The Weight of Lead — Part I: How Contaminated Houses Are Poisoning the Poor
David Norris, Jillian Olinger, and Mary McKay
The word home conjures thoughts of safety, but for many families in low-income neighborhoods, home is anything but safe.[1] In too many homes in our central cities, lead contamination from deteriorating lead-based paint continues to poison our most vulnerable residents: poor children of color. And this is true despite decades of public awareness and attempts at legislated solutions.
Lead Poisoning: A Primer
Lead is a naturally occurring neurotoxin primarily produced through mining, manufacturing, and burning fossil fuels (that is, human activities). Lead is used in numerous products, from car batteries and water pipes to paints, hair dye, and more. Although the United States has banned lead in paints or gasoline additives, people are still exposed to lead because of its high prevalence in soil, owing to the fact that lead does not degrade once it’s in the environment.
Most commonly, lead is found in paint in homes built before 1978. This lead can get into the soil, dust, and even drinking water of the home. However, the primary — and most important — method of exposure for children is ingestion of lead paint dust and chips. It’s important to highlight the threat of lead dust as a contaminant: People tend to think that their child is safe because they have never seen her eat a paint chip, but it is lead dust that is particularly harmful. Other routes of contamination tend to be episodic (eg, a batch of toys from China, a batch of pottery from Mexico, or a systemic failure like the one affecting the water supply in Flint, Michigan) and therefore noticed and addressed sooner or later. Lead paint exposures in a child’s home are chronic and too often go undetected until the damage has been done.
Research finds lead exposure is associated with such outcomes as lower IQ scores,[2] inability to pay attention, hyperactivity, and aggression.[3] Later in life, these problems can lead to delinquency and antisocial behaviors[4] and a less productive workforce. Unsurprisingly, prevention of lead poisoning improves the health and long-term prospects of children and the future workforce and saves money across sectors. The most direct way to prevent lead poisoning is to remove lead from the houses and day care centers where young children spend significant amounts of time.
Lead and Housing
Housing built prior to 1978 — and particularly housing built prior to 1950, due to the higher lead content of paint from that era — potentially contains some lead paint. When properly maintained, a surface with lead-based paint does not pose a hazard. However, when lead paint ages and chalks, peels, or chips, or when painted surfaces are subjected to friction (like the opening and closing of windows), producing lead dust, ingestion or inhalation of lead poses a threat to children. Residential properties of low value and great age are most at risk of harboring lead paint. And because families in tenuous housing circumstances are more mobile than families in stable housing and have fewer housing choices, these families tend to cycle through high-risk housing, meaning that any residence with an unresolved lead hazard has the potential to poison children in several families over a relatively short time span.
The Centers for Disease Control (CDC) have continually lowered the blood lead level that triggers public health action (referred to as the reference level, the concentration of lead in a person’s blood above which regulatory or remedial action is required).[5] Although this level currently stands at 5 micrograms of lead per deciliter of blood, CDC has declared that there is, in fact, no safe level of lead exposure.
Unfortunately, health departments act to address a residential lead paint hazard only after a blood test shows that a child has an elevated blood lead level. We are, quite literally, using the blood of children to identify the houses that poison them. Furthermore, this misguided approach falls short as a means of locating all the residential properties with lead hazards because we test far fewer children than required by law.
In 2018, lead exposure and poisoning are still defining features of much of the old and low-value housing in the United States. In contrast to efforts by the federal government to improve subsidized housing, little has been done across the country to hold landlords accountable for conditions in non-subsidized rental housing. Even with government supports for remediation, landlords still carry a significant financial burden for lead removal, which makes them less likely to address the issue. In addition, federal support for lead removal is limited and conditional; not every house receives federally granted funds for full abatement.
A final reason why addressing lead poisoning is necessary is the moral imperative for social justice. Children in African American, Latino, and low-income families bear the brunt of lead poisoning. Economic and historical forces have relegated these families to old, low-quality housing, where lead remains a threat. Lead exposure patterns perpetuate the disparities that already exist for these vulnerable populations.[6]
The Historic Link Between Health and Housing Quality
Prior to the 20th century, housing as a policy issue was largely the domain of public health advocates (see this post on the BLOCK Project’s Medium site for more). As industrialization and urbanization took hold in the United States in the late 19th century, tenements and slums housed the working poor and were sites of danger and disease.[7] In the 19th and early 20th centuries, reformers advocated for building and sanitary regulations (the modern-day equivalent of building codes). The main push from this group was for the federal government to increase its role in creating safe, affordable housing for poor urban populations. Part of the movement included a call for removal of many dangerous, unhealthy slums in US cities, which were replaced by government-subsidized, low-cost housing.
The federal government initially focused its efforts on unhealthy conditions in US inner cities, but by the Great Depression, the Roosevelt administration needed to provide relief to a broader segment of the country. In an effort to stem the flow of foreclosures and provide relief to lenders and homeowners, the Roosevelt administration created the Home Owners Loan Corporation (HOLC) in 1933 as part of the New Deal legislation. Unfortunately, HOLC adopted the private-market practices of racially discriminatory underwriting and appraisals. HOLC neighborhood assessors redlined many city neighborhoods primarily populated by minority residents and immigrants, denying or severely limiting access to federal mortgages and loans for residents of these neighborhoods; instead, loans were often redirected to white, suburban neighborhoods, establishing race as a defining feature of place in US cities. Subsequent disinvestment led to unchecked deterioration of housing in urban, nonwhite neighborhoods.
In parallel with racialized housing policy from the 1930s to the 1950s, the Lead Industries Association simultaneously espoused the benefits of white lead, a naturally occurring mineral that was a key ingredient in lead paint, and acknowledged that lead paint posed health hazards to children (without taking responsibility for the presence of lead in homes) through overtly racial victim-blaming pronouncements that lead poisoning was the fault of “Negro and Puerto Rican” parents incapable of protecting their children from harm.[8]
The negative cycle of disinvestment can be linked to the present-day poisoning of children of color by lead. Most housing in disinvested US neighborhoods predates the 1978 ban on the use of lead paint in home construction; the bulk of this housing is renter-occupied. The generally low value of such central city housing makes it less likely that property owners have invested in maintenance and renovations to contain or remove vestiges of lead paint, most significantly the replacement of doors and window frames where friction might generate lead dust particles if lead paint is present. Thus, lead paint remains a threat to children residing in these homes.
Preventing Lead Poisoning: Moving from a Reactive to a Proactive Approach
Lead-poisoned children need not be the triggers for public action on lead-contaminated properties. We know where to find the housing stock most likely to poison young children. Demographic, socioeconomic, and family characteristics have strong predictive power in determining the likelihood of a child having high levels of lead in their blood.[9] Lead is most commonly found in old rental housing primarily occupied by people of color, immigrants, refugees, and low-income families.[10] County parcel records contain data on the age, condition, and assessed value of residential structures. These records can also point to areas in our cities where homes are most likely to harbor lead paint hazards.
With sufficient public will and a commitment of resources, we can eliminate lead paint hazards proactively and thus prevent lead poisoning altogether. Part II of this article provides a case study of the efforts of advocates who have been working tirelessly for more than 4 years to protect the health of the most vulnerable citizens in Toledo, Ohio. So far, their efforts are a qualified success. Their story provides a compelling example for other localities as they strive to improve health equity in their own jurisdictions.
[1] In large part the comforts of home are due to the concerted efforts of government, over many decades, to enact certain attributes of a “safe and decent” shelter as outlined by the housing acts of the 1930s and 1940s. At the turn of the 20th century, political, business, and reformer interests recognized the need for improved housing conditions to facilitate public safety and stability. Although the priorities of each of these stakeholders differed, the end results were building codes, land use regulations, and infrastructure measures that improved housing conditions for the masses.
[2] Schwartz, J. (1994). Low-level lead exposure and children’s IQ: A meta-analysis and search for a threshold. Environmental Research, 65(1), 42–55. https://doi.org/10.1006/enrs.1994.1020
[3] Bellinger, D. C. (2008). Very low lead exposures and children’s neurodevelopment. Current Opinion in Pediatrics, 20(2), 172–177. https://doi.org/10.1097/MOP.0b013e3282f4f97b
[4] Dietrich, K. N., Douglas, R. M., Succop, P. A., Berger, O. G., & Bornschein, R. L. (2001). Early exposure to lead and juvenile delinquency. Neurotoxicology and Teratology, 23(6), 511–518.
[5] Sampson, R. J., & Winter, A. S. (2016). The racial ecology of lead poisoning: Toxic inequality in Chicago neighborhoods, 1995–2013. Du Bois Review: Social Science Research on Race, 13(2), 261–283.
[6] Novoa, C. (2017, July 24). Trump’s cuts to lead abatement programs will hurt children most. www.americanprogress.org/issues/early-childhood/news/2017/07/24/436475/trumps-cuts-lead-abatement-programs-will-hurt-children/
[7] Tenement housing was characterized by tight quarters with little or no ventilation or light. For example, the infant death rate in the tenements of New York’s Lower East Side was a stunning 1 in 10. See Jacob Riis, How the Other Half Lives: studies among the tenements of New York. New York: Garrett Press, 1970. (Originally published 1890).
[8] Markowitz, G. & Rosner, D. (2013). Lead wars. Berkeley: University of California Press. p. 209, and chap. 8, note 35.
[9] Ahrens, K. A., Haley, B. A., Rossen, L. M., Lloyd, P. C., & Aoki, Y. (2016). Housing assistance and blood lead levels: Children in the United States, 2005–2012. American Journal of Public Health, 106(11), 2049–2056.
[10] Novoa, C. (2017, July 24). Trump’s cuts to lead abatement programs will hurt children most.
David Norris is senior researcher and director of health equity at the Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University, where he manages their Health Equity Mapping projects. Prior to joining the Kirwan Institute, David was a researcher at Community Research Partners, and he also has more than 10 years’ experience in child advocacy and policy support.
Jillian Olinger is senior research associate and director of housing and civic engagement at the Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University. She has deep expertise in a variety of social justice issues, including fair housing and fair credit, the intersection of child well-being and community development, and healthy neighborhoods.
Mary McKay, a graduate research associate and doctoral candidate in sociology, is a dedicated proponent of research promoting social justice and equity. Exploring the intersection of immigration and place, Mary researches how neighborhood context influences health outcomes among immigrants. Her latest project involves understanding the complexities that newly resettled refugees face when they arrive in the United States.
Photos by Flickr Creative Commons: Abby Lanes and Bart Everson.
