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Between 1993 and 1997, the Oregon Childhood Lead Prevention Program tested 7,547 children in Multnomah County for lead. Those tests revealed that approximately one child in 20--or 5 percent--had a blood lead level higher than 10 micrograms of lead per deciliter of blood (µg/dl). Anything above that level is considered unsafe by the Oregon Health Division. Nationwide, the main culprit for childhood lead poisoning is lead-based house paint, phased out of production during World War II and banned completely in 1978. One of the best indicators for a childhood lead problem is the percentage of homes built before 1950. In Portland, approximately 55 percent of the homes predate 1950. Because they are more likely to be poor and live in dilapidated housing, minority children are the hardest hit by lead poisoning. Last year, a report from the Urban League said nearly one in 10 Latino, Native American and African-American children in Oregon have too much lead in their blood. Unfortunately, most of those kids will never know it. Victims of lead poisoning, often called a "silent disease," rarely show symptoms, and if they do, the symptoms are so common that they could mean anything. The good news is that the City of Portland finally seems committed to getting the lead out of children's homes. During the next five years, federal and city agencies will spend $8.6 million in Multnomah County to fix lead hazards. The bad news is that past lead-prevention efforts in Portland have suffered from a lack of clear leadership. To make matters worse, health officials still don't have a clear picture of the problem. They might never have one, either: Doctors aren't testing children for lead because they don't think childhood lead poisoning is a problem in the Northwest. The Oregon Health Division, meanwhile, firmly believes the problem exists but just lost federal funds for testing to prove it. The only ones truly suffering are the kids. Theresa Penn, a single African-American mom, had no idea her 3-year-old son, Kristopher, had a lead problem until both of her children were screened for lead a little more than a year ago. Penn says Kristopher's blood lead level was somewhere around 20 µg/dl. Kristopher, like most children with blood lead levels between 10 and 40 µg/dl, never showed symptoms of lead poisoning. But medical researchers have found that, sustained over time, blood lead levels as low as 10 µg/dl can lower IQ, decrease a child's success in school, or even lead to criminal behavior. Some studies link lead to Attention Deficit Disorder. It's hard to believe that, in 1998, any children haveproblems with lead poisoning. After all, lead poisoning is as old as the Roman Empire. Pliny and Hippocrates were the first to note occupational health problems related to lead in mine workers. Those who work with lead--plumbers, painters, remodelers, radiator mechanics, bridge workers and ceramicists--are most at risk for acute lead poisoning and its symptoms of depression, partial paralysis, seizures or impaired speech. But when it comes to lead hazards in the home, children are the ones to worry about. Toddlers face the greatest risk, because they tend to discover the world by tasting it. Children who live in deteriorating homes painted with lead-based paint, homes located near lead smelters or older homes undergoing renovation can absorb lead into their bodies by eating dust, soil or paint chips. In the 1970s, however, health concerns about lead began to overpower the metal's commercial benefits. (Lead whitens and hardens paint. In gasoline, it boosts octane.) Around that time, activists began to win a series of legislative battles, eventually resulting in new lead standards, routine screening for businesses with more than 10 employees that work with lead, and a requirement that owners or landlords of housing built before 1978 inform prospective buyers or renters about lead-based paint. Without a doubt, the biggest victories included national and state legislation banning specific uses of lead, such as in house paint, food cans, pipes, lead shot and gasoline. Since Congress stopped the burning of lead in gasoline in 1996, health concerns have shifted once again back to lead-based paint remaining in homes--the last area in which lead still poses significant risks for children. Young children like Kristopher are most at risk from lead poisoning, because their brains are still developing. Lead tricks the body into absorbing it by acting like iron or calcium. Once in the body, it interferes with the formation of brain synapses, which act like bridges to carry messages from the brain to other parts of the body. By any measure, great progress has been made toward eliminating lead in the environment. In 1969, roughly 88 percent of children had blood levels of more than 10 µg/dl. Today about 9 percent do. Yet campaigns against lead continue. In part, that's because the Centers for Disease Control keeps lowering the blood lead level it considers safe. In the 1960s, only acute lead poisoning was considered dangerous. In 1991, the CDC declared 10 µg/dl to be the threshold for safety in children. Very few children in Oregon would be considered in danger had the CDC not lowered the bar. Meanwhile, new and old products made with lead continue to be sold in stores. Imported crayons, hair dyes such as Grecian Formula and miniblinds are a few examples. Although some states require screening, no federal laws require that children be tested for lead poisoning. Instead, the federal Centers for Disease Control recommends guidelines and provides federal grants to states interested in starting screening programs. Oregon won such a grant in 1992. The CDC gave the Oregon Childhood Lead Prevention Program $1.5 million over five years to test kids for lead. The program focused mostly on high-risk areas like Multnomah County, which has both low-income families and older housing. The state found a problem: Roughly 5 percent of the children tested had blood lead levels higher than 10 micrograms of lead per deciliter of blood (µg/dl). But when the state reapplied for funding this summer, asking for $2.4 million for another four years of testing, its grant application was denied. The program received only $50,000 for surveillance and to "wind down the program," says Narda Tolentino of the State Health Division. State officials have said that Oregon lost the grant because it doesn't have as large a problem as other states also competing for funding. Claudette Grant of the Centers for Disease Control says that's only part of the reason. Other low-incident states like Arizona were funded. Oregon's No. 1 problem, she says, was a sloppy grant application. Rick Leiker of the Oregon Health Division admits that the application could have been better. "There was a lot of miscommunication between our office and the CDC," he says. "We didn't think we had to include some information because the CDC already had it in their files." The end result is bad news for Oregon's children: Without the state program, hundreds of kids with lead poisoning will never know it. Other screening programs for lead have also failed. Health Care Financing Administration policy requires that all babies whose health-care costs are paid by Medicaid be tested for lead at the 12- and 24-month "well baby" exams. Activists say the testing isn't happening nationally, and Oregon is no exception. The statistics back them up: Based on the number of children in the state receiving Medicaid in 1995, nearly 25,000 kids in the state should have been tested. Yet the Oregon Medical Assistance Plan received only 1,410 billings for lead tests. Officials at Oregon Health Sciences University admit they don't screen every child on Medicaid. Instead, they have parents fill out a questionnaire to determine if their children are at risk. Right now that's a clear violation of federal rules, says Anne Guthrie of the Alliance to End Childhood Lead Poisoning. But it's not a black-and-white case. The Centers for Disease Control just changed its screening policy in November and the Health Care Financing Administration may allow some exemptions along the new guidelines, says Guthrie. Children on Medicaid in Portland could become exempt from screening if Washington, D.C., officials don't perceive a problem. Hill, who is also a leader of Portland's Coalition of Black Men, says Medicaid officials should continue to require the testing. He says more screening is still needed in Portland, both to identify kids and to get a better handle on the problem. "Our main problem right now is that we don't have hard data in Portland," Hill says. "The fact remains we don't really know how bad a problem this is. We've extrapolated data from the small numbers that were tested." Community leaders like Hill aren't waiting around. The Urban League recently hired someone to do lead-hazard outreach work to educate parents about lead poisoning. In response to low screening rates at well-baby exams for Medicaid patients, Hill's group, Physicians for Social Responsibility, will soon launch a volunteer effort to screen more children at risk. Hill says he hopes to have testing stations set up sometime this spring. The Urban League may also be helping the volunteer health workers acquire a van for a mobile screening unit. "The main problem right now is getting the word out that children need to be tested," says Hill. "Of course, if you go out to Lake Oswego, kids don't have a problem. But doctors in the inner city should definitely be screening." Besides the fact that he doesn't show any signs of lead poisoning, Kristopher Penn's story is typical for another reason: After testing, Kristopher went right back into the home that had contaminated him in the first place. Usually, parents, sick with worry, are quick to fix problems. But in Kristopher's case, his mom, Theresa Penn, didn't have the resources to repaint the Northeast Portland home she had inherited from her mother. Nor did she have the energy: Penn suffers from multiple health problems, including kidney failure and a muscle disease. Fernando Carrillo, one of the two part-time state outreach workers who worked on the Penn case, says he was often faced with similar dilemmas: "Kids were being tested and we were finding elevated blood levels, but then we just had to say, 'You have this problem and we're just going to walk away.'" To help Kristopher, Carrillo and his work partner, Larry Ehrbar, tried to launch a county-funded pilot project that would have cleaned up the lead problem in Penn's home. A second part of the project would have corrected lead hazards in another house owned by an affordable-housing nonprofit and used it as a safe house for the Penns and other lead-poisoned families. The project soon unraveled. Douglas Dodds, a private contractor who was involved in the project, says state and county officials dragged out decisions so long that the money for the project frittered away. In the middle of it all, Penn's kidneys failed and she became too sick to move her family. Now that he's older and no longer tasting everything in sight, Kristopher's blood lead level has just fallen within acceptable limits, according to his pediatrician, Dr. Dana Salisbury at Oregon Health Sciences University. But for a year, Kristopher's blood lead level danced between 10 and 20 µg/dl. That's probably enough to harm him. No one will ever know. When Penn thinks about the work that was never completed--fresh, safe paint covering up the toxic and peeling lead-based paint--her eyes well up with tears. She blames herself. If the amount of money spent on a problem is any indication that things will improve, lead-prevention efforts may soon improve. Federal and local agencies have recently committed to spend $8.6 million during the next five years to get the lead out of homes in Multnomah County. Most of that money comes from the Portland Water Bureau through a creative deal brokered with the Environmental Protection Agency. The deal is basically a trade-off: The EPA has agreed to let the City of Portland spend less money meeting lead and copper standards in drinking water if it spends more to clean up lead paint in homes. The city's argument is that whatever problem Portland has with lead in the water pales in comparison to the lead-paint problem. The Water Bureau will still spend about $3 million adding sodium hydroxide to Bull Run water to prevent Portland's slightly acidic water from leaching lead from pipe solder and plumbing fixtures. But it won't add as much as the EPA wanted. Instead, the city will spend $2.7 million on Multnomah County's lead-prevention program, the biggest piece of which is the Community Lead Education and Reduction Corps (CLEARCorps), a branch of AmericaCorps specializing in cleaning up lead hazards. The city will pay all overhead and expenses. AmericaCorps provides the workers with a $9,175 stipend, free child care and a $4,700 award for school. CLEARCorps started three months ago. The group is now working to clean up three low-income rental homes owned by the Portland Community Reinvestment Initiatives, a nonprofit that provides affordable housing. Chris Johnson, who used to work on the state's screening program, is now program manager for CLEARCorps in Portland. He says that in its first year the project will focus on homes in the Humboldt neighborhood. CLEARCorps will find the homes through state and county health records, by referral from other agencies or through homeowner requests. Dressed in white "bunny suits" and equipped with respirators, the CLEARCorps crew sands and scrapes away old lead-based paint, repaints trouble areas and rids the house of lead dust with a special vacuum, called a HEPAvac. The project is meant to be a quick fix for lead-contaminated homes. The total cost of cleaning lead from each home should run around $2,000, says Ehrbar, who also now works for CLEARCorps as a crew supervisor. Homes that require extensive work will be referred to another new program that is expected to start this summer. The program will be run through the City of Portland's Bureau of Housing and Community Development and will be funded with a $2.9 million grant from the U.S. Department of Housing and Urban Development. Robert Bole of BHCD says the city expects to fix about 400 homes at a cost of about $4,478 each. Although most of the houses will belong to private homeowners, some units owned by nonprofit affordable-housing agencies will be made lead-safe. Private homeowners will be offered grants or subsidized loans, depending on their situation. Richard Brown of the Black United Front--who, along with Hill, has been leading the effort against lead poisoning in North and Northeast Portland--likes the two new programs. He sees what's happening now as a good first step. He likes that unemployed people have been hired to do the work. His only concern is that the housing continue to be rented to low-income families after the work is done. That concern is echoed by Ehrbar. "What happens if the landlord feels like the unit has been improved? We don't want people to end up on the street." Hill, Brown and others believe the fight against lead has greater stakes than solving one child's individual health problems. Some believe that lead poisoning may be one factor leading some inner-city kids to perform poorly in school, have short attention spans or even join gangs. Given that, a little elbow grease and some fresh paint might go a long way. "I don't think it's far-fetched to say that lead has caused some of the problems we see," says Hill. "High lead levels can lead to so many things--decreased intelligence, Attention Deficit Disorder, aggressive behavior and irritability." Those connections aren't a leap for Richard Brown, either. "Everyone has got a reason why these kids aren't succeeding," says Brown. "Certainly the environment has to be one factor in that." |
