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Although some have termed lead poisoning a “wicked problem,” one that is difficult or even impossible to solve, local health department officials and community outreach workers remain hopeful that they can bring it under control. The Wisconsin Department of Health Services (DHS) considers lead poisoning 100% preventable.
Recently released data provides a basis for some guarded optimism, and new sources of funding will provide much-needed practical assistance. New DHS data shows that the City of Milwaukee is making some progress in its battle to combat lead poisoning. In 2018, for example, 9.2% of children under 6 who were tested for lead poisoning in the City of Milwaukee had blood lead levels above the threshold for identifying poisoning (≥ 5 mcg/dL). This is a drop of 1.6 percentage points from 2016, when 10.8% of tested children had blood lead levels above this threshold.
Although the City of Milwaukee still has both the largest number and the highest percentage of lead-poisoned children among reporting units throughout Wisconsin, this drop is statistically meaningful and reflects similar trends throughout Wisconsin during the same time period.
“These decreases may result from outreach and education programs with families and the general public on how to prevent children from being exposed to lead,” says Marjorie Coons of the Lead Poisoning Prevention Section at DHS. “Each year, more homes are undergoing lead hazard remediation, reducing the risks for lead exposure in these homes.”
Lead Hazard Control Money
More home remediation will be made possible by a $6 million Lead Hazard Control Grant that was awarded to the City of Milwaukee by the U.S. Department of Housing and Urban Development (HUD) in October. “Two-hundred seventy-three homes are projected to be improved during this 42-month grant,” says Ron Green, environmental health services manager and HUD program manager for the City of Milwaukee Health Department.
DHS is also implementing a new Lead Safe Homes Program (LSHP) with Children’s Health Insurance Program funding to remediate lead hazards in homes of Medicaid-eligible children and pregnant women. “The Lead-Safe Homes Program funded by the Medicaid Health Services Initiatives (HSI) is providing new opportunities to eliminate lead hazards and protect children from lead poisoning in Wisconsin,” says Shelley Bruce, chief of DHS’s Lead and Asbestos Section. “This funding adds significantly to other funds used in the state to remove lead hazards and renovate old homes, such as HUD lead hazard reduction and community development grants,” she continues. “To the extent that more homes can be made lead-safe than otherwise could have been without this money, more children will be protected.” She adds the homes of children enrolled in Medicaid or BadgerCare Plus may be eligible for the program, which can pay up to 100% of the cost to make the home lead-safe.
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According to Bruce, more than 85% of all lead-poisoned children in Wisconsin receive Medicaid or BadgerCare Plus benefits. “The LSHP is designed to directly benefit those children most likely to live in the oldest housing with lead hazards,” she explains. HSI funds are available to the state on a continuing basis, with total funding dependent on annual state match dollars that the state legislature provides. If the legislature accepted the expanded Medicaid monies as the majority of states have done, fewer Wisconsin children would suffer from this preventable but serious issue. Bruce adds that hundreds more homes can be made lead-safe every year through this program and HUD funding, and she estimates that there could be as many as 400,000 older homes with lead hazards in Wisconsin.
“By targeting areas with the oldest housing stock and high lead poisoning rates we hope to continue our progress in reducing childhood lead poisoning,” Bruce explains. The state actively monitors childhood lead poisoning and trends in poisoning rates, which helps to identify populations and communities that need additional resources like the Lead-Safe Homes Program or HUD funding can provide. In Milwaukee, it is anticipated that 60 units can be completed under this reimbursement program—which has not yet begun—according to Claire Evers, deputy commissioner of environmental health and consumer environmental health for the City of Milwaukee Health Department.
‘Education Is the Most Important Thing’
“In 1996, nearly one-half of all Wisconsin children tested were lead-poisoned by today’s standard, with a blood lead level ≥ 5 mcg/dL,” Bruce says. “In the past two decades, we have reduced the percentage of lead-poisoned children significantly. In 2018, 4.4% of Wisconsin children tested were found to be lead-poisoned. However, there are still pockets within the state where lead poisoning is much more prevalent.” Milwaukee is one of those pockets.
Ninety percent of children first identified with lead poisoning from 1996–2005 lived in homes that were built before 1950. These older homes are a significant driver of lead poisoning. A 2008 DHS report found that the risk of a child becoming lead-poisoned was 6.4 times greater for tested children living in dwellings built before 1950 compared to children living in homes built since then.
Since April 2019, the Social Development Commission (SDC) on Milwaukee’s North Side has used a small outreach team, led by Tiffinne Pearson-Suggs, to go door-to-door in Aldermanic District 15, a hotspot for lead poisoning. In the past 10 months, with $150,000 in funding from Milwaukee’s Health Department, the team has knocked on more than 1,000 doors and made contact with people at 650 addresses in the district. Sixteenth Street Community Health Centers also received $150,000 in funding for implementing a similar program on Milwaukee’s South Side. “The good thing about this program is that we’re really able to educate the community about the importance of lead hazards,” Pearson-Suggs says. “We are able to do visual inspections of homes, if they need it, but the education is the most important thing.” She adds that, in addition to door-to-door canvassing, her team has been educating people at community events.
The team faces challenges because some people are apprehensive about answering their doors. According to Pearson-Suggs, there has been some good feedback from neighbors about what this pilot program is doing in the community, and the word is getting out about the program. Sometimes, the SDC receives calls from parents who have not yet been contacted by the team who want testing for their children. The SDC is also receiving calls from people who live outside the targeted 15th Aldermanic District who would like information or testing as well.
“The best situation is when we encounter someone who gets information that they didn’t know before our visit,” Pearson-Suggs says. It is most rewarding when they make a return visit to a home with a child whose elevated blood levels were once high, and “we see the lead level has gone down” after intervention, she adds. The SDC reports elevated blood levels and potential home hazards to the health department so appropriate follow up can be done. Funding for SDC’s pilot outreach program has been extended for another year (until April 2021).
‘Lead Is Dangerous. Wherever It Is, We Should Take Care of It’
Milwaukee Mayor Tom Barrett’s 2020 budget provides $13.6 million for lead service line replacement for more than1,000 at-risk households, along with another $8 million to assess and abate lead hazards in homes where children with high blood lead levels have been identified. Another $240,000 will be used to provide 2,400 kits to women who give birth in the targeted zip codes of 53204, 53206, 53208 and 53210—areas that lead has most impacted. This pilot program will reach almost every birthing mother in the targeted areas and provide a lead education kit, including a certified lead-filter water pitcher and two replacement filters.
In July 2019, Gov. Tony Evers signed an executive order creating a “lead czar” for Wisconsin to coordinate statewide efforts to reduce lead exposure. Earlier, the state Legislature struck $40 million from Evers’ proposed budget to replace some lead service lines in the state. The Evers administration, however, can use a portion of the $32 million for its clean water initiative for lead service line replacement.
George Hinton, SDC’s chief executive officer, is confident that the lead problem can be solved. “It’s something that will take a while to do, and it’s not easy, but we are starting to see money flow in from the federal government, the state and city to do some abatement work—not only on paint but on water,” Hinton said. “We know what the science is,” he continued. “We know what it will take to resolve the lead problem. Education alone will not solve this problem. We have to abate lead paint, and we need to fix our pipes, so we don’t accidentally poison our children. We have to have the will to do it, and we have to put infrastructure dollars in place to make it happen.”
Despite the encouraging new data and additional sources of funding, Milwaukee’s lead poisoning problem is far from solved. But with the additional city, state and federal resources, Milwaukee seems poised to combat lead poisoning more vigorously than in the past. “Lead is dangerous to our children, so wherever it is, we should take care of it,” Hinton says. “We need to be as aggressive as possible. For every year that we wait, there’s another group of children that are being negatively affected by lead.”
