At City Club 03.31.05 - "Ending an urban epidemic: eradicating lead poisoning of our youth"

Submitted by Norm Roulet on Fri, 04/01/2005 - 01:30.

At a very special City Club event, on March 31, 2005, Cleveland brought to town a world-expert on "Ending an urban epidemic: eradicating lead poisoning of our youth", following which area leaders kicked off "Greater Cleveland's Plan to Eliminate Lead Poisoning by 2010". The goal of this forum was to share expert perspectives on the enormous lead poisoning emergency in Northeast Ohio, and establish an oversight entity called the Greater Cleveland Lead Advisory Council to drive for measurable improvements. Mayor Campbell was here to champion this initiative, and representatives of regional government agencies, foundations and health and human service organizations were here to show their leadership - the Lead Advisory Council is real, well funded, organized, spirited, enlightened, collaborative, and positioned to change the future of this community and the lives of 100,000s of children forever here after!


The expert presenter was Dr. Mary Jean Brown, chief of the Lead Poisoning Prevention Branch at the Centers for Disease Control and Prevention, who reported on the federal government's plan to eliminate lead poisoning in America's children by 2010. The issue is summarized in the City Club announcement of this event:

Lead poisoning can be a devastating illness for young children. It affects their intellectual development and behavior, impacts their capacity for normal cognition and retention, and prevents them from reaching their full potential. All too often, children living in poverty are disproportionately affected, compounding the disadvantages that they already face.


In Cleveland, lead poisoning is the top environmental hazard facing our children. One in every five children tested is found to have lead poisoning; in some city neighborhoods, the rate is as high as 50 percent—one of the highest in the nation.


In 2000, the federal government drafted an ambitious plan to eliminate childhood lead poisoning in the United States by 2010. To address the epidemic here, the Saint Luke’s Foundation has approved a $1.3 million grant to eradicate lead poisoning in Greater Cleveland in three years.

Dr. Brown began her presentation explaining she is a "hometown girl", having grown up in Cleveland and practiced as a nurse at MetroHealth. She has dealt first-hand with lead poisoning here, and gone on to lead the battle against lead poisoning for the nation - she believes we can have remarkable success by 2010, and that NEO is well positioned to achieve success, for many reasons. 

No safe blood lead level has been identified - no lead level is acceptable - we must continue/expand screening and intervention for high blood lead level. Children with high blood lead levels need immediate intervention - must provide additional education support early... that makes a difference.

First, to consider the problem. Lead has been dealt with as a medical condition, when identified through testing, which is too late to avoid the harm caused to children - by the time we see there is a problem the damage is done. Thus, we must accept that new research and the continuing medical approach will not prevent damage associated with high blood lead levels - we must eliminate sources of lead poisoning. Thus, three federal agencies working hard developing better programs to eradicate lead - Centers for Disease Control (CDC) - Department of Housing and Urban Development (HUD) - and Environmental Protection Agency (EPA) - but it is all our jobs to drive success.

CDC has risen to challenge to put together elimination plan - CDC does research on high risk situations and provides information services. HUD evaluates housing stock and trains workforce - works to eliminate risk in public housing - provides grants for lead control including two to Cleveland and two to Cuyahoga County. They also enforce code and establish standards for lead and environmental media.

Over next year CDC, HUD and EPA will drive many exciting new programs. For example, housing receiving subsidy from government will no longer be allowed to have lead issues. They've been looking at repeat offender environments (landlords who refuse to remedy lead problems) - Mayor Campbell compared current situation to society using children like canaries to see if there are health hazards - the fact is there are many repeat offenders and they cause great harm to our children and society. Of properties that cause lead damage, 40% are government subsidized (e.g. receive Section 8) - that must stop... in future housing with lead problems will not receive government subsidy. Also, new programs will enforce better more honest disclosure of lead hazards in real estate transaction.

This enforcement effort so far has led to 10,000 houses being brought into compliance. When CDC piloted this effort, Cleveland was an early pilot because we have serious problems and the political leadership and infrastructure here is supportive. With collaboration we will achieve a safe housing stock.

Risk for lead exposure in greater Cleveland is 14% overall, but disproportionately high in some urban areas of Cleveland and inner ring suburbs (up to 50%). Nationwide average of children with elevated blood lead levels is 1.6% - Cleveland is nearly 10X that. Such problems are common in older cities - we are about the same as Philadelphia. But, Boston is only 3% and New York is 1%. They have largely eradicated the problem because for decades they've had support for very stringent testing and preventing children from ever having elevated blood levels - they have been very supportive of intervention and responsive to resident concerns. They do not have successive lead poisoning - repeat offenders. If residents call health department they will respond.

In Boston, where Dr. Brown now lives, she points out to residents that Boston won the World Series and so should now feel challenged for Boston to defeat NY in lead poison eradication (3% vs. 1%). Today, she challenges Cleveland (14%) to do the same... beat Boston... beat New York. 

As part of a new statewide lead eradication program in Ohio, the government will declare lead-problem houses as uninhabitable. Cuyahoga Country is looking to develop similar ordinances.

Dr. Brown sees state, counties and cities working together - most exciting, we use resource management to leverage foundations' support. Here, we have St. Luke's working with Invest in Children and respective health departments, faith based education, and welcome home and mom's first programs to effectively reduce exposure of babies to lead, and St. Luke's has provided $1.3 million for the program. Few other cities have been able to collaborate so effectively. Plans put together are not just goals but accountability and evaluation based programs working with health departments - wonderful, specific, accountable efforts.

Although lead paint is primary problem and the focus of most programming, there are lead problems with food and other products - many sold for use by children. E.g. 1.5 million lockets from China were found to contain lead - immigrant families bring lead contaminated things here, like lead painted bowls from Mexico - Target and Wal-Mart have recently been found to sell consumer goods like sweaters and chalk with lead. There needs to be better regulation of such products.

An interagency task force is the best approach to develop and promote solutions and that is in place. Unfortunately, we are still largely reacting rather than finding causes in advance. We in fact need to be concerned about lower blood lead levels than we have in the past - this problem is very real and won't go away without real action by everyone working together.

She is hopeful we develop a system that responds to problems - e.g. there was lead in a tea kettle that caused harm to children, and the food and drug administration is responsible for that - we need to pull together better strategies.

She concludes that our jurisdiction wide lead eradication plan is a good collaboration and we are well positioned to find problems before 2010, here in NEO.

Special gathering immediately following this on Cleveland's plan to address lead poisoning... first, questions and answers.

Q. Lead is everywhere - and pregnant mothers can get exposed - what about impact on babies in uterus?

A. Lead will follow calcium and will cross over to babies. There are several populations that are at high risk, like recent immigrants from where lead is common. Also, women who were lead poisoned in youth will store the lead in hard bones and expose nursing children to lead from hard bone liberation of calcium. There also is lead in cigarettes and wine and is lead transfer is more risky when mother's calcium levels are low - encourage mothers to avoid those risks and to not be involved in any renovation work.


Q. Which agency regulates tattoo parlors - they are known to be risky

A. Local regulation


Q. Addressing CDC, a doctor points out he believes there is no cost benefit in kelation (medical treatment for children with elevated lead levels) - is it worth doing?

A. In the old days when there were issues of life threatening lead levels, kelation was common - clear it is important for kids with high levels, as that saves those lives. Where there are reduced levels this is not advised - it will not reverse cognitive problems caused by lead. Once children have elevated levels the damage is done. Intellectual stimulation of mildly impacted children may help reverse some problems.


Q. Do grown ups develop problems from lead?

A. Some, usually from lead in the air (e.g. work on bridges sanding and painting) or if they use a product with lead added for "medicinal" value.


Q. We were told in an environmental forum there is need to elevate allowable lead standard from 10 to 20

A. She has seen pressure to change from 10 to 5 - rather than continue to medicalize this disease, which does not work, CDC believes it is more efficient to spend resources on primary prevention activities that reduce exposure across the board. Community-wide interventions help all children in area.


Q. You mentioned animal studies about stimulation helping to reverse problems of lead.

A. There are Head Start studies that found stimulation reduced problems with cognition and behavior resulting from lead poisoning. They have experimented with rats placed in stimulating environments - rat head start - and the rats that went through the stimulation have bigger brains with more connections - applies with lead exposed rats, as well - need to do a similar study with children.


Q. Parent has child who reached lead level of 70 - spoke with Campbell about this and they started parent based organization that has been valuable.

A. Dr. Brown suggests this mother come to the Lead Advisory Council meeting in the Pogue Room to speak with others about her interests - also offers to connect her with parent who is on her advisory panel and who has had same issues with her own child.


Q. Cleveland high school graduation has increased at the same time lead has gone down - connected?

A. Research has shown reducing lead improves graduation rates and reduces criminal activity. Difficult to prove but certainly connected.


Q. Traditionally in public health we look at the "carpet crawlers" (ages 0-2) as most effected by lead but is seems they are now also looking at 3-4 year olds

A. That is true, given what has been found in local research (Dr. Feingold) - CDC has found up tick in blood lead levels at 4 so they are exploring.


Q. What about regarding lead exposure in outside environment?

A. Lead paint was resigned to chalk and that has all gone into soil. Around drip line of older houses you could mine lead. That makes yards around old homes dangerous, and residents must beware intrusion into house. Children absorb lead from both inside and outside. Soil removal does not seem a viable solution but using doormats does help keep lead out.


Q. A mother in the audience is disturbed there are such high lead levels in unexpected products like lockets and tea kettles - is there a way to test?

A. There are some chemical tests available and they determine if there is lead but not how much - we have spread so much lead around the environment that there is some lead in just about everything now.


Q. How does the US compare with other developed and developing countries.

A. Northern Europe banned lead in late 1800s - "got it" a lot faster than we did - they banned lead in gas earlier and have even banned lead in shot and weights. Sub-Saharan Africa still uses leaded gas - and in Indonesia and Haiti. There are other cultural practices that put people at risk - e.g. Mexican pottery. We're not #1 - we're in the middle.


Q. Are there written guidelines for HUD and what are the incentives and penalties for landlord compliance, and why are some races more exposed and effected.

A. HUD has specific regulations for subsidized properties in Title 10. In terms of property owners this is a big issue - there are carrots in grants to support property owners to make houses lead safe and there are penalties for property owners who do not make houses lead safe - and failing to disclose is an issue in sales, with penalties. In terms of racial disparity, the issues include past housing discrimination, poverty factors, high turnover, lack of iron and calcium in diets.


Q. Some painters have said there are outpatient treatments that help in the way of kelation.

A. OSHA is working on regulations to better protect workers but only for large businesses - very difficult to use for small employers. She does not know of outpatient kelation. Best to wear protective clothing and mask and not to bring dust into homes with children.


Observations in conclusion. The federal, state and local governments are serious about dealing with lead, but it is a challenge. Lead is everywhere, especially in older cities like Cleveland - in the soil and in homes. Much lower levels than people imagine cause much greater harm than anyone attributes. Harm includes learning disability and increased crime. If NEO is serious about having successful children, successful education systems, and a successful economy, we must accept we have a tragic lead exposure problem and do much about that.

On the bright side, we have awareness of what can and must be done. We need a region-wide public awareness campaign on these issues and remedies. More children must be tested for elevated lead exposure - the City of Cleveland, University Hospitals and Kaiser all conduct these tests. Older houses must be inspected for lead hazards - our government must provide the testing and residents must ask for that - demand that - contact your city health department and if not satisfied contact the Center for Disease Control. As there is better testing of children and property, and better management of outcome data, hot spots will be identified and eliminated. Property owners must fix hazards - government must help with that. There are programs to help - check with your city and county for information. Property owners that do not remedy lead hazards must be pursued and prosecuted - a mind is a terrible thing to destroy, especially in an innocent young child.

For more on solutions being initiated in NEO, read the write up on "Greater Cleveland's Plan to Eliminate Childhood Lead Poisoning by 2010".