Issue Category: Child and School Health

Lansing’s Efforts to Prevent and Respond to Childhood Lead Exposure

 

“We started asking about lead, and what is the safe level of lead, and there isn’t one, especially for kids. So we said the prudent thing to do is to improve the testing and start getting these lead pipes out. Get the lead out.”

Virgil Bernero, Mayor of Lansing

 

Background

In 2004, then-Michigan State Senator Virg Bernero encouraged local officials to work with Lansing Board of Water and Light (BWL) Commissioners to speed up the removal of lead service lines (LSLs). The BWL, a municipally-owned utility, funded the program as an infrastructure investment, and utility customers shared the cost through an increase in their water rates. BWL gave priority to lines serving schools and licensed day care facilities, areas where children had elevated blood lead levels, households with pregnant women or children under age 6, and other places with high concentrations of LSLs.

From 2004 to 2016, Lansing, Michigan, replaced 12,150 LSLs with copper lines, becoming only the second city in the country to remove all its active lead service lines. The total cost was $44.5 million.

Lead Service Line Replacement

BWL has developed a faster, more efficient way to replace pipes; what had been a nearly 8-hour job, $9,000 job requiring a trench to be dug from the main in the street to the foundation of the house, has been streamlined to 4 hours at a cost of $3,600. Instead of trenching, BWL now digs a hole in the street and another where the shut-off valve is, pulls the old pipe out from underground and slides in the new one.

Additionally, where possible, the lead service line replacement program has followed planned street, sewer, and other infrastructure improvement projects to minimize street closures and reduce the cost of street reconstruction.

Service line replacements were scheduled to prioritize replacing any lead service lines serving schools and licensed day care centers, areas having children with elevated blood lead levels, households with pregnant women or children under age six, and other areas with large concentrations of lead service lines.

The lead service line replacement program engages customers through outreach (distribution of brochures and articles in bills, open houses at schools and community centers, and information inserted in routine water quality reports).

BWL water quality reports indicate a decrease in lead levels in the water over 10 years, from 2005 to 2015, with 90 percent of homes at or below 7.8 parts per billion in 2015 (down from 11.3 parts per billion in 2005). Although the BWL completed its lead service line replacement program, it will continue its corrosion control process.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Omaha’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

Lead is a significant environmental health hazard to children in Omaha, home to the nation’s largest residential U.S. Environmental Protection Agency (EPA) Superfund site– a program that provides resources to address lead contamination in soil caused by an old refinery. In 1998, after it was revealed that nearly 10 percent of the children tested in Douglas County had blood lead levels higher than 10 µg/dL, the Omaha City Council requested assistance from the EPA. In 2003, Omaha was added to the Superfund National Priorities List, with approximately 14 square miles of residential property in East Omaha considered at high risk.

Superfund

In 1998, when the Omaha City Council requested EPA assistance to address the high frequency of children in eastern Omaha found by the Douglas County Health Department to have elevated blood lead levels, the EPA began investigating the lead contamination in the Omaha areas under the authority of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), also known as the Superfund law.

After blood tests revealed elevated lead levels in nearly 600 children, the EPA formed the Omaha Lead Superfund Site in 1999, which has become the largest residential lead remediation in the country. Cleanup of residential properties included testing a wide array of soil in places like child care facilities, schools, playgrounds, parks, and homes; removal and replacement of contaminated soil; and planting new sod and grass seed.

The Douglas County Health Department Childhood Lead Poisoning Prevention Program offers free inspections to families in Douglas County living in pre-1978 housing where children under seven-years-old live and play. Families with children who have been found to have elevated blood lead levels are given top priority. They also administer an EPA-funded interior dust program where residents who have had their soil remediated can receive education and a free HEPA vacuum.

EPA’s work is ending after it completed testing soil samples from 40,000 properties and cleaned up more than 12,000 properties that were contaminated with lead; however, the work of lead remediation will continue in partnership with the city. In May 2015, the EPA awarded $40 million to the City of Omaha through a cooperative agreement to address the final phases of the work, including ongoing attempts to collect soil samples and clean up the remaining properties. The rationale is that the owners of remaining properties will feel more at ease working with the city than with the federal government.

Updated Nuisance Ordinance

In December 2010, the Omaha City Council amended the “nuisance” chapter of the Omaha Municipal Code, adding lead-based paint to the list of specific examples of situations declared to be nuisances. Under the revised law, lead-based paint or other lead-based coating materials (such as liquid coatings on furniture) is a hazard and a “nuisance” on the interior or exterior of a home when it is accessible, or may become accessible, to ingestion or inhalation.

Once notified of a lead-based paint “nuisance,” a designated city officer and/or health director of the health department gives written “notice to abate” to the property owner and/or occupant or to the person causing the nuisance. If the person ordered to remove the hazard neither requests a hearing nor abates it within the specified time, the city will take care of it and bill the responsible party. In addition, that person may be fined up to $500 and/or imprisoned for up to six months for each day the nuisance remains.

Lead Hazard Control Program

A HUD-funded initiative, the City of Omaha Lead Hazard Control program, repairs interior lead-based paint hazards, including window and door replacement and paint stabilization, in homes occupied by children under age 7 within the boundaries of the Superfund site. The Omaha Healthy Kids Alliance (OHKA) works in tandem with this program to address additional environmental hazards and structural concerns, to provide education and referrals, and to monitor the program’s impact on health and track data.

OHKA is a nonprofit children’s environmental health organization working to improve children’s health through their Healthy Homes initiative. OHKA evaluates residences for health, safety, and environmental risks, works with families to create individual plans for a healthy home environment, and advocates for policies and best practices that promote health and protect children. It assists clients by delivering supplies, repairing houses, and referring them to community partners.

Grassroots Latino Environmental Education Program

OHKA partnered with the University of Nebraska Medical Center’s College of Public Health, Omaha community-based organizations, and the EPA in 2014 to launch the Grassroots Latino Environmental Education (GLEE) program. GLEE’s goal is to make information about environmental hazards more easily available in Spanish. Understanding that promotoras – community health workers – are effective at disseminating information to the Latino population, it was important to teach them about the connections between a person’s personal health and the environment in which they live. Through GLEE, OHKA trained more than 40 promotoras who educated over 1,000 Spanish-speaking Omaha residents in two years.

Lead Education Action Program

In 2016, OHKA received 6 years of funding from the EPA and the City of Omaha for the Lead Education Action Program (LEAP). The goal of the $5.4 million LEAP program is to support the City’s efforts to take over the Superfund cleanup activities, to educate the community about lead and healthy homes, and to direct residents to use the Omaha Lead Registry website, which is kept up-to-date with new information provided by government agencies, community groups, and private citizens.

One LEAP’s key initiatives is the Lead Free in Five campaign. Launched in October of 2016, with a convening of over 100 community leaders, the campaign aims to address childhood lead poisoning in Omaha through a community-wide strategy of policies, education, and infrastructure.
Results

In 2012, the Douglas County Health Department reported 119 children had tested positive for elevated blood lead levels, compared to 451 children in 1998. Not only were more children tested (17,294) in 2012 than had been previously  but only 0.5 percent of the children showed blood lead levels higher than 9.5 µg/dL, a marked decrease from 13 percent in 1998. As of June 2013, fewer than two percent of eastern Omaha children tested showed elevated lead levels, compared to 33 percent before the Superfund cleanup.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

New York State’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

Although rates of childhood lead poisoning in New York have steadily declined since 1998, childhood lead poisoning remains a significant public health problem, where rates outside of New York City remain above national averages. New York State also consistently ranks high on key risk factors associated with lead poisoning, including many young children living in poverty, a large immigrant population, and an older, deteriorated housing stock.

Since 1993, New York State’s lead poisoning regulations have included a Notice and Demand (N&D) component that requires property owners to address lead hazards to prevent exposure. After inspecting a unit for lead-based paint hazards (including deteriorated lead paint and contaminated dust and bare soil), the local health department can issue a written N&D, which outlines the lead-based hazards present and requires owners to submit a corrective work plan within a fixed number of days. The Commissioner of Health or a designated representative determines the location and methods of controlling the hazards. Property owners are responsible for complying with federal, state, and local laws governing building construction, housing, worker health and safety, and disposal of lead-containing wastes and must provide documentation showing their compliance upon request. Individuals who fail to remedy issues within the specified time frame may face fines or prosecution.

Primary Prevention Program

The state-funded New York State Childhood Lead Poisoning Primary Prevention Program (NYS CLPPPP) was established in 2007 (under New York State Public Health Law1370-a [3]) to combat New York’s high rates of childhood lead poisoning through primary, rather than secondary, prevention methods.

Unlike most other existing lead programs, the NYS CLPPPP takes action to reduce lead hazards in housing units before a child’s blood lead-level exceeds federal standards. Under the program, local health departments receive funds to find and correct lead hazards in homes where children could be at risk. The New York State Department of Health (NYSDOH) is responsible for:

  • Coordinating with local health departments to implement the NYS CLPPPP and identifying housing at greatest risk of lead-based paint hazards;
  • developing partnerships and engaging with communities to promote primary prevention;
  • Promoting interventions to create lead-safe housing units;
  • Building workforce capacity to implement lead-safe work practices; and
  • Identifying community resources for lead-hazard control.

The New York State Department of Health uses surveillance data to find communities in the state with a high burden of childhood lead poisoning, then provides grants to local health departments in these communities to implement approved primary prevention programs.

Grantees are required to establish a housing inspection program that prioritizes units for inspections, corrects identified hazards using lead-safe work practices, and provides appropriate oversight of remediation work and clearance by certified inspectors. Grantees are also required to perform additional primary and secondary prevention actions beyond applicable Notice & Demand requests. If a child under the age of six in an inspected unit has not received required blood lead tests, the grantee is required to refer them to a primary care provider or local health department lead prevention program for follow-up. Grantees must also collect and report data to the NYSDOH to aid in continued program evaluation.

Although the NYS CLPPPP does not provide funding to property owners for repairing identified hazards, grantees coordinate available financial and technical resources to assist property owners with remediation and must also develop and implement lead-safe work practices training for property owners, contractors and residents. Previous NYS CLPPPP evaluation reports have identified this lack of funding for required repairs as a primary barrier to timely remediation in N&D cases, making this grantee task essential to the overall success of the program.

Lastly, grantees are required to develop formal partnerships and agreements with other county and municipal agencies/programs—possibly including code enforcement offices, local housing agencies, HUD Lead Hazard Control grantees, weatherization programs, and community groups. As a result, nearly one-third of all inspections in 2015 were conducted by staff of a code enforcement agency, not local health department officials.

Results

In the first eight years of the program, grantees visited and inspected the interiors of 37,731 homes, impacting over 23,000 children, and have cleared 75 percent of the units found to have at least one confirmed or potential interior lead hazard (roughly a third of the units inspected).

Over this same time frame, the state has invested $52.76 million in the program, equating to roughly $4,800 for each of the 11,020 children living in homes with confirmed or potential lead hazards (not including the homes into which other children will move in the future).

From 2007 to 2015, the percentage of children tested with confirmed blood lead levels (BLLs) greater than 10 µg/dL in New York dropped from 0.99 percent to 0.47 percent. Rates have dropped among both children tested in New York City and Upstate New York; however, the rates of children tested with confirmed elevated BLLs remains over three times higher in Upstate New York compared to New York City (0.91 percent versus 0.29 percent). Overall, rates dropped from 1.45 percent to 0.91 percent from 2007 to 2015 in Upstate New York and 0.68 percent to 0.29 percent in New York City.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Access a story on New York City’s efforts here.

Access a story on Rochester’s efforts here. 

New Orleans’ Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In New Orleans, Louisiana, more than 90 percent of housing structures were built prior to 1978 – the year lead was decreased in residential paint – making city residents vulnerable to lead-based paint hazards. In addition to deteriorating paint and the lead contaminated dust it generates, the lead dust from the use of leaded gasoline contributed significantly to elevated soil lead levels.

While leaded gasoline was phased out in the 1970s through the 1990s, the lead dust remains in soil, particularly within transit-heavy areas of the city. Researchers estimate that vehicles deposited more than 10,000 metric tons of lead dust in New Orleans soil between 1950 and 1985. In 2004, more than 40 percent of New Orleans soils exceeded the EPA’s cleanup standard for play areas.

Lead in soil can disproportionally impact children because they are more like to inhale and ingest dust and dirt.

Hurricanes Katrina and Rita

In August, 2005, storm surges from the Hurricanes flooded 80 percent of the homes of New Orleans and deposited massive quantities of low lead sediments into the city. The sediments created a natural barrier on top of the pre-existing high-lead soil establishing a cleaner, less hazardous landscape. This, combined with citywide cleanup and remediation efforts, reduced lead dust in homes and surrounding soil. Lead assessments conducted in Katrina’s immediate aftermath found a 46 percent reduction in median soil lead levels. And the declines continued. Before the storm, 15 of the city’s 46 census tract neighborhoods exceeded the EPA’s regulatory soil lead standards; by 2010, only 6 neighborhoods exceeded standards.

At the same time, there was a decrease in children’s BLL. Prior to the Hurricanes, 50 percent of New Orleans’s children had BLL’s equal or greater that the federal reference value of 5 µg/dL. Ten years after the Hurricanes, about 5 percent of the children’s BLL exceed that exposure value.

Lead-Safe Soil Emplacement Interventions

Inspired by the city’s unique natural experiment, researchers used a similar approach to clean up soil at 10 childcare centers in New Orleans, covering lead-contaminated surface soils with a water-permeable barrier and 6-inch layer of low-lead soil. Since 2005, nine of the 10 federal public housing projects were rebuilt using this process—landscaped with low lead soil to raise the elevation of the housing. This intervention was expanded to all New Orleans’s childcare center play areas and public playgrounds that tested high for lead.

Challenges Remain

These efforts, combined with the potential reduction of lead from fresh topsoil deposited by the storm surge during Hurricane Katrina, led to a decrease in the percentage of children with elevated BLLs in high-lead communities (mainly inner city) from 64 percent in 2005 to 19 percent by 2015. In short, household restoration and cleaning reduced lead-based paint hazards and washed-in sediments reduced soil lead. The remaining challenge is to reduce exposure in high lead communities by conducting more “soil emplacement interventions and continuing lead paint hazard reduction strategies.”

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

New York City’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

According to the New York City Department of Health and Mental Hygiene, lead paint, and the related dust, is the primary source of lead exposure for New York City children. Between November 2013 and January 2016, New York City’s Department of Housing Preservation and Development (HPD), which enforces the city’s housing code, issued more than 10,000 violations for dangerous lead paint conditions in units with children under 6-years-old.lead

Lead poisoning disproportionately affects lower-income individuals in New York City who live in older, poorly maintained housing. Half of the total violations were found in just 10 percent of the city’s ZIP codes in primarily low-income neighborhoods in northern Manhattan, Brooklyn, and the Bronx. And, more than three-quarters of all violations for lead paint hazards in units with children under age six were found in areas where the poverty rate exceeds the city’s average.

Rebuttable Presumption and Billing Noncompliant Landlords for Lead Hazard Control

In 2004, New York City introduced Local Law 1 amending its Administrative Code and replacing Local Law 38 of 1999 (additional information here). Local Law 1 requires building owners to identify and repair any unsafe lead paint conditions in units where young children live. The law applies to all buildings with three or more units built before 1960 (New York City prohibited the use of lead in residential paint in 1960 while the federal government did so in 1978). Buildings built between 1960 and 1978 are also subject to Local Law 1 if the owner knows that lead paint is present. Under the law, landlords must determine annually which units are home to children under age six and inspect them at least once a year for peeling paint.

The building owners must address whatever lead hazards they find promptly and safely. When fixing hazards and conducting general repair work that may disturb lead paint, they must use lead-safe work practices and trained workers. They are also responsible for repairing lead paint hazards in any apartment before turning it over to a new tenant. The law mandates that owners maintain records of all notices, inspections, lead paint hazard repairs, and other matters related to the law.

Local Law 1 requires the HPD to inspect deteriorated lead paint whenever they receive a complaint in any apartment occupied by young children. HPD may issue positive lead-based paint violations (if it tests the paint during the inspection) or presumed lead-based paint violations (if it is unable to test the paint during the inspection because the proper equipment is not available).

Under the law, once HPD issues a lead paint violation, the building owner has 21 days to repair the hazard or, if the presumed violation was issued, to contest the violation. If the owner either fails to meet the deadline for the repairs or is not given an extension (called a postponement), the city must try to perform, or contract for, the repairs at the owner’s expense. Repairs include remediation of peeling paint, the use of an EPA certified firm, and appropriate clearance testing.

Local Law 1 also mandates the New York City Department of Health and Mental Hygiene to investigate the potential sources of lead exposure. This includes, but is not limited to, paint inspections in a dwelling in response to a report of a person under 18 years of age with an elevated blood lead level of 15 mcg/dL or greater. The Health Department may issue a lead-based paint violation (notifying HPD), and, under the law, the building owner has to do the specified repairs. If the owner fails to complete the work, the dwelling is referred to the city’s emergency repair program as described above.

Functionally, the city’s Department of Finance bills the property for the cost of the emergency repair, related fees, and/or the cost of any repair attempts. It is likely to be far more expensive for the city to arrange repairs than if the owner had taken care of them in the first place. The added cost acts as an incentive for the owner to conduct the work before a violation is issued or, when a violation is issued, to complete it in a timely manner. This is likely the only regulation in the country in which the local government conducts lead remediation and bills the landlord if the landlord fails to do what is required.

Finally, if the owner fails to pay, the city files an interest-bearing tax lien against the property.

Results

Data from the New York City Department of Health and Mental Hygiene shows the number of children with a blood lead level of 5 µg/dL or greater has dropped over 80 percent since Local Law 1 was adopted, although in 2014, 6,550 New York City children younger than 6 still had blood lead levels at or above 5 mcg/dL.

 __________________________________________

In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Access a story on New York State’s efforts here.

Access a story on Rochester’s efforts here. 

California’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In the mid-1980s, the California state legislature declared childhood lead exposure the most significant environmental health problem in the state and subsequently established the Childhood Lead Poisoning Prevention Branch within the state’s Department of Public Health (CDPH).

The program compiles information, identifies target areas, and analyzes data to design and implement ways to reduce childhood lead exposure. The statutes also determine a “standard of care” to evaluate children for lead-exposure risk; mandate reporting by laboratories of all state blood lead test results; and require public health and environmental services for children identified with elevated blood lead levels, including ordering property owners to remove hazardous lead conditions. The state requires the establishment of procedures and the adoption of regulations regarding residential lead paint, and lead-contaminated dust and soil. It also authorizes and administers a lead-based paint prevention training, certification, and accreditation program.

Funding

To help pay for the program, in 1993, California adopted an annual Childhood Lead Poisoning Prevention Fee, administered jointly by CDPH and the California Board of Equalization (BOE), on manufacturers and other entities involved with the production or sale of lead and lead-based products collected from businesses in the petroleum and architectural coatings industries and from facilities reporting releases of lead into the air. The department deploys a “historical market share attributions” concept to estimate each payer’s long-term contribution to environmental lead contamination and allocate fees. It then deploys collected funds (the fee generated $20.6 million in fiscal 2015) to support healthcare referrals, assessments of homes for hazards, and educational activities.

Banning Lead in Certain Products

California has led U.S. efforts to ban lead from a range of products beginning with a 1986 law, Proposition 65, which requires manufacturers, retailers, and other businesses to notify consumers when they are being exposed to toxic chemicals, including lead. The law has made consumers more aware of toxic chemicals in their environment, and advocates have successfully pressed for more regulations to ban or curtail the use of lead and other toxins in products. In conjunction with these efforts, California passed a number of strict laws to safeguard products and protect its citizens from lead exposure. For example:

  • In 2005, California implemented a lead-in-candy law. The state considers candies with lead levels in excess of 0.1 parts per million (ppm) to be contaminated. The Food and Drug Branch of the California Department of Public Health is required to test samples, notify the manufacturer of the adulteration, and issue a health advisory. The federal Food and Drug Administration subsequently issued national guidance in 2006 recommending that all candy likely to be consumed by children contain no more than 0.1 ppm of lead.
  • In 2006, California enacted the Metal-Containing Jewelry Law. This requires jewelry and components, such as dyes and crystal, that  are sold, shipped, or manufactured for sale in California to meet limits set by the state under a 2004 consent judgment that applied to a number of manufacturers, retailers, and distributors in response to a lawsuit filed by the Attorney General of California and two environmental groups. The law forbids the manufacture, shipping, sale, or offer for retail sale or promotional purposes jewelry in California unless it is made wholly from one or more specified materials. It also mandates lead restrictions for certain specified materials allowed in manufacturing jewelry and establishes provisions for children’s jewelry and that used for body-piercing.
  • California passed additional legislation in 2006, effective in 2010, to reduce the lead content in water distribution products. The law prohibits more than 0.25 percent lead in commercial pipes, fittings, and fixtures.  In 2010, the U.S. Congress amended the Safe Drinking Water Act, including provisions similar to the California standard, and, in 2014, the 0.25 percent standard for lead in pipes, fittings, and fixtures became national.
  • In 2009, California passed the California Lead in Wheel Weights Ban to prevent lead from wheel weights, used to balance tires in vehicles, from entering the environment.  Before the ban, lead wheel weights, which can become dislodged from the wheels and end up on roads where they are abraded into lead dust and debris, were responsible for releasing 500,000 pounds of lead annually onto California roads. Since 2009, six other states, including Washington, Maine, Illinois, New York, Vermont, and Minnesota, have followed California’s lead. Also in 2009, the U.S. Environmental Protection Agency (EPA) started the process to consider banning lead wheel weights in the United States, but it has not taken formal action. The European Union has already banned lead wheel weights, while manufacturers in Japan and Korea stopped installing them in 2005.

In 2010, both California and Washington passed legislation restricting the use of heavy metals including lead in motor vehicle brake pads. In 2014, in California, and 2015 in Washington, brake pads sold in those states could not contain more than 0.1 percent by weight. The legislation also limits the levels of asbestiform fibers, cadmium, chromium, copper, and mercury in the brake friction materials. In January 2015, brake manufacturers signed a memorandum of agreement with the Environmental Protection Agency and the Environmental Council of the States declaring that all brake pads sold in the United States will meet the California/Washington standards. The brake- pad standards were adopted immediately, while standards for copper are being phased in.

  • In 2003, California passed the Toxics in Packaging Prevention Act, which limited harmful substances in packaging and reduced the levels of toxins contaminating soil and ground water near landfills. While the original law exempted lead paint or applied ceramic decoration on glass bottles, a 2008 amendment banned such uses if the lead content exceeds 600 ppm.
  • California passed a law in 2013 that made it the first state to require the use of only lead-free ammunition be used for hunting with a firearm in California. The regulations, which began to phase in in 2015, will be fully implemented in 2019. Lead ammunition for hunting waterfowl was banned nationally in 1991, but the California law extends the ban to hunting for all wildlife. The main purpose of the law is to protect endangered wildlife, including the California condor, from lead exposure. However the legislation should have the added benefit of reducing lead exposure for the families of hunters.

Results

The number of children from 0 to under 21 years who have been identified with blood lead levels at and above 4.5 mcg/dL has been decreasing significantly. In 2013, 1.7 percent of tested children had blood lead levels in this range. In 2007, 6.5 percent tested above 4.5 mcg/dL.

_______________________________________________

In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives. 

The case study does not attempt to to capture everything a location is doing on lead, but aims to highlight some of the important work.

National Youth Obesity Rate Holds Steady, New Data Show

Three out of 10 youth ages 10 to 17 are overweight or obese

Princeton, N.J., September 19, 2017—Roughly three out of 10 young people in the United States, 31.2 percent, are overweight or obese, according to the newest available data. Seven states—Alabama, Florida, Mississippi, North Dakota, Rhode Island, Tennessee, and West Virginia—have rates of overweight and obesity that exceed 35 percent. Only one state, Utah, has a rate under 20 percent.

The 2016 state-by-state rates for children and adolescents ages 10 to 17 were recently released on the Data Resource Center for Child and Adolescent Health (DRC) website (www.childhealthdata.org) and are reported at stateofobesity.org/children1017. This is the first update to this national data set since 2011-12.

The release of these new youth data follow the recent publication of the annual State of Obesity report by the Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health (TFAH), which includes state-by-state adult obesity rates. Together, the two data sets show that obesity rates may be levelling off, but that progress could be eroded if policies are weakened or programs are cut.

At the time of the State of Obesity release in August, the leaders of RWJF and TFAH shared their perspectives:

Richard Besser, president and CEO of RWJF:

“Obesity rates are still far too high, but the progress we’ve seen in recent years is real and it’s encouraging. That progress could be easily undermined if leaders and policymakers at all levels don’t continue to prioritize efforts that help all Americans lead healthier lives.”

John Auerbach, president and CEO of TFAH:

“It’s clear that the progress we’ve made in fighting obesity is fragile—and that we’re at a critical juncture where continuation of the policies that show promise and increased support and resources could truly help bend the rising tide of obesity rates. We’re far from out of the woods when it comes to obesity. But we have many reasons to be optimistic thanks to parents, educators, business owners, health officials, and other local leaders. Our nation’s policymakers must follow their example to build a culture of health.”

To accelerate progress in addressing obesity, RWJF and TFAH urge policymakers to:

  • Invest in prevention at the federal, state and local levels, including full funding for the Centers for Disease Control and Prevention and the Prevention and Public Health Fund.
  • Prioritize early childhood policies and programs, including support for Head Start and the Child and Adult Care Food Program.
  • Maintain progress on school-based policies and programs, including full implementation of current nutrition standards for school foods.
  • Invest in community-based policies and programs, including nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), and transportation, housing, and community development policies and programs that support physical activity.
  • Fully implement menu labeling rules and the updated Nutrition Facts label.
  • Expand healthcare coverage and care, including continued Medicare and Medicaid coverage of the full range of obesity prevention, treatment, and management services.

The stateofobesity.org site provides a new feature examining relevant policies at the state level and an interactive feature reporting on the latest obesity rates by state. The DRC website, www.childhealthdata.org, enables visitors to examine youth obesity rates by race/ethnicity, household income, and other demographic factors, as well as other relevant variables, such as physical activity rates.

About the new youth data

The new overweight and obesity rates among 10- to 17-year-olds are from the 2016 edition of the National Survey of Children’s Health (NSCH). The Maternal and Child Health Bureau (MCHB) funds and directs the NSCH, and develops survey content in collaboration with a national technical expert panel and the U.S. Census Bureau, which then conducts the survey. The NSCH uses parent reports of a child’s or adolescent’s height and weight to calculate body mass index.

The NSCH methods and sample size changed between 2011-12 and 2016, meaning it is not advisable to directly compare results across years. But the data do indicate a consistent stabilization in national and state rates of childhood overweight and obesity over the last decade. The NSCH is planned as an annual survey going forward, so these and other trends can be evaluated.

The Child and Adolescent Health Measurement Initiative (CAHMI) at the Johns Hopkins Bloomberg School of Public Health partners with MCHB in the design of the NSCH and analyzes and publishes state by state findings on its Data Resource Center for Child and Adolescent Health website, which is where the data reported here were obtained. RWJF and TFAH worked with CAHMI to announce the latest obesity rate data.

Overweight and Obesity Rate Among Youth Ages 10-17 by State, 2016

1.       Tennessee

37.7

18.          Georgia

32.2

35.      Minnesota

27.7

2.       North Dakota

37.1

19.          Michigan

32

36.      Colorado

27.2

3.       Mississippi

37

20.          New York

31.8

37.      Virginia

27.2

4.       Florida

36.6

21.          New Jersey

31.7

38.      Wyoming

27.1

5.       Rhode Island

36.3

22.          Pennsylvania

31.7

39.      Illinois

27

6.       Alabama

35.5

23.          South Dakota

31.4

40.      Arizona

26.9

7.       West Virginia

35.1

24.          California

31.2

41.      Massachusetts

26.6

8.       Louisiana

34

25.          Delaware

30.9

42.      Alaska

26.3

9.       Arkansas

33.9

26.          Kansas

30.9

43.      Idaho

26

10.   Indiana

33.9

27.       North Carolina

30.9

44.      Hawaii

25.5

11.   District of Columbia

33.8

28.          Nevada

30.5

45.      Washington

25.5

12.   Oklahoma

33.8

29.          Connecticut

30.2

46.      New Mexico

24.9

13.   Maryland

33.6

30.          Iowa

29.9

47.      New Hampshire

23.8

14.   Kentucky

33.5

31.          Wisconsin

29.5

48.      Montana

23.2

15.   Texas

33.3

32.          Missouri

29.4

49.      Vermont

22.2

16.   Ohio

33.1

33.          Nebraska

29.2

50.      Oregon

20.3

17.   South Carolina

32.9

34.          Maine

28.2

51.      Utah

19.2

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Trust for America‘s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

How Embedding Health Access and Nurses in Schools Improves Health in Grand Rapids, Michigan

For more than 20 years, Grand Rapids Public Schools (GRPS) has partnered with Spectrum Health to improve educational and health outcomes for their students through Spectrum’s School Health Program. Started in 1995, the School Health Program will be expanded to its 14th additional school districts in 2017.

The GRPS Model

The GRPS program utilizes school health teams comprised of registered nurses (RNs), licensed practical nurses (LPNs), and health aides to provide direct services to students in 48 schools. GRPS’ branch of the School Health Program currently employs 34 RNs, 11 LPNs, and 34 health aides and operates four full-service school-based health centers.

In the GRPS model, school teams operate under the supervision of a school nurse whose primary responsibility is oversight of health care delivery to students during the school day. The district has established policies and procedures to describe how care is to be delivered by the team under the supervision of the Registered Nurse. The nurse may delegate care to other school staff.

School nurse responsibilities include: identification of students who have health conditions; developing a plan for care during the school day; training and oversight of staff for safe delivery of medications and treatments; providing services that cannot be delegated; establishing medical response teams to respond to emergencies; telephone triage and support; surveillance and reporting of communicable diseases; connecting students to medical, dental, and mental health care through referrals; promoting health; health education; health screenings and follow up; and assisting students in obtaining immunizations.

GRPS uses funds from a variety of sources to support their school nurses including:

  • the district budget;
  • their local intermediate school district;
  • the State Department of Education—including grants and 31A funds (for students deemed at high risk); and
  • Spectrum Health.

The full-time equivalent (FTE) for the nurses for each school is adjusted based on the health needs of the student population and the availability of funds. Even though some funding for school nurses is still provided through Title I, GRPS has largely moved to alternative funding streams due to cumbersome reporting requirements.

While RNs serve as the cornerstones in the model, GRPS also braids together funding streams from both public and private entities to allow for reimbursement and service provision under a variety of health delivery models beyond the traditional school nurse reimbursement model. Coordinating funds and services across the spectrum of health providers and sources enables GRPS to provide services outside of the traditional school nurse model—such as dental services.

GRPS has also partnered with Cherry Health Services a local Federally Qualified Health Center (FQHC) to deliver health services in their school-based health centers and through a traveling dental program. Because these services are provided through an FQHC, they are eligible for Medicaid reimbursement and receive the FQHC enhanced reimbursement rate.

While data systems and privacy concerns have hindered data sharing and integration in the past, GRPS is actively moving towards linking education and health data under one system. The new data system is built upon the district’s student record system and has the potential to more easily link school health metrics to attendance and academic data. These system improvements are crucial steps to helping Spectrum Health and GRPS track and accomplish both its short-term goals to improve attendance and reduce chronic absenteeism and its long-term goals to improve graduation rates, workplace readiness and college entry.

Consultative RN Hub Model

In more rural districts, Spectrum Health has developed a consultative RN hub model for service delivery. Nurses are able to serve students utilizing telemedicine through its MedNow program—reducing travel time for school nurses and costs for the district. The Regional program will serve 13 districts in 2017 with 14 RN and two LPN.

Results

The partnership between Spectrum Health and the school districts have produced significant improvements in important school health indicators. Key accomplishments from FY 2015 included:

  • 97 percent of students at participating schools met current immunization requirements to attend school;
  • 98 percent of problems identified were resolved on-site by the school health care team;
  • 195,092 visits occurred to the school health office; and
  • 28,864 students were served across 7 school districts.

 

For more information, please visit http://www.spectrumhealth.org/healthier-communities/our-programs/school-health-program

TFAH Statement: Strongly Opposed to the House Obamacare Replacement Bill

Washington, D.C., March 7, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“We are strongly opposed to the House Obamacare Replacement bill, which would repeal significant portions of the Affordable Care Act (ACA), including the Prevention and Public Health Fund.

Under this plan, millions of people could lose health insurance—a devastating blow to the health of many of our nation’s most vulnerable individuals and families. Without affordable insurance coverage we will see increased levels of preventable illnesses, injuries and deaths.

In addition, eliminating the Prevention Fund would erase 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget. Of that investment, $625 million directly supports state and local public health efforts to fight preventable diseases such as diabetes, heart disease and cancer.

Losing this funding would wreak havoc on our efforts to reduce chronic disease rates, immunize our children, stop the prescription drug and opioid epidemic and prepare the public health system to prevent infectious disease outbreaks.

We know how to prevent many chronic and infectious illnesses—which make up a significant portion of the $3 trillion the nation spends yearly on healthcare.  If we lose access to health care coverage and to the Prevention Fund, our children, families and communities will suffer and ultimately costs will rise.

The bottom line? This Bill would make untold numbers of the American people less healthy.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.