We need a war on lead poisoning

Our view: CDC's revised guidelines on the risks to children from exposure to lead show the need for greater public investment in remediation of older homes

May 20, 2012

The reports that the Centers for Disease Control and Prevention cut its threshold for lead poisoning from 10 micrograms per deciliter to 5 micrograms were something of a simplification. What the CDC said, after years of study and discussion, was that no level of lead exposure for children is safe. The 5-microgram level was set somewhat arbitrarily as the point at which doctors and public health officials would recommend parents take action to reduce their children's risk, but there is ample evidence to show that levels of 3 or 4 micrograms — and perhaps even lower — are associated with learning and attention deficit disorders later in life.

Under the old standards, Maryland had made tremendous progress over the last two decades in lowering lead poisoning among children, mostly by focusing on regulation of rental property. The General Assembly took further steps this year to strengthen that program; rental registration requirements were extended to homes constructed before 1978 (the year lead paint was outlawed nationally) rather than just 1950 (when lead paint was outlawed in Baltimore), and it instituted requirements for contractors to test for lead dust after renovations. But the new standards, which multiply sevenfold the number of Maryland children at levels that require intervention, underscore the need for more action — and for more help from the federal government.

Unfortunately, the CDC's decision comes at the same time that its budget for lead poisoning programs has been slashed from $29 million last year to $2 million this year. (The cutting, in this case, was done by the Democrat-controlled Senate, not the Republican-controlled House of Representatives.) That means city and state grants for testing, monitoring and remediation of lead-contaminated homes will soon disappear.

It's a particularly shortsighted decision. There is no cure for childhood lead poisoning, and its effects last a lifetime. The only effective way to combat it is to prevent children from being exposed in the first place. But unlike other public health scourges, we know exactly how to combat this one. The answer is an aggressive program of lead mitigation — and, in particular, replacement of old windows and doors — in pre-1978 housing stock. At a time when the federal government is looking to cut any frivolous spending, this is one effort that should make the cut, as it is exceedingly cost effective — the return on investment is at least 17-1.

The CDC's funding should not only be restored but expanded. More money is needed for testing and monitoring of children's lead levels, but even more crucially, the government needs to be providing more incentives for remediation. If the government can provide tax breaks for window and door replacement in the name of energy efficiency, it can do it to prevent lead poisoning, too.

But in the meantime, there are more steps the state can take to increase awareness and encourage homeowners and landlords to step up maintenance efforts to reduce the risks of exposure. The state needs to provide additional guidance to doctors and other health professionals on the new standards, and in particular, it should focus its efforts on increasing counseling about the risks of lead exposure during prenatal visits. Not only is there a danger that lead can be passed from the mother to the fetus, but it is also wise to give parents-to-be the ability to evaluate their homes, whether they own or rent, before a child has a chance to be exposed. The new law requiring contractors to perform lead tests is an important advance because a leading cause of exposure for children in owner-occupied homes is dust associated with renovations, but the state could go further. It should work with home improvement stores such as Home Depot and Lowe's to develop classes on lead safety.

The federal government has declared war on cancer, drugs and terror — all important causes, but costly ones with no guarantee that we can ever declare victory. But a war on childhood lead poisoning is one we can win. We know how. All that is required is the will.

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