look at the data and make adjustments for what’s needed. For example, initially under our proactive rental inspections, we were doing dust wipes in all types of units on the same inspection schedule, but we found that 91 percent of kids with elevated blood levels lived in dwellings with 1 or 2 units. Only 9 percent lived in buildings with 3 or more units. So the city stopped doing dust-wipe testing [the process wherein wipes are used to test surfaces for lead dust] in larger structures.

O’Leary: We have so few resources to deal with lead paint—that’s my main concern. Much of what I’ve done, and our staff in building and housing has done, has focused on demolishing and securing vacant structures that are nuisances. We’ve demolished more than 8,800 structures since I joined the department in 2006. Our cost has been more than $68 million. There are, ballpark, another 5,000 structures that should be demolished and, at an average of $10,000 per demolition, there’s $50 million more in demo dollars needed right there. The amount that it would cost to really deal with lead far exceeds what we’ve done with demolition. You can appropriately maintain the lead paint to keep it safe—and those measures are relatively cost-effective—but the truth is you can’t maintain something indefinitely without constant focus on it. The cost to remediate all of the lead paint? I don’t have an estimate.

Korfmacher: In Rochester, by putting into place clear expectations and incentives for property owners, we have shifted the focus: For little incremental cost of maintaining paint and friction surfaces, property owners have been able to significantly raise the floor with regard to lead safety in rental housing. As a result, the number of kids with elevated blood-lead levels has come down 2.4 times faster than other upstate cities that do not take this approach to controlling lead hazards. I do think that the belief that we need to remove all leaded paint from buildings in order to address the problem is a barrier. It means people are afraid or reluctant to take the first step to make it better. Before adopting our law, the only model that people were aware of was full abatement, but that was not going to work with Rochester’s housing market. As Ron said, I can’t imagine how much it would cost to remove all of the lead from Rochester. That was stopping people from asking, “What can we do? If we can’t remove it all, let us do what we can that is sustainable and cost-effective.” It hasn’t eliminated lead hazards, but it has improved the lead safety significantly.

Coulton: It would seem that these lead-safe practices can also be disseminated effectively to homeowners. I don’t know that the models for that have come as far.

Coulton: We saw this very well demonstrated at the recent Cleveland Fed forum, specifically the sharing of statistics on the effectiveness of the program in Rochester and other studies demonstrating the impact of not-complete-abatement, lead-safe programs. I’m very encouraged that those rigorous studies are there and that people who have done them are willing to share their best practices. We can monitor the impact of programs here using some of the methodologies used elsewhere.

O’Leary: Our staff has worked with Rochester and a number of other cities helping us to develop best practices, and that’s tremendously helpful to us as we try to develop our program.

Korfmacher: People are recognizing that this isn’t a problem that one department or one sector can solve. You really need private, not-for-profit, and government groups to work together. Also, the sharing, the collaboration between cities—Cleveland doesn’t have to make all of the mistakes and learn all of the lessons we and others did.

O’Leary: It’s largely buildings that cause the problems. There are toys with lead paint on them and housekeeping issues where people are tracking in dirt from outside that has lead dust in it. But when we know that the structures themselves are so frequently the source of the lead poisoning, the responsibility is with the building department in any local government. That’s why we’re focused on that right now.

Coulton: I agree with Ron, the city is the authority regarding housing codes and rental registry and so forth. However, I feel like there is a lack of awareness, a lack of really actionable, systematic information about lead that’s being given to parents of newborns. I don’t think we have a message yet empowering parents to ensure lead safety or to insist that their landlords do it.

Korfmacher: Make sure paint is intact, remove paint on friction and impact surfaces, if possible replace windows, cover any bare soil, and use lead-safe cleaning techniques. In all cases, make sure to hire RRP- [Renovation, Repair, and Painting] certified contractors if you are doing any work that disturbs paint, and watch to make sure they use lead-safe work practices.

O’Leary: There are best practices for safety for dealing with lead paint. Those include proper ways to remove it: don’t use a sander on lead paint, don’t use a heat gun to help strip it, make sure to put down plastic or a drop cloth to catch paint chips outside versus letting them go into the grass. Be sure you keep the house clean. Lead poisoning oftentimes is from the dust from lead paint. It also can be tracked in: You walk through the grass, you track dirt in. Sometimes the concentration of lead in the soil in a tree lawn is very high because we used to use leaded gasoline for automobiles.

Korfmacher: Don’t panic—remember that more than 90 percent of people my age had lead levels we consider very hazardous today—but do take immediate action to find and remove the source of lead. As soon as possible, test your house and other pre-1978 places where the child spends time. Continue to test every 3 months until levels come down. And while it won’t prevent or cure lead poisoning, making sure the child has regular meals and a diet rich in iron and calcium won’t hurt. Finally, communicate with the school to make sure the child is proactively tested for learning or behavioral problems and offered appropriate early intervention and enrichment services.

Coulton: Lead exposure in children is just one of the negative consequences of housing disinvestment. Poorly maintained housing also exacerbates health problems (e.g., asthma), contributes to parental stress, and is associated with residential instability. Moreover, disinvested areas have a lot of vacant housing, which is associated with crime and social disorder, and these have negative effects on children.

O’Leary: Things that are safety issues for adults are safety issues for children. The things that our rental inspection team will be looking for include peeling paint. We’re also looking for things like operational smoke and carbon monoxide detectors, excessive use of extension cords (which is a huge fire hazard), and plumbing leaks that will cause mold. For me, if I see peeling paint and I see no smoke detector, the immediate concern is the lack of smoke detector.

Korfmacher: I’d say the first step is tenant education so residents know their rights and responsibilities. The second is access to free legal help to enforce those rights. As for physical challenges, I would put safety first (fire, trips and falls), followed by asthma triggers (mold, pests, etc.). On the larger scale, we should strive for a housing system where people (residents, landlords, agencies, and housing systems) don’t have to make tradeoffs between affordability and safety/quality.

Sum and substance: The lead poisoning of children can limit their future potential. Prevention of poisoning is key, and some city leaders are improving outcomes by regularly inspecting rental housing stock and encouraging landlords to take steps to mitigate risks.

—Michelle Park Lazette

The Experts

Claudia J. Coulton

Claudia J. Coulton

Professor, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University

Founder and co-director, Center on Urban Poverty and Community Development, Case Western Reserve University
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Ronald J.H. O'Leary

Ronald J.H. O’Leary

Director, Department of Building and Housing, City of Cleveland
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Katrina Smith Korfmacher

Katrina Smith Korfmacher

Director, Community Outreach and Engagement Core, Environmental Health Sciences Center, University of Rochester Medical Center

Associate Professor, Department of Environmental Medicine, University of Rochester Medical Center
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