The lens on lead poisoning prevention became more focused after the Centers for Disease Control and Prevention changed the standards on what is considered dangerous child blood lead levels this summer. But a reduction in state and federal funding to address the problem of childhood lead poisoning is blurring the vision.
Doctors should report any level of lead that is found to be five micrograms per deciliter of blood or higher in a child's bloodstream to a parent or guardian, according to the new standards that were announced in May. The level is a significant change from the previous 10 micrograms, which was altered after data collected by CDC officials showed that even lead levels between two and five micrograms had adverse effects on a child's academic abilities such as reading and writing. Under the new measurement for blood lead levels, about 535,000 children in the United States would be considered to have high blood lead levels, said Mary Jean Brown, CDC's chief of Healthy Homes and Lead Poisoning Prevention.
Brown said the new level should not preclude a child with any level of lead in her or his bloodstream from being treated. After parents are notified of blood lead levels, they must consult with a doctor on treatments such as chelation therapy, during which a child takes medication that removes heavy metals such as lead from the body and gets rid of them through urination.
"Our first message on the health side is to make sure that people understand clearly that five is not the new 10," Brown told The Nation's Health. "The committee and CDC concurred that we're trying to change the way we're thinking about this, that a child does not have to have a qualified blood lead level (to be at risk). I think that message is getting out there."
Children living in housing built before 1978 in poverty-stricken areas are at high risk for lead exposure due to the existence of lead-based wall paint, according to CDC. The risk is also high among children ages 6 and younger who frequently touch surfaces or toys containing lead. However, other sources of lead risks for children include cosmetics, candies imported from Mexico, cookware and home remedies.
Short-term preventive measures for parents whose children are at risk for lead exposure include mopping areas with loose paint chips and dust, finding U.S. Environmental Protection Agency-certified contractors for lead removal work and wiping feet on a household mat if the homeowners work around lead on a daily basis.
While lead poisoning is mainly thought of as a risk for children, adults can be endangered as well, especially those who work in construction and manufacturing. According to CDC, about 95 percent of high adult blood lead levels occur among people who work in painting, paper hanging, zinc ore mining and battery manufacturing. Adult lead exposure can harm cardiovascular and reproductive systems as well as kidney function, CDC said. A National Institute for Occupational Safety and Health blood screening program for adults — known as the Adult Blood Lead Epidemiology and Surveillance program — targets adults with high blood lead levels via programs in 41 states.
The CDC decision to change child blood lead level standards means a greater emphasis on primary prevention is needed, said Deborah Cory-Slechta, PhD, a member of the Advisory Committee on Childhood Lead Poisoning, who spoke at a session on the new standards at APHA's 140th Annual Meeting in October.
However, Congress has allocated less money for CDC lead poisoning prevention funding, which has dropped from as much as $29 million in fiscal year 2011 to $2 million in fiscal year 2012, said Ruth Ann Norton, executive director of the Baltimore-based Coalition to End Childhood Lead Poisoning, of which APHA is a member.
Norton, who is also executive director of the Green and Healthy Homes Initiative, said there is also a concern that adults may suffer long-term effects of excess lead, such as higher rates of cardiac arrest and hypertension.
"Primary prevention is the only cure, but we are at the same time pulling the rug out under these state programs and losing the institutional capacity because of the funding," Norton told The Nation's Health. "We're asking states to adopt these guidelines but not giving them the support needed."
A total of 35 state health departments in charge of lead poisoning case management and referrals lost CDC funding in September, Brown said. She said some states identified other sources of grant funding to keep their programs going, but others that were completely dependent on CDC funding could no longer provide services. Brown said she does not anticipate finding out about the status of funding for CDC programs until March.
Cory-Slechta said there has always been a relationship between CDC and state public health departments on lead poisoning prevention but the discussion now is how to get back lost funding.
"I suspect states will do what they've done before, which is to take the resources that they have and do as extensive a job as possible and they will probably have to end up having to prioritize, based on finite resources, what they're going to be able to accomplish," Cory-Slechta said.
The U.S. Housing and Urban Development's Office of Healthy Homes and Lead Hazard Control Program provides about $100 million annually to states for home lead removal. But Norton said that amount of money would not be nearly enough for adequate training of contractors nationwide to identify problem properties and safely remove lead. She said a total of $250 million suggested in the 1990s should have been allocated over a five-year period for lead removal and primary prevention.
As a short-term solution, Norton said individual states need to push for Medicaid reimbursement for renovations to prevent lead poisoning such as window replacements in older homes.
Norton added that state housing departments in general need to prioritize lead poisoning prevention in their overall budgets and emphasize proper training of contractors who are renovating homes that contain lead-based paints.
"The goal is, over time, to continue these efforts so that children don't have blood levels at or above the reference value that was established in 2012," Brown said. "We will revisit the reference value level in 2016, using another National Health and Nutrition Examination Survey."
Figure 1.
A child demonstrates a blood lead screening test as part of testing program held in conjunction with Wisconsin's Medicaid program in 2011. New blood lead level standards are drawing attention to screenings, but funding for them has been falling.
Photo courtesy PRNewsFoto/Magellan Biosciences
Figure 2.
Contractors clean up lead paint in a contaminated building in Rhode Island in 2006. Lead paint in older buildings is a common source of high blood lead levels in children.
Photo by Chitose Suzuki, courtesy AP Images
Nations Health. 2013;42(10) © 2013 American Public Health Association
