Lead Poisoning: Changing the Paradigm from Treatment to Prevention

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March 21, 2016; NPR, “Shots”

NPR offers an overview of Baltimore’s 66-year struggle to overcome childhood lead poisoning. Baltimore banned lead paint in 1950, nearly three decades before the rest of the country. Grassroots activism emerged early there, with a volunteer effort among parents that began in 1986 and became the national Coalition to End Childhood Lead Poisoning, which was instrumental in the passage of federal legislation between 1971 and 1989. According to NPR, “Baltimore has seen a dramatic decline in cases of lead poisoning, down 86 percent since 2002.” Even with this history, children continue to be poisoned by their homes and schools. The NPR story, in a “he said, she said” style, almost asks the key question: Why are children still being poisoned?

Federal action on lead poisoning required local government to adopt a “treatment” approach that set the course for lead programming for the next forty years. Here’s the irony: The decision to “treat” rather than “prevent” has been a source of frustration for activists since the 1980s. NPR’s story quotes Ruth Ann Norton, a longtime lead activist in Baltimore, saying, “There’s only one cure for lead poisoning, for the irreversible, high-cost impact of lead poisoning, and that’s prevention.”

The other contribution of federal “treatment” policy has been an intermittent and unreliable flow of funds to state and local agencies. Unlike the federal community development block grant, which flows in predictable amounts to eligible communities, lead grants are competitive. The fact is that federalized funding has let state and local jurisdictions off the hook. In Cleveland, for example, when 10,000 reports of poisoned children went uninvestigated for five years, the excuse was “our federal funding was cut.” The reality is that until local jurisdictions have skin in the game, there will be no effective prevention. Poisoned children will continue to be a revenue line item for state and city bureaucrats.

And then there’s the problem of federal silos. When it comes to lead, the Environmental Protection Agency addresses water systems in cooperation with state environmental bureaucracies. Housing and Urban Development does remediation through public housing authorities, private owners of subsidized properties, state and local health departments, and city- and community-based nonprofits. The Centers for Disease Control sets lead treatment standards for medical practitioners. Center for Medicare and Medicaid Services handles standards for program recipients and state offices.

One hopeful sign is the California liability suit against the paint industry. A successful outcome will go a long way to answering the question, “Who bears the cost of remediation?” David Rosner and Gerald Markowitz share insights into years of fighting the lead industry over liability for lead poisoning in their new book, Lead Wars:

Cases now underway, including in California, seek to hold lead paint and pigment manufacturers financially responsible for removing lead paint. In previous cases, notably one involving some 240,000 Rhode Island homes, juries have ruled against the manufacturers. But those verdicts were overturned on appeal.

“So as of now,” explained Markowitz and Rosner via email, “no lead company has been held liable.”

A national trust fund for lead remediation would be a nice steady stream of funding, analogous to the tobacco settlements, but hopefully better managed,

Local efforts in Toledo and Rochester to require lead safe certifications before permitting rental could clean up the housing stock by remediation or demolition. Carefully crafted, local initiatives can provide insights into how creating lead safe housing will affect the affordability of rental homes.

Absent a new federal commitment to a prevention strategy, what sector will be the new lead czar? Maybe the initiative for a new paradigm must come from health providers; with ACA focus on population health management and a mandate for prevention, it would make sense for the healthcare industry could spearhead a national effort. State and local public health agencies could coordinate programs through local housing, education, and community organizations to root out poisoned houses and demand remediation or demolition. If health organizations won’t step up voluntarily, maybe another ACA “nudge” would do it. Oh…and advocates could hold the system accountable and politicians reassure to public that lead poisoning is not personal, racial, or ideological.—Spencer Wells