Addressing lead exposure through partnerships, funding and policies

Victoria Patton, BA (Healthy Homes Coalition)

Olubukolami David, MPH, Katherine Robb, MSPH (American Public Health Association)

Exposure to lead, even in the smallest amount, is a threat to achieving overall health and well-being, as there is no safe level of lead, especially for children. Children, whose bodies are still developing, are also at increased risk of neurological and behavioral defects, which are often irreversible. 

Black and Indigenous children, People of Color (BIPOC) communities and communities with lower socio-economic status are disproportionately burdened by exposure to lead due to their surroundings at home, playgrounds, childcare facilities or schools. These health inequities and injustices are strongly attributed to structural racism. Historic and present-day U.S. policies, including exclusionary zoning and redlining, have enforced residential racial segregation, limiting housing options and economic opportunities for communities of color and indigenous communities, enhancing their risk of exposure to environmental health hazards such as lead and resulting in poor health outcomes.1 

Over the decades, there have been various efforts tailored toward reducing childhood lead poisoning, with the more recent lowering of CDC’s blood lead reference value from 5 μg/dL to 3.5 μg/dL, intended to facilitate earlier interventions.2 However, children continue to be exposed to lead even in the smallest dose, and children of color, in particular, are disproportionately disportionately harmed by lead exposure.  

Although lead prevention programs, initiatives and policies are critical toward achieving the goal of eradicating lead and its exposure sources, there are challenges to implementing services to lead-exposed families. Lack of trust in governmental agencies and lack of access to services are common barriers cited by communities. Additional cited issues include inconvenient hours to access resources for their children and uncoordinated response or action among government agencies.3 Beyond a coordinated governmental approach, partnerships with community-based organizations are critical to the successful creation, implementation and sustainability of these services. For example, the Healthy Homes Coalition of West Michigan (HHCWM), a nonprofit created to sustain the effort to end childhood lead poisoning in Grand Rapids, Michigan, uses a family-centered approach to advance environmental justice. HHCWM has created a model to reach underserved families that are in highest need of services. Their Nido program trains key community members to be certified advocates of healthy housing with the ability to screen homes for hazards. By empowering community members to conduct the screenings, HHCWM prevents gatekeeping of important information on potential hazards. From the screening, areas of need inform the development of the family-centered action plan. HHCWM’s case managers take a strengths-based, family focused approach to solution building and environmental hazard mitigation. 

The above underscores the importance of true, genuine and non-extractive partnerships that provide services to communities in dignified manners and work in partnership with community members to address environmental health hazards. This not only increases awareness of available services, but also builds trust and raises the visibility of local, state, local and federal government agencies as resources for addressing environmental health concerns, such as lead. 

Data trends in the past few years have indicated a decline in childhood blood lead testing attributed to the COVID pandemic and limited staff capacity across sectors and agencies. This could lead to an increased number of children exposed to lead without access to services or remediation of lead exposure. One approach to increase childhood blood lead testing is through required lead testing of children, like the recent Michigan-approved legislation passed in October 2023. This landmark policy requires universal lead testing of all children at 12 and 24 months.  

There is no safe blood lead level, and lead poisoning prevention is key to ensure children can live, learn and play in a healthy environment. To work toward environmental justice, our children need to stop being used as the determinants of housing hazards, with children of color disproportionately impacted. Currently, action is taken to address lead concerns in the home only after a child is tested and found to have an elevated blood lead level. One proactive model offered by HHCWM is the Lead Hazard Control Program which offers up to $20,000 for lead-related remediation repairs. The program serves families in Grand Rapids who own or rent homes that were built before 1978; families must have children 5 years old or younger, but they do not have to be tested for lead to begin services. This example showcases how creative thinking and funding will proactively address lead exposure before children are harmed. 

Lead poisoning has lifelong impacts on a child’s ability to develop and thrive. Centering the families of young children, particularly BIPOC and low-income families, in a comprehensive and coordinated approach among agencies and community-based organizations is needed to prevent lead exposure. Furthermore, an acknowledgment and awareness of structural racism impacts are vital to drive equitable actions taken to prevent lead exposure. Advancing these recommendations alongside continued federal leadership and sustained funding for lead prevention initiatives will result in healthier and safer environments for our most vulnerable population: children.   

Acknowledgments  

Thank you to Mary Stortstrom  for her review of the commentary.  

References 

1. American Public Health Association, Creating the Healthiest Nation: Health and Housing Equity. (2020) 

1. Centers for Disease Control and Prevention, Childhood Lead Poisoning Prevention Program: Data and Statistics. (2021) 

1. American Public Health Association, Protecting the Health of Children: A National Snapshot of Enviornmental Health Services. (2020) 

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