Lead threat prompts call for greater action

Last year, 728 kids in Davenport tested positive for lead in their blood. And while health experts say no amount of lead is safe for kids, public health authorities took their most stringent action in only a fraction of those cases.

Just nine cases met the threshold to assign a case manager to coordinate services and work with the families to ensure lower lead levels in those children.

Iowa has long had a problem with lead exposure, much of it due to the lead-based paint that remains in its older housing stock. That problem is especially significant for children, who are at greater risk of neurological problems from being exposed to lead. And with the federal government lowering a key metric aimed, in part, at determining whether medical or environmental action should be initiated to help kids testing positive, a researcher at the University of Iowa says the state needs to do more to fight the problem.

That includes, he said, lowering the level at which action is taken in cases where kids test positive for lead.

“We need to be open and honest about where we are as a state,” said David Cwiertny, a professor of civil and environmental engineering and director of the Center for Health Effects of Environmental Contamination at the University of Iowa.

A nationwide study published last year in JAMA Pediatrics said Iowa ranked fourth in the nation in the share of its children testing positive for lead in the bloodstream. The report said 76% of Iowa kids tested positive between 2018 and 2020.

The study matched blood tests from 1.1 million kids, conducted by Quest Diagnostics, with data from the U.S. Census Bureau. It found that several Midwest states had significantly higher percentage of lead-positive kids than the national average of 51%.

Since 2008, Iowa has required that young children get tested for lead. In 2021, about 7,800 Iowa kids under the age of 6 had a confirmed positive test.

When an Iowa child does test positive, the state notifies the family and provides information about the dangers of lead poisoning and how to prevent it in the home, along with scheduling a follow-up test, said Kevin Officer, childhood lead poisoning prevention program manager at the Iowa Department of Health and Human Services.

When lead levels hit 10 micrograms per deciliter in the blood, the state also takes further action, assigning a case manager to coordinate services with the family to ensure blood lead levels go down.

At 15 micrograms, a home visit is arranged to assess the child’s needs and determine the possible source of exposure, among other services.

Federal government sharpens lead focus

Nationally, the federal government is making changes to how it deals with lead poisoning.

A year ago, the Centers for Disease Control and Prevention changed what it calls its Blood Lead Reference Value, the point where a child has more lead in his or her blood than 97.5% of U.S. children between 1 and 5 years old. The new reference value is 3.5 micrograms per deciliter. Previously, it was 5 micrograms.

The terminology has changed over the years, but the federal government has been consistently lowering the level at which the presence of lead in childhood bloodstreams should prompt concern.

Some states also have lowered the levels at which they take action.

In Illinois, for example, the state changed its law so that beginning in 2019, public health authorities assign a case manager to educate families about the dangers of lead and perform a home inspection at 5 micrograms per deciliter, rather than the previous 10.

Iowa has not lowered its level. Changing its 10-microgram benchmark to the Blood Lead Reference Value of 3.5 micrograms would “significantly increase” the number of children who would require services, Officer said in an email, and at the current level of funding the state would not be able to provide the support to local public health programs to meet the demand.

The state childhood lead program budget, which includes state and federal funds, hasn’t increased in more than 20 years, he said.

According to state figures, nearly 1,000 Iowa children had confirmed blood lead levels at or above 3.5 micrograms per deciliter in 2021, while 263 Iowa children had confirmed blood levels at or above 10 micrograms.

Still, Officer said the state sees positive results when parents are notified and informed.

“Iowa consistently sees blood lead levels decrease after parents are educated on lead poisoning and what they can do to prevent or minimize future lead poisoning,” Officer said. “Empowering parents to be the first line of defense for their child is more impactful on reducing lead levels, especially at lower levels.”

However, Cwiertny said he believes Iowa should take more action in lower-level cases, and it should commit the money to fighting the problem. “We need more investment in this, in terms of the people who are trained in being able to work with families” and to do home inspections, he said. He added there also needs to be better and more consistent messaging about the lead threat.

Flint raised lead concerns in public

Public awareness of the threat of lead poisoning rose in 2014 when the people of Flint, Michigan, were exposed to elevated levels of lead in its drinking water.

Since then, the federal government has devoted more attention to dealing with lead in water systems, including the allocation of billions of dollars in the American Rescue Plan of 2021 to replace lead water lines that the government believes are a significant source of the problem. The U.S. Environmental Protection Agency has estimated that 20% or more of a person’s total exposure to lead can be due to drinking water.

In Iowa, the emphasis has historically been on lead-based paint.

Even though it was banned in 1978, lead-based paint still is a threat because of Iowa’s older housing stock. Several public sources have estimated that 60% of Iowa’s housing stock was built before 1960.

In Scott County alone, roughly 41,000 homes were built before 1978, and a local survey estimated five years ago that about 5,000 homes in the oldest parts of Davenport were at “high risk” of lead-based paint.

The threat of lead poisoning isn’t just limited to Iowa, of course. The study published in JAMA Pediatrics said that in Missouri, 82% of kids tested positive for lead. In Nebraska, it was 83%. In Illinois, 68% of kids tested positive for lead.

Illinois has made changes in recent years to try to deal with the lead issue.

State lawmakers changed the law so that, beginning in 2019, the state action level for lead would kick in at 5 micrograms per deciliter; previously, it was 10 micrograms. The state also imposed greater lead testing requirements for children. In Illinois, all kids 6 years old and younger must be assessed for lead risk. Physicians also must perform a blood test for children who live in high-risk areas or meet other criteria, according to the Illinois Department of Public Health web site.

In Rock Island County, which is part of the Quad-Cities, practically every child is tested for lead before going to school, according to Janet Hill, chief operating officer for the Rock Island County Health Department.

Hill said Rock Island County saw an increase in the number of kids requiring services once the state lowered its action levels.

In 2018, there were 133 cases that met the action level criteria. Through mid-December of this year, the number requiring action increased to 298 cases.

Hill says the state provided funding to devote to more part-time help to deal with the increased number of cases, and that has been sufficient.  “We’re able to keep up with our case load,” she said.

Whether the source is drinking water, soils or lead-based paint, Cwiertny said Iowa and other states need to place more emphasis on combatting lead poisoning. And when it comes to taking action, sooner is better than later. “We should not be satisfied with 10 (micrograms) or 5, but we should push for three-and-a-half and below because the overwhelming evidence is that even these lower levels can have impairment on IQ and neurodevelopment,” he said.