CLEVELAND — While talking with Lynn Lotas and Debbie Aloshen, it’s not long before the subject of young children’s health comes up. The two longtime nurses — with more than 80 years of combined experience…
CLEVELAND — While talking with Lynn Lotas and Debbie Aloshen, it’s not long before the subject of young children’s health comes up. The two longtime nurses — with more than 80 years of combined experience — have their attention focused on a very specific and longtime health problem.
That problem is lead poisoning in children — the kind that leaches into the bloodstream of kids from old paint on old houses or from the lead-contaminated soils from long-closed factories — a preventable, man-made chemical imbalance that causes “reductions in IQ, poor educational outcomes, behavioral challenges, attention disorders, and criminal activity,” according to one recent study by the Cleveland Federal Reserve.
“We saw a young boy, age 5, with high lead levels in his blood, and we found out he got expelled from school when we were trying to get him follow-up treatment,” says Lotas, associate dean for the Bolton School of Nursing program at Case Western Reserve University. “He is labeled as a bad kid at age 5. Amazing. And it is likely just because of where he lives.”
It’s been 40 years since putting lead paint on houses was legal, but older cities — particularly in the Midwest and Northeast — are still dealing with the adverse medical and psychological conditions the lead paint exposure causes in young children. Cleveland is one of those cities. From 2016 to 2017, according to the Ohio Department of Health, about 12 percent of Cleveland children who were screened for lead had a level in their blood that required action. The national level is 3 percent.
As the school year starts, the city is testing public schoolchildren for lead paint exposure for the second time. If results from the end of the last school year were any indication, about 10 to 15 percent will likely test positive for lead paint in their bloodstream.
The testing program in the schools involves a partnership among Case Western Reserve University, city officials, health-focused nonprofits and the Cleveland Metropolitan School District, which covers most of the city. The approach is simple: If children are in school, why not test them there, instead of relying on parents to seek out testing elsewhere after they’ve seen chronic unexplained conditions in their kids? It’s a way to test children at a younger age and before they show symptoms, which could include developmental delays, vomiting, weight loss, irritability and others.
“I don’t know of any other cities in the country testing at schools like this, and it will likely turn out to be a good way to increase the rate at which young children are getting tested,” says Dr. Giridhar Mallya, senior policy officer and health policy expert for the Robert Wood Johnson Foundation.
Blood tests for lead exposure are mandated for all children in 11 states and the District of Columbia, as well as for any young child covered by Medicaid, according to a Reuters investigation. But many children who are technically required to be tested don’t actually receive tests. That’s largely because the regulations require families to take the initiative and seek out testing.
Ohio requires lead testing for the very young children covered by Medicaid, but only about a third of children who are at risk in the Cleveland area are screened for the toxin, according to a 2015 analysis conducted for The Plain Dealer, the city’s major newspaper.
The school testing partnership, called The Partners in Health Lead Screening Program, is led by Lotas and Aloshen and funded largely by a local public health foundation. It uses student nurses and community volunteers prick the fingers of schoolchildren age 3 to 5, draw small amounts of blood and test for lead. Kids who have concerning levels of the substance in their bloodstream — 5 micrograms per deciliter or more — get follow-up care. During the pilot program last year, 156 children in four schools were tested and 17 were found with high enough lead levels to warrant follow-up care. This year, the plan is to expand to 30 different schools within the district.
“What we think we can do is get a better handle of which kids have a problem, which neighborhoods are worse than others, and get treatment started earlier,” Aloshen says.
Data obtained through the school testing program will be shared with the city, county and federal agencies charged with determining the programs and policies needed to treat the children affected.
Program leaders hope the data can help identify high-risk areas for housing-based lead exposure. Studies have already demonstrated that inner city high-poverty areas have a higher concentration of houses with lead paint, but little research has been done on the effect that old industries may have had on certain parts of a city due to lead-concentrated pollution that was belched from smokestacks and buried in the ground decades ago.
Advocates of the school testing program also hope it can accelerate the removal of lead-based health hazards in homes. Families that live in older rental housing, which has the highest concentration of lead paint problems, tend to move more often. That means the affected properties are often moved down on the fix-up list after the child leaves. Identifying exposed children early, when they are still living in the affected properties, helps ensure their homes will be examined and cleared of lead paint.
“Any community has to start with where things make sense, and what Cleveland is doing does make sense,” says Rebecca Morley, an expert on government safe housing policy and former director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts. “This Cleveland school testing program will help get to the housing cleanup sooner rather than later, and hopefully prevent more children getting lead poisoning in the future.”
While the school testing program is helpful in identifying children with lead paint exposure, it’s only likely to make a dent in such a large, complex problem.
A study published in the American Academy of Pediatrics last year found that 1.2 million children from age 1 to 5 had lead at a “level of concern” in their bloodstream from 1990 to 2010. The same year, a Reuters investigation identified 3,810 neighborhood areas with childhood lead poisoning rates at least double those found across Flint, Michigan, during its water contamination crisis.
There are also political, economic and property rights issues that fuel debate over who handles the necessary lead cleanup and its funding.
New York City is dealing with an investigation to find out why 820 children in the city’s housing projects tested for elevated levels of lead and why health officials failed to follow up and inspect their apartments; in California, the state legislature and courts are trying to figure out if the paint companies or property owners get the multibillion dollar lead housing cleanup bill; and senators are asking questions about 1,200 homes at the Fort Benning, Georgia, army base that were found to have lead paint.
As for Cleveland, the city tried to pass an ordinance last year that would require all city homes — owner-occupied single family, rentals and apartments — to be lead free by 2021, but that is stalled in city council committee because of opposition by many rental property owners.
Despite the legislative and funding challenges of tackling the lead problem in Cleveland, Lotas and Aloshen are confident their work is making a difference.
“One thing we will work very hard to prevent from happening is kids who are age 3 to 6 getting labeled as a behavioral problem,” Lotas says. “We can’t let them get a negative trajectory in their life from that designation at so early an age. We cannot let that happen because of how the house they live in was painted decades ago.”