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Synthesis/Regeneration 34   (Spring 2004)

Lead Poisoning in Saint Louis

by Daniel Berg, MD,
United States Public Health Service

St. Louis is one of many US cities which have failed to effectively confront a major health danger. Thousands of children in St. Louis now suffer from lead poisoning, which is a totally preventable cause of brain damage. About 29% of African Americans and 16% of white children who are tested in the city have levels greater than ten micrograms per deciliter—the federal definition of “poisoned.” Nationally, 2.2% of children suffer from lead poisoning. In some African American neighborhoods in north St. Louis, 55% of the children are poisoned! Lead poisoning leads to intellectual impairment in children including decreased intelligence and increased behavior disorders.

Furthermore, it is now known that children suffer intellectual impairment before technically being poisoned with 10 micrograms per deciliter of lead. The April 17, 2003, New England Journal of Medicine’s lead research article documents a loss of over seven IQ points in children before they reach this threshold.

Milwaukee, Wisconsin serves as a positive model…People there have halved the rate of childhood lead poisoning over the last five years while overseeing the remediation of about 5,000 units.

St. Louis has an ineffective, fragmented and poorly funded system for addressing this lead poisoning crisis. There is no primary prevention strategy to remediate homes before a child becomes poisoned. Instead, children are used as surrogate lead detectors. If a child has a level of greater than 12 micrograms per deciliter (above the federal cut-off and well above the safe limit), then the health department will send someone to the home to instruct the family in dust control, hand washing, and improved diet. These are all relatively ineffective interventions. They may also perform minor repair work on chipping or flaking paint.

Some people also become eligible for lead remediation grants. Lead remediation involves removing leaded paint through window replacement or wet scraping and covering with a special thick paint. Programs now offered are through the Building Division ($900,000 per year available from a tax on building permits) and the Community Development Agency (a little under $1,000,000 per year available from HUD for general housing, some of which goes to lead remediation). Grace Hill Neighborhood Services also will receive a three-year, $15 million grant to address lead poisoning. The Urban League also receives money for lead remediation, although their program has been plagued with mismanagement. All of the agencies combined remediate approximately 130 homes per year. At this rate, St. Louis will not be lead-free until after the year 3000.

In order to protect children’s health there must be implementation of a comprehensive plan to create safe housing for all 28,400 children under six years of age who are living in the city. Primary prevention—correcting the problem before children are poisoned—is possible. Many cities have dramatically reduced their childhood lead poisoning rates including Providence, Rhode Island and Milwaukee, Wisconsin. Investing in primary prevention not only benefits individuals, but also benefits society as a whole. The President’s Task Force on Environmental Health Risks and Safety Risks to Children showed that on a national level the cost would be $230 million per year for 10 years and the benefits would be at least worth $11.2 billion. Numerous studies have shown large pay-offs in decreased expenditures for special education, decreased criminal behavior and imprisonment, and increased productivity.

Milwaukee, Wisconsin serves as a positive model for St. Louis. People there have halved the rate of childhood lead poisoning over the last five years while overseeing the remediation of about 5,000 units. By comparison, St. Louis has assisted in fixing about 600 over the last four years. Milwaukee plans to eliminate childhood lead poisoning by 2010. One successful aspect of their program involves assisting landlords and homeowners to fix their windows. Research done by the Milwaukee Health Department, together with the federal government, shows that lead dust from window troughs as well as that released by friction from windows opening and closing contributes more to lead dust in the house than all other factors. The city contracts with 20 licensed contractors who can quickly take windows apart, plane them down to the wood in a lead-safe way, then insert double track liners—all for $145 per window.

Although the city assists property owners, it also levies financial penalties to owners who do not fix the property within 30 days of discovery of a lead-poisoned child. If an owner waits until a child is poisoned, they are not eligible for assistance on that unit, but can acquire assistance on other units which they agree to fix. In this way the city promotes the lead remediation of properties before lead poisoning occurs. The Milwaukee Health Department also developed an innovative program titled Milwaukee Community Capacity projects which facilitates the creation of grassroots advocacy groups. These groups not only promote education and neighborhood remediation projects but have successfully lobbied for the strict local ordinance passed in 1999 as well as having the city pursue a lawsuit against paint manufacturers.

St. Louis has no equivalent program although, in an interesting parallel, an activist named Ivory Perry succeeded in organizing people to pass an effective law in 1971 while he was employed by the federal government in a civil rights agency. Unfortunately, this law is only sporadically enforced today. St. Louis is also suing paint manufacturers, yet the recent failure of such a case in Providence, Rhode Island, does not augur well for St. Louis’ suit. St. Louis currently has neither the political leadership nor the grassroots demand to correct the lead problem.

Several positive trends have emerged, however, which may help the situation. First, the St. Louis Lead Prevention Coalition has brought all of the players to the table to accurately define the problem and to create a comprehensive plan. They have also created an infrastructure for dissemination of knowledge and grants. Second, there are positive rumblings from Washington, DC where both Rep. Lacy Clay and Sen. Kit Bond have shown interest in the issue. Third, the group Health and Environmental Justice (St. Louis HEJ) is currently working on a neighborhood level to create grassroots demand for change. This group was founded to combat the practice of exposing poor and ethnic neighborhoods to mercury and dioxin produced from medical waste incinerators and has now turned its attention to the lead poisoning issue.

At this rate, St. Louis will not be lead-free until after the year 3000.

The tangible goals of HEJ are:

Other cities have dramatically reduced childhood lead poisoning while St. Louis has not made much progress. Through a grassroots politicization of the issue and a demand for change, St. Louis can become more like Milwaukee, Providence, New York and Boston—cities that have made dramatic progress in this fight.

For more information or to get involved call the St. Louis City Health Department for testing (314-612-5450), the St. Louis Lead Prevention Coalition (314-664-9922) or Health and Environmental Justice–St. Louis (314-865-0318).

This article is based on the author’s presentation at Biodevastation 7, held May 16–18, 2003 in St. Louis, Mo.

[10 apr 04]

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