Last summer, the City of Milwaukee approved $300,000 to provide home visits, lead testing, water filters and other services to residents in neighborhoods with the highest numbers of lead-poisoned children. This came on the heels of a 2018 report which found staffing shortages, inadequate training, high turnover and poor coordination led to the failure of the Milwaukee Health Department to follow up with thousands of families with lead-poisoned children.
Children under the age of 5 are most vulnerable to lead poisoning. This can cause permanent neurological damage leading to learning disabilities and behavior problems. Testing can lead to prompt medical and environmental intervention, which can reduce toxic blood levels in children.
The city chose Aldermanic District 15, on Milwaukee’s North Side, and Aldermanic District 12 on the South Side for the initiative. The Social Development Commission (1730 W. North Ave.) and the Sixteenth Street Community Health Centers (1032 S. Cesar E. Chavez Drive), each received $150,000 to implement the pilot programs to do outreach in districts where lead poisoning is most prevalent. The initiatives have just recently gotten underway.
While testing for lead poisoning has increased and the number of cases of lead poisoning among children under 6 have decreased dramatically between 1999 and 2016, health experts nonetheless agree that much more testing and education needs to be done. The Wisconsin Department of Health Services reports that while only 21% of the children tested for lead in Wisconsin are African American, they have the highest rate of lead poisoning, accounting for 50% of all lead-poisoned children in Wisconsin.
George Hinton, CEO of the Social Development Commission (SDC), realizes there are barriers to reaching out to everyone in the community. “There are a lot of people who don’t want people in their house,” he says. “So we’re hoping as word of mouth gets out, it will be a little easier for us to get in the door.” And yet, the SDC, which has worked on the North Side for 55 years, is a well-known and respected stakeholder in the community.
One goal for the Milwaukee Health Department (MHD) is that all city of Milwaukee children get tested for lead, says Jean Schultz, the department’s environmental health services manager. MHD recommends children receive three blood tests by the age of 3. In 2018, 26,633 children received blood lead tests, totaling 35,824 total tests, according to MHD data. Of the children tested, 4.1% had levels ≥ 5 mcg/dL through venous testing. (The current standard for lead poisoning is a blood level greater than 5 mcg/dL.) In 2016, 65% of children in Milwaukee from 12 to 35 months old were tested, declining from 71% in 2011.
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Marjorie Coons, program manager of the Wisconsin Childhood Lead Poisoning Prevention Program of the Wisconsin Department of Health Services (DHS), says there is a need to improve blood lead testing of young children statewide. In 2016, only 32% of children enrolled in Medicaid, who are at the greatest risk of lead poisoning, had been tested at their most vulnerable ages of 1 and 2. “Working with Medicaid providers to improve these percentages gives us the opportunity to identify more children who are lead poisoned so that public health interventions can be provided to eliminate their lead exposure,” Coons says.
‘Lead Poisoning is 100% Preventable’
In the wake of the Flint, Mich., water crisis, lead poisoning received renewed attention. However, it caused many people to believe that water is the only source of lead poisoning. Schultz cautions that lead contamination can come from other sources, such as paint and soil. “The goal should be to discuss the hazards equally,” she says. “There is no safe level of lead in soil, paint or water for children. Families need to be aware of their built environment, how that can impact their health and what resources are available for them. Lead poisoning is 100% preventable. Keeping painted surfaces intact, installing water filters, covering bare soil with gravel or mulch and getting kids tested can reduce the risk of lead poisoning.”
Schultz says mixed messages in our community are making it difficult for MHD to get access inside these homes to address multiple lead hazards. “Some families think the source of lead poisoning is the water alone and will not let the Milwaukee Health Department also address the chipping and peeling paint that can be observed on the outside of their home,” she says. “A consistent message is needed to increase awareness and trust in the community.”
Schultz says a 2017 Environmental Protection Agency study that quantified and compared contributions of lead from air, soil, dust, water and food to children’s blood lead levels found that children living in older homes with lead-based paint hazards by far have the most exposure to lead. For 1 to 6-year-olds in the top 90-100 percentile, more than 70% of the lead in their blood was from soil and dust, lead from food was 20% and from drinking water, it was 10%. For infants, soil and dust contribute to 50% of the lead in their blood, while 40% was from water and 10% from food.
The Sixteenth Street Community Health Centers’ clinic has been testing for lead and doing community outreach for 20 years. When the clinic identifies a child with elevated blood levels of lead, a lead outreach worker will go to the home and talk to the family about lead poisoning. Sixteenth Street’s outreach team uses a multi-faceted approach when assessing lead hazards in the home.
“We have never really isolated any of the variables,” says Jamie Ferschinger, director of environmental health at Sixteenth Street. “We don’t say it’s only paint or it’s only water or it’s only pottery or it’s only soil, because we can’t. We say it’s all of them. We go into the home and help the family identify the hazards, not making any judgments of one over the other, but saying, here are reasons we think these hazards are contributing to an elevated blood level and then give them the opportunity to make some changes. This has been a really effective way to do it.”
“Childhood lead poisoning can be eliminated but doing that requires that the routes of exposure be eliminated,” says Coons. “Eliminating lead poisoning means keeping children from becoming lead poisoned in the first place. Since the major route of exposure to children is from lead paint dust found in their own homes, the best way to eliminate childhood lead poisoning is to fix the older housing units that have lead hazards.”
Moving Forward After Setbacks
The “stop-work order” issued by the U.S. Department of Housing and Urban Development (HUD) after the 2018 resignation of MHD commissioner Bevan Baker, who failed to notify 3,000 families that their children had been poisoned by lead, has temporarily shut down the city’s primary prevention program for lead abatement, which previously provided funding for residents for new windows and other projects to proactively prevent lead exposure. Now, MHD is “focusing on remediation for homes with children with elevated blood levels who test above 20 mcg/dL or have two tests above 15 mcg/dL within 90 days elevated blood,” Schultz says. She adds the city hopes to get the primary prevention funding from HUD restored soon.
MHD is still recovering from its earlier mistakes. For one, it is moving forward with two neighborhood initiatives on the North and South sides designed to reach many more residents living in areas with the reported densest concentration of lead poisoning.
Despite the recent setbacks for Milwaukee, Roy Irving, hazard assessment section chief of Wisconsin DHS, says progress in solving the lead problem is being made statewide. “Public health interventions focused on lead-based paint have been considerably successful in reducing blood lead levels in children,” he says. Although lead in water is another challenge for Milwaukee, as well as many other cities in Wisconsin and across the U.S., Irving notes positive developments in the state to reduce lead in drinking water. “These include stronger collaborations between drinking water systems and public health agencies in building public awareness and coordinating on investigations of lead-poisoned children, programs and policies that assist municipalities with removing lead service lines from their systems and efforts in some communities to understand and address the occurrence of lead in drinking water at schools and child care facilities.”
The cost of replacing the almost 80,000 lead laterals in the city of Milwaukee is estimated to be around $750 million. Milwaukee Water Works is replacing a small fraction year-by-year as funding permits.
“The science is still evolving on understanding the occurrence of lead in water and what it means for childhood exposures,” Irving continues. “Because lead was commonly used in household plumbing and water systems, replacing lead-containing service lines and household plumbing components presents a significant logistical and economic challenge to communities. Despite this, many state and local agencies in Wisconsin are taking meaningful steps to address this issue.”
Despite the ubiquity of lead in our environment, health experts agree that lead poisoning is 100% preventable. Coons says that using the following three-pronged approach would help achieve that goal:
- Remove lead paint hazards in old housing before children become exposed.
- Educate families and property owners about lead hazards in the environment and ways to correct the hazards to protect children.
- Make sure children who are at risk for lead exposure are tested, so if they’ve been exposed to lead, interventions to eliminate their exposure may be provided.
The new door-to-door lead outreach initiative aims to increase testing among children under 6 and to provide interim controls to residents in neighborhoods that have high-density lead poisonings.
Saving Our Children
“Our main objective is to protect our children,” says the SDC’s Hinton. “We talk a lot about the success of our children in school. Some of the things we’ve been able to correlate with lead poisoning are incarceration issues and bad performance in school. When you talk about root-cause issues, this is a root-cause issue. We have to do something about it. No child should ever be exposed to lead.”
Gov. Tony Evers’ proposed budget includes $54 million for lead abatement and intervention programs for children who have been poisoned.
For further information about the Lead Outreach Program in Milwaukee, contact the Social Development Commission at 414-906-2700 (Aldermanic District 15) or Jamie Ferschinger at Sixteenth Street Community Health Centers 414-897-5598 (Aldermanic District 12).
