We Know How To Stop The Epidemic Of Lead Poisoning. So Why Aren’t We?
Before Lanice Walker moved her family into a new home in Chicago, she and her nine children had to share the cramped quarters of a three-bedroom apartment. Even so, she struggled to afford that small space. The single mother was facing homelessness, which would mean likely having to send her children to live with their grandmother.
Getting a housing voucher to help cover rent is almost like winning the lottery. Just one in four eligible low-income families actually get the assistance, thanks to underfunding and long waitlists. In 2013, families spent nearly two years on average waiting for a voucher and over a year waiting for a public housing spot. In Chicago, 282,000 families compete for about 3,000 slots. So when Walker got approved for a voucher to help cover rent in a better apartment in early 2012, it was a cause for celebration.
“It felt like the best thing that could have happened,” she said. “It was like my life was brand new, like I could breathe a new breath.”
Little did she know that it would soon lead to her children getting poisoned.
Just two months after the family moved into their new home, Walker took her youngest daughter to the doctor for a routine checkup and received some devastating news: she had elevated levels of lead in her blood. The source was the apartment.
It had been visually inspected for potential lead hazards like peeling paint before her family moved in, as are all publicly funded units, and given a clean bill of health. But clearly something had been missed. Lead poisoning is particularly detrimental to children’s development, so Walker immediately told the Chicago Housing Authority what she’d learned from the doctor — only to find out that her daughter wasn’t poisoned enough to warrant an emergency move.
“They treated me as if I wasn’t nothing,” she said. “I had to choose between having a place to stay and my kids’ health. That was really rough.”
Most public housing units were built before lead paint was banned and are often left in states of disrepair and neglect, increasing the risk that the inhabitants are exposed to lead. We now know how exactly how to eliminate those hazards and keep children safe. Yet federal regulations that are supposed to protect these families in any kind of housing, public and private, have lagged far behind current scientific research and mean thousands of children across the country are still being poisoned by their homes.
The Centers for Disease Control and Prevention (CDC) has said that there is no safe level of lead for children’s bloodstreams, and it has updated its guidance such that 5 micrograms per deciliter is considered to be elevated and requires intervention. But the Department of Housing and Urban Development (HUD), which regulates publicly funded housing, still operates with different criteria that hasn’t been updated since it was released in 1999.
To get intervention — an order that a landlord fix dilapidated housing or the ability to simply pick up and move — a child under the age of six has to have a blood lead level of 20 micrograms or above in a single test or 15 and higher in two tests taken within three months. It’s a problem the agency now says it is starting to try and change, although there are plenty of other loopholes that keep children in lead-tainted homes.
“The science has continued to evolve, the CDC has continued to reduce blood lead levels at which intervention is necessary, and HUD’s regulations have remained in the Bush era,” said Emily Benfer, director of the civil legal aid organization Health Justice Project at Loyola University. “It’s very problematic.”
Walker didn’t have many options when she found out that her children had lead in their blood. She went back to the housing authority four times, but it kept telling her she couldn’t get an emergency move because their levels hadn’t risen above the 15 micrograms mark. She doesn’t have family in Chicago so she had no one to stay with, and with her income she couldn’t afford to pick up and move into a new market-rate apartment. “I would have been there if we had had somewhere to go,” she said.
So she and her children were trapped in her apartment for another two years. The levels of lead in their blood continued to rise. She did what she could, wiping down surfaces to try to collect lead dust every day, Googling remedies, feeding her children vegetables and vitamins to try to counteract the effects.
Despite her efforts, Walker sees the impact on her children every day. It took her daughter Mahogany, now eight, two years to learn to write her name. “It takes her a long time to catch onto things,” she said. Her three youngest all struggle with learning disabilities. “And the behavior…” she said, her voice trailing off.
Throughout the entire ordeal, Walker felt abandoned by the people whose job is to keep her family healthy and safe. “I went on and just did what I had to do because I felt like I was treated unfairly and nobody was really trying to help me,” she said. “It was really stressful just knowing and knowing the types of dangers it caused… A lot of nights I couldn’t sleep.”
The country has made remarkable progress in combating the widespread epidemic of lead poisoning. In the early 20th century, lead was ubiquitous: it was used in appliances, toys, pipes, gasoline, food cans, paint. Health officials first began raising concerns about the impacts of lead exposure in the 1950s, but the industry waged a mighty marketing and lobbying campaign to convince everyone that lead was safe, even claiming it promoted health. Action didn’t arrive until the 1970s after the scientific consensus of lead’s harms became undeniable and litigation piled up. The government banned its use in residential paint in 1978 , and it was phased out of gasoline and banned as a material for pipes in the 1980s.
The bans had a major impact. Between 1976 and 1980, about 78 percent of Americans had blood lead levels above 10 micrograms per deciliter; that fell to 4.4 percent by the 1990s. The share of children ages one to five with this level of blood poisoning fell by 84 percent between 1988 and 2004, reaching just 1.4 percent. Today, 0.5 percent of children tested under the age of six have lead levels that high.
Still, in 2012 about 122,000 children had blood lead levels of 5 micrograms per deciliter or above, and that’s just in 29 states — the others didn’t send data to the CDC. The agency estimates that there are a half a million children between the ages of one and five with that much lead in their blood, and despite the focus on lead-tainted water after the disaster in Flint, Michigan, peeling paint or paint chips is the biggest source. Victory over lead poisoning, a completely preventable public health disaster, is still far out of reach.
“This isn’t about getting an A or going most of the way,” said Ruth Ann Norton, president of the Green & Healthy Homes Initiative. “We have the knowledge, we have the facts, we have the science, we have the data. We know kids are getting poisoned… If we know it and we know what to do, then I think we should do everything we can at every moment.”
Children Slipping Through The Cracks
Stories like Lanice Walker’s are common, particularly because federal regulations meant to keep lead out of public housing have gaping holes that families frequently fall through.
One big problem is the lack of preventative measures, especially since the effects of lead poisoning are irreversible. HUD requires any home a family with children moves into that is supported by federal funding — a public housing unit or an apartment rented with a voucher, for example — to be visually inspected for lead hazards, which should mean that children are protected from being poisoned in the first place. But these inspections don’t mean much.
“The current assessments that occur prior to approving a home for occupancy by children will not identify lead,” Benfer said. A visual inspection means a certified inspector comes in and looks for peeling or chipping paint. But without taking actual samples of paint and other materials, they miss other potential sources of lead poisoning — the most common of which, according to Benfer, is dust. Dust samples from floors and windows, according to one study that focused on Rochester, New York, are reliable predictors of whether children will have high blood lead levels.
The inspectors, meanwhile, are far from experts on the subject. To get certified, a would-be inspector just needs to click through a series of online slides with text and images about lead paint.
Benfer herself has gone through the process. “I’m actually certified for visual assessments,” she said. “I cannot tell you with 100 percent certainty a child will not be poisoned in [a] unit.”
A thorough inspection could have helped Tolanda McMullen’s son Makheil’s health improve. Instead, lead followed him from home to home, making him sicker and sicker.
Makheil first got lead poisoning in a private market apartment in Chicago when he was just 18 months old. That meant McMullen qualified for a housing voucher to move somewhere that was free of lead hazards so that he wouldn’t get any worse. But she lived in three different units throughout the city, all of which passed visual inspections but ended up having lead present anyway.
She’s still living in one of those units. There wasn’t any chipped paint when they moved in last year, but when her son got a physical before the school year began, the doctor told her his blood lead level was at 20 micrograms per deciliter. The city eventually came back for a more thorough inspection and pinpointed the problem: lead paint on the windows, where Makheil loves to look out and watch cars go by. “He probably ingested it watching for his school bus,” McMullen said. “He loves cars.”
Eventually her landlord replaced the windows, but McMullen claims he didn’t hire contractors trained in lead safe techniques and that the workers left paint chips all over her floor and even in her heating vents. Because the landlord took some action, she didn’t get approval to move until February, when her lease was about to run out. “Basically we had to sit there until the lease was up,” she said.
Lead exposure has stolen an immeasurable amount from her family. “My child was a normal baby,” she said. But after he was poisoned, he started missing milestones. It took him until age four to talk and he still struggles with communication. “He used to run and crawl and jump up and laugh,” she said. Now he just “sits and stares… he’s lifeless.”
“He was robbed of being a normal little boy,” she said. “That shouldn’t be taken away from him at such an early age.”
It has also cost McMullen herself a lot, including her car, her job, and her husband, Makheil’s father. She winds up in the hospital to treat Makheil’s health two or three times a month. “My job didn’t understand,” she said, and she doesn’t have any family in the area that could help out. Without a job she couldn’t pay her car bill, so it got repossessed. Meanwhile, Makheil’s father blamed her for what happened. “He thought it was my fault, that I picked the place,” she said. “He didn’t understand that I didn’t know, I didn’t know this stuff was here in these units.”
Her task now is to find an apartment for her and her son that’s free of lead, but after so many wrong turns she’s scared that her misfortune will continue. “I got to live somewhere, but I don’t want to compromise my son,” she said. “I’ll stay sleeping in our car before I live in another unit that has lead. Or I’ll go to a shelter.”
It’s not just children in Chicago’s public housing who are suffering. Similar crises have been identified in cities as widespread as New Orleans, Louisiana; Rochester, New York; and Cleveland, Ohio. “The current regulations are not preventative,” Benfer argued. “They almost guarantee that the child is a litmus test for a lead hazard… we’re using their bodies to identify lead hazards instead of risk assessments that actually work.”
And it’s no secret in the federal government. In 1994, the Government Accountability Office (GAO) released a report titled “Children in Section 8 Tenant-Based Housing Are Not Adequately Protected.” It found that while cities were complying with the requirement that they conduct visual assessments, those inspections were missing a lot of lead, especially in windows and floors. At the time, it recommended that HUD conduct a pilot project that used more rigorous inspections to determine whether its regulations should be changed.
“No one in HUD or the federal government can explain why it has taken so long to respond to these issues,” Benfer said.
Demanding Government Do More
That’s why Benfer’s Health Justice Project, along with 29 other groups and individuals, has sent a petition to HUD to change its rules. In February, they delivered their request that the agency adopt the CDC’s definition of lead poisoning; replace visual assessments with risk assessments that would take and analyze samples of dust, dirt, water, and paint in units built before 1978; and allow families to get an emergency move if a lead hazard is identified in their home, among other things.
Members of Congress have made a recent push to address lead poisoning in public housing as well. On March 7, Democratic Sens. Dick Durbin (IL) and Robert Menendez (NJ) and Reps. Keith Ellison (MN) and Mike Quigley (IL) introduced legislation that would bring HUD’s lead poisoning guidelines in line with the CDC’s, require risk assessments, and help families move.
“I’m trying to push my friends in Congress and these agencies toward prevention and inspection,” Durbin told ThinkProgress. An important first step is updating HUD’s thresholds. “I think we should err on the side of the CDC, which has a fraction of the HUD level, when it comes to establishing a danger,” he said. “There is no acceptable level of lead contamination, so the lower the better as far as I’m concerned.”
Durbin also wants to press forward on helping families get out of apartments that are poisoning their children. “It just takes entirely too long to resolve the issue and to put the family in a safe place,” he said.
Time will tell whether the bill gains any traction, but Durbin is hopeful. “I think the time’s right,” he noted, pointing to the awareness raised around lead poisoning after the Flint water crisis.
HUD has heard at least some of these messages. Secretary Julian Castro submitted a proposed rule change to the Office of Management and Budget on March 8 to adopt the CDC’s lead poisoning threshold. “We cannot stand by as lead poisoning diminishes the health and future opportunities of the next generation, which is why we’re taking this necessary and decisive action to address the issue of lead in HUD assisted properties,” Castro said in a statement to ThinkProgress.
A HUD spokesperson also acknowledged that risk assessments are not required for all publicly funded housing, and making them uniformly required is something Castro is looking into. “This change may require legislative assistance, and the Secretary pledged to work with Congress if that authority is needed,” she said.
One major challenge to implementing some of these reforms is that they incur more short-term costs. Beefed up inspections, of course, won’t come free. But there’s evidence that these kinds of preventative measures pay off in the long term. One study found that every dollar spent on getting rid of lead paint hazards will eventually return as much as $221 through savings in health care, special education, and criminal justice plus benefits from children’s higher earnings and taxes.
Because the savings don’t show up immediately, however, it can be difficult to convince lawmakers of the value of reforms. “You don’t see those savings for 10, 15 years,” Benfer said. “It’s very hard to move things when the federal budget cycle is a four-year period.”
The petitions to HUD and the legislation pending in Congress are only scratching the surface of the obstacles standing in the way of eliminating lead from homes. Simply identifying publicly funded houses that are poisoning children is a challenge. The 1994 GAO report recommended requiring housing authorities to request data on children’s blood tests from health agencies and match it against the addresses of their own properties and voucher locations, identifying the sources of poisoning.
That is, in theory, what should be happening today. But it frequently doesn’t. Given gaps in the regulations and lax enforcement, the data sits with health departments unused. After all, if the authorities were to identify potential problems, they would have to send inspectors out to the properties and possibly spend money abating the hazard or at least force a landlord to deal with it.
“No one is doing this,” said George A. Thomas, a civil legal aid attorney based in Ohio. In his state, for example, just one local housing authority requested lead testing data from the health department over the last year. “If there’s no enforcement mechanism built into the regulations, there’s a really good chance that the public housing authorities are going to ignore it. They have other priorities,” he noted.
The HUD spokesperson acknowledged the problem, noting, “HUD’s compliance monitoring has revealed gaps in local communication, data sharing and capacity on both the public housing authority and health department sides.” She asserted that if a health department simply says it doesn’t want to get such reports, it doesn’t have to under current law.
But HUD could also do more to crack down on state health departments and urge them to collect the data, abiding by the original intent of the law. “It is an important part of the solution,” the spokeswoman acknowledged.
If public housing is so dangerous, low-income families with enough resources could take their chances on the private market. But they aren’t any safer there, as McMullen well knows. In fact, it’s just as common for families in run-down private homes in Chicago to be faced with the prospect of lead poisoning and have little recourse to escape it, a reality John Bartlett, executive director of the Metropolitan Tenants Organization, sees firsthand. The poor families who call his hotline are often forced into unbearable choices in private housing.
“In the private market, it’s all about resources. Families don’t have the options of necessarily always being safe,” he said.
No Safe Place To Turn
The problem is vast: A 2011 study found that about 35 percent of all homes have lead-based paint, and it constitutes a hazard in 22 percent, or more than 23 million houses. And poor families with few resources to move into nicer, newer homes are usually most at risk.
Preventative measures are even rarer in private housing, as inspections aren’t required at all. As a result, parents often have no idea what they’re moving into. “The question becomes, is it better to have a home or not a home,” he said. “Do you end up in a shelter situation or do you take what you can get?”
And even tenants who want to do something about it have little power to get landlords to listen to them. “Tenants lack the resources to go anywhere else, but they also lack the resources to stand up to the landlord,” Bartlett said. Many are already behind on rent and feel like they can’t raise an issue. And they might risk getting kicked out of their home rather than getting an actual fix. “Oftentimes landlords, instead of wanting to get rid of the lead hazard, want to get rid of the tenant,” he continued. That’s a particular problem in private housing, where the protections against wrongful evictions are weaker.
And as with HUD’s high threshold for blood poisoning, as of January, 26 states still hadn’t reformed their laws so that they require intervention in housing, public or private, at the CDC’s 5 micrograms per deciliter threshold. “It’s not only subsidized housing that follows the higher blood lead level in terms of intervention,” explained Anita Weinberg, a professor of law at Loyola University. “Our laws are written so that we respond after a child is harmed.” In those states, no inspections or clean up is required from private landlords until children’s levels hit the 15 or 20 microgram per deciliter levels.
There is one requirement that is meant to stop children from being poisoned in the first place: If a house was built before 1978, contractors who do any work are supposed to be certified in lead-safe techniques so that construction doesn’t kick up a bunch of lead and create a hazard. But there is little enforcement around it because HUD and the Environmental Protection Agency don’t have the resources to crack down on all contractors and homeowners don’t have to check to make sure contractors are certified, so it often falls by the wayside.
Some cities and states have instituted proactive rental inspection programs, which require housing to be checked at regular intervals, rather than waiting for a resident to make a complaint. That not only means that lead hazards are hopefully abated before poisoning becomes an issue, but that tenants who might fear taking action against landlords don’t have to shoulder the burden.
That proactive approach is what Bartlett has been pushing his city of Chicago to adopt. His group wants the city to mandate inspections every five years to catch lead hazards before children become poisoned. “If you’re not going out and pre-inspecting things, then kids move in, they get poisoned,” he said. The city has resisted the effort so far, though, because it would cost more to mandate extra inspections.
Green & Healthy Homes, which is based in Baltimore, has been working with the city and proven that it’s feasible to do much more. Baltimore has been ravaged by the plague of lead poisoning. As with the rest of the country, it’s made big strides toward eradicating the problem, with the number of new cases of lead poisoning dropping by 86 percent since 2002. Still, nearly 5,000 children in the state have been poisoned over the last decade, and the real number is likely higher as not all children are tested.
Norton’s organization has gotten the city to dedicate 250 housing choice vouchers to people whose children’s blood levels are at 5 micrograms per deciliter or above in any type of housing so that they can move to a new home immediately.
Now she’s working with the state of Maryland to require risk assessments, not just visual inspections, before people move into units financed through HUD funding and to adopt the 5 micrograms per deciliter level into state law. The state is putting up some resistance, but Norton says she’ll push forward. “If we say that 5 micrograms per deciliter is the correct threshold, then every state and every county should be looking at 5 micrograms per deciliter,” she argued.
There is little national urgency on the issue. “If anybody in your home was at threat for being poisoned, you’d make changes today,” Norton said. “Somehow we get to the public policy venue and we tend to move slower.”
But that may be changing, particularly with the recent spotlight on lead poisoning following the water crisis in Flint. Democratic presidential candidate Hillary Clinton has now made lead a prominent plank of her policy platform, pledging at the debate in Flint to get rid of it in any source — including paint, water, and soil — within five years. “I want us to have an absolute commitment to getting rid of lead wherever it is,” she said.
Norton thinks that’s achievable. “I think we can do that, eliminate childhood lead poisoning as a major public health threat,” she said.
Advocates crave federal attention on the issue. Norton’s organization has called for the president to reconstitute the task force on childhood lead poisoning to make the issue a clear priority for the country, as well as to align policies and practices among different government agencies. “Money is one thing, but standards is another,” she noted.
“You have to declare war on this if you really want to put a stake in its heart,” she added. “Otherwise it will continue to drip along for decades more.”
Lanice Walker doesn’t have decades to wait for things to change. She’s speaking out now in the hopes that the suffering her family has endured won’t afflict others. “I wouldn’t want this to happen to someone else,” she said.
The good news is that she finally got clearance to move and has since left the home that poisoned her family. “I feel so much better to be out of there,” she said. But she also knows that her problems haven’t ended; the ramifications will likely be with her children for their whole lives. The learning and behavior issues they’re living with now aren’t going away.
“I’m still worried about what’s to come,” she said. “That’s real stressful.”