While the Flint water crisis has brought lead poisoning back to the forefront, the issue is nothing new to many in Philadelphia, where thousands of children have been growing up with the reading, learning and behavioral problems that result from it.
The culprit has not been the city’s water supply, but it’s older housing stock — a huge percentage of which was built before 1978, when lawmakers finally banned the use of lead-based paint. By then, the paint was already coating the surfaces of untold numbers of homes, that eventually began to age and deteriorate, leaving the paint to chip and crack, and its dust to contaminate both the inside and outside of homes.
The lead in the paint was most poisonous to the developing nervous systems of children under 5 years old, the age most prone to playing on floors and in yards, of sticking their tiny fingers on windowsills and pushing dust-covered toys in their mouths.
In 2000, 6,483 Philadelphia children — or 1 in 6 children up to the age of 5 years — were tested and found to have elevated levels of it in their bodies.
Physicians, law makers, health experts, children’s advocates and landlords have had all worked together to address the issue over the years, and today, average blood lead levels for both children and adults have dropped more than 80 percent since the late 1970s.
In 2014, a Pennsylvania Department of Health report showed that 10.9 percent of the 35,863 Philadelphia children under the age of seven who tested were found to have at least 5 micrograms per deciliter of lead in the blood — the threshold of lead intake that necessitates public health action, as defined by the federal government.
But for all that progress, consider that those blood-lead levels in Philadelphia — 10.9 percent — are much higher than Michigan state data said blood-lead levels were for Flint in 2014-2015 — 3.21 percent.
The dangers of lead
Lead poisoning can cause reading and learning disabilities, impaired hearing, IQ deficiencies, hyperactivity and other behavioral problems, all considered to be irreversible.
As the medical director of the Children’s Hospital of Philadelphia’s Poison Control Center, Dr. Kevin Osterhoudt often treats children with lead poisoning. He said lead exposure can affect every organ system in the body.
Osterhoudt said Philadelphia’s number of children with blood-lead levels of more than 5 micrograms is higher than the national average. For some of his patients, their blood lead level is so high that they have to be treated with chelating medications and removed from their home during the treatment process.
“If you are one of the really sick patients who is having seizures or a coma, those medications can be lifesaving,” Osterhoudt said. “If you have very low-blood lead level and you’re not exhibiting those symptoms there is not good scientific evidence that those chelating agents will be as helpful.”
Medical professionals also recommend children be given foods with calcium, iron and vitamin C, which may help keep lead out of the body.
Children who suffer from the reading, learning and behavioral problems wrought by lead poisoning may be offered occupational therapy or end up in special education classes. Some victims just suffer mental frustrations whose source was never diagnosed, because they were never tested for lead poisoning in the first place.
How Philly tackled
The Philadelphia Public Health Department works with local physicians to make sure children are tested for lead at 12 and 24 months of age.
According to the Pennsylvania Health Department there is no universal testing law for lead in the state, however most clinical practice guidelines recommend testing children under seven and focusing on children at age 1 and 2. Medicaid requires medical providers to test children at those ages as well.
In Philadelphia, if children have a high lead level, the health department works with home and building owners to eliminate the sources of lead in the home.
“It’s not rocket science,” Colleen McCauley, health policy director at Public Citizens for Children and Youth, a non-profit that has been following the issue of childhood lead poisoning since the organization’s inception, said of ways to address lead dangers. “We knew there were way too many children who were being poisoned when we knew what the answer was.”
Finances, however, are an issue in that solution.
“The children who are disproportionately poisoned are children who live in families who have smaller incomes and it’s more of a challenge to maintain their properties,” McCauley said.
Abatement, or the removal of all lead paint, has historically been the primary strategy for addressing lead in homes.
When a home is found to have lead dangers, the homeowner or landlord must undertake the removal work or hire a contractor to it. When this doesn’t happen, city personnel may perform the work. However, the city can’t afford to do all the necessary work either.
Dr. Palak Raval-Nelson, Philadelphia Department of Public Health director of environmental health, said the remediation process costs about $9,800 per home and can take upwards of five days to complete.
Through the department’s Childhood Lead Poisoning Prevention Program, low income families whose children have elevated blood levels can apply for a grant for lead hazards to be removed from their homes. However, last year, only 85 homes went through the remediation process due to the lack of funding.
Philadelphia is on track to provide about 100 homes with remediation this year. Last September, Philadelphia received a $3.7 million three-year grant from the U.S. Department of Housing and Urban Department to assist in lead removal efforts.
In recent years, many other strategies have been undertaken to stabilize deteriorating paint including safely scraping peeling paint and painting over the area, washing down the walls and floors, using specialized vacuums to trap the lead dust, encapsulating problem areas, and replacing window sills and other high risk structures.
The Philadelphia Department of Public Health has been striving to address the problem of lead in homes through its comprehensive Childhood Lead Poisoning Prevention Program. The program provides education and outreach and maintains a computer database of blood lead test results to ensure that children with elevated blood levels receive proper medical management and follow-up. They also work with landlords to comply with the Philadelphia law requiring property rented to families with children 6 years and younger to be lead safe.
Since 2000, PCCY has issued three reports chronicling the status of childhood lead poisoning in Philadelphia and the city’s progress towards prevention. It joined with other advocates in urging the creation of the Lead Abatement Strike Team and Lead Court that aided in bringing increased federal funding into Philadelphia and significant expansion of primary prevention programs such as Lead Safe Babies. The Lead Safe Babies program targeted pregnant women and families with newborns to test their properties for lead hazards and remove them before the baby is exposed.
The Philadelphia Lead Court, established in 2002 by Philadelphia health officials and lawyers to speed the cleanup of lead hazards in apartments and rented homes, handles approximately 150 cases per year.
Nan Feyler, Temple law professor and former deputy commissioner for the public health program, Philadelphia Department of Public Health, acknowledges the progress, but also new frustrations.
“The issue I think that has been frustrating for many of us is at the same time there has been that progress, there has been increasing research to show that there is no safe level of lead,” said Feyler, who worked on lead poisoning issues during her time at the health department. “We still need to do research and figure out how to avoid crises like Flint and how to make sure that kids are not getting lower levels and prevent it. There’s not a lot of dollars for prevention. If you really emphasize screening, which is important, you might be missing the boat in actually preventing it. Every time a kid tests positive, prevention has failed.”
“I think the frustration is that it isn’t eradicated, that there is growing evidence of lower levels having an impact, but the attention and the funding has been disappearing,” she said.
The CDC estimates approximately 38 million homes in the United States have lead hazards that can result in childhood lead poisoning. Low-income and minority children bear a disproportionate burden of this condition caused by unhealthy housing.
Feyler has spent a significant portion of her career working on the impact of substandard housing conditions on children’s health.
“I think that lead poisoning is part of a larger conversation we need to have about the conditions that low income families are living in,” she said.
“For me the issue is that lead is really an important part of a conversation to say, what are we doing to prevent environmental health problems for low-income families in their homes.”