I grew up in a house in Flint built in 1939, one I know had lead in it. I can remember playing with the neighborhood kids, picking paint chips off of their porch to pass the time. Years later, during my pediatric residency, I heard one of our toxicologist physicians talk about how lead chips taste sweet, and immediately, I was transported to those childhood days.
In the 1970s, the average blood lead level for children 0-5 five years old, the highest risk category, was 15 micrograms per deciliter of blood. Today, the Centers for Disease Control recommends that 5 micrograms is cause for concern. Lead gasoline was used back then, we all breathed it, and lead paint covered the walls of our houses. That toxic exposure remains in urban places like Flint and Detroit today.
Events in both cities have shown how aging water infrastructure can also be a source of lead exposure. Yet, the leading cause of lead poisoning among children in the U.S. is lead-based paint and lead-contaminated dust found in deteriorating homes and buildings. Kids don’t have to be eating paint chips. They can get dust on their fingers and into their bodies just by living in houses difficult to maintain. Detroit’s a city that has not been subjected to earthquakes, wildfires or floods, things that cause you to have to rebuild every so often. As a result, it has a surplus of old housing stock.
Young children especially can be harmed by lead exposure. It can damage their brains and nervous systems, stunt growth and development, and put them at high risk for physical and behavioral challenges. Research shows a lead-poisoned child is seven times more likely to drop out of school, and six times more likely to enter the juvenile justice system. Since the early 2000s, there’s been significant progress made on this issue, but in 2018, Detroit ranked fifth out of ten cities in Michigan that had the highest rates of children with elevated blood lead levels (EBLL).
As a general pediatrician, I’ve been involved with lead advocacy since the mid-’90s. Back then, I ran a mobile team out of Children’s Hospital focused on preventive care on Detroit’s east side. We started the first home intervention program here, training people to super clean houses against lead. The work evolved into a partnership between the city, the health department, Wayne State University, us, and other local organizations, and it spurred a 2003 Detroit Free Press expose on lead poisoning in Detroit. That front-page news series was the impetus for the State taking action. Laws were passed addressed housing and a greater need for lead-level reporting.
Nationwide improvement to cases of lead poisoning was so dramatic that funding started drying up. It was the awful event of the Flint water crisis that renewed concern among legislators, gathered resources, and put money into this issue again.
The numbers in Detroit have come down, there’s no question. There were 10,000 kids a year in the city who were lead poisoned when we started, with levels of 10 mcg/dL and above. Now, we have over 1000 cases each year, at five mcg/dL and above. That’s 1000 kids too many, but it’s a significant improvement.
We’ve always struggled with getting enough children tested. The city of Detroit recommends they do so annually up to age six, and the CDC recommends any child get tested at one and two years old, with further testing depending on outcomes, but usually neither happens. Up until last year, it had been getting better, particularly once Women, Infant and Children Food Services (WIC) started testing.
Then COVID-19 hit. Now no one’s going to the doctor’s office, kids aren’t getting screened and they’re spending more time in what are probably high-risk homes. At some point, we’re going to see the results of that.
In collaboration with the Lead Safe Detroit Coalition, we’re working to identify homes where parents think there might be lead issues. The plan is to offer a virtual home visit, assess for lead hazards, and determine mitigation strategies of education, super cleaning, or relocation.
My organization, Kids’ Health Connections, works with multiple medical practices in the tri-county area and with some of the Medicaid health plans. We’re seeking those kids who are at the greatest risk because they haven’t been screened yet or because their levels are high, to get them support.
Beyond housing mitigation, language enrichment is the other really important piece here. We know lead poisoning can affect brain development. A real way to combat those effects is to help young children under age three and families learn to increase the language richness of their home environment.
The citywide program 313 Speaks, supported by the Bloomberg Philanthropies, uses Language Environmental Analysis (LENA) technology and curriculum to record the daily “talk” your child experiences to encourage and support more. Brilliant Detroit hosts this program in the form of an 8-week playgroup (LENA Play) as well as through a 10-week parent education program (LENA Start).
It’s open to anyone, but we’re trying to get the word out especially to those families where lead is an issue. Even if their child is only six months old, they communicate through sound. The importance of stimulating kids’ brains, talking and reading to them, I think that’s a message of hope we haven’t gotten out strongly enough.
Planet Detroit’s Solving Lead & Asthma in Detroit series is underwritten, in part, by the Erb Family Foundation.