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This article is an update to Milwaukee Chips Away at Lead Poisoning published February 4, 2020.
While the pandemic rages on, with more than 28,000 confirmed cases of and 300 deaths from COVID-19 in the City of Milwaukee so far this year, the city’s youngest children continue to be exposed to unsafe levels of lead in their homes.
Lead poisoning is a nationwide scourge and a stubborn local enemy. Children under the age of six are the most vulnerable to lead poisoning that can cause permanent neurological damage leading to learning disabilities and behavior problems. But testing can lead to prompt medical and environmental intervention and reduce toxic blood levels in children.
A 2019 study done at UWM’s Joseph J. Zilber School of Public Health found that in Milwaukee more than half of the people involved in gun violence—perpetrators and victims—had elevated blood lead levels as children. The study used public health, education and criminal justice data for 89,000 people born in Milwaukee between June 1, 1986, and December 31, 2003, who had been tested for lead exposure before the age of six.
Testing Declines in 2020
Ten thousand fewer children were tested in the first nine months of 2020 than in the first nine months of 2019, according to data supplied by the Milwaukee Health Department. The decline in testing has left some children with elevated lead levels unidentified because they are missing wellness exams. Some children who had elevated blood lead levels have not had follow-up visits because their families have relocated, and health department officials have been unable to find them.
Because of school closures, children are spending more time at home, increasing their exposure to potentially dangerous lead sources. In addition, disruptions in insurance and housing insecurity brought on by the pandemic are putting more children at risk of permanent damage from untreated lead poisoning. Kaiser Health News (KHN) reports that a drop in testing was widespread nationwide this year.
Though testing slowed in 2020, some good news emerged from the 2019 data. Nineteen percent fewer children under the age of six had elevated lead blood levels in 2019 compared to 2018, according to Wisconsin Department of Health Services data. In addition, 7.8% of the children tested had elevated blood levels in 2019 compared to 9.2% in 2018. But even with lead poisoning down in 2019, 1939 children in the City of Milwaukee under the age of 6, had elevated blood lead levels.
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$3.55 Million Budget for Increased Testing Proposed
MICAH’S Coalition on Lead Emergency (COLE) wants to change that. It recently asked the Milwaukee Common Council and Mayor Tom Barrett to provide the Milwaukee Health Department with $3.55 million in its 2021 budget to cover the costs associated with increased testing and assessment for all children who have elevated blood lead levels.
On October 29 and 30, the Finance and Personnel Committee will consider a budget amendment to fulfill the $3.55 million COLE request. The budget amendment is sponsored by Common Council President Cavalier Johnson, Finance and Personnel Committee Chair Ald. Michael Murphy and other co-sponsors. The $3.55 million would result in environmental testing and trigger more home abatement orders for more than 1,900 children who have elevated blood lead levels >5 µg/dL. Currently, only the homes of slightly more than 100 children who have blood lead levels > 20 µg/dL are inspected for lead contamination.
Helen Meier, associate professor of epidemiology at UWM’s Zilber School of Public Health said there are different standards for case management in Milwaukee than in Madison. “In Milwaukee, case management and environmental assessment are only provided to children who have blood lead levels >20 µg/dL,” Meier said. “In Madison, for example, case management and environmental assessment are provided to all children who have blood lead levels >5 µg/dL.”
Poverty and Low Levels of Home Ownership Affect Lead Exposure
Meier recently published a paper which found “the risk of elevated childhood blood lead levels is greatest in majority non-White Milwaukee County neighborhoods with high poverty and low home ownership.”
“Not only do we have inequities for risk for children in Milwaukee, but that's been compounded by a lack of access to services for children whose blood lead levels fall between 5 µg/dL and 20 µg/dL,” Meier said. “If these children lived in Madison, they would get services, but because they live in Milwaukee, they don’t. Meier also found that approximately 10,000 children between 2014-2016 would have received case management for their elevated blood levels if Milwaukee used the Madison standards. She hopes that the $3.55 million requested by COLE will address that inequity.
“The 3.55 million that COLE is requesting will not solve the entire lead problem in Milwaukee, but it would be an important step down that road,” said Rev. Dennis Jacobsen, the COLE chair. “The City has made a lot of progress on lead since the 90s, but I think it's been kind of stuck in the last few years.”
More Money Needed
Jacobsen acknowledged the need for more money to solve the lead poisoning problem. “We need a private/public partnership fund in Milwaukee to become a lead-safe city because the city is broke,” he said. “These are very tough budgetary decisions by the elected officials.” Jacobsen cited a public/private partnership called the Lead Safe Cleveland Coalition in Cleveland, Ohio that he thinks might be a good model for Milwaukee. The Lead Safe Cleveland Coalition was founded in early 2019. One of the coalition’s most important goals is to make rental units built before 1978 certified lead-safe beginning in March 2021. The 400-member coalition hopes to raise $99 million in public and private funds by 2024 to combat lead poisoning. So far it has raised $18 million.
“Cleveland started a private/public partnership to help particularly low-income landlords do lead abatement,” Jacobsen said. “There are property owners who don't have a lot of money, who are in a bind.” Jacobsen also said he supports lead-safe certification for rental properties in Wisconsin. “If I have young children and I am looking to rent, I can see if they are lead-safe certified or not,” he said. “That would be ideal. Now it’s guesswork.”
Meier agreed. “Other cities, such as Cleveland and Rochester, NY, require lead-safe certification of properties before they can be rented,” she said. “We don’t have any protections like that built in for our renting population here in Milwaukee.”
In July, the Milwaukee Common Council approved legislation that moved forward an effort to create a program certifying that properties are lead-safe before they are rented to the public. The resolution, authored by Khalif J. Rainey, and co-sponsored by Cavalier Johnson, Chantia Lewis, José G. Pérez, Marina Dimitrijevic, Mark A. Borkowski, Nik Kovac and Scott Spiker, directed the Wisconsin Department of Administration-Intergovernmental Relations Division to introduce and pass state legislation that would permit the City of Milwaukee to create a program requiring rental property owners to certify that rental properties are lead-safe before they are rented to the public.
New Focus on Primary Prevention
UWM’s Meier distinguished between primary and secondary prevention. Once a child has been exposed to lead, dealing with that exposure is considered a secondary prevention. Meier's research makes the case for investing in primary prevention.
“What we argued for in the [published] paper, is the need to focus on primary prevention, which is preventing exposure in the first place because we know that no amount of lead exposure is safe,” Meier said She said exposure can be prevented through equity-focused housing policies, and targeted economic policies that provide people with abatement resources and allow them to own a home, giving them the authority to make changes themselves.
Meier said she was most interested in the part of the proposed 2021 city budget that provides funding for helping people buy homes. Mayor Barrett’s proposed budget includes $12.3 million in funding for neighborhood investment, affordable housing and homeownership, which supports the Mayor’s 2018 initiative to create or fund 10,000 affordable housing units in 10 years.
“Providing funds for home ownership will improve health in general, not just reduce lead exposure,” Meier said. ‘Home ownership is a way for individuals to build equity. There’s lots of research out there that shows wealth and equity are associated with better health outcomes. That’s a great upstream intervention.”
Delays Have Costs
The State Department of Health Services' 2014 Report on Childhood Lead Poisoning in Wisconsin found that if lead poisoning in children were completely eliminated, an estimated $28 billion would be saved, which includes $7 billion in direct costs for medical treatments, special education, and crime and juvenile delinquency, plus an estimated $21 billion in new earnings because of increased high school graduation rates and lifetime ability to earn. “There is a solution to this serious and costly problem—remove LBP hazards from older homes,” the report concluded.
Jacobsen concluded that delaying to solve the lead problem is shortsighted. He said we need to consider the nightmare that families have to face with children whose behavior is out of control, whose cognitive development is damaged, and who may end up in prison. “It’s a man-made problem,” he said. “We have a moral responsibility to remedy it.”
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