Lead Poisoning in Private and Public Housing: The Legacy Still Before Us

Public health professionals and allies have long fought to eliminate and control the exposures that have come with increased global lead production (Figure 1). But unless new action is taken, history demonstrates that additional cases of elevated blood lead levels can be expected, despite the overwhelming evidence that interventions are effective. Indeed, the global disease burden from lead increased by 160% between 1990 and 2010 and accounts for 674 000 deaths and 14 million disability-adjusted life years.¹

FIGURE 1—

World Production of Lead From 1960 to 2018 (in Millions of Tons)

Source: Adapted from the International Lead and Zinc Study Group (printed with permission).

This issue of AJPH contains two important new contributions to the lead poisoning prevention literature (pages 906 and 912). Together, these articles demonstrate that public perceptions about the problem can be at odds with the scientific evidence. More important, however, they show that concerted public actions can succeed when they are implemented and enforced.

All too often, the public views lead exposure as a “legacy” problem that has already been solved by earlier actions to remove lead from new paint, gasoline, cosmetics, food canning, and other products. Lead exposure is sometimes perceived to be a problem for only a few places where something unusual happened, such as Flint, Michigan, when the evidence clearly shows the problem is far more widespread.

REFUGEE CHILDREN

Shakya and Bhatta (p. 912) show that refugee children are at high risk of lead exposure, not only from their native lands but also from the low-income US housing into which they move, where lead hazards still exist in 23 million housing units. They report that, between 2009 and 2016, more than 27% of young resettled children in Ohio had blood lead levels at or above the current Centers for Disease Control and Prevention reference value of five micrograms per deciliter. Shockingly, 75.5% of Afghani children younger than six years who resettled in Ohio had elevated blood lead levels. The study shows that refugee children have a prevalence of elevated blood lead four to seven times higher than the prevalence among children born in the United States. Tragically, one three-year-old child from Iraq was hospitalized with a blood lead level of 125 micrograms per deciliter after living in a Cleveland home for seven months, demonstrating that the problem is both global and local.

As we struggle with increased numbers of refugees in this era of climate disruption, war, and other problems, the authors suggest that clearer guidelines are needed for resettlement agency personnel to assess both previous and potential future lead exposures. Far from a small, vanishing problem, global childhood lead poisoning remains an urgent and growing threat. For example, many countries still permit the manufacture of lead paint for both residential and industrial use, despite the good work done by the Global Alliance to Eliminate Lead Paint, led by the World Health Organization and the United Nations Environment Programme.² Indeed, some US manufacturers such as Sherwin Williams continue to make this dangerous product, despite repeated calls to stop doing so.³ Other manufacturers, such as those making lead acid batteries, have also not done enough to ensure that their products do not cause high exposures, leaving it to the rest of us to clean up the mess they have made.⁴

PUBLIC VS PRIVATE HOUSING

Chiofalo et al. (p. 906) also challenge public perceptions about lead exposure. In their study, they compared blood lead levels among young children residing in public and private housing in New York City. Recent press reports and legal actions suggest that lead paint hazards in public housing are a very large problem. However, this new study shows that public housing is associated with 92% reduced odds of elevated blood lead levels; that is, public housing is safer. The authors suggest that the reasons are the passage of Title X of the 1992 Housing and Community Development Act and the city’s action to ban lead in residential paint in 1960, well before Congress finally did so in 1978.

In fact, however, progress in public housing started much earlier. Public housing (as distinguished from privately owned Section 8 housing or low-income housing without subsidies) was the first nationwide program in which homes were required to be fully inspected, starting in the late 1980s. Lead paint in public housing is required to be fully abated at the time of modernization, and hazards are required to be controlled in the interim. In fact, the lead-based paint risk assessment protocols now used throughout the nation originated as an insurance program in public housing.

The authors report that, between 2003 and 2017, 0.25% of New York City children residing in public housing had an elevated blood lead level, as compared with 2.76% of children living in privately owned housing. Because the public housing requirements have been in place for nearly 30 years, one would think that by now all public housing should have been completely abated. But clearly this has not been the case in the New York City Housing Authority (NYCHA) and other housing authorities’ public housing, where children with elevated blood lead levels continue to be identified, albeit at a much lower frequency than in privately owned low-income housing.

In short, the evidence suggests that public housing is indeed much safer and that the policy of full inspections and abatement is effective when properly implemented and enforced. But NYCHA and other public housing authorities should finish the job and ensure that no taxpayer dollars are used to subsidize housing units with lead hazards; Congress should end its decades-old disinvestment in public and assisted housing, which has in part prevented full implementation of the law to protect children.

Additional resources need to be devoted to ensure that the higher risks the authors found in privately owned housing are eliminated as well. Through the advocacy of the National Safe and Healthy Housing Coalition⁵ and others, Congress recently appropriated a record level of funding for the Department of Housing and Urban Development’s lead poisoning prevention and healthy homes program. This program is the nation’s largest source of funding to inspect and remediate low-income privately owned housing, where, as shown by this study (and many others), risks remain far too great.

REAPING THE SAVINGS

A 2017 report⁶ that examined lead exposure prevention policies both qualitatively and quantitatively produced two primary findings. First, monetized benefits far outweigh costs (or, put another way, we continue to foolishly pay the costs of lead exposure instead of reaping the savings to be gained by finally eliminating our lead problem). Second (and something all of us already know), caring for our children is simply the right thing to do.

If we fail to end all nonessential uses of lead, both globally and locally, and if we fail to ensure that lead hazards are eliminated in both public and private housing, we will continue to needlessly delay the time when childhood lead poisoning becomes a true legacy, one that is behind us rather than ahead of us.