Lead does serious harm to the neurological system of developing children. This harm continues for the rest of their lives as there is no cure for lead poisoning. There is only remediation, as happens in classrooms for children with learning and behavioral problems. Consequently, much more attention needs to be paid to the primary prevention of childhood lead poisoning.
Blood lead levels have been steadily decreasing in the past two to three decades. This decline is generally attributed to the discontinuance of the use of leaded gasoline; however, this decreasing rate is expected to slow down, and lead poisoning is expected to continue as an issue, as the bans on lead-based paint and leaded gasoline might have already had the bulk of their effects. The rates are still much higher for African American children in urban areas. For example, in Cleveland, Ohio, a city with a majority black population, the proportion of children with blood lead levels greater than the level at which the CDC recommends public health action was 18 percent in 2011.
Lead abatement, the complete removal of lead-based paint or lead in the soil, is the preferred method of primary prevention; however, there are other interim or temporary approaches like encapsulation, where a liquid coating sealant is applied to surfaces with lead paint, but it is not yet clear how long or how well encapsulation works. Thus, abatement is the surest method. Abatement of lead from within houses addresses the problems of lead paint, while the abatement of lead outside of houses addresses lead in the soil which can be caused by paint as well as automobile exhausts and other emissions. Lead-contaminated soil is removed by digging and removing the topsoil to the depth of approximately one foot. While either approach is needed, depending upon the environment, I will focus here on lead abatement within the home.
Despite increasing attention to lead abatement, the most prominent prevention activity for lead poisoning is testing. Blood lead level testing is obviously not a primary prevention technique. With testing of children they are being used the way miners previously used canary birds. Miners would send a canary down a mine to test for poisonous gases. If the bird came back that was a signal that there were no poisonous gases and it was safe for the men to enter the mine. If the bird did not come back that was a signal that there were poisonous gases and the bird had succumbed. Similarly, with children, if we test them to determine whether their environments contain lead we may find out too late, after they have been poisoned.
Instead of testing the children, we need to practice more primary prevention and test and treat the environment–the home and the soil. That way we move closer to assuring that we can act before children are poisoned.
Participating in a conference on lead poisoning hosted by Cleveland’s mayor back in the early 1990’s I provoked a debate between a couple of environmental experts from Washington when I asked how much it would cost to remove lead paint from all the problematic homes in the country. One contended $20 billion and the other said it was more like $30 billion. Taking the more conservative $30 billion figure I argued against the prevailing sentiment in the room by claiming that $30 billion was not that expensive considering the problem. This was “only” $3 billion per year for 10 years AND most of the money would be provided to small businesses–lead abatement companies, a situation that Republicans as well as Democrats could accept. Furthermore, the money spent would be less than the economic costs of doing nothing. Unfortunately, lead poisoning prevention advocates never adopted this kind of approach.
At least one state, Massachusetts, addresses a part of the issue of lead in homes. The Massachusetts “Lead Law” requires an owner to remove or appropriately cover lead paint hazards in homes built before 1978 if a child under six lives there. If there is lead in the home, the owner must remove or cover it. When a buyer is about to purchase a home built before 1978, the owner must provide a copy of the lead inspection report and a letter of compliance. This law also covers all owners of residential rental property, as well as owners of single or multi-family homes.
Lead poisoning is probably our most serious urban health problem, and it is preventable. It is past time to begin more prevention efforts.