The District of Columbia’s Efforts to Prevent and Respond to Childhood Lead Exposure
Background
The District of Columbia is at the national forefront of efforts to reduce childhood lead poisoning, enacting several prevention-focused laws. Reflecting a long legacy of lead usage – an estimated 75 percent of housing predates the 1978 ban on residential use of lead-based paint – the District also mandates universal screening, requiring two lead tests for all children by age two.
The law at the center of the city’s efforts to combat lead poisoning is the District’s Lead Hazard Prevention and Elimination Act of 2008, amended in 2011 (D.C. Official Code § 8-231.01 et seq.). This law prohibits the presence of a lead-based paint hazard in dwelling units, common areas of multifamily properties, and day care and prekindergarten facilities constructed before 1978. Under the law, any paint in or on a pre-1978 dwelling unit or “child-occupied facility” that is not intact is automatically considered hazardous.
Clearance Examination
A key preventive provision in the District’s lead law (see implementing regulations) is the required clearance examination whenever a pre-1978 residential rental property is about to be occupied by a pregnant woman or a child under age six. Specifically, the property owner must furnish a passing clearance report, issued within the previous 12 months, providing documented proof that the individual rental unit contained no lead-based paint hazards, including deteriorated lead-based paint or lead-contaminated dust or soil. This information must be disclosed before a buyer or renter is obligated under contract to purchase or lease the unit.
A related provision extends this requirement to units occupied or visited by a child or pregnant woman. Additionally, if owners discover lead-based paint in their properties, they must disclose it to their tenant within 10 days.
Lead-Based Paint Presumption
The District’s lead law also expands the definition of “lead-based paint hazard” to presume that any paint in or on a pre-1978 residential or child-occupied facility is lead-based. Any paint that is peeling, chipping, cracking, flaking, or otherwise not intact is automatically considered to be a lead-based paint hazard, unless proven otherwise.
This broader definition facilitates the District’s proactive approach to lead-based paint hazards. Any time there is a “reasonable belief” that a lead-based paint hazard may be present, the Government of the District of Columbia is empowered to inspect residential housing or child-occupied facilities (DC Official Code § 8-231.05(a)). Under this authority, inspections can take place for a variety of reasons, including a tenant complaint or knowledge that a particular neighborhood has a higher prevalence of lead hazards.
The law allows the Government of the District of Columbia to enter a property and conduct a lead risk assessment to determine if lead-based paint hazards may exist. If a lead hazard is found, the property owner may be issued an Administrative Order to Eliminate Lead-Based Paint Hazards. The order specifies the type and location of the hazard and how and when it must be eliminated. Additionally, the property owner is charged for recovery of costs associated with conducting the risk assessment.
Eliminating the lead-based paint hazard must follow specific safe practices. Once the work is complete – to ensure that no lead-based paint hazards remain – the owner must hire a District-certified risk assessor to perform a clearance examination.
The law also states that contractors that disturb paint during work in a pre-1978 property must use lead-safe practices, which includes containing the immediate work area to protect the occupants. A Cease and Desist Order, a Notice of Violation, and/or a Notice of Infraction can be issued to any contractor who fails to do so.
The District may require landlords to arrange and pay for temporary relocation of tenants whose homes contain lead-based paint hazards. In addition, the landlords must make all reasonable efforts to relocate tenants in the same school district or ward and near public transportation.
The law also includes tough disclosure requirements. Owners are required to disclose any “pending actions” ordered by the District and any reasonably known information about the presence of lead-based paint or lead-based paint hazards.
Renovation, Repair and Painting Permitting Requirement
Another preventive measure applies to contractors seeking renovation permits. They must provide proof of training as required under EPA’s Renovation, Repair, and Painting Rule to the permitting office at the District’s Department of Energy and Environment (DOEE). DOEE provides a list of individuals and business entities certified by DOEE to conduct lead-based paint activities in the District.
Universal Lead Screening and Reporting
The District also passed the Childhood Lead Screening Amendment Act of 2006 (D.C. Official Code § 7-871.01 et seq.), mandating that all District children be tested twice by the time they are two-years-old, once, between 6 and 14 months, and the second time between 22 and 26 months. Additional screening is required up to age six if the child has received no prior screening and whenever there are other risk factors. Laboratories must report all test results to DOEE’s Childhood Lead Poisoning Prevention Program. Similarly, health care providers must notify the DOEE about lead-poisoned children within 72 hours.
To increase compliance with the District’s lead screening and reporting law, DOEE provides education to health care providers and builds community awareness, especially among at-risk populations. DOEE has also created formal data-sharing agreements with several District agencies to identify and reach out to families who need to update their children’s screenings.
DOEE provides case management to families whose child has an elevated blood lead level, including help with follow-up testing, education, and referrals. In addition, a DOEE lead inspector conducts an environmental investigation and provides a risk assessment report detailing where lead-based paint hazards were found, with instructions for the property owner about necessary steps to eliminate the hazards. The law also allows DOEE to be reimbursed by the District’s Medicaid agency for lead risk assessments it conducts in the homes of Medicaid-enrolled, lead-exposed children.
Lead-Safe and Healthy Homes
In 2011, DOEE published a Strategic Plan for Lead-Safe and Healthy Homes, the first-ever District-wide agenda for maintaining homes free of lead hazards, asthma triggers, and other environmental health threats. The plan was developed with extensive input and feedback from community groups, providers, environmental experts, and sister agencies.
In 2012, DOEE launched the District’s first full-fledged Healthy Homes program. Local health providers and social service agencies identify families with children or pregnant women in distress due to lead exposure, poorly controlled asthma, or hazardous conditions, and refer those families to DOEE. Participants receive a comprehensive home environmental assessment, family education, an asthma management diagnostic, and case management coordination. Once health and safety threats are identified and systematically documented, DOEE issues a technical assistance report to the property owner to help them correct the identified hazards. The agency also provides a customized care plan to help clients avoid additional exposure while waiting for hazards to be addressed. DOEE’s case managers monitor progress as the identified hazards are eliminated.
DOEE also designed the District’s Lead-Safe and Healthy Homes Hub to help teach residents about possible health risks at home. This interactive site features a variety of healthy homes topics, including lead, mold, secondhand smoke, pest infestations, and radon, and describes how residents can help prevent exposure to these hazards.
Results
For Fiscal Year 2015, the District reported that it had 196 new confirmed cases of children below age six with a blood lead level at or above CDC’s reference value of 5 µg/dl. Overall, District data suggest a downward trend in children’s lead exposure, with approximately 98 percent of children under six testing below the 5 µg/dL action level. DOEE’s Healthy Homes documented improvements in 80 percent of the 137 homes it managed in 2012, the program’s first year. Over time demand for the Healthy Homes program has grown, with 202 households served in Fiscal Year 2016.
_______________________________________________
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.
